Yonivyapat Chikitsa

Yonivyapat Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 30
Preceding Chapter	Vatarakta Chikitsa
Succeeding Chapter	None
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 30, Chapter on the Management of Disorders of Male and Female Genital Tracts)

Abstract

Yonivyapat Chikitsa mainly deals with the management of disorders of male and female genital tract and reproductive system. It also includes the abnormalities of breast milk and its impact on baby, guidelines for management of diseases in children. The last part comprises of some important general principles in clinical management of disease like factors influencing disease process, time of administration of medicine and route of administration.

The disorders of the female genital tract are described under twenty yonivyapat (yoni(vagina),vyapat(disorders)) based upon the vitiation of doshas and dushyas. Rakta yoni (per vaginal bleeding) and pradara (menorrhagia) are described separately considering its importance in gynecology practice. The local and generalized management of these disorders with Panchakarma, basti and uttara basti procedures, vaginal douches are enlisted.

Various disorders of the male genital tract, causes of impotency, defects of semen and their management are elaborated further. The chapter is comprehensive manual of management of disorders of male and female genital tract as well as guidelines for pediatric practice.

Keywords: Yonivyapat (disorders of female genital tract), shukra (semen and sperm), artava (menstruation), klaibya (impotency), disorders of male genital tract, stanya (breast milk), pradara (menorrhagia), dysmenorrhoea, pediatrics,circadian rhythm, aushadha sevana kala, chrnonopharmacolgy.

Introduction

Yoni means origin or source. The source of birth of human being is in the male and female genital tracts. The present chapter describes the disorders of male and female genital tracts.

It largely describes disorders of female genital tract due to excessive aggravation of doshas i.e. vata, pitta, kapha and rakta. The chapter explains causes, numbers, classifications, symptoms, clinical features, complications and treatment of gynecological and menstrual disorders. Some references about this are also available in 19th chapter of Sutra Sthana.

As female is considered to be the root of a healthy offspring, due importance is given to her reproductive health especially external and internal reproductive system and the diseases which affect those. A female afflicted with any such diseases will not be able to conceive and will be susceptible for various other disorders.

Abnormal diet and lifestyle, abnormalities of sperm and ovum are responsible for vitiation of doshas mainly vata dosha, causing gynecological disorders. All gynecological disorders should be managed with purvakarma like proper oleation and sudation followed by Panchakarma. Besides Panchakarma and special therapies, healthy diet, purgatives and milk are also beneficial to treat the gynecological disorders. Importance of purification before conception for healthy progeny is highlighted.

This is highly significant to prevent hereditary or genetic disorders from passing them to next generations.

The second part of this chapter deals with disorders of male genital tract. It mentions factors causing male infertility.

Characteristics of abnormal semen and dosha involvement, shuddha shukra (normal semen) characteristics, male impotency, coital dysfunction, its classifications and causes are discussed. The treatment of shukra dushti (faulty semen) and other dysfunctions need Panchakarma, rasayana and vajikarana treatment. It also gives guidelines of management of diseases in newborn originated due to defective breast milk.

The third part guides some common factors to be considered in clinical management of diseases like habitat, season, time of administration and adaptability. Consideration of assessment of dosha dominance in anukta vyadhi (diseases which are not mentioned in the text) is important guideline given in this chapter.

Sanskrit Text, Transliteration and English Translation

अथातो योनिव्यापच्चिकित्सितं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

athātō yōnivyāpaccikitsitaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

yonivyApaccikitsitaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter dealing with Yonivyapat (disorders of the genital tract)”. Thus said Lord Atreya.[1-2]

Agnivesha’s query

दिव्यतीर्थौषधिमतश्चित्रधातुशिलावतः | पुण्ये हिमवतः पार्श्वे सुरसिद्धर्षिसेविते ||३||

विहरन्तं तपोयोगात्तत्त्वज्ञानार्थदर्शिनम् | पुनर्वसुं जितात्मानमग्निवेशोऽनु पृष्टवान् ||४||

divyatīrthauṣadhimataścitradhātuśilāvataḥ| puṇyē himavataḥ pārśvē surasiddharṣisēvitē||3||

viharantaṁ tapōyōgāttattvajñānārthadarśinam| punarvasuṁ [1] jitātmānamagnivēśō'nu pr̥ṣṭavān||4||

divyatIrthauShadhimatashcitradhAtushilAvataH| puNye himavataH pArshve surasiddharShisevite||3||

viharantaM tapoyogAttattvaj~jAnArthadarshinam| punarvasuM jitAtmAnamagnivesho~anu pRuShTavAn||4||

Agnivesha asked to Punarvasu who was self controlled, seer of the ideas, spiritual knowledge, wandering besides Himalaya possessed with places like Ganga etc., herbs, various metals of different colors and stones as well as inhabited by gods, virtue of knowledge of penance accomplished by the sages. [3-4]

Queries

भगवन्! यदपत्यानां मूलं नार्यः परं नृणाम् | तद्विघातो गदैश्चासां क्रियते योनिमाश्रितैः ||५||

तस्मात्तेषां समुत्पत्तिमुत्पन्नानां च लक्षणम् | सौषधं श्रोतुमिच्छामि प्रजानुग्रहकाम्यया ||६||

bhagavan! yadapatyānāṁ mūlaṁ nāryaḥ paraṁ nr̥ṇām| tadvighātō gadaiścāsāṁ kriyatē yōnimāśritaiḥ||5||

tasmāttēṣāṁ samutpattimutpannānāṁ ca lakṣaṇam| sauṣadhaṁ śrōtumicchāmi prajānugrahakāmyayā||6||

bhagavan! yadapatyAnAM mUlaM nAryaH paraM nRuNAm| tadvighAto gadaishcAsAM kriyate yonimAshritaiH||5||

tasmAtteShAM samutpattimutpannAnAM ca lakShaNam| sauShadhaM shrotumicchAmi prajAnugrahakAmyayA||6|

Oh Lord ! The original source of progeny is the woman. An offspring cannot conceived if there are disorders in the genital tract. Hence I want to hear or know how the causes of disorders of the genital tract and the symptoms of the disorders along with their treatment for the welfare of people? [5-6]

Explanation by Atreya

इति शिष्येण पृष्टस्तु प्रोवाचर्षिवरोऽत्रिजः | विंशतिर्व्यापदो योनेर्निर्दिष्टा रोगसङ्ग्रहे ||७||

iti śiṣyēṇa pr̥ṣṭastu prōvācarṣivarō'trijaḥ| viṁśatirvyāpadō yōnērnirdiṣṭā rōgasaṅgrahē||7||

iti shiShyeNa pRuShTastu provAcarShivaro~atrijaH| viMshatirvyApado yonernirdiShTA rogasa~ggrahe||7||

Thus after queried by the disciple Agnivesha, the son of Atri, best among the sages said that twenty types of the disorders of the genital tract are mentioned in the Rogasangrah (enumeration of diseases) chapter.[7]

Causative factors

मिथ्याचारेण ताः स्त्रीणां प्रदुष्टेनार्तवेन च | जायन्ते बीजदोषाच्च दैवाच्च शृणु ताः पृथक् ||८||

mithyācārēṇa tāḥ strīṇāṁ praduṣṭēnārtavēna ca| jāyantē bījadōṣācca daivācca śr̥ṇu tāḥ pr̥thak||8||

mithyAcAreNa tAH strINAM praduShTenArtavena ca | jAyante bIjadoShAcca daivAcca shRuNu tAH pRuthak||8||

Those occur in women due to their faulty lifestyle habits, vitiated menstrual blood, defects in ovum (beeja)(hereditary or congenital defects) and the destiny. (Now) Listen about each of them.[8]

Vata dominant yonivyapat

वातलाहारचेष्टाया वातलायाः समीरणः | विवृद्धो योनिमाश्रित्य योनेस्तोदं सवेदनम् ||९||

स्तम्भं पिपीलिकासृप्तिमिव कर्कशतां तथा | करोति सुप्तिमायासं वातजांश्चापरान् गदान् ||१०||

सा स्यात् सशब्दरुक्फेनतनुरूक्षार्तवाऽनिलात् |

vātalāhāracēṣṭāyā vātalāyāḥ samīraṇaḥ| vivr̥ddhō yōnimāśritya yōnēstōdaṁ savēdanam||9||

stambhaṁ pipīlikāsr̥ptimiva karkaśatāṁ tathā| karōti suptimāyāsaṁ vātajāṁścāparān gadān||10||

sā syāt saśabdarukphēnatanurūkṣārtavā'nilāt|

vAtalAhAraceShTAyA vAtalAyAH samIraNaH| vivRuddho yonimAshritya yonestodaM savedanam||9||

stambhaM pipIlikAsRuptimiva karkashatAM tathA| karoti suptimAyAsaM vAtajAMshcAparAn gadAn||10||

sA syAt sashabdarukphenatanurUkShArtavA~anilAt|

If woman of vatika constitution follows vata-aggravating diet and life style, then vata gets aggravated and reaches the genital tract. This leads to piercing pain, stiffness, feeling of crawling of ants, hardness, numbness and exhaustion. Beside this, other vatika disorders are likely to occur. Vitiated yoni due to vata, secretes frothy, thin, rough menstrual blood with sound and pain. [9-10]

Pitta dominant yonivyapat

व्यापत्कट्वम्ललवणक्षाराद्यैः पित्तजा भवेत् ||११||

दाहपाकज्वरोष्णार्ता नीलपीतासितार्तवा | भृशोष्णकुणपस्रावायोनिःस्यात्पित्तदूषिता||१२||

vyāpatkaṭvamlalavaṇakṣārādyaiḥ pittajā bhavēt||11||

dāhapākajvarōṣṇārtā nīlapītāsitārtavā| bhr̥śōṣṇakuṇapasrāvā yōniḥ syātpittadūṣitā||12||

vyApatkaTvamlalavaNakShArAdyaiH pittajA bhavet||11||

dAhapAkajvaroShNArtA nIlapItAsitArtavA| bhRushoShNakuNapasrAvA yoniH syAtpittadUShitA||12||

Due to excessive use of pungent, sour, salty, alkaline substances etc. pitta dominant type of disorders of the genital tract are prone to occur. In the vagina, which is vitiated by pitta, the burning sensation, suppuration (inflammation) and heat occurs with the feeling of fever and heat. The menstrual blood flow is of blue, yellow and black color with excessive heat and as the smell of cadaver. [11-12]

Kapha dominant yonivyapat

कफोऽभिष्यन्दिभिर्वृद्धो योनिं चेद्दूषयेत् स्त्रियाः | स कुर्यात् पिच्छिलां शीतां कण्डुग्रस्ताल्पवेदनाम् ||१३||

पाण्डुवर्णां तथा पाण्डुपिच्छिलार्तववाहिनीम् |

kaphō'bhiṣyandibhirvr̥ddhō yōniṁ cēddūṣayēt striyāḥ| sa kuryāt picchilāṁ śītāṁ kaṇḍugrastālpavēdanām||13||

pāṇḍuvarṇāṁ tathā pāṇḍupicchilārtavavāhinīm|

kapho~abhiShyandibhirvRuddho yoniM ceddUShayet striyAH| sa kuryAt picchilAM shItAM kaNDugrastAlpavedanAm||13||

pANDuvarNAM tathA pANDupicchilArtavavAhinIm|

If kapha aggravated substances are used in excess then kapha gets aggravated and affects the genital tract of woman which makes it slimy, cold, associated with itching and mild pain. Woman becomes pale and secretes the pale and slimy menstrual blood.[13]

Tridosha dominant yonivyapat

समश्नन्त्या रसान् सर्वान्दूषयित्वा त्रयो मलाः ||१४||

योनिगर्भाशयस्थाः स्वैर्योनिं युञ्जन्ति लक्षणैः | सा भवेद्दाहशूलार्ता श्वेतपिच्छिलवाहिनी ||१५|

samaśnantyā rasān sarvāndūṣayitvā trayō malāḥ||14||

yōnigarbhāśayasthāḥ svairyōniṁ yuñjanti lakṣaṇaiḥ| sā bhavēddāhaśūlārtā śvētapicchilavāhinī||15||

samashnantyA rasAn sarvAndUShayitvA trayo malAH||14||

yonigarbhAshayasthAH svairyoniM yu~jjanti lakShaNaiH| sA bhaveddAhashUlArtA shvetapicchilavAhinI||15||

When a woman uses all the rasas in excess, then all three doshas located in her uterus vitiate the genital tract and produce their symptoms. Thus the vitiated genital tract suffers from the burning sensation and pain and discharges the white, slimy menstrual blood. [14-15]

Asrija yonivyapat

रक्तपित्तकरैर्नार्या रक्तं पित्तेन दूषितम् | अतिप्रवर्तते योन्यां लब्धे गर्भेऽपि सासृजा [१] ||१६||

raktapittakarairnāryā raktaṁ pittēna dūṣitam| atipravartatē yōnyāṁ labdhē garbhē'pi sāsr̥jā [1] ||16||

raktapittakarairnAryA raktaM pittena dUShitam| atipravartate yonyAM labdhe garbhe~api sAsRujA [1] ||16||

The menstrual blood (stored in yoni) is vitiated by the pitta due to excessive intake of rakta & pitta aggravating diet and lifestyle, then even after conception, the menstrual blood flows excessively. It is known as asrija (raktaja) yoni. [16]

Arajaska yonivyapat

योनिगर्भाशयस्थं चेत् पित्तं सन्दूषयेदसृक् | साऽरजस्का मता कार्श्यवैवर्ण्यजननी भृशम् ||१७||

yōnigarbhāśayasthaṁ cēt pittaṁ sandūṣayēdasr̥k| sā'rajaskā matā kārśyavaivarṇyajananī bhr̥śam||17||

yonigarbhAshayasthaM cet pittaM sandUShayedasRuk| sA~arajaskA matA kArshyavaivarNyajananI bhRusham||17||

If the blood is vitiated by the pitta which is located in the genital tract and uterus, then the patient becomes emaciated and develops abnormal complexion. It is known as Arajaska.[17]

Acharana yonivyapat

योन्यामधावनात् कण्डूं जाताः कुर्वन्ति जन्तवः | सा स्यादचरणा कण्ड्वा तयाऽतिनरकाङ्क्षिणी ||१८||

yōnyāmadhāvanāt kaṇḍūṁ jātāḥ kurvanti jantavaḥ| sā syādacaraṇā kaṇḍvā tayā'tinarakāṅkṣiṇī||18||

yonyAmadhAvanAt kaNDUM jAtAH kurvanti jantavaH| sA syAdacaraNA kaNDvA tayA~atinarakA~gkShiNI||18||

When a woman does not wash her external genitalia , then micro-organisms (bacteria, virus) are likely to grow and cause itching, by which woman has frequent desire of man. This is known as Acharna.[18]

Aticharana yonivyapat

पवनोऽतिव्यवायेन शोफसुप्तिरुजः स्त्रियाः | करोति कुपितो योनौ सा चातिचरणा मता ||१९||

pavanō'tivyavāyēna śōphasuptirujaḥ striyāḥ| karōti kupitō yōnau sā cāticaraṇā matā||19||

pavano~ativyavAyena shophasuptirujaH striyAH| karoti kupito yonau sA cAticaraNA matA||19||

Due to excessive coitus, the vata gets aggravated and causes swelling, numbness, pain in female genital tract. This is known as Aticharana. [19]

Prakcharana yonivyapat

मैथुनादतिबालायाः पृष्ठकट्यूरुवङ्क्षणम् | रुजन् दूषयते योनिं वायुः प्राक्चरणा हि सा ||२०||

maithunādatibālāyāḥ pr̥ṣṭhakaṭyūruvaṅkṣaṇam| rujan dūṣayatē yōniṁ vāyuḥ prākcaraṇā hi sā||20||

maithunAdatibAlAyAH pRuShThakaTyUruva~gkShaNam| rujan dUShayate yoniM vAyuH prAkcaraNA hi sA||20||

When the sexual intercourse is performed in too premature (younger/adolescent) girls, then vata is aggravated leading to vitiation of the genital tract and produces pain in back, waist, thighs and groins. This is known as Prakcharana. [20]

Upapluta yonivyapat

गर्भिण्याः श्लेष्मलाभ्यासाच्छर्दिनिःश्वासनिग्रहात् | वायुः क्रुद्धः [१] कफं योनिमुपनीय प्रदूषयेत् ||२१||

पाण्डुं सतोदमास्रावं श्वेतं स्रवति वा कफम् | कफवातामयव्याप्ता सा स्याद्योनिरुपप्लुता ||२२||

garbhiṇyāḥ ślēṣmalābhyāsācchardiniḥśvāsanigrahāt| vāyuḥ kruddhaḥ [1] kaphaṁ yōnimupanīya pradūṣayēt||21||

pāṇḍuṁ satōdamāsrāvaṁ śvētaṁ sravati vā kapham| kaphavātāmayavyāptā sā syādyōnirupaplutā||22||

garbhiNyAH shleShmalAbhyAsAcchardiniHshvAsanigrahAt| vAyuH kruddhaH [1] kaphaM yonimupanIya pradUShayet||21||

pANDuM satodamAsrAvaM shvetaM sravati vA kapham| kaphavAtAmayavyAptA sA syAdyonirupaplutA||22||

