Charaka Chikitsa Sthana 30th Chapter – Yoni Vyapat

30th chapter of Charaka Samhita Chikitsa Sthana is called Yoni Vyapat Chikitsa Adhyaya. It deals with gynecological disorders, seminal disorders and postpartum disorders in women.

Chapter 30
Now we shall explore and the chapter on the 147;Treatment uterine disorders. Thus said Lord Atreya [1-2]

Prologue

Punarvasu who has mastered self-controlled and who knew about truth of this universe by virtue of his penance and meditation was taking a stroll by the slopes of the Himalayas which abounds in celestial and sacred river, medicinal herbs and stones containing varieties of metals of variegated colors, and which is the abode of Gods, Siddhas (higher spiritual persons) and saints.
Agnivesha inquired as below:
147;O Lord! Among human beings, women are the root cause of existence. The diseases of female reproductive system causes many problems. Therefore, please explain the origin, signs, symptoms and treatment of these disorders for the welfare of humanity. [3-6]

Atreya Punarvasu’s reply

Atreya Punarvasu replies as below:
Being thus asked by the disciple, Atreya the foremost of the sages replied, 147;In Sutrasthana number of gynaecological disorders (Yonivyapat) is listed as 20.
These 20 uterine ailments are caused by
Mithyachara – wrong regime,
Pradushta Arthava – menstrual morbidities,
Beeja Dosha – defective genes, ovum and
Daiva or Karma.
Now, listen to their description individually (which follows) [7-8]

Vataja yoni roga

Vatika Yoni Roga causes and symptoms:
If a woman having Vata body type, resorts to Vata increasing food and regimen, it causes Vata increase. The aggravated Vata gets located in the reproductive organs to produce below symptoms –
Stambha – stiffness
Pipilika – a sensation as if ants are crawling
Stambha – numbness
Supti – numbness and such other ailments caused by Vata in that place (reproductive organs).
Because of aggravated Vata, she gets untimely menstrual bleeding which is
Phena – frothy
Tanu; thin and
Ruksha – dry and
Sa syat sa shabda – is associated with sound and pain. [9 & 11]

Pittaja yoni roga

Paittika Yoni Roga Nidana and Lakshana
Paittika Yonivyapat is caused by the intake of Katu (pungent), Amla (sour), Lavana (saline), Kshara (Alkaline) and similar other types of food ingredients as a result of which the woman suffers from
Daha – burning sensation
Paka – suppuration
Jwara – fever and
Ushna – heating sensation.
Her menstrual discharge becomes
Nila, Pita sita artava – blue, yellow or black in color, and
Bhrsha – in large quantity
Ushna – hot and
Kunapa Gandha – having offensive smell of a dead body [11 – 12]

Kaphaja yoni roga

Kaphaja Yoni Roga Nidana and Lakshana:
By the intake of Abhisyandi ingredients (which cause obstruction to the channels of circulation, which form a coat on the inner lining of channels), the aggravated Kapha vitiated the reproductive organs of the woman, causes
Picchilam – sliminess
Shitam – cold
Kandu- itching
Vedanam – mild pain and
Pandu varna – pallor of her genital organ.
Pandu picchila artava vahinim – Her menstrual discharge will be pale in color and slimy. [13- 14]

Sannipataja yoni roga

Sannipatika Yoniroga Nidana Lakshana:
If the woman indulges in Samashana (intake of wholesome and unwholesome food together), The whole of uterus and related organs get vitiated to cause manifestation of the signs and symptoms of all the 3 Doshas – Vata, Pitta and Kapha – as described above.
She becomes afflicted with
Daha – burning sensation and
Shula – colic pain.
Sveta picchila artava vahini – Her menstrual discharge will be white in color and slimy. [14 – 15]

Rakta Yoni

If the woman resort to (food and regimens) which cause Raktapitta (bleeding disorders), then her blood being vitiated by Pitta flows in excess quantity through the genital tract , and the blood- flow does not stop even when the women becomes pregnant. [16]

Arajaska Yoni Vyapat

If Pitta located in the vaginal tract and Uterus vitiated blood, then there will be no menstruation.
In addition, there will be
Karshya – extreme emaciation and
Vaivarnya – discoloration of the skin.
This ailment of reproductive organs is called Arajaska or amenorrhea. [17]

Acharana Yoniroga

If the genital tract is not washed properly, then microbes (germs) grow and cause itching. This ailment attended with itching is called Acharana. The woman suffering from this ailment has excessive desire to have sex. [18]

Aticharana Yonivyapat

Because of excessive sexual intercourse, the aggravated Vata causes
Shopha, swelling
Supti – numbness and
Ruja – pain in the genital tract of the woman.
This ailment is called Aticharana. [19]

Prakcharana Yoniroga

If a girl before attaining appropriate age (puberty) indulges in sexual intercourse, the aggravated Vata vitiates reproductive organs and causes pain in back, waist, thighs and groins. This ailment is called Prakcharana. [20]

Upapluta Yoniroga

If a pregnant woman indulges in Kapha aggravating food and regimes, and suppresses the manifested natural urge of vomiting and deep breathing, then the Vata in her reproductive organs gets aggravated. This increased Vata carrying Kapha to the genital organs vitiates Kapha. This leads to yellow discharge and of mucus and pain. This Vata and kapha agravated condition is called Upapluta. [21-22]

Paripluta Yoniroga

If a Pitta body type woman suppresses the manifested urge for sneezing and eructation during the sexual intercourse, then the aggravated Vata being afflicted by Pitta vitiates her reproductive organs.
This cause
Shoona oedema
Sparsha kshama – tenderness and
Sa arti – pain in her genital organ and
Nila pitam asrk – discharge of bluish as well as yellowish blood.
Shroni vankshana prstha arti – She suffers from pain in waist, groin and back, and
Jvara – fever. This ailment is called Paripluta.[23-24]

Udavartini Yoniroga

If in a woman the course of the [downward moving] natural urges are reversed and made to move upward, then the aggravated Vata causes upward movement of the reproductive organs. This makes the woman afflicted with pain.
She gets painful periods because of tendency of the discharge to move in the reverse direction. The pain is relieved after discharge of menstrual blood. Because of the tendency of the menstrual flow (Avarta) to move upwards (Urdhva), wise physicians call this ailment as Udavartini. [25- 26]

Karnini Yoni Roga

If the pregnant woman strains prematurely to expel the fetus, then Vata in reproductive organs gets obstructed by the foetus. Being afflicted with Kapha and Rakta (blood), this aggravated Vata gives rise to Karnika (Polyp or nodular growth) in her genital organ. This polyp obstructs the course of blood flow, and the ailment is called Karnini. [27 -1/2 28]

Putraghni Yoniroga

When the aggravated Vata, because of its dryness destroys each and every foetus produced from the polluted ovum, the ailment is known as Putraghni. [28 – 28]

Antarmukhi Yoni Roga

If a woman after a heavy meal enters into sexual intercourse posture, then Vata located in the channels of reproductive organs gets suppressed by food. This aggravated Vata causes distortion of cervix as a result, she suffers from pain in the bones and muscles. Because of excrutiating pain, sexual act becomes intolerable for her. This ailment of the uterine organ is called Antarmukhi. [29 & 31]

Soochimukhi Yoniroga

If a pregnant woman resorts to wrong regimens, then Vata gets vitiated. Because of dryness of Vata, the genital organ of the female foetus in the womb of the mother become narrow in opening (stenosis) [and continues to be so even when the girl is grown up]. This ailment of the uterine organ is called Suchimukhi (needle like or narrow opening of the genital tract). [31 – 32]

Shushka Yoni Roga

If during the sexual intercourse, the woman suppresses her natural urges, then the aggravated Vata causes pain, obstruction to the passage of stool and urine, and dryness of the opening of the uterine organ [because of this dryness (Shushka) of the uterine organ (Yoni), the ailment is called Suska Yoni. [32 – 1/ 33]

Vamini Yoni Roga

If the semen deposited in the vagina for 6 days or 7 nights is excreted with or without pain, then the ailment is called Vamini. [33 – 34]

Shandi Yoni Roga

Because of genetic defect, the Vata in the foetus destroys its developing reproductive organs in the womb of the mother. In later stage of her life, the woman develops aversion for men (sexual intercourse), and her breasts do not grow.
The woman having this ailment is called Shandi, and is incurable. [34 – 35]

Maha Yoni

If the woman sleeps in irregular postures or on an uncomfortable bed during sexual intercourse, then Vata gets aggravated to cause dilatation of the opening of uterus and vagina, since the dilated openings do not get closed, she suffers from pain and discharge of dry and frothy blood from the genital tract. There will be protuberance of the muscles, and she suffers from pricking pain in the joints and groins. [35 – 37]

Yoniroga complications

Thus, 20 Yonirogas are described. When the reproductive organs of the woman are afflicted with these ailments, she becomes incapable of retaining the semen as a result of which she does not conceive.
She becomes liable to many diseases like
Gulma (tumor),
Arsha – piles and
Pradara – menorrhagia because of the excessive affliction by Vata, etc. [37 – 39]

Dosha predominance

Predominance of Doshas in Yonirogas:
Among the aforesaid [20] uterine diseases, in the last 16 varieties, the first 2, viz.,
Rakta Yoni and Arjaska varieties are caused by the aggravated Pitta,
Paripluta and Vamini varieties are caused by the aggravated Vata and Pitta
Karnini and Upapluta are caused by Vata and Kapha Dosha
And the remaining uterine disorders (viz, Acharana, Aticharana, Prakcharana, Udavartini, Putraghni, Antarmukhi, Suchimukhi, Sushka, Sandhi and Maha Yoni) are caused by aggravated Vata Dosha.
The aggravated Doshas, Viz, Vata etc, afflict the reproductive organs of the patient with their respective signs and symptoms. [39 – 41]

Predominance of Doshas in the 20 varieties of uterine disorders is as follows:
Name of the uterine Disorders – Predominace of Doshas

Vata Dosha dominant Yonivyapat:
Vatika Yoni Roga
Acharana
Aticharana
Prakcharana
Putraghni
Udavartini
Antarmukhi
Suchimukhi
Shushka
Shandi
Mahayoni

Pitta Dosha dominant Yoni Roga:
Paittika Yoni Roga
Arajaska
Rakta Yoni

Kaphaja Yoni Roga – Kapha Dosha
Vata and Pitta – Paripluta and Vamini
Vata and Kapha – Upapluta and Karnini
Sannipatika Yoni Roga – Vata Dosha, Pitta & Kapha

Yonivyapat Chikitsa Sutra

Yonivyapat Chikitsa Sutra – line of treatment:
For Vata imbalance uterine disorders, patients are given
Snehana – oleation,
Swedana – sweating treatment (fomentation),
Basti – enema and such other therapies which alleviate Vayu .