If a woman ingests kapha aggravating substances and suppresses the urges of vomiting and respiration, then vitiated vayu carries the aggravated kapha to the genital tract and affects it. In this condition pale colored fluid with piercing pain or white mucus is secreted. The defects of kapha and vata are involved in this genital disorder. This is known as upapluta [21-22]

Paripluta yonivyapat

पित्तलाया नृसंवासे क्षवथूद्गारधारणात् | पित्तसम्मूर्च्छितो वायुर्योनिं दूषयति स्त्रियाः ||२३||

शूना स्पर्शाक्षमा सार्तिर्नीलपीतमसृक् स्रवेत् | श्रोणिवङ्क्षणपृष्ठार्तिज्वरार्तायाः परिप्लुता ||२४||

pittalāyā nr̥saṁvāsē kṣavathūdgāradhāraṇāt| pittasammūrcchitō vāyuryōniṁ dūṣayati striyāḥ||23||

śūnā sparśākṣamā sārtirnīlapītamasr̥k sravēt| śrōṇivaṅkṣaṇapr̥ṣṭhārtijvarārtāyāḥ pariplutā||24||

pittalAyA nRusaMvAse kShavathUdgAradhAraNAt| pittasammUrcchito vAyuryoniM dUShayati striyAH||23||

shUnA sparshAkShamA sArtirnIlapItamasRuk sravet| shroNiva~gkShaNapRuShThArtijvarArtAyAH pariplutA||24||

When a woman of pitta dominant constitution uses the pitta aggravating things, suppresses the urges of sneezing and eructation during coitus, then vayu mixed with pitta gets aggravated affecting the female genital tract. Due to this woman suffers from fever and yoni (female genital tract) becomes swollen, inflamed, tender and painful. The menstrual blood becomes blue, yellow with pain in pelvis, groin and back of the woman, this is known as paripluta. [23-24]

Udavartini yonivyapat

वेगोदावर्तनाद्योनिमुदावर्तयतेऽनिलः | सा रुगार्ता रजः कृच्छ्रेणोदावृत्तं [१] विमुञ्चति ||२५||

आर्तवे सा विमुक्ते तु तत्क्षणं लभते सुखम् | रजसो गमनादूर्ध्वं ज्ञेयोदावर्तिनी बुधैः ||२६||

vēgōdāvartanādyōnimudāvartayatē'nilaḥ| sā rugārtā rajaḥ kr̥cchrēṇōdāvr̥ttaṁ [1] vimuñcati||25||

ārtavē sā vimuktē tu tatkṣaṇaṁ labhatē sukham| rajasō gamanādūrdhvaṁ jñēyōdāvartinī budhaiḥ||26||

vegodAvartanAdyonimudAvartayate~anilaH| sA rugArtA rajaH kRucchreNodAvRuttaM [1] vimu~jcati||25||

Artave sA vimukte tu tatkShaNaM labhate sukham| rajaso gamanAdUrdhvaM j~jeyodAvartinI budhaiH||26||

When natural urges are suppressed, then vayu goes upwards and takes the genital tract in upward direction (retroversion condition). Due to this, severe pain occurs by which eviction of the menstrual blood is very difficult because of its upward tendency. After discharge of menstrual blood, pain subsides. It is known by the wise physician as udavartini because of the upward course of menstrual blood.[25-26]

Karnini yonivyapat

अकाले वाहमानाया गर्भेण पिहितोऽनिलः | कर्णिकां जनयेद्योनौ श्लेष्मरक्तेन मूर्च्छितः ||२७||

रक्तमार्गावरोधिन्या सा तया कर्णिनी मता |२८|

akālē vāhamānāyā garbhēṇa pihitō'nilaḥ| karṇikāṁ janayēdyōnau ślēṣmaraktēna mūrcchitaḥ||27||

raktamārgāvarōdhinyā sā [1] tayā karṇinī matā|28|

akAle vAhamAnAyA garbheNa pihito~anilaH| karNikAM janayedyonau shleShmaraktena mUrcchitaH||27||

raktamArgAvarodhinyA sA tayA karNinI matA|28|

If woman strains without labor pains untimely to deliver a fetus, then vayu combined with kapha and blood and gets obstructed by the fetus and produces the small muscular spots or knots in the yoni which obstructs the passage of menstrual blood. This is known as karnini.[28]

Putraghni yonivyapat

रौक्ष्याद्वायुर्यदा गर्भं जातं जातं विनाशयेत् ||२८||

दुष्टशोणितजं नार्याः पुत्रघ्नी नाम सा मता |२९|

raukṣyādvāyuryadā garbhaṁ jātaṁ jātaṁ vināśayēt||28||

duṣṭaśōṇitajaṁ nāryāḥ putraghnī nāma sā matā|29|

raukShyAdvAyuryadA garbhaM jAtaM jAtaM vinAshayet||28||

duShTashoNitajaM nAryAH putraghnI nAma sA matA|29|

Due to dryness (consumption of ununctuous diet and lifestyle), the aggravated vayu destroys the fetus again and again which is formed by the abnormalities of the shonita. [28]

Antarmukhi yonivyapat

व्यवायमतितृप्ताया भजन्त्यास्त्वन्नपीडितः ||२९||

वायुर्मिथ्यास्थिताङ्गाया योनिस्रोतसि संस्थितः | वक्रयत्याननं योन्याः साऽस्थिमांसानिलार्तिभिः ||३०||

भृशार्तिर्मैथुनाशक्ता योनिरन्तर्मुखी मता |३१|

vyavāyamatitr̥ptāyā bhajantyāstvannapīḍitaḥ||29||

vāyurmithyāsthitāṅgāyā yōnisrōtasi saṁsthitaḥ| vakrayatyānanaṁ yōnyāḥ [1] sā'sthimāṁsānilārtibhiḥ||30||

bhr̥śārtirmaithunāśaktā yōnirantarmukhī matā|31|

vyavAyamatitRuptAyA bhajantyAstvannapIDitaH||29||

vAyurmithyAsthitA~ggAyA yonisrotasi saMsthitaH| vakrayatyAnanaM yonyAH sA~asthimAMsAnilArtibhiH||30||

bhRushArtirmaithunAshaktA yonirantarmukhI matA|31|

When a woman overeats and indulges in coitus in an abnormal posture, then vayu situated in genital tract and pressed with food, produces different types of vatika pains in the bone and muscles and twists the vaginal opening. There is severe pain in vagina and intolerant to coitus. This is known as antarmukhi. [29-30]

Suchimukhi yonivyapat

गर्भस्थायाः स्त्रिया रौक्ष्याद्वायुर्योनिं प्रदूषयन् ||३१||

मातृदोषादणुद्वारां कुर्यात् सूचीमुखी तु सा |३२|

garbhasthāyāḥ striyā raukṣyādvāyuryōniṁ pradūṣayan||31||

mātr̥dōṣādaṇudvārāṁ kuryāt sūcīmukhī tu sā|32|

garbhasthAyAH striyA raukShyAdvAyuryoniM pradUShayan||31||

mAtRudoShAdaNudvArAM kuryAt sUcImukhI tu sA|32|

If pregnant woman consumes the vata aggravating ununctuous diet and lifestyle, then the yoni (genital tract) of female fetus is affected. Due to this vaginal orifice becomes narrow because of maternal defects. This is known as suchimukhi.[32]

Shushka yonivyapat

व्यवायकाले रुन्धन्त्या वेगान् प्रकुपितोऽनिलः ||३२||

कुर्याद्विण्मूत्रसङ्गार्तिं शोषं योनिमुखस्य च |३३|

vyavāyakālē rundhantyā vēgān prakupitō'nilaḥ||32||

kuryādviṇmūtrasaṅgārtiṁ śōṣaṁ yōnimukhasya ca|33|

vyavAyakAle rundhantyA vegAn prakupito~anilaH||32||

kuryAdviNmUtrasa~ggArtiM shoShaM yonimukhasya ca|33|

During coitus, if the natural urges are suppressed, then vitiated vayu causes the retention of feces, urine and pain, dryness of the vaginal orifice. This is known as sushkayoni.[33]

Vamini yonivyapat

षडहात् सप्तरात्राद्वा शुक्रं गर्भाशयं गतम् ||३३||

सरुजं नीरुजं वाऽपि या स्रवेत् सा तु वामिनी |३४|

ṣaḍahāt saptarātrādvā śukraṁ garbhāśayaṁ gatam||33||

sarujaṁ nīrujaṁ vā'pi yā sravēt sā tu vāminī|34|

ShaDahAt saptarAtrAdvA shukraM garbhAshayaM gatam||33||

sarujaM nIrujaM vA~api yA sravet sA tu vAminI|34|

The expulsion of the shukra with or without pain within six or seven days after entry in the uterus, that is known as vamini. [34]

Shandhi yonivyapat

बीजदोषात्तु गर्भस्थमारुतोपहताशया ||३४||

नृद्वेषिण्यस्तनी चैव षण्ढी स्यादनुपक्रमा |३५|

bījadōṣāttu garbhasthamārutōpahatāśayā||34||

nr̥dvēṣiṇyastanī caiva ṣaṇḍhī syādanupakramā|35|

bIjadoShAttu garbhasthamArutopahatAshayA||34||

nRudveShiNyastanI caiva ShaNDhI syAdanupakramA|35|

Due to the genetic defects and abnormalities of sperm and ovum of the parents, the uterus of the female fetus is affected with abnormal vata. The woman dislikes the males and is devoid of breasts. This is incurable and is known as shandhi.[35]

Mahayoni yonivyapat

विषमं दुःखशय्यायां मैथुनात् कुपितोऽनिलः ||३५||

गर्भाशयस्य योन्याश्च मुखं विष्टम्भयेत् स्त्रियाः | असंवृतमुखी सार्ती [१] रूक्षफेनास्रवाहिनी ||३६||

मांसोत्सन्ना महायोनिः पर्ववङ्क्षणशूलिनी |३७|

viṣamaṁ duḥkhaśayyāyāṁ maithunāt kupitō'nilaḥ||35||

garbhāśayasya yōnyāśca mukhaṁ viṣṭambhayēt striyāḥ| asaṁvr̥tamukhī sārtī [1] rūkṣaphēnāsravāhinī||36||

māṁsōtsannā mahāyōniḥ parvavaṅkṣaṇaśūlinī|37|

viShamaM duHkhashayyAyAM maithunAt kupito~anilaH||35||

garbhAshayasya yonyAshca mukhaM viShTambhayet striyAH| asaMvRutamukhI sArtI [1] rUkShaphenAsravAhinI||36||

mAMsotsannA mahAyoniH parvava~gkShaNashUlinI|37|

If coitus is performed on uneven and uncomfortable bed, the vitiated vata dilates the orifices of uterus and vagina. By this, vaginal opening is unclosed, painful and rough, frothy menstrual blood comes out. There is muscular protuberance in the vagina and there is associated pain in the joints and groin. This is known as mahayoni. [35-37]

Consequences of yonivyapat

इत्येतैर्लक्षणैः प्रोक्ता विंशतिर्योनिजा गदाः ||३७||

न शुक्रं धारयत्येभिर्दोषैर्योनिरुपद्रुता | तस्माद्गर्भं न गृह्णाति स्त्री गच्छत्यामयान् बहून् ||३८||

गुल्मार्शःप्रदरादींश्च वाताद्यैश्चातिपीडनम् |३९|

ityētairlakṣaṇaiḥ prōktā viṁśatiryōnijā gadāḥ||37||

na śukraṁ dhārayatyēbhirdōṣairyōnirupadrutā| tasmādgarbhaṁ na gr̥hṇāti strī gacchatyāmayān bahūn||38||

gulmārśaḥpradarādīṁśca vātādyaiścātipīḍanam|39|

ityetairlakShaNaiH proktA viMshatiryonijA gadAH||37||

na shukraM dhArayatyebhirdoShairyonirupadrutA| tasmAdgarbhaM na gRuhNAti strI gacchatyAmayAn bahUn||38||

gulmArshaHpradarAdIMshca vAtAdyaishcAtipIDanam|39|

Thus, the twenty female gynecological disorders (disorders of the genital tract) have been described based upon clinical features. The affected yoni (uterus) due to these defects is unable to hold the semen (sperm). So, woman does not conceive and suffers from gulma, piles, heavy bleeding and gets afflicted with various disorders of vata, pitta and kapha. [37-39]

Dosha dominance in yonivyapat

आसां षोडश यास्त्वन्त्या आद्ये द्वे पित्तदोषजे ||३९||

परिप्लुता वामिनी च वातपित्तात्मिके मते | कर्णिन्युपप्लुते वातकफाच्छेषास्तु वातजाः ||४०||

देहं वातादयस्तासां स्वैर्लिङ्गैः पीडयन्ति हि |४१|

āsāṁ ṣōḍaśa yāstvantyā ādyē dvē pittadōṣajē||39||

pariplutā vāminī ca vātapittātmikē matē| karṇinyupaplutē vātakaphācchēṣāstu vātajāḥ||40||

dēhaṁ vātādayastāsāṁ svairliṅgaiḥ pīḍayanti hi|41|

AsAM ShoDasha yAstvantyA Adye dve pittadoShaje||39||

pariplutA vAminI ca vAtapittAtmike mate| karNinyupaplute vAtakaphAccheShAstu vAtajAH||40||

dehaM vAtAdayastAsAM svairli~ggaiH pIDayanti hi|41|

Sixteen disorders mentioned in the end (excluding those four, described first with specific dosha dominance). Among these, the first two are caused by pitta dosha.

Paripluta and vamini are caused by dominance of vata and pitta dosha.

Karmini and upapluta are caused by vata and kapha dosha; while remaining ten disorders are vataja. Vatadi doshas afflict the genital tract with their respective symptoms. [40-41]

General principles of management

स्नेहनस्वेदबस्त्यादि वातजास्वनिलापहम् ||४१||

कारयेद्रक्तपित्तघ्नं शीतं पित्तकृतासु च | श्लेष्मजासु च रूक्षोष्णं कर्म कुर्याद्विचक्षणः ||४२||

सन्निपाते विमिश्रं तु संसृष्टासु च कारयेत् |

snēhanasvēdabastyādi vātajāsvanilāpaham||41||

kārayēdraktapittaghnaṁ śītaṁ pittakr̥tāsu ca| ślēṣmajāsu ca rūkṣōṣṇaṁ karma kuryādvicakṣaṇaḥ||42||

sannipātē vimiśraṁ tu saṁsr̥ṣṭāsu ca kārayēt|

snehanasvedabastyAdi vAtajAsvanilApaham||41||

kArayedraktapittaghnaM shItaM pittakRutAsu ca| shleShmajAsu ca rUkShoShNaM karma kuryAdvicakShaNaH||42||

sannipAte vimishraM tu saMsRuShTAsu ca kArayet|

In vatika disorders, vata alleviating procedures such as snehana (unction), swedana (fomentation), basti (enema) should be prescribed.

In paittika disorders, cold measures which pacify the rakta and pitta should be used. The expert should exert the dry and hot remedies in kaphaja disorders of the genital tract.

In sannipataja and dwandaja female genital disorders, mixed treatment should be done. [41-42]

Manual intervention in displaced genital tract/uterus

स्निग्धस्विन्नां तथा योनिं दुःस्थितां स्थापयेत्पुनः ||४३||

पाणिना नामयेज्जिह्मां संवृतां वर्धयेत् पुनः | प्रवेशयेन्निःसृतां च विवृतां परिवर्तयेत् ||४४||

योनिः स्थानापवृत्ता हि शल्यभूता मता स्त्रियाः |

snigdhasvinnāṁ tathā yōniṁ duḥsthitāṁ sthāpayētpunaḥ||43||

pāṇinā nāmayējjihmāṁ saṁvr̥tāṁ vardhayēt punaḥ| pravēśayēnniḥsr̥tāṁ ca vivr̥tāṁ parivartayēt||44||

yōniḥ sthānāpavr̥ttā hi śalyabhūtā matā striyāḥ|

snigdhasvinnAM tathA yoniM duHsthitAM sthApayetpunaH||43||

pANinA nAmayejjihmAM saMvRutAM vardhayet punaH| praveshayenniHsRutAM ca vivRutAM parivartayet||44||

yoniH sthAnApavRuttA hi shalyabhUtA matA striyAH|

If vagina or genital organs are displaced from their place, it should be brought to its normal position after the snehana (unction) and swedana (fomentation).

If it becomes twisted, then it should be pressed with hand.

If the vaginal opening is contracted,it should be dilated.

If it is prolapsed from its place, then it should be placed inside.

If the yoni is dilated, then it should be turned (for contraction), because displaced genital organs act as the shalya (foreign body). [43-44]

Mild purification in management of all yonivyapat

सर्वां व्यापन्नयोनिं तु कर्मभिर्वमनादिभिः ||४५||

मृदुभिः पञ्चभिर्नारीं स्निग्धस्विन्नामुपाचरेत् |

sarvāṁ vyāpannayōniṁ tu karmabhirvamanādibhiḥ||45||

mr̥dubhiḥ pañcabhirnārīṁ snigdhasvinnāmupācarēt|

sarvAM vyApannayoniM tu karmabhirvamanAdibhiH||45||

mRudubhiH pa~jcabhirnArIM snigdhasvinnAmupAcaret|

In all the disorders of the genital tract, female should be treated with application of five mild vamanadi (evacuative) measures after snehana (unction) and swedana (fomentation). [45]

Treatment after purification

सर्वतः सुविशुद्धायाः शेषं कर्म विधीयते ||४६||

sarvataḥ suviśuddhāyāḥ śēṣaṁ karma vidhīyatē||46||

sarvataH suvishuddhAyAH sheShaM karma vidhIyate||46||

Now when woman is evacuated by the mild application of five evacuative measures, remaining measures should be applied.[46]

Management of vata vitiation

वातव्याधिहरं कर्म वातार्तानां सदा हितम् | औदकानूपजैर्मांसैः क्षीरैः सतिलतण्डुलैः ||४७||

सवातघ्नौषधैर्नाडीकुम्भीस्वेदैरुपाचरेत् | अक्तां लवणतैलेन साश्मप्रस्तरसङ्करैः ||४८||

स्विन्नां कोष्णाम्बुसिक्ताङ्गीं वातघ्नैर्भोजयेद्रसैः |४९|

vātavyādhiharaṁ karma vātārtānāṁ sadā hitam| audakānūpajairmāṁsaiḥ kṣīraiḥ satilataṇḍulaiḥ||47||

savātaghnauṣadhairnāḍīkumbhīsvēdairupācarēt| aktāṁ lavaṇatailēna sāśmaprastarasaṅkaraiḥ||48||

svinnāṁ kōṣṇāmbusiktāṅgīṁ vātaghnairbhōjayēdrasaiḥ|49|

vAtavyAdhiharaM karma vAtArtAnAM sadA hitam| audakAnUpajairmAMsaiH kShIraiH satilataNDulaiH||47||

savAtaghnauShadhairnADIkumbhIsvedairupAcaret| aktAM lavaNatailena sAshmaprastarasa~gkaraiH||48||

svinnAM koShNAmbusiktA~ggIM vAtaghnairbhojayedrasaiH|49|

The woman who is suffering from the vataja yoni roga (disorders of genital tract, affected by the vata), vata alleviating treatment is always beneficial. Yoni (vagina) should be fomented with the meat of aquatic and marshy animals or milk mixed with sesame and rice and vata-alleviating drugs. Or vagina should be massaged with salt and oil and fomented with warm iron, stone or bolus. When vagina is completely smooth, then woman should take the bath with warm water and take vata alleviating meat soup. [47-49]

Various formulations in management of vataja yonivyapat

बलाद्रोणद्वयक्वाथे घृततैलाढकं पचेत् ||४९||

स्थिरापयस्याजीवन्तीवीरर्षभकजीवकैः | श्रावणीपिप्पलीमुद्गपीलुमाषाख्यपर्णिभिः ||५०||

शर्कराक्षीरकाकोलीकाकनासाभिरेव च | पिष्टैश्चतुर्गुणक्षीरे सिद्धं पेयं यथाबलम् ||५१||

वातपित्तकृतान् रोगान् हत्वा गर्भं दधाति तत् |

balādrōṇadvayakvāthē ghr̥tatailāḍhakaṁ [1] pacēt||49||

sthirāpayasyājīvantīvīrarṣabhakajīvakaiḥ| śrāvaṇīpippalīmudgapīlumāṣākhyaparṇibhiḥ||50||

śarkarākṣīrakākōlīkākanāsābhirēva ca| piṣṭaiścaturguṇakṣīrē siddhaṁ pēyaṁ yathābalam||51||

vātapittakr̥tān rōgān hatvā garbhaṁ dadhāti tat|

balAdroNadvayakvAthe ghRutatailADhakaM pacet||49||

sthirApayasyAjIvantIvIrarShabhakajIvakaiH| shrAvaNIpippalImudgapIlumAShAkhyaparNibhiH||50||

sharkarAkShIrakAkolIkAkanAsAbhireva ca| piShTaishcaturguNakShIre siddhaM peyaM yathAbalam||51||

vAtapittakRutAn rogAn hatvA garbhaM dadhAti tat|

One adhaka (approx. 2.50kg) ghrita and oil mixed and should be cooked in the two drone decoction (approx. 20 lts.) of bala, At the time of preparation, the decoction of paste of sariwana, payasya, jivanti, veera, rishbhaka, jivaka, shravani, pippali, mudaga parni, pilu, mashaparni, sharkara, ksheerakakoli and kakanasa should be mixed. This should be cooked tactfully along with the mixing of four times (four adhaka) milk. After processed, it should be used according to strength. It helps in conception after treating the yoni rogas (genital disorders) caused by the vata and pitta. [49-51]

काश्मर्यत्रिफलाद्राक्षाकासमर्दपरूषकैः ||५२||

पुनर्नवाद्विरजनीकाकनासासहचरैः | शतावर्या गुडूच्याश्च प्रस्थमक्षसमैर्घृतात् ||५३||

साधितं योनिवातघ्नं गर्भदं परमं पिबेत् |

kāśmaryatriphalādrākṣākāsamardaparūṣakaiḥ||52||

punarnavādvirajanīkākanāsāsahacaraiḥ| śatāvaryā guḍūcyāśca prasthamakṣasamairghr̥tāt||53||

sādhitaṁ [2] yōnivātaghnaṁ garbhadaṁ paramaṁ pibēt|

kAshmaryatriphalAdrAkShAkAsamardaparUShakaiH||52||

punarnavAdvirajanIkAkanAsAsahacaraiH| shatAvaryA guDUcyAshca prasthamakShasamairghRutAt||53||

sAdhitaM [2] yonivAtaghnaM garbhadaM paramaM pibet|

One prastha (approx. 640 gm) ghrita should be cooked with the paste of one karsha each of kashmarya, triphala, draksha, kasamarda, parushaka, punarnava, haridra, daruharidra, kakanasa, sahachara, shatavari and guduchi. This should be taken to destroy the vataja yoni roga and is best for conception.[52-53]

पिप्पलीकुञ्चिकाजाजिवृषकं [३] सैन्धवं वचाम् ||५४||

यवक्षाराजमोदे च शर्करां चित्रकं तथा | पिष्ट्वा सर्पिषि [४] भृष्टानि पाययेत् प्रसन्नया ||५५||

योनिपार्श्वार्तिहृद्रोगगुल्मार्शोविनिवृत्तये |

pippalīkuñcikājājīvr̥ṣakaṁ [3] saindhavaṁ vacām||54||

yavakṣārājamōdē ca śarkarāṁ citrakaṁ tathā| piṣṭvā sarpiṣi [4] bhr̥ṣṭāni pāyayēt prasannayā||55||

yōnipārśvārtihr̥drōgagulmārśōvinivr̥ttayē|

pippalIku~jcikAjAjIvRuShakaM [3] saindhavaM vacAm||54||

yavakShArAjamode ca sharkarAM citrakaM tathA| piShTvA sarpiShi [4] bhRuShTAni pAyayet prasannayA||55||

yonipArshvArtihRudrogagulmArshovinivRuttaye|

The equal quantity of pippali, upakunchika, jiraka, vrishaka, saindhava, vacha, yavakshara, ajmoda, sharkara, and chitraka mula should be crushed, fried in ghrita and mixed with prasanna (clear wine). After drinking, it helps to alleviate the pain in vagina, flanks, heart diseases, gulma and the piles. [54-55]

वृषकं मातुलुङ्गस्य मूलानि मदयन्तिकाम् ||५६||

पिबेत् सलवणैर्मद्यैः पिप्पलीकुञ्चिके तथा |

vr̥ṣakaṁ mātuluṅgasya mūlāni madayantikām||56||

pibēt salavaṇairmadyaiḥ pippalīkuñcikē tathā|

vRuShakaM mAtulu~ggasya mUlAni madayantikAm||56||

pibet salavaNairmadyaiH pippalIku~jcike tathA|

Vrishaka, matulunga mula, madayantika should be pounded and drink with wine and rock salt. Or pippali and upakunchika should also be pounded and drink with alcohol and rock salt. Both these preparations helps to pacify the pain of vagina (genital tract).[56]

रास्नाश्वदंष्ट्रावृषकैः पिबेच्छूले शृतं पयः ||५७||

गुडूचीत्रिफलादन्तीक्वाथैश्च परिषेचयेत् |

rāsnāśvadaṁṣṭrāvr̥ṣakaiḥ pibēcchūlē śr̥taṁ payaḥ||57||

guḍūcītriphalādantīkvāthaiśca pariṣēcayēt|

rAsnAshvadaMShTrAvRuShakaiH pibecchUle shRutaM payaH||57||

guDUcItriphalAdantIkvAthaishca pariShecayet|

In case of pain in vagina the rasna, shwadransta, vrishaka should be pasted and cooked with milk or yoni should be irrigated with the decoction of guduchi, triphala and dantimula in equal parts. It helps to relieve the yonishula.[57]

सैन्धवं तगरं कुष्ठं बृहती देवदारु च ||५८||

समांशैः साधितं कल्कैस्तैलं धार्यं रुजापहम् |

saindhavaṁ tagaraṁ kuṣṭhaṁ br̥hatī dēvadāru ca||58||

samāṁśaiḥ sādhitaṁ kalkaistailaṁ dhāryaṁ rujāpaham|

saindhavaM tagaraM kuShThaM bRuhatI devadAru ca||58||

samAMshaiH sAdhitaM kalkaistailaM dhAryaM rujApaham|

Oil should be cooked with the paste of equal parts of saindhava, tagara, kushtha, brahati and devadaru. Tamponing in vagina with this medicated oil helps to relieve the yonishula. [58]

गुडूचीमालतीरास्नाबलामधुकचित्रकैः ||५९||

निदिग्धिकादेवदारुयूथिकाभिश्च कार्षिकैः | तैलप्रस्थं गवां मूत्रे क्षीरे च द्विगुणे पचेत् ||६०||

वातार्तायाः पिचुं दद्याद्योनौ च प्रणयेत्ततः |

guḍūcīmālatīrāsnābalāmadhukacitrakaiḥ||59||

nidigdhikādēvadāruyūthikābhiśca kārṣikaiḥ| tailaprasthaṁ gavāṁ mūtrē kṣīrē ca dviguṇē pacēt||60||

vātārtāyāḥ picuṁ dadyādyōnau ca praṇayēttataḥ|

guDUcImAlatIrAsnAbalAmadhukacitrakaiH||59||

nidigdhikAdevadAruyUthikAbhishca kArShikaiH| tailaprasthaM gavAM mUtre kShIre ca dviguNe pacet||60||

vAtArtAyAH picuM dadyAdyonau ca praNayettataH|

One prastha oil (approx. 640ml) should be cooked with the paste of guduchi, jati, rasna, bala, madhuka, chitraka, kantakari, devadaru, yuthika each 1-1 karsha (10gm) along with the cow’s urine and milk (two prastha each). The vaginal tamponing should be done with this oil. After this, this oil should be used for uttarabasti. [59-60]

Therapeutic procedures for management of vata dominant yonivyapat

वातार्तानां च योनीनां सेकाभ्यङ्गपिचुक्रियाः ||६१||

(उष्णाः स्निग्धाः प्रकर्तव्यास्तैलानि स्नेहनानि च [५] ) |

vātārtānāṁ ca yōnīnāṁ sēkābhyaṅgapicukriyāḥ||61||

(uṣṇāḥ snigdhāḥ prakartavyāstailāni snēhanāni ca [5] )|

vAtArtAnAM ca yonInAM sekAbhya~ggapicukriyAH||61||

(uShNAH snigdhAH prakartavyAstailAni snehanAni ca [5] )|

The vatika disorders of the female genital tract should be treated with warm and smooth substances in the form of irrigation, massage and tamponing. The oil for unction (snehana) should be prepared and used.[61]

हिंस्राकल्कं तु वातार्ता कोष्णमभ्यज्य धारयेत् | पञ्चवल्कस्य पित्तार्ता श्यामादीनां कफातुरा ||६२||

hiṁsrākalkaṁ tu vātārtā kōṣṇamabhyajya dhārayēt| pañcavalkasya pittārtā śyāmādīnāṁ kaphāturā||62||

hiMsrAkalkaM tu vAtArtA koShNamabhyajya dhArayet| pa~jcavalkasya pittArtA shyAmAdInAM kaphAturA||62||

If the vagina is afflicted due to vata, it should be massaged with warm oil and the paste of hanspadi root should be retained.

The yoni suffering from pitta, the paste of panchavalkala should be retained in vagina and in that which is suffering from kapha, the paste of shyamadi drugs should be used. [62]

Therapeutic procedures for management of pitta dominant yonivyapat

पित्तलानां तु योनीनां सेकाभ्यङ्गपिचुक्रियाः | शीताः पित्तहराः कार्याः स्नेहनार्थं घृतानि च ||६३||

(पित्तघ्नौषधसिद्धानि कार्याणि भिषजा तथा [१] ) |

pittalānāṁ tu yōnīnāṁ sēkābhyaṅgapicukriyāḥ| śītāḥ pittaharāḥ kāryāḥ snēhanārthaṁ ghr̥tāni ca||63||

(pittaghnauṣadhasiddhāni kāryāṇi bhiṣajā tathā [1] )|

pittalAnAM tu yonInAM sekAbhya~ggapicukriyAH| shItAH pittaharAH kAryAH snehanArthaM ghRutAni ca||63||

(pittaghnauShadhasiddhAni kAryANi bhiShajA tathA [1] )|

In gynaecological disorders (disorders of the genital tract) which are caused by pitta then cold, pitta alleviating irrigation, massage and tamponing etc. should be done. A vaidya should use the ghrita (processed with vata alleviating drugs) for unction (snehana). [63]

Various formulations in management of pittaja yonivyapat

Brihat shatavari ghritam

शतावरीमूलतुलाश्चतस्रः सम्प्रपीडयेत् ||६४||

रसेन क्षीरतुल्येन पचेत्तेन घृताढकम् | जीवनीयैः शतावर्या मृद्वीकाभिः परूषकैः ||६५||

पिष्टैः प्रियालैश्चाक्षांशैर्द्वियष्टिमधुकैर्भिषक् | सिद्धे शीते च मधुनः पिप्पल्याश्च पलाष्टकम् ||६६||

सितादशपलोन्मिश्राल्लिह्यात् पाणितलं ततः | योन्यसृक्शुक्रदोषघ्नं वृष्यं पुंसवनं च तत् ||६७||

क्षतं क्षयं रक्तपित्तं कासं श्वासं हलीमकम् | कामलां वातरक्तं च वीसर्पं हृच्छिरोग्रहम् ||६८||

उन्मादारत्यपस्मारान् वातपित्तात्मकाञ्जयेत् | इति बृहच्छतावरीघृतम् |

śatāvarīmūlatulāścatasraḥ samprapīḍayēt||64||

rasēna kṣīratulyēna pacēttēna ghr̥tāḍhakam| jīvanīyaiḥ śatāvaryā mr̥dvīkābhiḥ parūṣakaiḥ||65||

piṣṭaiḥ priyālaiścākṣāṁśairdviyaṣṭimadhukairbhiṣak| siddhē śītē ca madhunaḥ pippalyāśca palāṣṭakam||66||

sitādaśapalōnmiśrāllihyāt pāṇitalaṁ tataḥ| yōnyasr̥kśukradōṣaghnaṁ vr̥ṣyaṁ puṁsavanaṁ ca tat||67||

kṣataṁ kṣayaṁ raktapittaṁ kāsaṁ śvāsaṁ halīmakam| kāmalāṁ vātaraktaṁ ca vīsarpaṁ hr̥cchirōgraham||68||

unmādāratyapasmārān vātapittātmakāñjayēt| iti br̥hacchatāvarīghr̥tam

shatAvarImUlatulAshcatasraH samprapIDayet||64||

rasena kShIratulyena pacettena ghRutADhakam| jIvanIyaiH shatAvaryA mRudvIkAbhiH parUShakaiH||65||

piShTaiH priyAlaishcAkShAMshairdviyaShTimadhukairbhiShak| siddhe shIte ca madhunaH pippalyAshca palAShTakam||66||

sitAdashapalonmishrAllihyAt pANitalaM tataH| yonyasRukshukradoShaghnaM vRuShyaM puMsavanaM ca tat||67||

kShataM kShayaM raktapittaM kAsaM shvAsaM halImakam| kAmalAM vAtaraktaM ca vIsarpaM hRucchirograham||68||

unmAdAratyapasmArAn vAtapittAtmakA~jjayet| iti bRuhacchatAvarIghRutam|

Four tula (16 kg) shatavari root should be crushed to evict the juice. With this juice, an equal quantity of milk to be mixed and one adhaka (2.56 kg) ghrita should be cooked with the paste of vitalizer drugs, shatavari, draksha, parushaka, priyala and two types of madhuka one karsha (10gm) each. When ghrita is prepared, it should be poured and cooled. Then it is mixed with honey, pippali powder each eight pala (320 gm) and sugar 10 pala (400 gm). This should be used in dose of one karsha (10 gm). It relieves the abnormalities or defects of the genital tract, menses and the semen. It is an aphrodisiac and helps in healthy progeny. It helps to treat the chest wound, tuberculosis or wasting, internal hemorrhage (raktapitta), cough, dyspnea, halimaka, kamala (jaundice), vatarakta, visarpa, heart diseases, shiroroga and insanity, restlessness, epilepsy and other caused by the vata and pitta dosha. [64-68]