For Pittaja Yonirogas – the Patient is given therapies which are cooling and which are curative of Raktapitta (an ailment characterized by bleeding from different parts of the body).
For Kaphaja Yonirogas: physician should administer therapies which are dry and hot.
If the uterine diseases are caused by the aggravation of 2 or all the 3 Doshas, then the therapies prescribed above is combined and administered. If there is displacement of the uterus, the patient is given oleation and fomentation therapies. The tortuous uterus is pressed by the hand and brought to its normal position. If there is dilatation, after the administration of oleation and fomentation therapies, the passage is constricted.
If the uterus is displaced from its normal position, then it behaves like a foreign body in the woman.
In all the varieties of uterine diseases, after giving Snehana (oleation) and Svedana (fomentation) therapies, Pancha karma (5 elimination and fomentation therapies like emesis etc.,) is administered in a mild form.
When her body is clean of the morbid material, the remaining therapeutic measures (to be described hereafter) is administered. [41 – 46]

Vataja Yonivyapat Chikitsa

Treatment of Vatika Yoni Roga:
For the woman suffering from uterine diseases caused by aggravated Vayu, therapeutic measures which are curative of Vatik diseases are always useful.
Her body is smeared with oil mixed with rock- salt and thereafter, Nadi, Kumbhi, Ashma, Prastara and Sankara types of Sweda karmas are administered with the medicines containing meat of aquatic (Audaka) and marshy land- inhabiting animals (Anupamamsa), milk, dehusked Tila – Sesame and Vayu- alleviating herbs.
After Swedana, she is sprinkled with warm water, and given mamsarasa repared by boiling with Vayu- Alleviating herbs. [47 – 49]

Bala Ghrita:
1 Adhaka of each of ghee and oil is cooked by adding 2 Dronas of the decoction of
Bala Country mallow (root) Sida cordifolia
Paste of Sthira – Desmodium gangeticum (Shala Parni)
Payasya – Impomoea paniculata (Arka – Calotropis gigantea Puspi)
Jivanti Leptadenia reticulata
Vira(Shatavari Asparagus racemosus)
Rishabhaka – Manilkara hexandra
Jivaka – Malaxis acuminata
Sravani (morata or Murva Marsdenia tenacissima)
Masha Parni Phaseolus labialis
Sugar
Ksira Kakoli – Fritillaria roylei and
Kaka Nasa Tricosanthes tricuspidata and
Milk (4 times in quantity of ghee and oil, i.e 8 Adhakas).
This medicated fat is taken in appropriate dose according to the strength of the patient. It cures diseases caused by aggravated Vayu and Pitta, and helps the woman to conceive. [49 – 52]

Kashmaryadi Ghrita
1 Prastha of ghee is cooked by adding [the paste of] 1 Aksha of each of
Kashmarya Gmelina arborea
Haritaki Terminalia chebula
Vibhitaka Terminalia bellerica
Amalaki Phyllanthus emblica
Draksha Vitis vinfera
Kasamarda Cassia occidentalis
Parusaka Phoenix pusilla
Punarnava Boerhavia diffusa
Haridra Curcuma longa
Daru Haridra Berberis aristata
Kaka nasa Trichosanthes tricuspidata
Sahacara Casearia esculanta
Shatavari Asparagus racemosus and
Guduchi Tinospora cordifolia.
This medicated ghee is an excellent curative of uterine diseases caused by Vayu. It is also an excellent medicine for the woman to help conceive. [52 – 54]

Pippalyadi Yoga
The paste of
Pippali Long pepper fruit Piper longum
Kunchika (Krishna Jeeraka) Cuminum cyminum
Ajaji (Sveta Jiraka) – Cuminum cyminum
Vrsaka (Vasaka) Adhathoda vasaka
Saindhava – rock salt
Vacha (Acorus calamus Linn.)
Yava Kshara
Ajamoda Ajowan (fruit) Trachyspermum roxburghianum
Sugar and
Chitraka – Leadword – Plumbago zeylanica is sizzled with ghee.
Adjuvant – Prasanna (a type of Alcohol)
Indicated in –
Yoni shoola -Pain in the reproductive organs
Parshva arti – Pain in the sides of the chest
Hrd roga heart diseases
Gulma – Phantom tumor and
Arsha – piles. [54, 56]

Vrushakadi Churna:
The powder of
Vrsaka(Vasa) Adhathoda vasica
Root of Matulunga – Lemon variety – Citrus decumana / Citrus limon
Madayantika Lawsonia alba
Pippali Long pepper fruit Piper longum and
Kuncika (Krishna Jiraka Cuminum cyminum) is taken with alcohol added with salt to cure pain in the reproductive organs. [56 – 57]

Rasnadi Dugdha Paka and Guduchyadi Pariseka:
Intake of the milk boiled by adding
Rasna (Vanda roxburghi / Pluchea lanceolata),
Svadamstra (goksura) Tribulus terrerstris and
Vrushaka (vasa) Adhathoda vasica cures the pain in reproductive organs.
Affusion (Seka) is done over this part with the decoction of
Guduchi Tinospora cordifolia
Haritaki Terminalia chebula
Bhibhitaka Terminalia bellerica
Amalaki Phyllanthus emblica and
Danti Baliospermum montanum [57, 58]

Saindhavadi Taila
Oil is cooked by adding the paste of (quantity to be equal to that of oil)
Saindhava – rock salt
Tagara Valerian walichii
Kushta Saussurea lappa
Brihati – Solanum indicum and
Devadaru Cedrus deodara
This medicated oil [Soaked in tampon] is kept inside the vagina which cures local pain. [58, 59]

Guduchyadi Taila:
1 Prastha of oil is cooked by adding 2 Prasthas of each of Cows urine and cows milk and the paste of 1 Karsa of each of
Guduchi Tinospora cordifolia
Malati Jasminum grandiflorum
Rasna (Vanda roxburghi / Pluchea lanceolata)
Bala Sida cordifolia
Madhuka Licorice Glycyrrhiza glabra
Chitraka – Plumbago zeylanica
Nidigdhaika Garcinia morella
Devadaru Cedrus deodara and
Yuthika Jasmin auriculata
A Tampon soaked with this medicated oils is inserted into the vagina and this may be administered in the form of douche for curing uterine diseases caused by Vayu. [59 ,61]

General Treatment for Vatika Yoniroga:
For the patient suffering from uterine diseases, Seka, massage and pichu- kriya (insertion of tampon soaked in medicated oil in the general tract) is given with recipes which are hot and unctuous. For the purpose of oleation, medicated oils are used. [61 – 1/3 62]

Kalka – medicinal pastes
The patient suffering from Vatika Yonivyapat is given massage over the genital organs, and thereafter, she should keep warm paste of Himsra Nardostachys jatamamsi in vagina.
The patient suffering from Paittika Yoniroga should similarly be given massage, and thereafter, should keep the paste of Pancha Valkala (bark of Nyagrodha Ficus bengalensis, Udumbara Ficus racemosa, Asvattha Ficus religiosa, Parisa Ficus arnottiana and Plaksa Ficus lacor) in her vagina.
The patient suffering from Kaphaja Yonivyapat should keep the paste of shyama Trivrit, etc., in her vagina ( Charaka Vimanasthana 8: 136) similarly after massage. [62 2/3]

Pittaja Yonivyapat Chikitsa

General Treatment of Paittika uterine Diseases:
For the patient suffering from Paittika type of uterine diseases, Seka (affusion), Abhyanga (massage) and Pichu- Kriya (insertion of tampon soaked in medicated oil or ghee in the genital tract) is given with the help of recipes which are cooling and alleviators of Pitta. For the purpose of oleation, ghee boiled by adding Pitta alleviating herbs should be used. [63; 64]

Brihat Shatavari Ghrita
The juice extract of 4 Tulas of the root of Shatavari Asparagus racemosus and equal amount of milk is boiled with 1 Adhaka of ghee this is cooked by adding the paste of 1 Aksha of each of the drugs belonging to
Jivaniya group (Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Maha meda, Kakoli – Fritillaria roylei, Mudga Parni Phaseolus trilobus, Masha parni Teramnus labialis, Jivanti Leptadenia reticulata and Madhuka Licorice Glycyrrhiza glabra)
Shatavari Asparagus racemosus
Mrdvika Vitis vinfera
Parusaka Phoenix pusilla
Priyala (Buchanania lanzan)
Jalaja Yastimadhu Glycyrrhiza glabra and
Sthalaja Yastimadhu Glycyrrhiza glabra.
After it is cooked and cooled, 8 Palas of honey, 8 Palas of Pippali Long pepper fruit Piper longum (powder) and 10 Palas of Sugar is added to it.
Dosage: 1 Pani Tala (Tola).

Indications:
Uterine diseases and morbidities of menstruation and semen. It promotes virility, and helps the woman to get a male progeny.
It is a curative of
Kshatam – Phthisis
Kshayam – consumption
Rakta Pitta – an ailment characterized by bleeding from different parts of the body)
Kasa – cough
Shvasam – Asthma
Halimaka (a serious type of Jaundice)
Kamala (ordinary Jaundice)
Vata Rakta (gout including other forms of arthritis)
Visarpa – erysipelas
Shiro graham – Stiffness (sluggishness) of the heart and head
Unmada – insanity
Arati (depression and epilepsy caused by Vayu and Pitta).
Apsmara
Thus, ends the description of Brhat Shatavari Ghrita. [64 – 69]

Jeevaneeyadi Ghrita:
In the aforesaid manner (i.e by adding the juice of 4 Tulas of the root of Shatavari Asparagus racemosus), Ksira Sarpi (ghee collected from the cream of milk) is cooked by adding the paste of drugs belonging to Jivaniya group (Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Maha meda, Kakoli – Fritillaria roylei, Mudga Parni Phaseolus trilobus, Jivanti Leptadenia reticulata and Madhuka Licorice Glycyrrhiza glabra).
It helps in the conception, and cures uterine diseases caused by aggravated pitta. [69, 70]

Kaphaja Yoniroga Chikitsa

For the uterine disorders caused by Kapha, application of wick- bougie in the genital tract for cleansing it is useful. It is to be prepared of a rolled piece of cloth (Laktaka) which is to be impregnated for several times with the bile of wild pig.
The Varti (wick- Bougie) prepared of Barley- flour and rock- salt is impregnated with the latex of Arka – Calotropis gigantea. It is kept in the genital tract for a short period, and thereafter, removed. Then the genital tract is douched with luke warm water.
A Varti (wick Bougie) of the shape and size (length and thickness) of the index finger is prepared out of Pippali Long pepper fruit Piper longum, Maricha – Black pepper fruit – piper nigrum, Masam, Satahva, Kushta Saussurea lappa and rock- salt, and is inserted in the genital tract which cleanses the reproductive organs. [70 – 73]

Udumbaradi Taila
1 Drona of the Udumbara Shalatu (tender fruit cut into thin slices) of Ficus racemosa
Pancha Valkala (barks of Nyagrodha Ficus bengalensis, Udumbara Ficus racemosa, Asvattha Ficus religiosa, Parisa Ficus arnottiana and Plaksa Ficus lacor), and
leaves of Kulaka (Patola Trichosanthes dioica),
Malati – Jasminum angustifolium and
Nimba – Neem (Azadirachta indica) is kept soaked in 1 Drona of water for whole night in the next morning, the water is strained out.