एवमेव क्षीरसर्पिर्जीवनीयोपसाधितम् ||६९||

गर्भदं पित्तलानां च योनीनां स्याद्भिषग्जितम् |७०|

ēvamēvakṣīrasarpirjīvanīyōpasādhitam||69||

garbhadaṁ pittalānāṁ ca yōnīnāṁ syādbhiṣagjitam|70|

evameva kShIrasarpirjIvanIyopasAdhitam||69||

garbhadaM pittalAnAM ca yonInAM syAdbhiShagjitam|70|

Thus, milk and ghrita processed with vitalizer drugs (jivaniya varga) helps in conception and it is the best treatment for the paittika disorders of the female genital tract.[70]

Management of kapha dominant yonivyapat

योन्यां श्लेष्मप्रदुष्टायां वर्तिः संशोधनी हिता ||७०||

वाराहे बहुशः पित्ते भावितैर्लक्तकैः कृता |

yōnyāṁ ślēṣmapraduṣṭāyāṁ vartiḥ saṁśōdhanī hitā||70||

vārāhē bahuśaḥ pittē bhāvitairlaktakaiḥ kr̥tā|

yonyAM shleShmapraduShTAyAM vartiH saMshodhanI hitA||70||

vArAhe bahushaH pitte bhAvitairlaktakaiH kRutA|

In the kaphaja disorders of the female genital tract, the application of cleansing suppository made of piece of cloth and impregnated many times in the bile of pig is beneficial. [70]

Various formulations in management to kapha dominant yonivyapat

भावितं पयसाऽर्कस्य यवचूर्णं ससैन्धवम् ||७१||

वर्तिः कृता मुहुर्धार्या ततः सेच्या सुखाम्बुना |

bhāvitaṁ payasā'rkasya yavacūrṇaṁ sasaindhavam||71||

vartiḥ kr̥tā muhurdhāryā tataḥ sēcyā sukhāmbunā|

bhAvitaM payasA~arkasya yavacUrNaM sasaindhavam||71||

vartiH kRutA muhurdhAryA tataH secyA sukhAmbunA|

The suppository made of rock salt and barley should be impregnated with milk of madara and it should be kept in vagina frequently and after this vagina should be washed with warm water. [71]

पिप्पल्या मरिचैर्माषैः शताह्वाकुष्ठसैन्धवैः ||७२||

वर्तिस्तुल्या प्रदेशिन्या धार्या योनिविशोधनी |७३|

pippalyā maricairmāṣaiḥ śatāhvākuṣṭhasaindhavaiḥ||72||

vartistulyā pradēśinyā dhāryā yōniviśōdhanī|73|

pippalyA maricairmAShaiH shatAhvAkuShThasaindhavaiH||72||

vartistulyA pradeshinyA dhAryA yonivishodhanI|73|

In kaphaja disorders of the genital tract, the suppository should be made as the size of index finger with the paste of pippali, maricha, masha, shatahva, kushtha and rock salt and it should be put in vagina for cleansing.[72]

उदुम्बरशलाटूनां द्रोणमब्द्रोणसंयुतम् ||७३||

सपञ्चवल्ककुलकमालतीनिम्बपल्लवम् [१] | निशां स्थाप्य जले तस्मिंस्तैलप्रस्थं विपाचयेत् ||७४||

लाक्षाधवपलाशत्वङ्निर्यासैः शाल्मलेन च | पिष्टैः सिद्धस्य तैलस्य पिचुं योनौ निधापयेत् ||७५||

सशर्करैः कषायैश्च शीतैः कुर्वीत सेचनम् | पिच्छिला विवृता कालदुष्टा योनिश्च दारुणा ||७६||

सप्ताहाच्छुध्यति [२] क्षिप्रमपत्यं चापि विन्दति |

udumbaraśalāṭūnāṁ drōṇamabdrōṇasaṁyutam||73||

sapañcavalkakulakamālatīnimbapallavam [1] | niśāṁ sthāpya jalē tasmiṁstailaprasthaṁ vipācayēt||74||

lākṣādhavapalāśatvaṅniryāsaiḥ śālmalēna ca| piṣṭaiḥ siddhasya tailasya picuṁ yōnau nidhāpayēt||75||

saśarkaraiḥ kaṣāyaiśca śītaiḥ kurvīta sēcanam| picchilā vivr̥tā kāladuṣṭā yōniśca dāruṇā||76||

saptāhācchudhyati [2] kṣipramapatyaṁ cāpi vindati|

udumbarashalATUnAM droNamabdroNasaMyutam||73||

sapa~jcavalkakulakamAlatInimbapallavam [1] | nishAM sthApya jale tasmiMstailaprasthaM vipAcayet||74||

lAkShAdhavapalAshatva~gniryAsaiH shAlmalena ca| piShTaiH siddhasya tailasya picuM yonau nidhApayet||75||

sasharkaraiH kaShAyaishca shItaiH kurvIta secanam| picchilA vivRutA kAladuShTA yonishca dAruNA||76||

saptAhAcchudhyati [2] kShipramapatyaM cApi vindati|

Unripe fruit of udumbara, panchavalkala, kulattha, leaves of jati and nimba should be taken in equal part and all in quantity of one drone (10.24 kg). All these should be crushed and soaked in one drone (10.24 lts) of water overnight. In early morning should be pressed with hands and pour the water. In this extract one prastha oil should be mixed and cooked with the paste of lac, dhava, bark and exudation or gum of palash and shalmali, each 1-1 karsha (10 gms) each.

A tampon dipped in this oil and put it into the vagina after this vagina should be washed with cold decoction added with sugar. By using this, slimy (pichcchhila) yoni, dilated yoni, kaladushta and darunayoni are cleansed within seven days and woman gets progeny very soon. [73-76]

उदुम्बरस्य दुग्धेन षट्कृत्वो भावितात्तिलात् ||७७||

तैलं क्वाथेन तस्यैव सिद्धं धार्यं च पूर्ववत् |

udumbarasya dugdhēna ṣaṭkr̥tvō bhāvitāttilāt||77||

tailaṁ kvāthēna tasyaiva siddhaṁ dhāryaṁ ca pūrvavat|

udumbarasya dugdhena ShaTkRutvo bhAvitAttilAt||77||

tailaM kvAthena tasyaiva siddhaM dhAryaM ca pUrvavat|

Oil should be extracted from the sesame seeds which are impregnated six times with the milk of udumbara and cooked in the decoction of udumbara. With this oil a tampon should be put into the vagina. [77]

धातक्यामलकीपत्रस्रोतोजमधुकोत्पलैः ||७८||

जम्ब्वाम्रमध्यकासीसलोध्रकट्फलतिन्दुकैः | सौराष्ट्रिकादाडिमत्वगुदुम्बरशलाटुभिः ||७९||

अक्षमात्रैरजामूत्रे क्षीरे च द्विगुणे पचेत् | तैलप्रस्थं पिचुं दद्याद्योनौ च प्रणयेत्ततः ||८०||

कटीपृष्ठत्रिकाभ्यङ्गं स्नेहबस्तिं च दापयेत् | पिच्छिला स्राविणी योनिर्विप्लुतोपप्लुता तथा ||८१||

उत्ताना चोन्नता शूना सिध्येत् सस्फोटशूलिनी |

dhātakyāmalakīpatrasrōtōjamadhukōtpalaiḥ||78||

jambvāmramadhyakāsīsalōdhrakaṭphalatindukaiḥ| saurāṣṭrikādāḍimatvagudumbaraśalāṭubhiḥ||79||

akṣamātrairajāmūtrē kṣīrē ca dviguṇē pacēt| tailaprasthaṁ picuṁ dadyādyōnau ca praṇayēttataḥ||80||

kaṭīpr̥ṣṭhatrikābhyaṅgaṁ snēhabastiṁ ca dāpayēt| picchilā srāviṇī [3] yōnirviplutōpaplutā tathā||81||

uttānā cōnnatā śūnā sidhyēt sasphōṭaśūlinī|

dhAtakyAmalakIpatrasrotojamadhukotpalaiH||78||

jambvAmramadhyakAsIsalodhrakaTphalatindukaiH| saurAShTrikAdADimatvagudumbarashalATubhiH||79||

akShamAtrairajAmUtre kShIre ca dviguNe pacet| tailaprasthaM picuM dadyAdyonau ca praNayettataH||80||

kaTIpRuShThatrikAbhya~ggaM snehabastiM ca dApayet| picchilA srAviNI [3] yonirviplutopaplutA tathA||81||

uttAnA connatA shUnA sidhyet sasphoTashUlinI|

Dhataki flower, amalaki, srotanjana, madhuka, utpala, seed pulp of jambu and mango, kasisa, lodhra, katphala, tinduka, saurashtrika, covering of pomegranate, tender fruits of udumbara, each should be taken one karsha (10 gms each), pounded and pasted and cooked in the double quantity of goat’s urine and milk.Then one prastha (640 ml) oil should be mixed and cooked. With this oil, vaginal tamponing should be done and followed by the massage of the pelvis or waist, back and the sacral region. Anuvasana basti (unctuous enema) should be given with this oil. This oil should be used to treat the pichchhila yoni, discharges from the vagina, vipluta, antarmukhi, suchimukhi yoni and also the swelling and eruptions in the yoni. [78-81]

करीरधवनिम्बार्कवेणुकोशाम्रजाम्बवैः ||८२||

जिङ्गिनीवृषमूलानां क्वाथैर्मार्द्वीकसीधुभिः | सशुक्तैर्धावनं मिश्रैर्योन्यास्रावविनाशनम् ||८३||

कुर्यात् सतक्रगोमूत्रशुक्तैर्वा त्रिफलारसैः |८४|

karīradhavanimbārkavēṇukōśāmrajāmbavaiḥ||82||

jiṅginīvr̥ṣamūlānāṁ kvāthairmārdvīkasīdhubhiḥ| saśuktairdhāvanaṁ miśrairyōnyāsrāvavināśanam||83||

kuryāt satakragōmūtraśuktairvā triphalārasaiḥ|84|

karIradhavanimbArkaveNukoshAmrajAmbavaiH||82||

ji~gginIvRuShamUlAnAM kvAthairmArdvIkasIdhubhiH| sashuktairdhAvanaM mishrairyonyAsrAvavinAshanam||83||

kuryAt satakragomUtrashuktairvA triphalArasaiH|84|

The vagina should be washed with the decoction of kasisa, dhava, bark of nimba, flower of arka, venu, koshamra, jambu, roots of jingini and vasa, mixed with sidhu and sukta (vinegar) of draksha. It helps to treat the vaginal discharges or vagina should be washed with the decoction or juice of triphala mixed with takra (butter milk), cow’s urine or sukta. [82-83]

पिप्पल्ययोरजःपथ्याप्रयोगा मधुना हिताः ||८४||

pippalyayōrajaḥpathyāprayōgā madhunā hitāḥ||84||

pippalyayorajaHpathyAprayogA madhunA hitAH||84||

This powder of pippali, lohabhasma and haritaki mixed with honey is useful in vaginal discharges.[84]

General guidelines for basti medication in dosha dominance

श्लेष्मलायां कटुप्रायाः समूत्रा बस्तयो हिताः | पित्ते समधुरक्षीरा वाते तैलाम्लसंयुताः ||८५||

सन्निपातसमुत्थायाः कर्म साधारणं हितम् |८६|

ślēṣmalāyāṁ kaṭuprāyāḥ samūtrā bastayō hitāḥ| pittē samadhurakṣīrā vātē tailāmlasaṁyutāḥ||85||

sannipātasamutthāyāḥ karma sādhāraṇaṁ hitam|86|

shleShmalAyAM kaTuprAyAH samUtrA bastayo hitAH| pitte samadhurakShIrA vAte tailAmlasaMyutAH||85||

sannipAtasamutthAyAH karma sAdhAraNaM hitam|86|

In case of genital tract disorders with predominance of kapha, uttara basti of pungent drugs and cow’s urine is beneficial.

In pitta dominant disorders, uttara basti should be given with the decoction and milk processed with sweet drugs (madhura dravyas) and mixed together. In that of vata, uttara basti should be given with oil and decoction or juice of sweet drugs together. In the sannipatika disorders, all the measures (general treatment of disorders of the genital tract due to vata, pitta and kapha) mixed together are beneficial.[85-86]

Management of rakta yoni (vaginal bleeding)

रक्तयोन्यामसृग्वर्णैरनुबन्धं समीक्ष्य च ||८६||

ततः कुर्याद्यथादोषं रक्तस्थापनमौषधम् |

raktayōnyāmasr̥gvarṇairanubandhaṁ samīkṣya ca||86||

tataḥ kuryādyathādōṣaṁ raktasthāpanamauṣadham|

raktayonyAmasRugvarNairanubandhaM samIkShya ca||86||

tataH kuryAdyathAdoShaM raktasthApanamauShadham|

In rakta yoni (bleeding through the vagina), the color of bleeding should be observed for the association of doshas and hemostatic drugs should be used according to the involvement of doshas. [86]

Management of vata dominant asrigadara

तिलचूर्णं दधि घृतं फाणितं शौकरी वसा ||८७||

क्षौद्रेण संयुतं पेयं वातासृग्दरनाशनम् |

tilacūrṇaṁ dadhi ghr̥taṁ phāṇitaṁ śaukarī vasā||87||

kṣaudrēṇa saṁyutaṁ pēyaṁ vātāsr̥gdaranāśanam|

tilacUrNaM dadhi ghRutaM phANitaM shaukarI vasA||87||

kShaudreNa saMyutaM peyaM vAtAsRugdaranAshanam|

For relief (alleviation) of vataja asrigdara (menorrhagia due to vata), powder of sesame, curd, ghee, rava, pigfat all mixed with honey and should be used.[87]

वराहस्य रसो मेद्यः सकौलत्थोऽनिलाधिके ||८८||

शर्कराक्षौद्रयष्ट्याह्वनागरैर्वा युतं दधि |

varāhasya rasō mēdyaḥ sakaulatthō'nilādhikē||88||

śarkarākṣaudrayaṣṭyāhvanāgarairvā yutaṁ dadhi|

varAhasya raso medyaH sakaulattho~anilAdhike||88||

sharkarAkShaudrayaShTyAhvanAgarairvA yutaM dadhi|

The use of fat rich pig flesh juice mixed with the decoction of kulattha destroys the vataja asrigdara or curd prepared with the sugar, honey, mulethi and shunthi is beneficial in vataja asrigdara. [88]

Management of pitta dominant asrigadara

पयस्योत्पलशालूकबिसकालीयकाम्बुदम् ||८९||

सपयःशर्कराक्षौद्रं पैत्तिकेऽसृग्दरे पिबेत् |९०|

payasyōtpalaśālūkabisakālīyakāmbudam||89||

sapayaḥśarkarākṣaudraṁ paittikē'sr̥gdarē [1] pibēt|90|

payasyotpalashAlUkabisakAlIyakAmbudam||89||

sapayaHsharkarAkShaudraM paittike~asRugdare pibet|90|

In paittika pradara roga, payasya, uttapala, shaluka, bias, kaliyaka, musta, all these together or single drug should be taken along with milk, sugar and honey.[89]

Pushyanuga churna

पाठा जम्ब्वाम्रयोर्मध्यं शिलोद्भेदं रसाञ्जनम् ||९०||

अम्बष्ठा शाल्मलीश्लेषं समङ्गां वत्सकत्वचम् | बाह्लीकातिविषे बिल्वं मुस्तं लोध्रं सगैरिकम् ||९१||

कट्वङ्गं मरिचं शुण्ठीं मृद्वीकां रक्तचन्दनम् | कट्फलं वत्सकानन्ताधातकीमधुकार्जुनम् ||९२||

पुष्येणोद्धृत्य तुल्यानि सूक्ष्मचूर्णानि कारयेत् | तानि क्षौद्रेण संयोज्य पिबेत्तण्डुलवारिणा ||९३||

अर्शःसु चातिसारेषु रक्तं यच्चोपवेश्यते | दोषागन्तुकृता ये च बालानां तांश्च नाशयेत् ||९४||

योनिदोषं रजोदोषं श्वेतं नीलं सपीतकम् | स्त्रीणां श्यावारुणं यच्च प्रसह्य विनिवर्तयेत् ||९५||

चूर्णं पुष्यानुगं नाम हितमात्रेयपूजितम् |९६| इति पुष्यानुगचूर्णम् |

pāṭhā jambvāmrayōrmadhyaṁ śilōdbhēdaṁ rasāñjanam||90||

ambaṣṭhā śālmalīślēṣaṁ samaṅgāṁ vatsakatvacam| bāhlīkātiviṣē bilvaṁ mustaṁ lōdhraṁ sagairikam||91||

kaṭvaṅgaṁ maricaṁ śuṇṭhīṁ mr̥dvīkāṁ raktacandanam| kaṭphalaṁ vatsakānantādhātakīmadhukārjunam||92||

puṣyēṇōddhr̥tya tulyāni sūkṣmacūrṇāni kārayēt| tāni kṣaudrēṇa saṁyōjya pibēttaṇḍulavāriṇā||93||

arśaḥsu cātisārēṣu raktaṁ yaccōpavēśyatē| dōṣāgantukr̥tā yē ca bālānāṁ tāṁśca nāśayēt||94||

yōnidōṣaṁ rajōdōṣaṁ śvētaṁ nīlaṁ sapītakam| strīṇāṁ śyāvāruṇaṁ yacca prasahya vinivartayēt||95||

cūrṇaṁ puṣyānugaṁ nāma hitamātrēyapūjitam|96|

iti puṣyānugacūrṇam pAThA jambvAmrayormadhyaM shilodbhedaM rasA~jjanam||90||

ambaShThA shAlmalIshleShaM sama~ggAM vatsakatvacam| bAhlIkAtiviShe bilvaM mustaM lodhraM sagairikam||91||

kaTva~ggaM maricaM shuNThIM mRudvIkAM raktacandanam| kaTphalaM vatsakAnantAdhAtakImadhukArjunam||92||

puShyeNoddhRutya tulyAni sUkShmacUrNAni kArayet| tAni kShaudreNa saMyojya pibettaNDulavAriNA||93||

arshaHsu cAtisAreShu raktaM yaccopaveshyate| doShAgantukRutA ye ca bAlAnAM tAMshca nAshayet||94||

yonidoShaM rajodoShaM shvetaM nIlaM sapItakam| strINAM shyAvAruNaM yacca prasahya vinivartayet||95||

cUrNaM puShyAnugaM nAma hitamAtreyapUjitam|96|

iti puShyAnugacUrNam|

Patha, kernel of jamun, kernel of mango, shilabheda, rasanjana, ambashtha, mocharasa, lajjalu, bark of kutaja, kesara, ativisha, bilva, musta, lodhra, gairika, aralu, maricha, shunthi, mridvika, red sandal, katphala, indrayava, ananta, dhataki, madhuka and arjuna all these drugs should be collected in pushya constellation in equal quantity. Prepare the fine powder of these. It should be given to lick with madhu and followed by rice water. It helps to stop the bleeding caused by the piles and diarrhea. It also stops the bleeding in children caused by the doshas or extraneous factor. It cures the genital tract disorders, menstrual disorders and discharges as white, blue, yellow, blackish and reddish. This powder named as pushyanuga is praised by Atreya and extremely beneficial in above mentioned disorders. [90-96]

तण्डुलीयकमूलं तु सक्षौद्रं तण्डुलाम्बुना ||९६||

रसाञ्जनं च लाक्षां च छागेन पयसा पिबेत् |

taṇḍulīyakamūlaṁ tu sakṣaudraṁ taṇḍulāmbunā||96||

rasāñjanaṁ ca lākṣāṁ ca chāgēna payasā pibēt|

taNDulIyakamUlaM tu sakShaudraM taNDulAmbunA||96||

rasA~jjanaM ca lAkShAM ca chAgena payasA pibet|

The paste of tanduliyaka mula mixed with honey should be taken with rice water and rasanjana and lac should be drink with goat’s milk. [96]

पत्रकल्कौ घृते भृष्टौ राजादनकपित्थयोः ||९७||

पित्तानिलहरौ, पैत्ते सर्वथैवास्रपित्तजित् |

patrakalkau ghr̥tē bhr̥ṣṭau rājādanakapitthayōḥ||97||

pittānilaharau, paittē sarvathaivāsrapittajit|

patrakalkau ghRute bhRuShTau rAjAdanakapitthayoH||97||

pittAnilaharau, paitte sarvathaivAsrapittajit|

Paste of rasanjana and kapittha leaves, roasted in ghee destroys the disorders due to pitta and kapha.[97]

Management of kapha dominant asrigadara

मधुकं त्रिफलां लोध्रं मुस्तं सौराष्ट्रिकां मधु ||९८||

मद्यैर्निम्बगुडूच्यौ वा कफजेऽसृग्दरे पिबेत् |

madhukaṁ triphalāṁ lōdhraṁ mustaṁ saurāṣṭrikāṁ madhu||98||

madyairnimbaguḍūcyau vā kaphajē'sr̥gdarē pibēt|

madhukaM triphalAM lodhraM mustaM saurAShTrikAM madhu||98||

madyairnimbaguDUcyau vA kaphaje~asRugdare pibet|

In kaphaja asrigdara, fine powder (kaphadachana) of mulethi, amalaki, haridra, baheda, lodhra, musta, sourashtrika in equal quantity, should be taken in dose of one gm with honey. Or the paste of nimba leaves and guduchi should be taken with liquor. [98]

Virechana in pitta dominant asrigadara

विरेचनं महातिक्तं पैत्तिकेऽसृग्दरे पिबेत् ||९९||

हितं गर्भपरिस्रावे यच्चोक्तं तच्च कारयेत् |१००|

virēcanaṁ mahātiktaṁ paittikē'sr̥gdarē pibēt||99||

hitaṁ garbhaparisrāvē yaccōktaṁ tacca kārayēt|100|

virecanaM mahAtiktaM paittike~asRugdare pibet||99||

hitaM garbhaparisrAve yaccoktaM tacca kArayet|100|

In paittika type of pradara, mahatikta ghrita should be used for purgation. The beneficial measures mentioned in management of abortion should be followed.[100]

Formulation for uttara basti

काश्मर्यकुटजक्वाथसिद्धमुत्तरबस्तिना ||१००||

रक्तयोन्यरजस्कानां पुत्रघ्न्याश्च हितं घृतम् |

kāśmaryakuṭajakvāthasiddhamuttarabastinā||100||

raktayōnyarajaskānāṁ putraghnyāśca hitaṁ ghr̥tam|

kAshmaryakuTajakvAthasiddhamuttarabastinA||100||

raktayonyarajaskAnAM putraghnyAshca hitaM ghRutam|

Ghrita prepared with the decoction of kashmarya and kutaja should be used in raktayoni, arajaska and putraghani yonivyapada, by the uttara basti.[100]

Treatment of arajaska (amenorrhoea)

मृगाजाविवराहासृग्दध्यम्लफलसर्पिषा [१] ||१०१|| अरजस्का पिबेत् सिद्धं जीवनीयैः पयोऽपि वा | mr̥gājāvivarāhāsr̥gdadhyamlaphalasarpiṣā [1] ||101|| arajaskā pibēt siddhaṁ jīvanīyaiḥ payō'pi vā|

mRugAjAvivarAhAsRugdadhyamlaphalasarpiShA [1] ||101|| arajaskA pibet siddhaM jIvanIyaiH payo~api vA|

The woman having arajaska (amenorrhea) yoni, should take blood of deer or goat or sheep or pig mixed with curd, sour fruit juice and ghee, in variation with sour curd, honey and ghee or she should drink milk processed with jivaniya varga (vitalizer) drugs. [101]

कर्णिन्यचरणाशुष्कयोनिप्राक्चरणासु च ||१०२||

कफवाते च दातव्यं तैलमुत्तरबस्तिना |

karṇinyacaraṇāśuṣkayōniprākcaraṇāsu ca||102||

kaphavātē ca dātavyaṁ tailamuttarabastinā| karNinyacaraNAshuShkayoniprAkcaraNAsu ca||102||

kaphavAte ca dAtavyaM tailamuttarabastinA|

The oil processed with jivaniya varga (vitalizer) drugs should be given by the uttarabasti or through the vaginal douche in these karnini, acharna, sushkayoni, prakcharna gynecological disorders and other disorders of genital tract due to kapha and vata. [102]

गोपित्ते मत्स्यपित्ते वा क्षौमं त्रिःसप्तभावितम् ||१०३||

मधुना किण्वचूर्णं वा दद्यादचरणापहम् | स्रोतसां शोधनं कण्डूक्लेदशोफहरं च तत् ||१०४||

gōpittē matsyapittē vā kṣaumaṁ triḥsaptabhāvitam||103||

madhunā kiṇvacūrṇaṁ vā dadyādacaraṇāpaham| srōtasāṁ śōdhanaṁ kaṇḍūklēdaśōphaharaṁ ca tat||104||

gopitte matsyapitte vA kShaumaM triHsaptabhAvitam||103||

madhunA kiNvacUrNaM vA dadyAdacaraNApaham| srotasAM shodhanaM kaNDUkledashophaharaM ca tat||104||

A flaxen cloth impregnated (bhavana) 21 times with bile of cow or bile of fish, should be kept inside the vagina or a wick prepared with the mixture of yeast (surakitta) powder and honey should be put to clean the channels of menstrual blood and it cures the itching, moisture and swelling. [103-104]

वातघ्नैः शतपाकैश्च तैलैः प्रागतिचारिणी | आस्थाप्या चानुवास्या च स्वेद्या चानिलसूदनैः ||१०५||

स्नेहद्रव्यैस्तथाऽऽहारैरुपनाहैश्च युक्तितः |

vātaghnaiḥ śatapākaiśca tailaiḥ prāgaticāriṇī| āsthāpyā cānuvāsyā ca svēdyā cānilasūdanaiḥ||105||

snēhadravyaistathāhārairupanāhaiśca yuktitaḥ|

vAtaghnaiH shatapAkaishca tailaiH prAgaticAriNI| AsthApyA cAnuvAsyA ca svedyA cAnilasUdanaiH||105||

snehadravyaistathA~a~ahArairupanAhaishca yuktitaH|

The woman suffering from prakcharna and aticharna should be administered non-unctuous enema (niruha and anuvasana basti) with vata alleviating oil cooked hundred times. Or sudation should be done with vata-alleviating drugs or oily food substances and poultice should be used tactically.[105]

शताह्वायवगोधूमकिण्वकुष्ठप्रियङ्गुभिः ||१०६||

बलाखुपर्णिकाश्र्याह्वैः संयावो धारणः स्मृतः |

śatāhvāyavagōdhūmakiṇvakuṣṭhapriyaṅgubhiḥ||106||

balākhuparṇikāśryāhvaiḥ saṁyāvō dhāraṇaḥ smr̥taḥ|

shatAhvAyavagodhUmakiNvakuShThapriya~ggubhiH||106||

balAkhuparNikAshryAhvaiH saMyAvo dhAraNaH smRutaH|

A wick (utkarika) cooked with the paste of ground drugs shatahva (aniseed), barley, wheat, yeast, kushtha, priyangu, bala, akhuparni, gandhaviroja should be put into the vagina. This purifies the aticharana and acharana yoni and becomes fit for conception.[106]

Management of vamini and upapluta yonivyapat

वामिन्युपप्लुतानां च स्नेहस्वेदादिकः क्रमः ||१०७||

कार्यस्ततः स्नेहपिचुस्ततः सन्तर्पणं भवेत् |

vāminyupaplutānāṁ ca snēhasvēdādikaḥ kramaḥ||107||

kāryastataḥ snēhapicustataḥ santarpaṇaṁ bhavēt|

vAminyupaplutAnAM ca snehasvedAdikaH kramaH||107||

kAryastataH snehapicustataH santarpaNaM bhavet|

In vamini and upapluta disorders, oleation and sudation should be done. After this yoni should be saturated with the application of unctuous tampons. After fomentation, a cloth soaked in vata alleviating oil should be kept into the vagina.[107]

Management of vipluta yonivyapat

शल्लकीजिङ्गिनीजम्बूधवत्वक्पञ्चवल्कलैः ||१०८||

कषायैः साधितः स्नेहपिचुः स्याद्विप्लुतापहः |

śallakījiṅginījambūdhavatvakpañcavalkalaiḥ||108||

kaṣāyaiḥ sādhitaḥ snēhapicuḥ syādviplutāpahaḥ|

shallakIji~gginIjambUdhavatvakpa~jcavalkalaiH||108||

kaShAyaiH sAdhitaH snehapicuH syAdviplutApahaH|

A tampon or cloth soaked in oil, cooked with the decoction of bark of sallaki, jingini (majitha), bark of jambu, bark of dhava, panchavalkala (vata, pipal, paras, gular, pakad) should be put in vagina which purifies the vipluta yoni.[108]

कर्णिन्यां वर्तिका कुष्ठपिप्पल्यर्काग्रसैन्धवैः ||१०९||

बस्तमूत्रकृता धार्या सर्वं च श्लेष्मनुद्धितम् |

karṇinyāṁ vartikā kuṣṭhapippalyarkāgrasaindhavaiḥ||109||

bastamūtrakr̥tā dhāryā sarvaṁ ca ślēṣmanuddhitam|

karNinyAM vartikA kuShThapippalyarkAgrasaindhavaiH||109||

bastamUtrakRutA dhAryA sarvaM ca shleShmanuddhitam|

In karnini yoni roga, a long, fatty suppository or a wick as an index finger, made up of equal parts of kushtha, pippali, front part of leaf of madara, rock salt pasted with goat’s urine, should be applied into the vagina. Besides, all kapha alleviating measures should be used. [109]

Management of udavarta and mahayoni yonivyapat

त्रैवृतं स्नेहनं स्वेदो ग्राम्यानूपौदका रसाः ||११०||

दशमूलपयोबस्तिश्चोदावर्तानिलार्तिषु | त्रैवृतेनानुवास्या च बस्तिश्चोत्तरसञ्ज्ञितः ||१११||

एतदेव महायोन्यां स्रस्तायां च विधीयते |

traivr̥taṁ snēhanaṁ svēdō grāmyānūpaudakā rasāḥ||110||

daśamūlapayōbastiścōdāvartānilārtiṣu| traivr̥tēnānuvāsyā ca bastiścōttarasañjñitaḥ||111||

ētadēva mahāyōnyāṁ srastāyāṁ ca vidhīyatē|

traivRutaM snehanaM svedo grAmyAnUpaudakA rasAH||110||

dashamUlapayobastishcodAvartAnilArtiShu| traivRutenAnuvAsyA ca bastishcottarasa~jj~jitaH||111||

etadeva mahAyonyAM srastAyAM ca vidhIyate|

In udavarta yoni and vatika disorders, unction (snehana) and fomentation (swedana) with trivrit oil, meat soup of domestic marshy birds and animals or live in water, and enema (uttarabasti) with milk boiled with dashamula are beneficial. The unctuous anuvasana basti with nishoth oil or uttarabasti with oil prepared with trivrit are efficacious. The same treatment should be given in mahayoni and srasta yoni. [110-111]

Management of mahayoni

वसा ऋक्षवराहाणां घृतं च मधुरैः शृतम् ||११२||

पूरयित्वा महायोनिं बध्नीयात् क्षौमलक्तकैः |

vasā [2] r̥kṣavarāhāṇāṁ ghr̥taṁ ca madhuraiḥ śr̥tam||112||

pūrayitvā [3] mahāyōniṁ badhnīyāt kṣaumalaktakaiḥ|

vasA RukShavarAhANAM ghRutaM ca madhuraiH shRutam||112||

pUrayitvA mahAyoniM badhnIyAt kShaumalaktakaiH|

Fat of bear and pig or cow’s ghrita with sweet drugs should be put into mahayoni and bandaged the yoni with flaxen piece. Here bandaging means that plugged fat or ghrita should not leak out of vagina. [112]