With this water, 1 Prastha of oil is cooked by adding the paste of Laksa and the extract of the bark of Dhava – Anogeissus latifolia and Palasha Butea monosperma and Gum- resin of Salmala – Salmalia malabarica. A tampon (picu) soaked in this medicated oil is kept inserted in the genital tract. Thereafter, the genital tract is douched with the cold decoction of the aforesaid drugs (Udumbara Ficus religiosa, etc) mixed with Sugar.
This therapy helps in quickly cleaning the genital tract, which is slimy and dilated, and which is afflicted with chronic as well as serious types of uterine diseses within seven days. Therafter, the woman becomes quickly capable of conception. [73 – 77]

Udumbara Ksheera:
Tila – Sesame is impregnated for 6 times the latex of Udumbara Ficus racemosa. The oil extracted from these seeds of Tila – sesame is cooked by adding the decoction of Udumbara – Ficus racemosa.
The tampon soaked with this medicated oil is kept inserted into the genital tract in the aforesaid manner [for the cure of uterine diseases]. [77 , 78]

Dhatakyadi Taila:
1 Prastha of oil is cooked by adding 2 Prastha of each of Goats milk. And the paste of 1 Aksa of each of
Dhataki – Woodfordia fruticosa,
leaves of Amalaki Phyllanthus emblica/ Emblica officinalis
Srotoja (Srotanjana),
Madhuka Licorice Glycyrrhiza glabra
Utpala (Nymphaea alba),
Pulp of the seeds of Jambu – Syzygium cumini and
Amra – mango – Mangifera indica
Kaseesa – Green vitriol
Lodhra (Symplocos racemosa)
Katphala – Myrica nagi,
Tinduka – Diospyros tomentosa
Saurastrika (Tuvari) – Sphatika
bark of Dadima – Pomegranate – Punica granatum and
Salatu (tender fruits) into thin medicated oil, and kept inserted into the genital tract.
Thereafter, massage is done over her lumbar region, back and sacral region, and the patient is given unctuous type of medicated enema.
This cures the sliminess as well as exudation from the genital tract, uterine diseases like Vipluta, Upapluta, Uttana (Prolapse of Uterus), Unnata (Upward displacement of the uterus) and oedema accompanied with Pustular growth as well as pricking pain. [78 – 82]

Dhavana Yoga – Recipe for Douche
Douching of the female genital tract with the decoction of
Karira Capparis decidua
Dhava – Anogeissus latifolia
Nimba – Neem (Azadirachta indica)
Arka – Calotropis gigantea
Venu
Koshamra – Schleichera trijuga
Jambu – Syzygium cumini
Jingini Rhus odina and
root of Vrusha (Vasa) Adhathoda vasica
Wine as well as Sidhu types of wine along with Sukta (vinegar) cures morbid vaginal discharges.
Similarly, douching could be done with buttermilk, cow urine, sukta (vinegar) or the decoction of triphala [which cures morbid vaginal discharges] [82 – 84]

Pippali Ayoraja Yoga:
The portion contain Pippali Piper longum, powder (Bhasma) of Iron and Haritaki Terminalia chebula is mixed with honey and given to the patient which is useful in curing Kaphaja Yonivyapats.

Recipes for Enema
In uterine diseases of:
Kaphaja type – enema of recipes containing pungent drugs in general and cows urine is useful.
Paittika type – enema of recipes containing sweet drugs and milk is useful.
Vatika type – enema of recipes containing oil and sour juice is useful.
Sannipatika type – all the aforesaid therapies mixed together is administered. [85- 86]

Treatment of Rakta Yoni

In Rakta Yoni, the physician should ascertain the association of other Doshas from the color of the blood, and respective Dosha balancing haemostatic medicines are administered.
Intake of the Yoga containing powder of Tila – Sesame, Yoghurt, ghee, Phanita (Penidium) and pig fat mixed with honey cures Asrugdara (Rakta Yoni) caused by the association of Vayu.
Intake of the soup of fatty meat of pig and Kulattha (horsegram) is useful for curing Rakta Yoni type of uterine diseases caused by the association of Vayu.
Similarly, intake of yoghurt mixed with sugar, honey, Yasti Madhu Glycyrrhiza glabra and Nagara (ginger) is useful in this condition.
If the rakta yoni (Asrgdara) is caused by the association of Pitta, then the patient should take:
Payasya – Impomoea paniculata (Ksira Vidari (Ipomoea paniculata / Pueraria tuberosa))
Nilotpala – blue lilly
Shaluka(Rhizome of lotus),
Bisa (Lotus Stalk),
Kaliyaka (pitta Chandana (Sandalwood – Santalum album) or
Ambuda (musta Cyperus rotundus) mixed with milk, Sugar and honey. [86 – 90]

Pushyanuga Churna:
These are made into fine powder and are culled when the moon is in Pusya constellation all in equal quantities:
Patha Cissampelos parriera
seed- Pulp of Jambu Syzygium cumini and
Amra – mango – Mangifera indica,
Silodbhava (pasana bheda Cyclea peltata),
Rasanjana (Aqueous extract of Berberis aristata),
Ambastha (a type of Patha) Cissampelos parriera
Resin of Shalmali Salmalia malabarica
Samanga – Rubia cordifolia,
Bark of Vatsaka (Holarrhena antidysenterica Wall.),
Bahlika (kunkuma),
Ativisa Aconitum heterophyllum
Bilva Aegle marmelos
Musta (Cyperus rotundus),
Lodhra (Symplocos racemosa),
Gairika
Katvanga (aralu) Orchis mascula
Maricha – Black pepper fruit – piper nigrum,
Sunthi Zingiber officinale
Mrdvika Vitis vinfera
Rakta Chandana (Sandalwood – Santalum album),
Katphala – Myrica nagi,
Vatsaka (Holarrhena antidysenterica Wall.)(fruits),
Ananta
Dhataki – Woodfordia fruticosa,
Madhuka Licorice Glycyrrhiza glabra and
Arjuna Terminalia arjuna
This powder is mixed with honey, and taken along with rice water (Tandula Vari).
It effectively cures
Arsas (piles) and
Rakta atisara – diarrhoea associated with bleeding, and
Disease of infants caused by Doshas (endogenous) and exogenous factors.
It effectively cures uterine and menstrual disorders associated with white, blue, yellow, brownish, black and pinkish discharges.
This useful recipe called Pusyanuga Churna is held in high esteem by Lord Areya. Thus, ends the description of Pusyanuga Churna. [90 – 96]
Read more about Pushyanuga Churna

Recipes for Rakta Yoni (Asrugdara)
For Asgdara, the following recipes are used:
The paste of the root of Tanduliyaka mixed with honey is taken along with rice water (tandulambu).
Rasanjana and Laksa are taken along with goats milk.
The paste of the leaves of Rajadana and Kapittha (Feronia limonia) sizzled with ghee. This recipe alleviates pitta and Vayu.
In Paittika type of Asrgdara, the paste of Madhuka Madhuca longifolia, Haritaki Terminalia chebula, Bibhitaka Terminalia bellerica, Amalaki Phyllanthus emblica, Lodhra (Symplocos racemosa), Musta (Cyperus rotundus), Saurastrika and honey is taken. It cures Rakta Pitta (an ailment characterized by bleeding from different parts of the body).
In Kaphaja type of Asrgdara, Nimba – Neem (Azadirachta indica) and Guduchi Tinospora cordifolia is taken along with alcohol.
In Paittika type of Asrgdara, Purgation with Trivrt Operculina turpethum, etc., is given, and the patient should take Maha Tiktaka Ghrta ( Chikitsa 7: 144-150)
Therapeutic measures described for the management of Garbha Srva (threatened abortion) is used ( Sarira 8: 24). [96 – 100]

Kashmaryadi Ghrita:
Ghee cooked with the decoction of Kashmarya and Kutaja – Connessi (Holarrhena antidysenterica Wall.) Is used for vaginal douche which is beneficial for the treatment of uterine diseases like Rakta Yoni, Arajaska and Putraghni. [100 – 101]

Arajaska, Karnini treatment

Treatment of Arajaska – amenorrhea:
The woman suffering from Arajaska (amenorrhoea) type of uterine disease should drink the blood of deer, Goat, sheep and pig mixed with Yoghurt, juice of sour fruits and ghee.
She may also take the milk boiled with herbs and belonging to Jivaniya Group (Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Maha Meda – Polygonatum cirrhifolium, Kakoli – Fritillaria roylei, Ksira, Kakoli – Fritillaria roylei, Mudga Parni Teramnus labialis, Mashaparni, Jivanti Leptadenia reticulata and Madhuka Licorice). [101 – 102]

Taila Uttara Basti for Karnini Etc
In Karnini, Acharana, Shushka Yoni, Prakcharana and such other diseases caused by Kapha as well as Vayu, the patient is given vaginal douche with the medicated oil prepared by boiling oil with drugs belonging to Jeevaniya group (Jivaka – Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Maha meda,Kakoli – Fritillaria roylei, Ksira Kakoli – Fritillaria roylei, Mudga parni Phaseolus trilobus, Mashaparni and Teramnus labialis, Jivanti Leptadenia reticulata and Madhuka Madhuca longifolia). [102 – 103]

Acharana, Prakcharana, Aticharana treatment

Treatment of Acharana:
For the cure of Acharana, a piece of silk cloth impregnated for 21 times with cows bile or fish- bile, and kept inserted into the vaginal tract.
Similarly, for the cure of this ailment, the powder of yeast mixed with honey may be kept inside the genital tract. This cleanses the genital tract, and removes itching, sloughening as well as oedema in the vagina [103 – 104]

Treatment of Prakcharana and Aticharana
In Prakcharana and Aticharana, the patient is given Asthapana and Anuvasana Basti with the medicated oil cooked for 100 times with Vata balancing and medicines. Thereafter, Swedana is appropriately given with fat, food preparations and Upanaha (hot poultice) prepared with drugs which alleviate Vayu. [105 106]

Vamini, Upapluta, Vipluta treatment

Treatment of Vamini:
The Samyava (Utkarika or thick gruel) prepared of Shatahva, Barley, wheat, yeast, Kushta( Saussurea lappa), Priyangu (Callicarpa macrophylla), Bala (Sida cordifolia), AkhuParnika and Sryahva (Gandha phiroja) is kept inserted in the genital tract [which helps in the embedment of the embryo in the uterus of the woman suffering from Vamini]. [106 – 107]

Treatment of Vamini and Upapluta
In Vamini and Upapluta, therapies like and Snehana, Swedana etc are given. and Thereafter, the tampon (Pichu) soaked with the medicated oil is inserted into the vagina for providing nourishment to the genital tract. [107 – 108]

Treatment of Vipluta
Oil is cooked with the decoction of
Sallaki Boswellia serrata
Jingini Lania grandis and
the barks of Jambu Eugenia jambolana
Dhava Anogeissus latifolia
Nyagrodha – Ficus bengalensis
Udumbara – Ficus racemosa
Asvattha Ficus religiosa
Parisa Ficus arnottiana and
Plaksa Ficus lacor
Tampoon soaked with this medicated oil is kept inserted into the gential tract which cures Vipluta Yonivyapat. [108 – 109]

Karnini, Udavarta, Maha yoni treatment

Treatment of Karnini [Kusthadi Varti]
Varti (medicated bougie) is prepared of Kushta Saussurea lappa, Pippali Piper longum, buds of Arka – Calotropis gigantea and rock salt by triturating with goats urine.
It is kept inserted into the vagina which cures Karnini type of uterine diseases. All the therapeutic measures prescribed for the treatment of diseases caused by kapha are also beneficial for the cure of this ailment. [109 – 110]