प्रस्रस्तां सर्पिषाऽभ्यज्य क्षीरस्विन्नां प्रवेश्य च ||११३|| बध्नीयाद्वेशवारस्य पिण्डेनामूत्रकालतः | prasrastāṁ sarpiṣā'bhyajya kṣīrasvinnāṁ pravēśya ca||113|| badhnīyādvēśavārasya piṇḍēnāmūtrakālataḥ|

prasrastAM sarpiShA~abhyajya kShIrasvinnAM praveshya ca||113|| badhnIyAdveshavArasya piNDenAmUtrakAlataH|

Uterus or genital organs which are displaced, should be massaged with ghrita first, after that fomentation or sudation should be done with milk. After proper fomentation, the displaced genital organs or uterus should be placed inside manually, bandaging should be done after putting the bolus of vesavara into the vagina. This bandage should not be removed till the pressure of urination.(113) यच्च वातविकाराणां कर्मोक्तं तच्च कारयेत् ||११४|| सर्वव्यापत्सु मतिमान्महायोन्यां विशेषतः | yacca vātavikārāṇāṁ karmōktaṁ tacca kārayēt||114|| sarvavyāpatsu matimānmahāyōnyāṁ viśēṣataḥ|

yacca vAtavikArANAM karmoktaM tacca kArayet||114|| sarvavyApatsu matimAnmahAyonyAM visheShataH|

Vata alleviating (Vatanashak) treatment in yoni vyapat: It should be decided by the skilled physician that the remedy or treatment of vatika disorders should be applied in all types of yonivyapat disorders and specially in mahayoni. (114) नहि वातादृते योनिर्नारीणां सम्प्रदुष्यति ||११५|| शमयित्वा तमन्यस्य कुर्याद्दोषस्य भेषजम् |११६| nahi vātādr̥tē yōnirnārīṇāṁ sampraduṣyati||115|| śamayitvā tamanyasya kuryāddōṣasya bhēṣajam|116| nahi vAtAdRute yonirnArINAM sampraduShyati||115|| shamayitvA tamanyasya kuryAddoShasya bheShajam|116|

The Yoni (genital tract or uterus) is never vitiated without involvement of vata dosha. So, vata should be pacified first then treat other doshas. (115-116) Management of shweta pradara (leukorrheoa): रोहीतकान्मूलकल्कं पाण्डुरेऽसृग्दरे पिबेत् ||११६|| जलेनामलकीबीजं कल्कं वा ससितामधुम् | rōhītakānmūlakalkaṁ pāṇḍurē'sr̥gdarē pibēt||116|| jalēnāmalakībījaṁ kalkaṁ vā sasitāmadhum|

rohItakAnmUlakalkaM pANDure~asRugdare pibet||116|| jalenAmalakIbIjaM kalkaM vA sasitAmadhum|

In shweta pradara (excessive whitish discharge), the paste of root of rohitaka should be taken with water or pasted seeds or amalaki mixed with sugar and honey should be taken with water.(116) मधुनाऽऽमलकाच्चूर्णं रसं वा लेहयेच्च ताम् ||११७|| न्यग्रोधत्वक्कषायेण लोध्रकल्कं तथा पिबेत् | आस्रावे क्षौमपट्टं वा भावितं तेन धारयेत् ||११८|| प्लक्षत्वक्चूर्णपिण्डं वा धारयेन्मधुना कृतम् | योन्या स्नेहाक्तया लोध्रप्रियङ्गुमधुकस्य वा ||११९|| धार्या मधुयुता वर्तिः कषायाणां च सर्वशः | स्रावच्छेदार्थमभ्यक्तां धूपयेद्वा घृताप्लुतैः ||१२०|| सरलागुग्गुलुयवैः सतैलकटुमत्स्यकैः | madhunāmalakāccūrṇaṁ rasaṁ vā lēhayēcca [1] tām||117|| nyagrōdhatvakkaṣāyēṇa lōdhrakalkaṁ tathā pibēt| āsrāvē kṣaumapaṭṭaṁ vā bhāvitaṁ tēna dhārayēt||118|| plakṣatvakcūrṇapiṇḍaṁ vā dhārayēnmadhunā kr̥tam| yōnyā snēhāktayā lōdhrapriyaṅgumadhukasya vā||119|| dhāryā madhuyutā vartiḥ kaṣāyāṇāṁ ca sarvaśaḥ| srāvacchēdārthamabhyaktāṁ dhūpayēdvā ghr̥tāplutaiḥ||120|| saralāgugguluyavaiḥ satailakaṭumatsyakaiḥ|

madhunA~a~amalakAccUrNaM rasaM vA lehayecca tAm||117|| nyagrodhatvakkaShAyeNa lodhrakalkaM tathA pibet| AsrAve kShaumapaTTaM vA bhAvitaM tena dhArayet||118|| plakShatvakcUrNapiNDaM vA dhArayenmadhunA kRutam| yonyA snehAktayA lodhrapriya~ggumadhukasya vA||119|| dhAryA madhuyutA vartiH kaShAyANAM ca sarvashaH| srAvacchedArthamabhyaktAM dhUpayedvA ghRutAplutaiH||120|| saralAgugguluyavaiH satailakaTumatsyakaiH|

The woman suffering from shweta pradara should be advised to lick the powder or juice of amalaki, mixed with honey. She should take the paste of lodhra with the decoction of bark of nyagrodha or in case of excessive discharge, a flaxen cloth should be impregnated with the decoction of nyagrodha and put into the vagina. A vatanashaka oil should be applied first then a bolus or thick wick of powder of bark of plaksa with honey should be retained into the vagina. She should retain a thick wick or suppository, made of powder of lodhra, priyangu, mulethi and honey after smearing the vagina with oil. A wick or suppository, made of powder of astringent (kashaya rasa) drugs mixed with honey should be retained inside the yoni. It cures the vaginal discharges. After smearing the vagina with plenty of ghrita, it should be fumigated with sarala, guggulu, barley and katu matasyaka (dried small siddhari fish) mixed with oil. (117-120) Treatment of sticky vaginal discharge: कासीसं त्रिफला काङ्क्षी समङ्गाऽऽम्रास्थि धातकी ||१२१|| पैच्छिल्ये क्षौद्रसंयुक्तश्चूर्णो वैशद्यकारकः | kāsīsaṁ triphalā kāṅkṣī samaṅgāmrāsthi dhātakī||121|| paicchilyē kṣaudrasaṁyuktaścūrṇō vaiśadyakārakaḥ|

kAsIsaM triphalA kA~gkShI sama~ggA~a~amrAsthi dhAtakI||121|| paicchilye kShaudrasaMyuktashcUrNo vaishadyakArakaH|

In pichchhila yoni roga, a powder of kasisa, triphala, saurashtri, lajjalu, amra seeds and dhataki mixed with honey should be applied into the vagina. It makes the genital tract clean. (121) पलाशसर्जजम्बूत्वक्समङ्गामोचधातकीः ||१२२|| सपिच्छिलापरिक्लिन्नास्तम्भनः कल्क इष्यते |

palāśasarjajambūtvaksamaṅgāmōcadhātakīḥ||122|| sapicchilāpariklinnāstambhanaḥ kalka iṣyatē|

palAshasarjajambUtvaksama~ggAmocadhAtakIH||122|| sapicchilApariklinnAstambhanaH kalka iShyate|

A paste of bark of palasha, sarja, bark of jambu, lajjalu, mocharasa, flower of dhataki should be applied locally. It cures the sliminess (greasiness) and wetness of the genital tract. (122) Treatment of stiff and dryness in vagina: स्तब्धानां कर्कशानां च कार्यं मार्दवकारकम् ||१२३|| धारयेद्वेशवारं वा पायसं कृशरां तथा | stabdhānāṁ karkaśānāṁ ca kāryaṁ mārdavakārakam||123|| dhārayēdvēśavāraṁ vā pāyasaṁ kr̥śarāṁ tathā|

stabdhAnAM karkashAnAM ca kAryaM mArdavakArakam||123|| dhArayedveshavAraM vA pAyasaM kRusharAM tathA|

In stiffed (stambha) and hard (karkash) genital tract, the seeds of softness or flabbiness should be adopted and vesavara or payasa or krishara should be retained in vagina.(123) Treatment of foul smelling vaginal discharge: दुर्गन्धानां कषायः स्यात्तौवरः कल्क एव वा ||१२४|| चूर्णं वा सर्वगन्धानां पूतिगन्धापकर्षणम् | durgandhānāṁ kaṣāyaḥ syāttauvaraḥ kalka ēva vā||124|| cūrṇaṁ vā sarvagandhānāṁ pūtigandhāpakarṣaṇam|

durgandhAnAM kaShAyaH syAttauvaraH kalka eva vA||124|| cUrNaM vA sarvagandhAnAM pUtigandhApakarShaNam|

In foul smell from the genital tract, the decoction of tuvaraka should be used to clean or wash or paste of tuvaraka should be applied or the powder of sarvagandha dravyas helps to remove the foul smell. (124) Importance of purification before conception: एवं योनिषु शुद्धासु गर्भं विन्दन्ति योषितः ||१२५|| अदुष्टे प्राकृते बीजे जीवोपक्रमणे सति |१२६| ēvaṁ yōniṣu śuddhāsu garbhaṁ vindanti yōṣitaḥ||125|| aduṣṭē prākr̥tē bījē jīvōpakramaṇē sati|126| evaM yoniShu shuddhAsu garbhaM vindanti yoShitaH||125|| aduShTe prAkRute bIje jIvopakramaNe sati|126|

Thus when the genital tract is purified and the seeds (sperm and ovum) are normal (in their own form), undamaged, then the jivatama or consciousness wants to come into the foetus (garbha) then women conceive. (125)

पञ्चकर्मविशुद्धस्य पुरुषस्यापि चेन्द्रियम् ||१२६|| परीक्ष्य वर्णैर्दोषाणां दुष्टं तद्घ्नैरुपाचरेत् |१२७| pañcakarmaviśuddhasya puruṣasyāpi cēndriyam||126|| parīkṣya varṇairdōṣāṇāṁ duṣṭaṁ tadghnairupācarēt|127| pa~jcakarmavishuddhasya puruShasyApi cendriyam||126|| parIkShya varNairdoShANAM duShTaM tadghnairupAcaret|127| The purification of man should be done by five measures (panchakarma) and after examining the senses, and involved vitiated doshas due to colour in semen, he should be treatment with those drugs which pacify the vitiated doshas in semen. (126-127) Summary: भवन्ति चात्र- सलिङ्गा व्यापदो योनेः सनिदानचिकित्सिताः ||१२७|| उक्ता विस्तरतः सम्यङ्मुनिना तत्त्वदर्शिना | bhavanti cātra- saliṅgā vyāpadō yōnēḥ sanidānacikitsitāḥ||127|| uktā vistarataḥ samyaṅmuninā tattvadarśinā|

bhavanti cAtra- sali~ggA vyApado yoneH sanidAnacikitsitAH||127|| uktA vistarataH samya~gmuninA tattvadarshinA| The disorders of the female genital tract along with the symptoms, causes and treatment have been said in detail by the sage Atreya. (127) Agnivesha’s queries about disorders of male genital tract: पुनरेवाग्निवेशस्तु पप्रच्छ भिषजां वरम् ||१२८|| आत्रेयमुपसङ्गम्य शुक्रदोषास्त्वयाऽनघ! | रोगाध्याये समुद्दिष्टा ह्यष्टौ पुंसामशेषतः ||१२९|| तेषां हेतुं भिषक्श्रेष्ठ! दुष्टादुष्टस्य चाकृतिम् | चिकित्सितं च कार्त्स्न्येन क्लैब्यं यच्च चतुर्विधम् ||१३०|| उपद्रवेषु योनीनां प्रदरो यश्च कीर्तितः | तेषां निदानं लिङ्गं च चिकित्सां चैव तत्त्वतः ||१३१|| समासव्यासभेदेन प्रब्रूहि [१] भिषजांवर! | punarēvāgnivēśastu papraccha bhiṣajāṁ varam||128|| ātrēyamupasaṅgamya śukradōṣāstvayā'nagha!| rōgādhyāyē samuddiṣṭā hyaṣṭau puṁsāmaśēṣataḥ||129|| tēṣāṁ hētuṁ bhiṣakśrēṣṭha! duṣṭāduṣṭasya cākr̥tim| cikitsitaṁ ca kārtsnyēna klaibyaṁ yacca caturvidham||130|| upadravēṣu yōnīnāṁ pradarō yaśca kīrtitaḥ| tēṣāṁ nidānaṁ liṅgaṁ ca cikitsāṁ caiva tattvataḥ||131|| samāsavyāsabhēdēna prabrūhi [1] bhiṣajāṁvara!|

punarevAgniveshastu papraccha bhiShajAM varam||128|| Atreyamupasa~ggamya shukradoShAstvayA~anagha!| rogAdhyAye samuddiShTA hyaShTau puMsAmasheShataH||129|| teShAM hetuM bhiShakshreShTha! duShTAduShTasya cAkRutim| cikitsitaM ca kArtsnyena klaibyaM yacca caturvidham||130|| upadraveShu yonInAM pradaro yashca kIrtitaH| teShAM nidAnaM li~ggaM ca cikitsAM caiva tattvataH||131|| samAsavyAsabhedena prabrUhi [1] bhiShajAMvara!|

Agnivesha approached Atreya, the best preceptor among physicians, and asked that Oh ! Innocent or sinless, you have mentioned the eight defects of semen in the chapter of diseases in Sutrasthana. Oh best among the phsyicains, you have told about the causes of eight defects of semen (shukra), symptoms of normal and abnormal semen, its proper treatment, four types of impotency and pradara (menorrhoea or D.U.B.), and complications of disorders of genital tract or uterus. Tell me, in brief as well as in detail about their causes, etiology, symptoms and proper treatment of those disorders. (128-131)

Atreya, the foremost or leading among the sages, said to devoted Agnivesha. (132) Process of ejaculation and causes of vitiation of shukra (defects in semen and sperms): तस्मै शुश्रूषमाणाय प्रोवाच मुनिपुङ्गवः ||१३२|| बीजं यस्माद्व्यवाये [१] तु हर्षयोनिसमुत्थितम् | शुक्रं पौरुषमित्युक्तं तस्माद्वक्ष्यामि तच्छृणु ||१३३|| यथा बीजमकालाम्बुकृमिकीटाग्निदूषितम् | न विरोहति सन्दुष्टं तथा शुक्रं शरीरिणाम् ||१३४|| अतिव्यवायाद्व्यायामादसात्म्यानां च सेवनात् | अकाले वाऽप्ययोनौ वा मैथुनं न च गच्छतः ||१३५|| रूक्षतिक्तकषायातिलवणाम्लोष्णसेवनात् | नारीणामरसज्ञानां [२] गमनाज्जरया तथा ||१३६|| चिन्ताशोकादविस्रम्भाच्छस्त्रक्षाराग्निविभ्रमात् | भयात्क्रोधादभीचाराद्व्याधिभिः [३] कर्शितस्य च ||१३७|| वेगाघातात् क्षताच्चापि धातूनां सम्प्रदूषणात् | दोषाः पृथक् समस्ता वा प्राप्य रेतोवहाः सिराः ||१३८|| शुक्रं सन्दूषयन्त्याश ... |१३९| tasmai śuśrūṣamāṇāya prōvāca munipuṅgavaḥ||132|| bījaṁ yasmādvyavāyē [1] tu harṣayōnisamutthitam| śukraṁ pauruṣamityuktaṁ tasmādvakṣyāmi tacchr̥ṇu||133|| yathā bījamakālāmbukr̥mikīṭāgnidūṣitam| na virōhati sanduṣṭaṁ tathā śukraṁ śarīriṇām||134|| ativyavāyādvyāyāmādasātmyānāṁ ca sēvanāt| akālē vā'pyayōnau vā maithunaṁ na ca gacchataḥ||135|| rūkṣatiktakaṣāyātilavaṇāmlōṣṇasēvanāt| nārīṇāmarasajñānāṁ [2] gamanājjarayā tathā||136|| cintāśōkādavisrambhācchastrakṣārāgnivibhramāt| bhayātkrōdhādabhīcārādvyādhibhiḥ [3] karśitasya ca||137|| vēgāghātāt kṣatāccāpi dhātūnāṁ sampradūṣaṇāt| dōṣāḥ pr̥thak samastā vā prāpya rētōvahāḥ sirāḥ||138|| śukraṁ sandūṣayantyāśu ...|139| tasmai shushrUShamANAya provAca munipu~ggavaH||132|| Bijam yasmAdvyavAye tu harShayonisamutthitam| shukraM pauruShamityuktaM tasmAdvakShyAmi tacchRuNu||133|| yathA bIjamakAlAmbukRumikITAgnidUShitam| na virohati sanduShTaM tathA shukraM sharIriNAm||134|| ativyavAyAdvyAyAmAdasAtmyAnAM ca sevanAt| akAle vA~apyayonau vA maithunaM na ca gacchataH||135|| rUkShatiktakaShAyAtilavaNAmloShNasevanAt| nArINAmarasaj~jAnAM gamanAjjarayA tathA||136|| cintAshokAdavisrambhAcchastrakShArAgnivibhramAt| bhayAtkrodhAdabhIcArAdvyAdhibhiH karshitasya ca||137|| vegAghAtAt kShatAccApi dhAtUnAM sampradUShaNAt| doShAH pRuthak samastA vA prApya retovahAH sirAH||138|| shukraM sandUShayantyAshu ...|139| that as the semen (shukra) gets ejaculated as a result of excitement and is the sign of masculinity. The reason behind calling it seed will be explained by me which one should listen. The seed as an effect of delighted coitus, has been described as shukra, is the male characteristic known as semen. As the (plant) seed at inappropriate time, affected by unseasonal rains, worms, pests & fire does not grow out, in the same way the semen (does not grow up) in human body. Excess intercourse, excess exercise, consumption of un-suitable food, untimely coitus, other than in vagina, or abstinence from it, consumption of dry, bitter, astringent, salty, sour, hot food; unaware of female desire, untimely ejaculation, senility, anxiety, distress, distrust, imperfect (local) usage of surgical instruments, alkali, agni (cautery); apprehension, rage, exorcism, emaciation (secondary) to diseases; repression of urges, wound, morbidity producing dhatus, doshas, individually or collectively reaching to retovaha srotas lead to acute disorders of the shukra (semen).(132-139) Eight abnormalities in semen: ... तद्वक्ष्यामि विभागशः | फेनिलं तनु रूक्षं च विवर्णं पूति पिच्छिलम् ||१३९|| अन्यधातूपसंसृष्टमवसादि तथाऽष्टमम् | फेनिलं तनु रूक्षं च कृच्छ्रेणाल्पं च मारुतात् ||१४०|| भवत्युपहतं शुक्रं न तद्गर्भाय कल्पते | सनीलमथवा पीतमत्युष्णं पूतिगन्धि च ||१४१|| दहल्लिङ्गं विनिर्याति शुक्रं पित्तेन दूषितम् | श्लेष्मणा बद्धमार्गं तु भवत्यत्यर्थपिच्छिलम् ||१४२|| स्त्रीणामत्यर्थगमनादभिघातात् क्षतादपि | शुक्रं प्रवर्तते जन्तोः प्रायेण रुधिरान्वयम् ||१४३|| वेगसन्धारणाच्छुक्रं वायुना विहतं पथि | कृच्छ्रेण याति ग्रथितमवसादि तथाऽऽष्टमम् ||१४४|| इति दोषाः समाख्याताः शुक्रस्याष्टौ सलक्षणाः | ... tadvakṣyāmi vibhāgaśaḥ| phēnilaṁ tanu rūkṣaṁ ca vivarṇaṁ pūti picchilam||139|| anyadhātūpasaṁsr̥ṣṭamavasādi tathā'ṣṭamam| phēnilaṁ tanu rūkṣaṁ ca kr̥cchrēṇālpaṁ ca mārutāt||140|| bhavatyupahataṁ śukraṁ na tadgarbhāya kalpatē| sanīlamathavā pītamatyuṣṇaṁ pūtigandhi ca||141|| dahalliṅgaṁ viniryāti śukraṁ pittēna dūṣitam| ślēṣmaṇā baddhamārgaṁ tu bhavatyatyarthapicchilam||142|| strīṇāmatyarthagamanādabhighātāt kṣatādapi| śukraṁ pravartatē jantōḥ prāyēṇa rudhirānvayam||143|| vēgasandhāraṇācchukraṁ vāyunā vihataṁ pathi| kr̥cchrēṇa yāti grathitamavasādi tathāṣṭamam||144|| iti dōṣāḥ samākhyātāḥ śukrasyāṣṭau salakṣaṇāḥ|

... tadvakShyAmi vibhAgashaH | 

phenilaM tanu rUkShaM ca vivarNaM pUti picchilam ||139|| anyadhAtUpasaMsRuShTamavasAdi tathA~aShTamam | phenilaM tanu rUkShaM ca kRucchreNAlpaM ca mArutAt ||140|| bhavatyupahataM shukraM na tadgarbhAya kalpate | sanIlamathavA pItamatyuShNaM pUtigandhi ca ||141|| dahalli~ggaM viniryAti shukraM pittena dUShitam | shleShmaNA baddhamArgaM tu bhavatyatyarthapicchilam ||142|| strINAmatyarthagamanAdabhighAtAt kShatAdapi | shukraM pravartate jantoH prAyeNa rudhirAnvayam ||143|| vegasandhAraNAcchukraM vAyunA vihataM pathi | kRucchreNa yAti grathitamavasAdi tathA~a~aShTamam ||144|| iti doShAH samAkhyAtAH shukrasyAShTau salakShaNAH |

It’s (The disorders of shukra) being described discretely. Fenilam (frothy), tanu (slender), ruksham (arid), vivarnam (discolored), pooti (putrid), pichhilam (slimy), afflicted with other dhatus, & precipitant are the eight (shukra disorders). Frothy, slender, arid, scanty, discomforting ejaculation is due to vata (dominance). Thus affected semen is incapable of fertilization (garbha). Semen of bluish or yellow discoloration, (with) putrid odor, ejaculation with burning sensation is affected by pitta. Semen affected by kapha is extremely slimy and obstructs channel of semen (ejaculatory duct). Ejaculated semen with blood is due to excess coitus, (local) or injury. The eighth (type of semen disorder) is due to repression of shukra. SSemen gets obstructed within its channel by (vitiated) vata; which may ejaculate painfully with increased viscosity.Thus eight disorders of shukra (semen) are illustrated with symptoms. (139-144) Characteristics of shuddha retas (normal semen): स्निग्धं घनं पिच्छिलं च मधुरं चाविदाहि च ||१४५|| रेतः शुद्धं विजानीयाच्छ्वेतं [१] स्फटिकसन्निभम् |१४६| snigdhaṁ ghanaṁ picchilaṁ ca madhuraṁ cāvidāhi ca||145|| rētaḥ śuddhaṁ vijānīyācchvētaṁ [1] sphaṭikasannibham|146|

snigdhaM ghanaM picchilaM ca madhuraM cAvidAhi ca ||145|| retaH shuddhaM vijAnIyAcchvetaM [1] sphaTikasannibham |146|(Retah)Virile Semen which is Snigdha (unctous), Ghana (Viscous), Picchila (Slimy), Madhur (Sweet), Avidahi (non-blazing), looking like white crystal quartz; known as normal (semen).(146) Principles of management of disorders of semen: वाजीकरणयोगैस्तैरुपयोगसुखैर्हितैः ||१४६|| रक्तपित्तहरैर्योगैर्योनिव्यापदिकैस्तथा | दुष्टं यदा भवेच्छुक्रं तदा तत् समुपाचरेत् ||१४७|| घृतं च जीवनीयं यच्च्यवनप्राश एव च | गिरिजस्य प्रयोगश्च रेतोदोषानपोहति ||१४८|| वातान्विते हिताः शुक्रे निरूहाः सानुवासनाः | अभयामलकीयं च पैत्ते शस्तं रसायनम् [१] ||१४९|| मागध्यमृतलोहानां त्रिफलाया रसायनम्| कफोत्थितं शुक्रदोषं हन्याद्भल्लातकस्य च||१५०|| यदन्यधातुसंसृष्टं शुक्रं तद्वीक्ष्य युक्तितः| यथादोषं प्रयुञ्जीत दोषधातुभिषग्जितम्||१५१|| सर्पिः पयो रसाः शालिर्यवगोधूमषष्टिकाः| प्रशस्ताः शुक्रदोषेषु बस्तिकर्म विशेषतः||१५२|| इत्यष्टशुक्रदोषाणां मुनिनोक्तं चिकित्सितम्|१५३|

vājīkaraṇayōgaistairupayōgasukhairhitaiḥ||146|| raktapittaharairyōgairyōnivyāpadikaistathā| duṣṭaṁ yadā bhavēcchukraṁ tadā tat samupācarēt||147|| ghr̥taṁ ca jīvanīyaṁ yaccyavanaprāśa ēva ca| girijasya prayōgaśca rētōdōṣānapōhati||148|| vātānvitē hitāḥ śukrē nirūhāḥ sānuvāsanāḥ| abhayāmalakīyaṁ ca paittē śastaṁ rasāyanam [1] ||149|| māgadhyamr̥talōhānāṁ triphalāyā rasāyanam| kaphōtthitaṁ śukradōṣaṁ hanyādbhallātakasya ca||150|| yadanyadhātusaṁsr̥ṣṭaṁ śukraṁ tadvīkṣya yuktitaḥ| yathādōṣaṁ prayuñjīta dōṣadhātubhiṣagjitam||151|| sarpiḥ payō rasāḥ śāliryavagōdhūmaṣaṣṭikāḥ| praśastāḥ śukradōṣēṣu bastikarma viśēṣataḥ||152|| ityaṣṭaśukradōṣāṇāṁ muninōktaṁ cikitsitam|153|

vAjIkaraNayogaistairupayogasukhairhitaiH ||146|| raktapittaharairyogairyonivyApadikaistathA | duShTaM yadA bhavecchukraM tadA tat samupAcaret ||147|| ghRutaM ca jIvanIyaM yaccyavanaprAsha eva ca | girijasya prayogashca retodoShAnapohati ||148|| vAtAnvite hitAH shukre nirUhAH sAnuvAsanAH | abhayAmalakIyaM ca paitte shastaM rasAyanam [1] ||149|| mAgadhyamRutalohAnAM triphalAyA rasAyanam | kaphotthitaM shukradoShaM hanyAdbhallAtakasya ca ||150|| yadanyadhAtusaMsRuShTaM shukraM tadvIkShya yuktitaH | yathAdoShaM prayu~jjIta doShadhAtubhiShagjitam ||151|| sarpiH payo rasAH shAliryavagodhUmaShaShTikAH | prashastAH shukradoSheShu bastikarma visheShataH ||152|| ityaShTashukradoShANAM muninoktaM cikitsitam |153|

In case of diseases of semen, treatment with use of vajikarana formulations (aphrodisiac) are beneficial . Management with jeevaneeya ghritam, chyavanaprasham, (girija) shilajatu remove the diseases of virile semen. For semen affected by vata, niruha basti with anuwasana is advisable. For pittaja (disorder) of semen rasayana (formulations) are preferred. Semen disorders caused by kapha shall be treated with pippali, amruta (guduchi), loha, triphala, and bhallataka rasayana. When Semen is affected by other dhatus, it shall be observed and skillfully treated, according to the dosha (vitiated), & the dhatu. Sarpi ghee), payo (milk), rasa (mamsarasa/ soup of meat), shali (shali rice), yava (barley), shashtika, especially basti are advisable in the disorder of the semen. This is the treatment advised by the sages for eight semen disorders.(146-153) Klaibya (impotency): रेतोदोषोद्भवं क्लैब्यं यस्माच्छुद्ध्यैव सिध्यति ||१५३|| ततो वक्ष्यामि ते सम्यगग्निवेश! यथातथम् |१५४| rētōdōṣōdbhavaṁ klaibyaṁ yasmācchuddhyaiva sidhyati||153|| tatō vakṣyāmi tē samyagagnivēśa! yathātatham|154|

retodoShodbhavaM klaibyaM yasmAcchuddhyaiva sidhyati ||153||

tato vakShyAmi te samyagagnivesha! yathAtatham |154| An impotency due to disorders of semen is cured by elimination of the disorder; which is appropriately being described as it is (Agnivesha).(153-154) Causes of klaibya (impotency): बीजध्वजोपघाताभ्यां जरया शुक्रसङ्क्षयात् ||१५४|| क्लैब्यं सम्पद्यते तस्य शृणु सामान्यलक्षणम् | सङ्कल्पप्रवणो नित्यं प्रियां वश्यामपि स्त्रियम् ||१५५|| न याति लिङ्गशैथिल्यात् कदाचिद्याति वा यदि | श्वासार्तः स्विन्नगात्रश्च मोघसङ्कल्पचेष्टितः ||१५६|| म्लानशिश्नश्च निर्बीजः स्यादेतत् क्लैब्यलक्षणम् | सामान्यलक्षणं ह्येतद्विस्तरेण प्रवक्ष्यते ||१५७||bījadhvajōpaghātābhyāṁ jarayā śukrasaṅkṣayāt||154|| klaibyaṁ sampadyatē tasya śr̥ṇu sāmānyalakṣaṇam| saṅkalpapravaṇō nityaṁ priyāṁ vaśyāmapi striyam||155|| na yāti liṅgaśaithilyāt kadācidyāti vā yadi| śvāsārtaḥ svinnagātraśca mōghasaṅkalpacēṣṭitaḥ||156|| mlānaśiśnaśca nirbījaḥ syādētat klaibyalakṣaṇam| sāmānyalakṣaṇaṁ hyētadvistarēṇa pravakṣyatē||157||

bIjadhvajopaghAtAbhyAM jarayA shukrasa~gkShayAt ||154|| 

klaibyaM sampadyate tasya shRuNu sAmAnyalakShaNam | sa~gkalpapravaNo nityaM priyAM vashyAmapi striyam ||155|| na yAti li~ggashaithilyAt kadAcidyAti vA yadi | shvAsArtaH svinnagAtrashca moghasa~gkalpaceShTitaH ||156|| mlAnashishnashca nirbIjaH syAdetat klaibyalakShaNam | sAmAnyalakShaNaM hyetadvistareNa pravakShyate ||157|| Common symptoms of the impotency caused by the beeja-upaghata (hereditary/congenital defect), dhwajopaghata (erectile dysfunction), jara (senility), shukrasamkshaya (diminished semen) shall be noticed. A person desiring sex is unable to complete sexual intercourse with loved and even obedient female due to loss of erection. Even if he (tries to ) attempt, he gets more exhausted with dysnoea, excess perspiration, futile sexual efforts, languid penis and is devoid of semen. These are the general features of impotency. Specific feautures will be described later.(154-157) Bijopaghataja klaibya (impotency due to genetic abonormality): शीतरूक्षाल्पसङ्क्लिष्टविरुद्धाजीर्णभोजनात् [१] | शोकचिन्ताभयत्रासात् स्त्रीणां चात्यर्थसेवनात् ||१५८|| अभिचारादविस्रम्भाद्रसादीनां च सङ्क्षयात् | वातादीनां च वैषम्यात्तथैवानशनाच्छ्रमात् ||१५९|| नारीणामरसज्ञत्वात् पञ्चकर्मापचारतः | बीजोपघाताद्भवति पाण्डुवर्णः सुदुर्बलः ||१६०|| अल्पप्राणोऽल्पहर्षश्च प्रमदासु भवेन्नरः | हृत्पाण्डुरोगतमककामलाश्रमपीडितः ||१६१|| छर्द्यतीसारशूलार्तः कासज्वरनिपीडितः | बीजोपघातजं क्लैब्यं ... |१६२| śītarūkṣālpasaṅkliṣṭaviruddhājīrṇabhōjanāt [1] | śōkacintābhayatrāsāt strīṇāṁ cātyarthasēvanāt||158|| abhicārādavisrambhādrasādīnāṁ ca saṅkṣayāt| vātādīnāṁ ca vaiṣamyāttathaivānaśanācchramāt||159|| nārīṇāmarasajñatvāt pañcakarmāpacārataḥ| bījōpaghātādbhavati pāṇḍuvarṇaḥ sudurbalaḥ||160|| alpaprāṇō'lpaharṣaśca pramadāsu bhavēnnaraḥ| hr̥tpāṇḍurōgatamakakāmalāśramapīḍitaḥ||161|| chardyatīsāraśūlārtaḥ kāsajvaranipīḍitaḥ| bījōpaghātajaṁ klaibyaṁ ...|163|

shItarUkShAlpasa~gkliShTaviruddhAjIrNabhojanAt [1] | 

shokacintAbhayatrAsAt strINAM cAtyarthasevanAt ||158|| abhicArAdavisrambhAdrasAdInAM ca sa~gkShayAt | vAtAdInAM ca vaiShamyAttathaivAnashanAcchramAt ||159|| nArINAmarasaj~jatvAt pa~jcakarmApacArataH | bIjopaghAtAdbhavati pANDuvarNaH sudurbalaH ||160|| alpaprANo~alpaharShashca pramadAsu bhavennaraH | hRutpANDurogatamakakAmalAshramapIDitaH ||161|| chardyatIsArashUlArtaH kAsajvaranipIDitaH | bIjopaghAtajaM klaibyaM ... |162|