Treatment of Udavarta:
In Udavarta Yonivyapat and in Vatika type of Pain, Snehana and with Traivrta (ghee, oil and muscle fat), Swedana and and Mamsarasa of domesticated (gramya), marshy land (Anupa) inhabiting and aquatic animals (Audaka) are useful. In this disease, enema with Dashamoola ksheerapaka and(milk boiled with Dashamoola) is also useful.
The patient is given Anuvasana Basti and Uttarabasti (vaginal douche) with Traivrta (ghee, oil and muscle fat).
The aforesaid therapeutic measures are also to be adopted for the treatment of Maha Yoni and for prolapse of uterus. [110 – 112]

Treatment of Maha Yoni:
Vasa (muscle fat) of bears and pigs, and Ghee is cooked by adding the herbs and belonging to sweet group (Vimanasthana 8/139). This recipe of medicated fat is kept inserted into the vagina of the woman suffering from Maha Yoni Yonivyapat. The vagina and bebandaged with and silk cloth. [112 -1/2 113]

Prasruta Yoni Vyapat treatment

Treatment of Prolapse Uterus – Prasruta Yoni Vyapat:
In the case of Prasruta (prolapsed of uterus), the uterus is massaged with ghee, fomented with warm milk and inserted into its normal position. Thereafter, the vagina is tied with a pad of Vesavara (a type of meat preparation) till there is the urge for urination. [113 – 114]

Importance of balance of Vata in uterine and Diseases
In all types of uterine disorders, and especially in Maha Yoni variety, a wise physician should administer all the therapeutic measures prescribed for the treatment of diseases caused by Vayu.
A woman never suffers from uterine diseases except as a result of affliction by increased Vata Dosha. Therefore, first, the aggravated Vayu is alleviated, and only thereafter, therapies are administered for the alleviation of other Doshas.

Pandura Asrugdara treatment

Treatment of Leucorrhoea – Pandura Asrugdara:
For the cure of Pandura Asrugdara (Leucorrhoea) and for its associated ailments, the patient should use following recipes:
Paste of the root of Rohitaka is mixed with sugar, and taken along with water.
Paste of the seeds (Pulp) of Amalaki Phyllanthus emblica is mixed with sugar and honey, and taken along with water.
The powder or the juice of Amalaki – Phyllanthus emblica is mixed with honey and made to linctus which the patient should use.
In the aforesaid manner, she should take the paste of Lodhra (Symplocos racemosa) along with the decoction of the bark of Nyagodha Ficus bengalensis.
If there is profuse white discharge and from the genital tract, then a piece of silken cloth impregnated with the decoction of the bark of Nyagrodha Ficus bengalensis is kept inserted in the vagina.
The powder of the bark of Plaksha Ficus lacor is made to a lump by triturating with honey. This is kept inserted in the vagina after anointing the part with fat.
The powder of Lodhra (Symplocos racemosa), Priyangu (Callicara macrophylla) and Madhuka Licorice Glycyrrhiza glabra is made to a lump by triturating with honey. This is kept inserted in the vagina after anointing the part with fat.
The varti (medicated bougie) prepared of astringent drugs and honey is kept inserted in the vagina.
For checking the discharge, the vagina is oleated, and thereafter, fumigated by Sarala, Guggulu (Commifora mukul Engl.) And barley mixed with butter, or by bitter fish (saphari) mixed with oil.
If there is sliminess of Vagina, then the powder of Kasisa, Haritaki151;Terminalia chebula, Bibhitaka Terminalia bellerica, Amalaki Phyllanthus emblica, Kanksi mixed with honey. This is kept inserted into the genital tract which makes it non- slimy.

Palashadi varti: If there is sliminess and stickiness of vagina, then the paste of Palasha Butea monosperma, Sarja (Vateria indica), bark of Jambu Eugenia jambolana, Samanga – Rubia cordifolia, Moca and Dhataki – Woodfordia fruticosa is kept inserted into the genital tract which is stambhana (Arrests exudation).
In the case of stiffness and roughness of Vagina, softening remedies is used. For this, Vesavara (a type of meat preparation), Payasa (preparation of milk and rice) and Krsara (preparation of Pulses) is kept inserted in the vagina.
If there is foul smell in vagina, the decoction or the paste of Tuvaraka or the powder of Sarva Gandha (group of aromatic drugs) is kept inserted into the genital tract which works as deodorant.
When the gyneacic organs get cleansed by the aforesaid measures, the woman becomes capable of conception of the sperm of her husband and her own ovum are unpolluted, and possessed of natural attributes, and there is entry of the Jiva (soul).
Even if the man is cleansed of his physical morbidities by the administration of Pancha Karma (5 elimination therapies) his semen is examined, and from its colour, the nature of the afflicting Doshas (if any) is ascertained. If any morbidity of Doshas is found, then it is corrected by appropriate therapeutic measures. [116 – 127]
Thus it is said
The great Sage having spiritual insight has explained above in detail the signs symptoms, etiology and treatment of various types of Yoni Vyapat (uterine disorders). [127 – 128]

Dialogue

Dialogue between disciple and Preceptor
Again, Agnivesha approached Atreya, the foremost physician and asked, 147;Oh, Sinless one and foremost among the physicians!, in Sutrasthana 19:3, you have stated in brief that there are 8 types of seminal defects. Please explain us the etiology, signs and symptoms of normal and abnormal semen, and the treatment in their entirety.
Similarly, O foremost Physician! Kindly explain us the etiology, signs and symptoms, and treatment of Klaibya (impotency) which is described to be of 4 types and Pradara (menorrhagia) which is enumerated to be one of the complications of uterine diseases ( Shloka 39) appropriately both in brief and in detail.
To the disciple desirous of hearing these details, the Foremost among the physicians (Atreya) replied as follows (to be described in the subsequent verses) [128 -132]

Seminal Defects

Importance of Beeja – semen / sperm and
During sexual intercourse, semen gets ejaculated as a result of excitement. It is the sign of masculinity. The reason for which it is called Bija or seed (the ingredient of procreation) (addressed by Atreya to disciple Agnivesha). [133]

Infertility of Polluted Semen
As a seed does not grow when impaired by un-seasonal implantation and when afflicted by water microbes, insects and fire, similarly the vitiated or polluted semen in human beings does not help in the precreation of an offspring. [134]

Etiology of seminal Pollution – Shukra Dosha Nidana: and
Factors which cause seminal pollution:
Excessive sexual indulgence
Excessive physical exercise
Intake of unwholesome food
Untimely sexual intercourse
Sexual intercourse through tracks other than the female genital organ
Abstinence from sexual rapport during appropriate time
Intake of food which are exceedingly dry, bitter,astringent, saline, sour and hot
Sexual intercourse with women who are not passionate
Old age , worry, grief and lack of confidence [in the sexual partner]
Injury by sharp instruments, alkalies (Ksara) and cauterization (agnikarma)
Fear, anger and application of black magic (Abhicara)
Emaciation by diseases
Suppression of the manifested natural Urges and
Injury to and vitiation of tissue elements
Because of the above mentioned factors, the Doshas individaually or jointly get aggravated, and reach the seminal channels instantaneously to vitiate the semen. [135 -1/4 139]

Seminal Morbidities – 8 Shukra Dosha and
Now the differing types of seminal morbidities will be described by me (Atreya). These are of 8 types as follows:
Phenila (frothy semen)
Tanu (thin semen)
Ruksa(dry semen)
Vivarna (discoloured semen)
Puti(semen with putrid smell)
Picchila (slimy semen)
Anya dhatu-Samsrsta (semen mixed with other tissue elements) and
Avasadi (semen sinking to the bottom when placed on water). [139 ,- 140]

Vataja Shukra Dosha – Seminal Morbidities Caused by Vayu
When the semen is vitiated by Vayu, it becomes frothy, thin, and dry.
It gets ejaculated with pain, and in small quantity. This type of vitiated semen does not help in conception. [140 – 141]

Seminal defects and caused by Pitta
If the semen is vitiated by Pitta, then it becomes blue or yellow in colour, excessively hot and putrid in smell. It causes burning sensation in the phallus during ejaculation [141 – 142]

Seminal morbidities caused by Kapha
If the semen is obstructed by the aggravated kapha, then it becomes exceedingly slimy. [142 ]
Semen associated with Blood:
Because of excessive sexual intercourse with women Injury or ulceration, the semen gets ejaculated generally in association with blood. [143]

Avasadi Shukra
Because of the suppression of the manifested urge for sex, the semen gets obstructed in its course by the aggravated Vayu, thus making it grathita (Knotty) and Avasadi (which sinks when placed over water). This semen associated with the 8 type of morbidity gets ejaculated with difficulty. [144]

Thus, the 8 types of semen are described with reference to their signs and symptoms. [1/2 145]

Shuddha Shukra Lakshana

Shuddha Shukra Lakshana: Signs of Pure semen:
The semen which is
Snigdham(unctuous),
Ghanam – dense,
Picchilam – slimy,
Madhuram – sweet,
Vidahi – non-irritating and
Sphatika sannibham – white (transparent) like a crystal is to know as pure or normal [145 – 146]

Shukradosha Chikitsa Sutra

Shukradosha Chikitsa Sutra: and
For the treatment of the vitiated semen, the following measures are taken:
Aphrodisiac recipes which are pleasant to use and beneficial
Therapeutic measures described for the treatment of Rakta Pitta (an ailment characterized by bleeding from different parts of the body-and Charaka Chikitsa 4th chapter)
Therapeutic meausers decribed (earlier in this chapter) for the Jivaniya group- Sutra 4: 9)
Chyavana Prasa( Chikitsa 1:1:62-74) and
Shilajatu ( Chikitsa 1:3:48- 65)

Vataja Shukra Dosha Chikitsa
In Vataja Shukra Dosha, the patient is given Niruha and and Anuvasana Basti. [1/2 149]

Treatment of Seminal Morbidities Caused by Pitta:
In the seminal morbidities caused by the aggravated Pitta, the patient is given Abhayamalakiya Rasayana ( Chikitsa 1:1: 76- 77) [149]

Treatment of seminal Morbidities caused by Kapha
PippaliRasayana ( Chikitsa 1:3 32-35), Amalaki Rasayana ( Chikitsa 1:1: 75), Loha Rasayana ( Chikitsa 1:2: 13) cure and Kaphaja Shukradosha. and [150]

Treatment of seminal Morbidities Caused by Association of Other and Dhatus:
If seminal morbidities are caused by the vitiated tissue elements, then after ascertaining their nature and those of the vitiated Doshas, the patient is given appropriate therapeutic measures for the correction of the concerned Doshas and tissue elements. [151]

Treatment of seminal Morbidities in General
Ghee, milk, meat soup, food ingredients like Shali (rice), barley, wheat and Sastika rice and medicated enema in special are very useful for correcting the treatment of eight types of seminal morbidities. [152 -1/2 153]

Klaibya

IMPOTENCY (KLAIBYA)
Varieties of Impotency:
Since impotency is caused by the seminal morbidities and it gets corrected by the purification of the semen, now O Agnivesha! I shall appropriately described [the etiology, signs and treatment of] this disease systematically.
Impotency is of 4 types depending upon its causative factors as follows:
Bijopaghataja Klaibya (impotency caused by seminal diminution)
Dhvajabhangaja Klaibya (impotency caused by non-erectile phallus)
Jaraja Klaibya (impotency caused by old age) and
Shukra Ksayaja Klaibya (impotency caused by excessive loss of semen, i.e by sexual intercourse).
Now listen about their general signs and symptoms [which follows in subsequent verses][153 – 155]

Signs and Symptoms of impotency in General
Even though a man is constantly descrous of sexual intercourse with the partner who is cooperative, because of the looseness (absence of erection) of the phallus becomes incapable of performing the sexual act. Even if he rarely attempts sexual act, he gets afflicted with dysponea as well as perspiration in the body, and gets frustrated in his determined effects. His phallus becomes loose (because of the lack of erection), and he does not ejaculate any semen. These are the general signs and symptoms of impotency. Specific signs and symptoms of impotency will, hereafter be, described in detail. [155 – 157]

Bijopaghataja klaibya

Etiology and signs of Bijopaghataja Klaibya
In Bijopaghataja type (impotency caused by the diminution of semen), the semen gets vitiated and diminished in quantity because of the following:
Intake of cold, dry, scanty, polluted and mutually contradictory ingredients of food.
Intake of food before the previous meal is digested
Grief, anxiety, fear and terror
Excessive indulgenece in sex with woman
Abhicara (affliction by black magic)
Avisrambha (suspicious nature)
Diminution of Rasa(plasma) and other tissue elements
Disharmony among Vata and other Doshas
Fasting and farting
Disliking for women and
Improper administration of Pancha Karma(5 elimination therapies)
Because of the seminal destruction (diminution) as a result of the aforesaid factors, the patient becomes pale in color, very weak and low in vitality. He gets low excitement while meeting female partners, he suffers from
Hrt roga – heart diseases
Pandu roga – anemia
Tamaka shwasa – asthma
Kamala – jaundice
Shrama – physical exhaustion
Chardi – vomiting
Atisara – diarrhoea,
Shoola – colic pain
Kasa- cough and
Jwara- fever. [158- 1/3 162]

Dhvajpaghataja klaibya

Etiology of Dhvajabhangaja Klaibya:
Hear about the impotency caused by Dhvaja Bhanga (non-erectile phallus) which takes place because of the following factors:
atyamla lava kra viruddh?s?tmyabhojan?t – Intake of excessively sour, saline, alkaline, mutually antagonistic and unwholesome ingredients of food
Intake of water in excess
Taking meals irregularly
Intake of pastry and heavy food habitually
Intake of yoghurt, milk and meat of animals inhabiting marshy land
Emaciation because of diseases
Cohabitation with young virgin girls
Sexual intercourse in parts other than vagina
Because of excitement and ignorance, sexual intercourse with a woman who is suffering from chronic diseases, in continuation who has shunned sexual relationship for a long time, who is in menstruation, and whose is offensive in smell, afflicted with diseases and has profuse discharge
Sexual intercourse with quadruped animals,Trauma to the phallus,not cleaning the phallus properly
Injury to the phallus by weapons, tech, nails, beating by a stick or compression
Excessive use of Sukas (a type of insect which is applied for the elongation of the phallus) and
Suppression of the urge for seminal ejaculation during sexual intercourse. [; 162- 1/3 168]
I shall, hereafter, describe the signs and symptoms caused by Dhvajabhanga (morbidity of the phallus) which are as follows:
Swelling, pain and redness of the phallus
Serious types of pustular eruption in and suppression of the phallus
Fleshy growth in the phallus and its quick ulceration
Exudation which appears like rice water (Pulakodaka) or which is brownish black or pink in color
Circular and hard indurations below the glance penis
Fever, morbid thirst, giddiness, fainting and vomiting
Discharge of red, black, blue, turbid and red colored liquid from the urethra
Acute burning sensation as if burnt by fire, and pain in the region of urinary bladder, testicles, perineal suture and groins.
Discharge of slimy and pale yellow liquid at times
Mild swelling, numbness and scanty discharge
It takes long time to suppurate and may get abated quickly
Appearance of maggots in the phallus:
Sloughing and foul smell of the phallus and
Dropping of the glance penis or of the whole penis or of the testicles
Thus, the impotency caused by Dhwajabhanga (morbidity of the phallus) is explained.
According to some physicians, this types of impotency caused by Dhvajabhanga is of 5 varieties. [168 2/3 176]

The 5 varieties of Dhvajabhanga are as follows
Vatika variety having the signs and symptoms described above in item no 1:
Paitika variety having the signs and symptoms described above in the item no 2
Kaphaja variety having the signs and symptoms described above in item nos. 3-5
Rakthaja variety having the signs nand symptoms described above initem nos 6-7 and
Sannipatika variety having the signs and symptoms described above in item nos. 8- 14

Jaraja Klaibya

Now I shall describe the type of impotency caused by old age which you may hear (addresses by the Preceptor Atreya to the disciple Agnivesha).
Age of a person is divided into 3 parts, viz,
Jaghanya (childhood),
Madhya (adulthood) and
Pravara (old age).
In the old age, generally the semen gets diminished.
Impotency takes place in the old age because of the following:
Diminution of tissue elements like Rasa(plasma) etc
Constant use of ingredients which are detrimental to the vitality of a person
Gradual diminution of strength, energy, power of senses and span of life
Inability of take nourishing food and
Physical as well as mental fatigue
Because of the aforesaid factors, the tissue element of the old man becomes diminished and excessively weak. His complexion becomes perverted; he becomes physically and mentally weak; and he succumbs to different types of diseases quickly.
These are the characteristic features of geriatric impotency. [176 – 181]

Kshayaja Type of Impotency

Now hear about the 4th type of impotency which is caused by the diminution of semen gets diminished because of the following factors:
Constant exposure to worry, grief, anger, fear, envy, anxiety, intoxication and nervousness
Intake of dry food, drinks and drugs by an emaciated person
Fasting by a person who is weaking nature; and
Intake of unwholesome food
By the aforesaid factors, Rasa (plasma) which is the primary tissue element and which is located in the heart gets diminished soon. As a result of thus, other tissue elements beginning from Rakta (blood) up to semen get diminished in that person. Among all these tissue elements, semen (Shukra) which is the final product is the most important
If a person because of excessive mental excitement indulges in sexual intercourse in excess, his semen gets diminished soon, and he gets emaciated. He succumbs to serious diseases, and even death.
Therefore, a person desirous of good health should specially preserve his semen.Thus, the etiology and signs as well as symptoms of 4 types of impotency are described. [181 – 187]

Prognosis

According to some physician, impotency caused by Dhwajabhanga (morbidity of Phallus) and Ksaya (diminution of semen) are incurable. In this context, Dhvajabhanga caused by amputation of the phallus and testicles is to be considered as incurable.
The term Ksaya; in this context of incurability refers to the condition when because of the morbidities of the soerm of the past life, during the embryonic of the aggravated Doshas afflict the channel carrying sperm, and make it atrophied. Because of this, [in the later part of life] the process of semen formation in the offspring is inhabited. Thus, the man though having full physical development becomes emasculated.
Different types of impotency described before which are caused by the simultaneous vitiation of all the 3 Doshas (sannipata) are also incurable. [188- 191]

Line of treatment

Line of treatment of Impotency
O! Sinless one (addressed to Agnivesha), hereafter will be described the treatment of impotency in brief as well as in detail which you may hear. These therapies for the cure of impotency, in brief, are as follows:
Remedies described by me (Atreya) for the treatment of seminal morbidities in this chapter
Therapeutic measures described earlier(in the chapter XI) for the treatment of Ksina(Phthisis) and
Medicated enema, medicated milk, medicated ghee aphrodisciac, recipes and rejuvenating recipes.
To the patient suffering from impotency as a result of sexual indulgenece (Vyavaya hetuja), and disharmony among the Dhatus (Doshas), the physician well versed in medicaments (Bhesaja) and time (Kala) should administer all the aforesaid therapeutic measures keeping in view the strength of his body, Doshas and Agni (power of digestion and metabolism).
If the impotency is caused by Abhicara (black magic), then such a patient is treated with religious prayers and rituals (Daiva Vyapasrya Chikitsa). Thus, in brief, the remedies for the cure of impotency are described.

Pancha Karma Therapy:
Now, the therapeutic measures for the cure of impotency will be described by me (Atreya) in detail.
After giving proper fomentation therapy to the patient whose body is oleated, he is given purgation therapy with a recipe containing fat. This should follow the patients taking appropriate food (according to prescribed procedure). Thereafter, the wise physician should administer Asthapana type of medicated enema followed by Anuvasana type of enema.
Asthapana type of enema is given again with [the decoction of] the leaves of Palasha Butea monosperma, Eranda Ricinus communis, etc., or with Musta (Cyperus rotundus). Etc [196- 198]

Treatment of Bijophataja Type of Impotency:
Aphrodisiac therapies described earlier may be used by the physician to cure impotency caused by Bijopaghata (Pollution of semen). [198 – 199]

Treatment of Dhvajabhanga Type of Impotency: and
If the impotency is caused by Dhvajabhanga (morbidity of the phallus), then the patient is treated with
Pradeha (application of warm paste of drugs),
Pariseka (affusion with the decoction of drugs),
Rakta Moksana (blood-letting),
Sneha Pana (administration of ghee, etc) and
Vireka (purgation) with a recipe containing fat.
After that, Anuvasana type of medicated enema followed by Asthapana type of medicated enema is administered. The intelligent physician should, thereafter adopt all the therapeutic measures prescribed for the treatment of wounds. [199 – 201]

Treatment of Jaraja and Ksayaja Impotency: and
If the impotency is caused by Jara (old age) and Ksaya (seminal diminution), then the patient should first of all be oleated and fomented. Thereafter, purgation therapy with unctuous ingredients is administered.
These 2 types of impotency is treated with medicted ghee, aphrodisiac recipe, Yapana type of medicated enema ( Siddhi 12:16) and rejuvenating recipes (described in Chikitsa 1).
Thus, I (lord Atreya) have explained the treatment of impotency. [202- 204]

Pradara

PRADARA (MENORRHAGIA)
Now listen (address of the disicple Agnivesha) to the etiology, etc. Of Pradara which has been mentioned earlier ( verse no 39][204 ]

Etiology, pathogenesis and signs of Pradara
If a woman takes excess of saline, sour, heavy , pungent, irritant and unctuous ingredients as food, fatty meat of domesticated and aquatic animals, Krsara (a preparation of rice and pulses), Payasa (a preparation of milk and rice), yoghurt, Vineger, whey, Sura (a type of alcohol), etc, then the Vayu in her body gets aggravated. This aggravated Vayu causes increases in the quantity of blood, and gets lodged in the channels which go to the (are connected with) Uterus carrying menstrual fluid.
Since by propelling blood of the body to these menstrual fluids immediately because of the liquid nature of the former (blood), it is called Asrdagara (menorrhagia) by the experts in this field of specialty (gynaecology)
Since the quantity of menstrual fluid is augmented or expanded, it is called Pradara.
Thus, the etiology and signs of Pradara are explained in general. [205- 209]

Varieties of Pradara
Regarding the details of this disease, Pradara is of 4 varieties, viz,
Vatika Pradara
Paittika Pradara
Kaphaja Pradara and
Sannipatika Pradara (the last one caused by the simultaneous aggravation of all 3 Doshas). [210]

Etiology, Pathology and Signs of Vatika Pradara: and
Because of the intake of dry, brownish black, Kimshukodaka sankasa (pink or like the juice of Kimsuka (Palasha Butea monosperma)) which may or may not be associated with pain, and if the aggravated Vayu causes Kati vankshna hrt parshva prstha shroni ruk (excruciating pain in the waist, groins, cardiac region, sides of the chest, back and hips), then this ailment is to be diagnosed as Vatika type of pradara. [211- 213]

Etiology and signs of Paittika Pradara: and
When the Pitta aggravated by the intake of sour, hot, saline and alkaline ingredients causes Pradara in the aforesaid manner, then it is called Paittika Pradara. Now, listen to its signs and symptoms.
If the menstrual discharge is blue, yellow, excessively hot, black or red, if it flows frequently associated with pain, and if the patient suffers from
Daha – burning sensation
Raga – redness
Trshna – thirst
Moha – unconsiciousness
Jwara – fever and
Bhrama giddiness then this is to be diagnosed as Paittika type of Asrgdara (pradara) [214- 216]

Etiology and Signs of Kaphaja Pradara: and
Hereafter will be described Kaphaja type of Pradara
Kapha aggravated by the intake of ingredients which are heavy, etc., causes Pradara in the manner stated before. Now, listen to the characteristic features of this type of Pradara.
In this type of Pradara, the menstrual discharge is
Picchilam – slimy
Pandu varnam – pale in color
Guru – heavy
Snigdha – unctuous
Shitalam – cold
Sravat shlesham ya ghanam – mucous or dense;
There is
Manda ruja – dull pain, and the patient suffers from
Chardi – vomiting
Arochaka – anorexia
Hrllasa – nausea
Shvasa – asthma and
Kasa – cough. [216 – 219]

Sannipatika Type of Pradara:
The factors in general to be described as cases of the morbidity of mothers milk ( verse nos. 232- 235) are also the causative factors of Sannipatika type of Pradara.
In these types of Pradara, all the signs and symptoms of afore said 3 types of Pradara (Viz., Vatika Pradara, Paittika Pradara and Kaphaja Pradara) are manifested in complete form. This Sannipatika Pradara is not characterized by the signs and symptoms of only one of them. [219 -220]

An associated Ailment:
If a woman who is excessively exhausted and who is excessively depleted of blood, resorts to all the aforesaid factors (described in respect of Vatika, Paittika and Kapha having opposite attributes through the channels of blood. The Kapha being afflicted (lit. Burnt) by the heat of Pitta becomes foul smelling, Slimy and yellow. The aggravated Vayu moving rapidly makes this Kapha (flid) along with Vasa (muscle fat) and Medas (adipose tissue) to be discharged through the vaginal tract. The fluid, thus discharged, appears like ghee, Majja (bone marrow) and Vasa (muscle fat).
This discharge from the vaginal tract takes place constantly, and the patient suffers from
Trshna – morbid thirst
Daha – burning sensation and
Jwara – fever
Curability: This patient whose blood is depleted and who is very weak is incurable, and the physician should avoid treatment of such a patient. [221-224]

Characteristics of Healthy Menstruation

The menstruation which appears every month, which is
Nis pichha – free from sliminess of discharge,
Daha arti – burning sensation and pain,
Pancha ratra anubandhi – which continues for 5 nights and
Na ati bahu na ati alpam – which is neither excessive nor scanty is to be considered as normal.
Gunja phala sa varnam – the menstrual discharge which is of the color of Gunja fruits or
Padma alaktaka sannibham – of lotus or of Indra Gopa (trombidium) is considered as unpolluted. [225- 226]

Treatment of Pradara

The therapeutic measures prescribed before for the treatment of different types of Yoni vyapat (uterine disorders) in this chapter is used by the physician for the treatment of [4 types of ] Pradara (menorrhagia).
Similarly, [for the treatment of these 4 types of Pradara], the therapeutic measures prescribed for Raktatisara or diarrhoea associated with bleeding ( Chikitsa 19:71- 100), Raktapitta (an ailment characterized by bleeding from different parts of the body Chikitsa 4) and Rakta arshas or bleeding piles ( Chikitsa 14) used. [227-228]

Breast milk morbidities

MORBIDITIES OF BREAST MILK
Earlier, detailed description has already been pro d on the following topics:
Dhatri Sampat (characristics of a wet nurse)- Sarira 8: 52
Stana Sampat (qualities of well formed breasts) Sarira 8: 52
Stanya Sampat (qualities of healthy breast milk) Sarira 8: 53-54
Stanya Samjanana (galactogogue drugs)- Sutra 4: 12 and Sarira 8: 57
Stanya Visodhana (drugs for purification of breast milk) Sutra 4: 12 and Sarira 8 : 56
Signs of breast milk vitiated by Vayu, etc- Sarira 8: 55
Treatment of diminished breast milk- Sutra 4:12 and Sarira 8; 56 and
8 types of morbidities of breast milk Sutra 19:4:1
The aforesaid 8 morbidities of breast milk are also caused by Vayu, etc. Which an able physician well versed in the scriptures should know.
Disciples are of 3 different types, viz Pravara (Superior more intelligent), Madhya (mediocre or of low intelligence). Therefore the comprehension of all (including those disciples who are of low intelligence), details of these 8 types of morbidities of breast milk will be described hereafter. [229-231]

Etiology and Pathogenesis of 88 Lactatial Morbidities:
In a woman, Doshas get aggravated because of the following:
Asatmya Bhojanat – Intake of food before the previous meal is digested
Intake of unwholesome, irregular and mutually contradictory food
Atyartha bhojanat – Intake of food in excess quantity
Intake of saline, sour, pungent , alkaline and pasty food
Affliction with mental as well as physical miseries
Remaining awake at night and worry
Suppression of the manifested natural urges, and forceful excitation of the unmanifested ones.
Sleep during day time after the frequently intake of Krsara (a preparation of rice and pulses), Mandaka Dadhi (Yoghrut not fully fermented or matured), ingredients which are Abhisyandi (which cause obstruction to the channels of circulation) and the meat of domesticated, marshy land- inhabiting as well as aquatic animals
Excessive intake of alcohol
Lack of exercise and affliction with trauma and anger and
Excessive emaciation because of chronic diseases.
The Doshas aggravated by the above mentioned factors reaches the Galactic channels to vitiated the breast milk, thus causing 8 types of morbidities [as described in Sutra 19 : 4:1]
Hereafter, the signs of the vitiation of breast milk by different Doshas will be described which you (addressed to Agnivesha) may understand. [232- 236]

Morbidities of Breast milk caused by different Doshas:
If the breast milk is vitiated by Vayu, then it becomes
Vairasyam – distasteful,
Phena sangatam – froathy and
Raukshyam – dry.
Breast milk vitiated by Pitta becomes
Vaivarnya – discolored and
Daurgandhya – foul smelling.
If it is vitiated by Kapha, then the breast milk becomes
Rukshya – unctuous
Anila – slimy and
Guru – heavy. [237- 238]

Pathogenesis and signs of Breast milk Vitiated by vayu: and
By the intake of Vayu provoking ingredients, like these which are dry etc, the Vayu gets aggravated. Having reached the breasts, it afflicts the taste of the breast milk.
By taking this tasteless milk, the child becomes emaciated. He does not relish this type of milk. And thus, his growth gets impaired. In addition, the aggravated Vayu churns up the milk inside the breast, and makes it a mass of fourthy substance. As a result of this, the milk flows out of the breasts with difficulty.
By taking polluted milk, the child becomes weak of voice, and suffers from stasis of stool, urine and flatus. He may also get Vatika type of head- diseases and Pinasa (chronic coryza)
The Vayu aggravated by the aforesaid factors dries up the unctuosness (sneha) of the milk, and makes it dry. By taking this milk, the child gets reduced of his strength because of dry. [248 – 242]

Pathogenesis and signs of Breast milk vitiated by Pitta
Pitta aggravated by ingredients which are hot etc., afflicts the breast of a woman. As a result of this, the milk becomes discolored, blue, yellow, black, etc. In the child who takes this milk, there will be
Vivarna gatra – discoloration of the body,
Svinna – perspiration,
Trshna -morbid thirst and
Atisara – diarrhea. His body remains warm constantly, and it dislikes breast feed.
The Pitta aggravated in the aforesaid manner causes foul smell in the breast milk, and the child taking this milk gets afflicted with anaemia and Jaundice. [243-245]

Pathogenesis and Signs of Breast milk Vitiated by Kapha:
Kapha aggravate by the intake of ingredients which are heavy, etc., afflicts the breast milk of the woman. Because of the unctuous attribute of this aggravated Kapha, the afflicted breast milk becomes excessively unctuous.
The child feeling on this Breast – milk suffers from
Chardanah – vomitting
Kunthanastena – gripping pain and
Lala srava – excessive salivation.
Since the channels in his body remain constantly smeared with this aggravated Kapha, the child constantly feels sleepy and fatigued (inactive).
He suffers from
Svasa (dyspnoea)
Kasa – cough
Lala srava – dribbling of saliva and
Tamaka (Asthma).
Because of the affliction by Kapha, the breast milk becomes slimy. The child feeding on this type of brest milk suffers from excessive salivation, swelling of the face as well as eyes dull.
When the aggravated Kapha which is heavy in attribute afflicts the breasts, the milk also becomes heavy. The child taking this milk suffers from heart diseases and another different types of diseases caused by the polluted milk. [246- 250]

Affliction by other ailments: and
When the Breast milk is afflicted with aggregated Vayu, etc., then other diseases specific to these Doshas also afflict the child. [ 251]

Treatment

Emetic therapy:
For the purification of the polluted breast milk, in the beginning the wet nurse (or the mother) is given oleated and fomentation therapies. Thereafter, the physician should appropriately administer emetic therapy to her. [251 – 252]

Recipe of Emetic Therapy:
The patient suffering from the pollution of breast milk is given emetic therapy with a recipe containing the paste of Vacha (Acorus calamus Linn.). Priyangu (Callicarpa macrophylla), Yastimadhu (Glycyrrhiza glabra), Madana Phala( Randia dumetorum), bark of Kutaja – Connessi (Holarrhena antidysenterica Wall.) and Sarsapa (Brassica campestris), and the decoction of nimba( Azadirachta indica )as well as Patola (Trichosanthes dioica) mixed with Salt. [252 – 253]

Purgation Therapy: 
After proper emesis, the patient is given Samsarjana Karma (rehabilitating diet). Thereafter, depending upon the nature of the aggravated Doshas, seasonal nature and strength of the patient, she is given purgation therapy preceded with oleation therapy. [253 – 254]

Recipe of Purgation Therapy: 
The physician proficient in scriptures should administer purgation therapy to the patient with the following recipes:
The paste Trivrt Operculina turpethum or Abhaya Terminalia chebula mixed the decoction of Triphala or honey or
Only Haritaki Terminalia chebula mixed with cows urine [254 – 255]

Food and drinks:
After proper purgation, a wise physician should again give Samsarjana Karma (rehabilitating diet) to the patient and, thereafter, for the alleviation of the residual Doshas, she is treated with different types of food and drinks [which are as follows]:
Sali and Sastika types of rice, Syamaka Saccaharum officinarium, Priyangu (Callicarpa macrophylla), Kodrava Paspalum scrobiculatu, Barley and Venu Yava – Barley (Hordeum vulgare) (seeds of Bamboo) are useful as food;
Bamboo shoots, Vertra Calamus rotang and Kalaya Pisum sativum sizzeled with fat is given vegetable preparation.
Vegetables soup prepared of Mudga Vigna radiata, Masura Lens esculenta and Kulattha Cajanus cajan may also be given.
Vegetable soups prepared by boiling tender leaves of Nimba – Neem (Azadirachta indica) and Vetra (Salix caprea), Kulaka (Karavellaka), Vartaka and Amalaki, and added with Ginger, black pepper, long pepper and rock- salt may be given for the purification of breast milk and
The meat of Sasa, Kapinijala and Ena may be given after sizzling, to the patient to take. [257- 260]

Recipes for Treatment of Polluted Breast milk in General
For the purification of the polluted breast milk, the patient is given the following recipes
Decoction of Sarngesta, bark of Saptaparna Raulwolfia serpentina, and Ashwagandha – Winter Cherry / Indian ginseng (root) – Withania somnifera
Decoction of Katukarohini – Picrorhiza kurroa (Katuki – Picrorhiza kurroa)
Decoction of Amrta(Guduchi Tinospora cordifolia) and the bark of Saptaparna – Raulwolfia serpentina
Decoction of ginger
Decoction of Kirata Tikta Swertia chirata
Thus, the recipes for the purification of polluted breast milk in general are described. Hereafter, treatment of specific morbidities of the breast milk will be described which may be listed to (addresses to Agnivesha). [260 – 263]
Recipes for corrections Distaste of breast milk
If there is distaste(bad taste) of the breast milk, then the patient is made to drink the fine paste of Draksha – Raisin – Vitis vinifera, Madhuka Licorice Glycyrrhiza glabra, Sariva – Indian Sarsaparilla – Hemidesmus indicus and Payasya – Impomoea paniculata mixed with warm water.
The paste of Pancha Kola (Pippali Long pepper fruit Piper longum, Pippali mula, Cavya Piper chaba, Chitraka – Plumbago zeylanica and Nagara) and Kulattha is applied over the breasts. After it is dried up, the breasts are washed, and the accumulated milk is squeezed out. Thus the breast milk gets purified [and the bad taste of the milk is removed]. [263 – 265]

Treatment of frothy milk
If the Breast milk is like thick foam, then the woman is given to drink the paste of Patha Cissampelos pariera, Nagara Zingiber officinale, Sarngesta and Murva Marsedenia tenacissima along with luke warm water.
In the aforesaid manner, her breast is anointed with the paste of anjana, Nagara Zingiber officinale, Devadaru (Cedrus deodara), root of bilva Aegle marmelos and Priyangu (Callicarpa macrophylla) [after the paste is dried up, the breasts are washed and the accumulated milk is squeezed out]. This purifies the polluted breast151;milk [and forthiness of the milk is corrected]
The decoction of Kirata tikta Swertia chirata, Sunthi Zingiber officinale and Amrta – Tinospora cordifolia is given to the wet nurse to drink which purifies polluted [frothy] milk.
In the aforesaid manner, the breasts are anointed with the paste of barley, wheat and mustard seed. [After the paste is dried up, the breasts are washed, and the accumulated milk is squeezed out. This purifies the polluted (froathy) breast milk]. [265 -268]

Treatment of dry Milk
Milk boiled with the drugs described in Sutra 4: 12., for the purification of breast milk, is taken by the woman who was unctuous breast milk.
Ghee cooked with the above mentioned drugs is also useful in this condition (dryness of breast milk).
In the aforesaid manner, the luke warm paste of Jivaka, etc., (jivaka Malaxis acuminata, Rishabhaka – Manilkara hexandra, Meda – Polygonatum cirrhifolium, Maha meda, Kakoli – Fritillaria roylei, Ksira Kaloli, Mudga parni, Masa parni, jivanti and Madhuka Licorice Glycyrrhiza glabra) or Panchamula (bilva Aegle marmelos, syonaka, gambari Gmelina arborea, Patali Ficus microcarpa and Ganikarika) is applied over the breast . After the paste is dried up, is washed and the accumulated milk is squeezed out. This purifies the [dry] breast milk [269- 270]

Treatment of Discolored Breast milk:
Intake of the paste of Yastimadhu Glycyrrhiza glabra, Mrdvika Vitis vinfera, Payasya – Impomoea paniculata (Ksira Vidari (Ipomoea paniculata / Pueraria tuberosa)) and Sindhuvara (Vitex negundo)(nirgundi) along with cold water corrects the discoloration of the breast milk.
The breasts of the paste woman having discolored milk are smeared with the paste of Madhuka Licorice Glycyrrhiza glabra. After the paste gets dried up, they are washed with water, and [the accumulated milk] is squeezed out repeatedly. This helps in correcting the polluted (discolored) breast milk. [271-272]

Treatment of foul odour in breast milk:
Intake of the paste of visanika (mesa Srngi Prosopis specigra), Aja sringi Rhus succedenea, Haritaki Terminalia chebula, Bibhitaki Terminalia bellerica, Amalaki Phyllanthus emblica, Haridra (turmeric – Curcuma longa) and Vacha (Acorus calamus Linn.) along with cold water cures foul odour of the breast milk.
The wet nurse should take the powder of Abhaya Terminalia chebula, Sunthi Zingiber officinale, Pippali Long pepper fruit Piper longum and Maricha – Black pepper fruit – piper nigrum mixed with the honey along with wholesome diet for the removal of foul odour in her breast milk.
The breasts of the woman having foul odour in her milk is anointed with the paste of
Sariva – Indian Sarsaparilla – Hemidesmus indicus,
Ushira – Vetiver – Vetiveria zizanioides,
Manjistha Rubia cordifolia
Slesmataka,
Kachandana,
Patra – Cinnamomum tamala Nees and Eberum.(tamala Patra – Cinnamomum tamala Nees and Eberum.),
Ambu (Hrivera) Pavoria odorata
Chandana (Sandalwood – Santalum album) and
After the paste is dried up, the breasts are washed with water, and the accumulated milk is squeezed out. [273- 275]

Treatment of unctuousness of Breast milk:
The woman having very unctuous breast milk should take the paste of Devadaru (Cedrus deodara), Musta (Cyperus rotundus) and Patha Cissampelos parriera mixed with rock- salt along with Luke warm water. By this, the unctuousness of the breast milk gets quickly corrected. [276]

Treatment of Sliminess in Breast milk:
The woman whose breast milk is slimy should drink Takrarista which is Prescribed for the treatment of piles ( Chikitsa 14; 71: 75)
Her breasts is anointed with the paste of Vidari (Ipomoea paniculata / Pueraria tuberosa), Bilva Aegle marmelos and Madhuka Licorice Glycyrrhiza glabra. After the paste gets dried up, the breasts are washed, and the accumulated milk is squeezed out]. [277-278]

Treatment of Heaviness in Breast milk: and
The woman whose breast milk is heavy should take the decoction of
Tryamana Gentiana kuroo,
Amrta Tinospora cordifolia,
Nimba – Neem (Azadirachta indica),
Patola Trichosanthes dioica,
Haritaki Terminalia chebula,
Bibhitaka Terminalia bellerica and
Amalaki Phyllanthus emblica.
By this her breast milk gets purified (heaviness removed) quickly.
She may also take the decoction of
Pippali Mula Long pepper fruit Piper longum-,
Cavya Piper chaba
Chitraka – Plumbago zeylanica and
Nagara Zingiber officinale for the removal of heaviness in her breast milk.
Her breasts are anointed with the paste of
Bala Sida cordifolia,
Nagara ginger
Sarngesta (Kakamaci Solanum nigrum) and
Murva Marsedenia tenacissima
After the paste is dried up, her breasts are washed with water, and the accumulated milk is squeezed out. This purifies (removes heaviness of) the breast milk.
Similarly, application of the paste of
Prsni parni Uraria picta and
Payasya – Impomoea paniculata (Vidari (Ipomoea paniculata / Pueraria tuberosa)-Kanda) [in the aforesaid manner corrects the heaviness of the breast milk]. [279- 281]
Thus, etiology, signs and treatment of 8 galactic disorders, and some other ailments arising out of the polluted milk are described. [281 – 282]

Paediatric diseases treatment

TREATMENT OF PAEDIATRIC DISEASES
The Doshas, dhatus (tissue elements), Malas (waste products) and the diseases of adults are all present in children. But in the case of the latter, these are only is small quantity and of mild intensity.
The physician well versed in scriptures should avoid the administration of Vamana (emesis) and such other therapies of Pancha Karma to a child., in view of his tenderness, dependency on others and inability to speak as well as act.
The dose of the medicine for children is very small and appropriate to the disease. The wise physician should carefully administer sweet and astringent drugs which are mild. Medicines, diet and drinks which are excessively unctuous, dry, hot, sour, pungent in Vipaka (the taste that emerges after digestion) and heavy are contra indicated for children.
In brief, these are the guiding principles for administering medicines to children for the all their ailments. A physician well versed in scriptures should administer therapies to children after considering all aforesaid aspects. [282 – 287]

Thus it is said:
This Chikitsa Sthana (section of Therapeutics) deals with the therapeutic measures for all the diseases. It constitutes the most significant secret of treatise (Charaka Samhita). [288]

Portion of treatment supplemented by Drdhabala
17th chapter of this section (on therapeutics) and the successive 2 sections, viz., Kalpa (section on Pharmacetics) and Siddhi (section on Therapeutic Perfection) are not available in the Agniveshas Treatise which was redacted by Charaka. Therefore, Drdhabala, the son of kapilabala reconstructed and supplemented them appropriately leading to the completion of this treatise endowed with great objective. [289-290]

Treatment of Unnamed Diseases

There are several other diseases which are not described in this Section with names and forms. Even such diseases are to be treated on the lines suggested in this Section after examining the Doshas and such other factors involved in their manifestation. [291]

Line of Treatment in General
Therapies which are opposite to the properties of the Doshas, Dusyas (tissue elements) and etiological factors involved in the causation of the disease are certainly useful to cure it. If appropriately used, such therapeutic measures will cure all the diseases whether they are named or not in the text [292]

Appropriate Use of Therapeutic Measure
Therapeutic measures are appropriately used keeping in view the following:
Desha(location)
Kala(time)
Pramana(Dose)
Satmya(Wholesomeness) and
Asatmya(unwholesomeness)
Otherwise, even a useful therapy (Pathya) may turn out to be harmful (apathy). [293]

Mode of administration of medicine

Desha(Administration of Drugs Through Particular Channel)
If a drug is administered through mouth, it works quickly on diseases located in stomach.
Administration of a drug by inhalation quickly cures diseases of the head.
Administration of a therapy through the anus quickly cures diseases located in the colon.
For the cure of disese located in various parts of the body like Visarpa(erysipelas or Herpes), Pidaka(pimples) etc., application of therapies externally like Pradeha (application of hot poultices), etc, in that particular part afflicted by the disease are useful. [294 -295]
Kala (Time of Administration of Drugs)
The term Kala (time) in the present context has reference to the following:
Dina (different parts of the day)
Atura (nature of the patient)
Ausadha (time of taking medicine)
Vyadhi (nature of the disese)
Jirna Linga (stage of the digestion of food) and
Rtu (nature of the season)
Examples of these aspects of Kala (time) are as follows:
as regards the time with reference to the different parts of the day, the morning is the mst suitable time for the administration of emetic therapy
(b) as regards the time with reference to the nature of the patient , a strong person should take medicines in the morning on empty stomach and a weak person should take medicines along with light and wholesome food.
(c) As regards the time (frequency) of taking medicine it is of ten categories as follows:
Bhuktadau or before the meals (i. E once on empty stomach in the morning and once before the morning meal)
Bhukta Madhye (during the meal, i.e in the middle of the meal)
(iv-v) Bhukta Pascat (after the meals, i.e in the morning meal and after the evening meal)
(vi)Muhurmuhuh (repeatedly during the day and night)
(vii) Samudga (before as well as after the meal)
(viii) Bhakta Samyukta (mixed with the food)
(ix) Grase (along with each morsel of food)
(x) Grasantare (between two meals)
If the Apana Vayu is vitiated, then the medicine is given before food.
If the Samana Vayu is vitiated, then the medicine is given during the meal.
If Vyana Vayu is vitiated then the medicine is given after the morning meal.
If Udana Vayu is vitiated, then the medicine is given after the meal.
If Prana Vayu is vitiated, then the medicine is given along with each morsel of food or in between morsels of food.
In asthma, cough and morbid thirst, the medicine is given at short intervals frequently.
To the patient suffering from hiccup, medicine is given before and after food adding to the light articles of food.
In anorexia, medicine is mixed with various types of food.
(d) As regards the time with reference to the diseases (Vyadhi), the patient suffering from fever is given peya (thin gruel), Kashaya (decoctions), medicated milk, medicated ghee and purgation therapy consecutively at an interval of 6 days after observing the time (number of the days of suffering) of disease.
(e) Jirna Linga: Appearance of hunger, proper evacuation of stool and urine, lightness of the body and purity [of eructation]- these are the signs of proper digestion. Medicines are given to the patient only thereafter. [This according to Chakrapani, refers to the time of medicine which is administered before food]. Otherwise, the medicine will produce harmful effects.
As regards the time with reference to the nature of seasons , accumulation, etc., of Doshas, the ingredients to be used to avoid such accumulation, etc, and regiments to be used in different seasons depending upon the condition of Doshas are already described (in Sutra 6).
Administration of therapeutic measures, reasons for prohibiting their use, and examination of the permutation and combination of Doshas in a weak patient are already described.
The physician who very frequently keeps on observing the development of the disease and the conducts of the patient will not commit mistakes in treatment.
Administration of therapeutic measures without careful examination of the 6 conditions of Kala (time) leads to harmful effects as the unseasonal rain damages the crops. [296-307]

Aggravation of doshas according to season

Aggravation of Doshas in Different Seasons etc:
With reference to Kala(time), the specific classification of diseases[on the basis of aggravated Doshas] during different seasons, different parts of the day and night, different ages (parts of the span of life) and different stages of the digestion of food will be described hereafter.
Generally Kaphaja diseases are manifested in the spring, Paittika diseases ae manifested [the beginning of] the rainy season.
Vatika diseases get aggravated [the term Varsante here should read as Vardhane] – during the end of the night and the day (afternoon),
Kaphaja diseases get aggravated during the morning and evening; and
Paittika diseases get aggravated during the midday and midnight.
As regards the age, during old age
Vata gets aggravated after the digestion of food,
Paittika diseases get aggravated during the digestion of food, and
Kaphaja diseases get aggravated immediately after taking food. [308- 312]

Dose of medicine

III Dose (Quantity) of Medicine:
As a small amount of water cannot extinguish fire, similarly medicine in small quantity cannot cure a disease. As irrigation with overflood is harmful for the crops, similarly medicine in excessive quantity (dose) is harmful for the patient.
Therefore, after carefully examining the strength of the disease and the medicine, the remedial measures are administered in a quantity (dose) which is neither too large nor too small. [313-314]

Satmya

IV Satmya (wholesomeness):
If a non- homologous (Apathya) item [of food and regimen] has become wholesome (Satmya) to a person because of habit (aucitya) or the nature of the place of Habitat (desha), then sudden and total withdrawal of this item (even though it is non- homologous or Apathya) dose not give happiness to a person.
Persons like Bahlikas, Pahlavas, Cinas, Sulikas, Yavanas and Shakas are habituated with meat, wheat, Madhvika (a type of wine), carrying arms and fire [for keeping them warm].
People living in the eastern part (of Indian) are habituated with taking fish which is wholesome for them.
People of Sindh are habituated with taking milk which is wholesome for them.
For people living in the southern part (of India), intake of Peya (thin gruel) is wholesome.
For the people of northern and western parts (of India), intake of mantha (roasted corn- flour mixed with water) is wholesome.
For the people living in the middle part (of India), intake of barley wheat and milk- products is wholesome.
For the (people living in the aforesaid geographical areas and people of aforesaid ethnic origin), medicines is administered by adding to the food and drinks which are wholesome to them.
The wholesome ingredients promote strength instantaneously. If given in excess, these wholesome items do not produce any harmful effect. [315- 320]

Mistakes committed by Ignoring Desha etc
The physician treating a patient simply with recipes without paying any attention to factors like Desha (habitation in different areas), etc, may commit mistakes (may not achieve success). On the basis of age, strength and physical features, physiques are of innumerable types. Accordingly patients are also innumerable types. [320- 321]

Usefulness of Therapies Generally Considered as Harmful:
If the morbidities have afflicted the deep- seated organs like those in the Kostha (thoracic and abdominal viscera) and joints, at times, for their cure, therapeutic measures generally considered as contradictory (viruddha) may be useful.
If Pitta is deep-seated and located in the internal pathway (thoracic and abdominal visceras), then by the application of hot fomentation, Seka (affusion) and Upadeha (hot poultices), it comes out to the exterior of the body resulting in the alleviation of Pitta or heat. Thus, heat producing therapies may cure Pitta which is hot in nature.
By the application of external therapies like Seka (affusion) etc., which are cooling in nature, the external heat is pressed to go inside, and cure the deep- seated Kapha in the internal path way (thoracic and abdominal visceras). Thus, a cooling therapy may cure Kapha which is cold in nature.
Sandal-wood is cooling in nature. But if it is made to a fine paste and applied over the skin in thick layer, it causes burning sensation (heart production) by obstructing the evaporation of heat from the skin. Similarly, Aguru Aquallaria agallocha which is hot in potency, [if made to a coarse paste and applied in a thin layer over the skin] produces cooling effects.
Intake of the whole fly causes emesis; but intake of the stool of fly is anti emetic. Similarly, modification of effects (manifestation of opposite effects) can be observed if an article [of food or drugs] is subjected to physical heat or taken internally [and exposed to the effects of the digestive fire].

Need for proper examination of Desha, etc.
Therefore, a wise physician should carry out treatment after examining carefully the diseases and drugs with reference to 10 items ( commentary), and only by recipes [described with reference to the diseases in the classics]. [326 – 327]
Reoccurrence of disease:
Even if disease is cured, it may reoccur by minor from of etiological factors because by the earlier disease the body has become already weak., and the channels for the manifestation of the disease have already become vulnerable.This reccurrence takes place like the flaring up of a small quantity of residual fire [after the main fire is extinguished].
Therefore, the body is immured from such recording attacks of the disease by the continuous use of effective and otherwise harmless drugs which were used before for the treatment of the primary disease. [327 – 329]

Effects of wholesome food and regimens: and
Doshas may get aggravated in 2 different ways, viz.,
Kathinya (with compactness) which occurs internally, and
Punarbhava (with non- compactness) which occurs in gross form.
By wholesome food and regimes, these compact and non-compact Doshas may get softened or reduced in quantity respectively as a result of which the morbid manifestation will be of mild nature. Therefore, if a disease is manifested incite of the intake of wholesome food, etc., then for its cure, after ascertaining its nature, wholesome food, etc., is increased in quantity or is taken habitually for a long duration.[329 – 331]

Management of aversion to Pathya

Management of Aversion for wholesome Items and Linking for Unwholesome Ones:
Because of constant use and unpalatability, a wholesome regime may [at times] become repulsive. Such wholesome but repulsive regimes may again be made palatable by processing them through different modes of cooking.
Therapeutic measures agreeable to the mind and senses promote
Tusti (mental satistfaction)
Urja (mental strength)
Ruchi (relish)
Bala (strength) and
Sukha Bhogata (non-resistance to the use of therapeutic measures) as a result of which the strength of the disease gets diminished.
If a patient has developed liking for a particular unwholesome ingredient because of Laulya (desire to indulge because of mental perversion), Ksaya (diminution of Doshas) Vyadhi (nature of the disease) and Vyadhi Vaidharmya (desire to take ingredients which are opposed to the attributes of the disease), then such events is managed by the administration of suitable wholesome regains, different types of recipes and different food preparations. [331 – 334]

Summary

To sum up:
The topics described in this chapter for the benefits of the disciples are as follows:
Etiology, signs, symptoms and therapeutic measures for the treatment of 20 varieties of genetic diseases (yoni Dosha);
Etiology, signs , symptoms and therapeutic measures for the treatment of 8 types of seminal morbidities (Shukra Dosha)
Etiology, signs , symptoms and therapeutic measures for the treatment of 4 types of impotency (Klaibya)
Etiology, signs , symptoms and therapeutic measures for the treatment of 4 types of menorrhagia (Pradara)
Etiology, signs , symptoms and therapeutic measures for the treatment of 8 types of galactic morbidities (Ksira Dosha)
Signs of pure (natural or normal) semen (Shukra) and Menstrual blood (Rajas)
Treatment of diseases which are described by name and which are not described by name in the text
Appropriate line of treatment for the aforesaid diseases
Highlighting the excellence of the knowledge of the attributes of Desha (Habitat) etc
6 types of times for the administration of therapeutic measures (bhesaja Kala)
Homologation in different countries
Non-achievement of success by the physician because of the ignorance of the aforesaid factors; and
Treatment of deep-seated morbidities. [334 – 339]

Interpretations:
A physician who is not well versed in the scriptures and their interpretations should not attempt treatment of diseases as a painter without eye sight should not attempt painting a picture. [340]

Colophon of the Chapter:
Thus, ends the 30th chapter on the treatment of uterine diseases[etc] in the Chikitsa section of Agniveshas work as redacted by Charaka, and supplemented by Dridhabala.

Colophon of the Section: (Sthana)
Thus, ends the 6th section called Chikitsa Sthana (section on Therapeutics) of Agniveshas work as redacted by Charaka.
End of Chikitsa Sthana