Intake of sheeta (cold), ruksha (arid), less, sanklishta (muddled), incompatible, unprocessed food; shoka (anguish), chinta (apprehension), bhaya (fear), trasa (trouble), excess indulgence in women, exorcism, suspicion, deficiency of Rasadi dhatus, doshic imbalances (vata, pitta, kapha), fasting, exertion, unawareness of female interests, undergoing incorrect panchakarma, and deficient semen leads to pallor, weak, less vital person with incomplete erection (even) for young women; may get affected with disorders of the heart, pandu, tamaka (disorders of respiratory system), kamala (liver disorders), exhaustion, vomiting, diarrhea, colic, cough, & jawara (fever). This impotency is due to loss of beeja (sperms).(158-162) Dhwajabhangaja klaibya (impotency due to erectile dysfunction): ... ध्वजभङ्गकृतं शृणु ||१६२|| अत्यम्ललवणक्षारविरुद्धासात्म्यभोजनात् | अत्यम्बुपानाद्विषमात् पिष्टान्नगुरुभोजनात् ||१६३|| दधिक्षीरानूपमांससेवनाद्व्याधिकर्षणात् | कन्यानां चैव गमनादयोनिगमनादपि ||१६४|| दीर्घरोगां [१] चिरोत्सृष्टां तथैव च रजस्वलाम् | दुर्गन्धां दुष्टयोनिं च तथैव च परिस्रुताम् [२] ||१६५|| ईदृशीं प्रमदां मोहाद्यो गच्छेत् कामहर्षितः | चतुष्पदाभिगमनाच्छेफसश्चाभिघाततः ||१६६|| अधावनाद्वा मेढ्रस्य शस्त्रदन्तनखक्षतात् | काष्ठप्रहारनिष्पेषाच्छूकानां चातिसेवनात् ||१६७|| रेतसश्च प्रतीघाताद्ध्वजभङ्गः प्रवर्तते | (भवन्ति [३] यानि रूपाणि तस्य वक्ष्याम्यतः परम्) | श्वयथुर्वेदना मेढ्रे रागश्चैवोपलक्ष्यते ||१६८|| स्फोटाश्च तीव्रा जायन्ते लिङ्गपाको भवत्यपि | मांसवृद्धिर्भवेच्चास्य व्रणाः क्षिप्रं भवन्त्यपि ||१६९|| पुलाकोदकसङ्काशः स्रावः श्यावारुणप्रभः | वलयीकुरुते [४] चापि कठिनश्च परिग्रहः ||१७०|| ज्वरस्तृष्णा भ्रमो मूर्च्छा च्छर्दिश्चास्योपजायते | रक्तं कृष्णं स्रवेच्चापि नीलमाविललोहितम् ||१७१|| अग्निनेव च दग्धस्य तीव्रो दाहः सवेदनः | बस्तौ वृषणयोर्वाऽपि सीवन्यां वङ्क्षणेषु च ||१७२|| कदाचित्पिच्छिलो वाऽपि पाण्डुः स्रावश्च जायते | श्वयथुर्जायते मन्दः स्तिमितोऽल्पपरिस्रवः ||१७३|| चिराच्च पाकं व्रजति शीघ्रं वाऽथ प्रमुच्यते | जायन्ते क्रिमयश्चापि क्लिद्यते पूतिगन्धि च ||१७४|| विशीर्यते मणिश्चास्य मेढ्रं मुष्कावथापि च | ध्वजभङ्गकृतं क्लैब्यमित्येतत् समुदाहृतम् ||१७५|| एतं [५] पञ्चविधं केचिद्ध्वजभङ्गं प्रचक्षते |१७६| ... dhvajabhaṅgakr̥taṁ śr̥ṇu||162|| atyamlalavaṇakṣāraviruddhāsātmyabhōjanāt| atyambupānādviṣamāt piṣṭānnagurubhōjanāt||163|| dadhikṣīrānūpamāṁsasēvanādvyādhikarṣaṇāt| kanyānāṁ caiva gamanādayōnigamanādapi||164|| dīrgharōgāṁ [1] cirōtsr̥ṣṭāṁ tathaiva ca rajasvalām| durgandhāṁ duṣṭayōniṁ ca tathaiva ca parisrutām [2] ||165|| īdr̥śīṁ pramadāṁ mōhādyō gacchēt kāmaharṣitaḥ| catuṣpadābhigamanācchēphasaścābhighātataḥ||166|| adhāvanādvā mēḍhrasya śastradantanakhakṣatāt| kāṣṭhaprahāraniṣpēṣācchūkānāṁ cātisēvanāt||167|| rētasaśca pratīghātāddhvajabhaṅgaḥ pravartatē| (bhavanti [3] yāni rūpāṇi tasya vakṣyāmyataḥ param)| śvayathurvēdanā mēḍhrē rāgaścaivōpalakṣyatē||168|| sphōṭāśca tīvrā jāyantē liṅgapākō bhavatyapi| māṁsavr̥ddhirbhavēccāsya vraṇāḥ kṣipraṁ bhavantyapi||169|| pulākōdakasaṅkāśaḥ srāvaḥ śyāvāruṇaprabhaḥ| valayīkurutē [4] cāpi kaṭhinaśca parigrahaḥ||170|| jvarastr̥ṣṇā bhramō mūrcchā cchardiścāsyōpajāyatē| raktaṁ kr̥ṣṇaṁ sravēccāpi nīlamāvilalōhitam||171|| agninēva ca dagdhasya tīvrō dāhaḥ savēdanaḥ| bastau vr̥ṣaṇayōrvā'pi sīvanyāṁ vaṅkṣaṇēṣu ca||172|| kadācitpicchilō vā'pi pāṇḍuḥ srāvaśca jāyatē| śvayathurjāyatē mandaḥ stimitō'lpaparisravaḥ||173|| cirācca pākaṁ vrajati śīghraṁ vā'tha pramucyatē| jāyantē krimayaścāpi klidyatē pūtigandhi ca||174|| viśīryatē maṇiścāsya mēḍhraṁ muṣkāvathāpi ca| dhvajabhaṅgakr̥taṁ klaibyamityētat samudāhr̥tam||175|| ētaṁ [5] pañcavidhaṁ kēciddhvajabhaṅgaṁ pracakṣatē|176|

... dhvajabha~ggakRutaM shRuNu ||162|| 

atyamlalavaNakShAraviruddhAsAtmyabhojanAt | atyambupAnAdviShamAt piShTAnnagurubhojanAt ||163|| dadhikShIrAnUpamAMsasevanAdvyAdhikarShaNAt | kanyAnAM caiva gamanAdayonigamanAdapi ||164|| dIrgharogAM [1] cirotsRuShTAM tathaiva ca rajasvalAm | durgandhAM duShTayoniM ca tathaiva ca parisrutAm [2] ||165|| IdRushIM pramadAM mohAdyo gacchet kAmaharShitaH | catuShpadAbhigamanAcchephasashcAbhighAtataH ||166|| adhAvanAdvA meDhrasya shastradantanakhakShatAt | kAShThaprahAraniShpeShAcchUkAnAM cAtisevanAt ||167|| retasashca pratIghAtAddhvajabha~ggaH pravartate | (bhavanti [3] yAni rUpANi tasya vakShyAmyataH param) | shvayathurvedanA meDhre rAgashcaivopalakShyate ||168|| sphoTAshca tIvrA jAyante li~ggapAko bhavatyapi | mAMsavRuddhirbhaveccAsya vraNAH kShipraM bhavantyapi ||169|| pulAkodakasa~gkAshaH srAvaH shyAvAruNaprabhaH | valayIkurute [4] cApi kaThinashca parigrahaH ||170|| jvarastRuShNA bhramo mUrcchA cchardishcAsyopajAyate | raktaM kRuShNaM sraveccApi nIlamAvilalohitam ||171|| agnineva ca dagdhasya tIvro dAhaH savedanaH | bastau vRuShaNayorvA~api sIvanyAM va~gkShaNeShu ca ||172|| kadAcitpicchilo vA~api pANDuH srAvashca jAyate | shvayathurjAyate mandaH stimito~alpaparisravaH ||173|| cirAcca pAkaM vrajati shIghraM vA~atha pramucyate | jAyante krimayashcApi klidyate pUtigandhi ca ||174|| vishIryate maNishcAsya meDhraM muShkAvathApi ca | dhvajabha~ggakRutaM klaibyamityetat samudAhRutam ||175|| etaM [5] pa~jcavidhaM keciddhvajabha~ggaM pracakShate |176| Lets us understand (the impotency) due to erectile dysfunction. Intake of excess sour, salty, kshara (alkaline), incompatible and unsuitable food, drinking excess water, irregular meals, intake of floury & heavy preparations, use of curd, milk, meat of marshy animals, emaciation after the diseases, coitus with female child, other than vaginal coitus, cohabitation of with female with chronic illness, who is menstruating, with foul odor, with vaginal disorders, and excessive vaginal discharge leads to the impotency due to the erectile dysfunction. The kind of coitus out of exhilaration with young females, with quadrupeds, injury to phallus, no cleansing of penis, wounds on penis due to sharp instruments, teeth, nails, or strikes by wood stick, pressing, excess use of awry insects and holding back the virile semen leads to to the impotency due to the erectile dysfunction. Let’s understand the rupa (characteristics) of it— Swelling, pain, & redness at the penis, appearance of severe boils, lingapaka (penile inflammation), abnormal growth of mamsa (warts), wounds occur instantaneously. Further, appearance of watery discharge like pulaka (rice), or blackish or reddish in color, ring formation, hardening of penile circumference; fever, excess thirst, giddiness, fainting, vomiting occurs. Reddish, blackish, bluish or voilet discharge occurs with intense burning sensation & pain at bladder, scrotum, seevani(frenum of the prepuce) and inguinal region. Perhaps there is slimy, pale discharge, mild swelling, with moist feeling and scanty discharge.(163-175) It may take time to suppurate or may subside quickly or may get infected with parasites; it becomes moist and has foul odour. The glans penis is necrosed or even the whole phallus and scrotum may slough out. This is description of the impotency due to erectile dysfunction. Some (other authors) consider five types of the same. (174-175) Jarasambhavajaja klaibya (impotency due to senility):

क्लैब्यं जरासम्भवं हि प्रवक्ष्याम्यथ तच्छृणु ||१७६|| जघन्यमध्यप्रवरं वयस्त्रिविधमुच्यते | अतिप्रवयसां शुक्रं प्रायशः क्षीयते नृणाम् ||१७७|| रसादीनां सङ्क्षयाच्च तथैवावृष्यसेवनात् | बलवीर्येन्द्रियाणां च क्रमेणैव परिक्षयात् ||१७८|| परिक्षयादायुषश्चाप्यनाहाराच्छ्रमात् क्लमात् | जरासम्भवजं क्लैब्यमित्येतैर्हेतुभिर्नृणाम् ||१७९|| जायते तेन सोऽत्यर्थं क्षीणधातुः सुदुर्बलः | विवर्णो दुर्बलो दीनः क्षिप्रं व्याधिमथाश्नुते ||१८०|| एतज्जरासम्भवं हि ... |१८१| klaibyaṁ jarāsambhavaṁ hi pravakṣyāmyatha tacchr̥ṇu||176|| jaghanyamadhyapravaraṁ vayastrividhamucyatē| atipravayasāṁ śukraṁ prāyaśaḥ kṣīyatē nr̥ṇām||177|| rasādīnāṁ saṅkṣayācca tathaivāvr̥ṣyasēvanāt| balavīryēndriyāṇāṁ ca kramēṇaiva parikṣayāt||178|| parikṣayādāyuṣaścāpyanāhārācchramāt klamāt| jarāsambhavajaṁ klaibyamityētairhētubhirnr̥ṇām||179|| jāyatē tēna sō'tyarthaṁ kṣīṇadhātuḥ sudurbalaḥ| vivarṇō durbalō dīnaḥ kṣipraṁ vyādhimathāśnutē||180|| ētajjarāsambhavaṁ hi ...|181| klaibyaM jarAsambhavaM hi pravakShyAmyatha tacchRuNu ||176|| jaghanyamadhyapravaraM vayastrividhamucyate | atipravayasAM shukraM prAyashaH kShIyate nRuNAm ||177|| rasAdInAM sa~gkShayAcca tathaivAvRuShyasevanAt | balavIryendriyANAM ca krameNaiva parikShayAt ||178|| parikShayAdAyuShashcApyanAhArAcchramAt klamAt | jarAsambhavajaM klaibyamityetairhetubhirnRuNAm ||179|| jAyate tena so~atyarthaM kShINadhAtuH sudurbalaH | vivarNo durbalo dInaH kShipraM vyAdhimathAshnute ||180|| etajjarAsambhavaM hi ... |181| The impotency due to senility is being described here for understanding… Age has been categorized in three groups – jaghanya (early), madhya (middle) and pravar (elder) age group. Generally, lesser semen is in elderly person due to deficiency of rasadi dhatu, consumption of avrushya (non-aphrodisiac) food, gradual loss of strength, energy and sensory-motor organs, reducing life span, malnutrition, physical exertion & mental exhaustion leads to senility related impotency. Eventually, the person keeps on aging with deep debility of dhatus, weakness, loss of complexion, with poor energy, easily caught by the diseases. This is the impotency due to senility.(176-180) Kshayaja klaibya (impotency due to deficiency of dhatu): ... चतुर्थं क्षयजं शृणु | अतीव चिन्तनाच्चैव शोकात्क्रोधाद्भयात्तथा ||१८१|| ईर्ष्योत्कण्ठामदोद्वेगान् [१] सदा विशति यो नरः | कृशो वा सेवते रूक्षमन्नपानं तथौषधम् ||१८२|| दुर्बलप्रकृतिश्चैव निराहारो भवेद्यदि | असात्म्यभोजनाच्चापि [२] हृदये यो व्यवस्थितः ||१८३|| रसः प्रधानधातुर्हि क्षीयेताशु ततो नृणाम् | रक्तादयश्च क्षीयन्ते धातवस्तस्य देहिनः ||१८४|| शुक्रावसानास्तेभ्योऽपि शुक्रं धाम परं मतम् | चेतसो वाऽतिहर्षेण व्यवायं सेवतेऽति यः ||१८५|| तस्याशु क्षीयते शुक्रं ततः प्राप्नोति सङ्क्षयम् | घोरं व्याधिमवाप्नोति मरणं वा स गच्छति ||१८६|| शुक्रं तस्माद्विशेषेण रक्ष्यमारोग्यमिच्छता | एवं निदानलिङ्गाभ्यामुक्तं क्लैब्यं चतुर्विधम् ||१८७|| केचित् क्लैब्ये त्वसाध्ये द्वे ध्वजभङ्गक्षयोद्भवे | वदन्ति शेफसश्छेदाद्वृषणोत्पाटनेन च ||१८८|| मातापित्रोर्बीजदोषादशुभैश्चाकृतात्मनः | गर्भस्थस्य यदा दोषाः प्राप्य रेतोवहाःसिराः ||१८९|| शोषयन्त्याशु तन्नाशाद्रेतश्चाप्युपहन्यते | तत्र सम्पूर्णसर्वाङ्गः स भवत्यपुमान् पुमान् ||१९०|| एते त्वसाध्या व्याख्याताः सन्निपातसमुच्छ्रयात् |१९१| ... caturthaṁ kṣayajaṁ śr̥ṇu| atīva cintanāccaiva śōkātkrōdhādbhayāttathā||181|| īrṣyōtkaṇṭhāmadōdvēgān [1] sadā viśati yō naraḥ| kr̥śō vā sēvatē rūkṣamannapānaṁ tathauṣadham||182|| durbalaprakr̥tiścaiva nirāhārō bhavēdyadi| asātmyabhōjanāccāpi [2] hr̥dayē yō vyavasthitaḥ||183|| rasaḥ pradhānadhāturhi kṣīyētāśu tatō nr̥ṇām| raktādayaśca kṣīyantē dhātavastasya dēhinaḥ||184|| śukrāvasānāstēbhyō'pi śukraṁ dhāma paraṁ matam| cētasō vā'tiharṣēṇa vyavāyaṁ sēvatē'ti yaḥ||185|| tasyāśu kṣīyatē śukraṁ tataḥ prāpnōti saṅkṣayam| ghōraṁ vyādhimavāpnōti maraṇaṁ vā sa gacchati||186|| śukraṁ tasmādviśēṣēṇa rakṣyamārōgyamicchatā| ēvaṁ nidānaliṅgābhyāmuktaṁ klaibyaṁ caturvidham||187|| kēcit klaibyē tvasādhyē dvē dhvajabhaṅgakṣayōdbhavē| vadanti śēphasaśchēdādvr̥ṣaṇōtpāṭanēna ca||188|| mātāpitrōrbījadōṣādaśubhaiścākr̥tātmanaḥ| garbhasthasya yadā dōṣāḥ prāpya rētōvahāḥsirāḥ||189|| śōṣayantyāśu tannāśādrētaścāpyupahanyatē| tatra sampūrṇasarvāṅgaḥ sa bhavatyapumān pumān||190|| ētē tvasādhyā vyākhyātāḥ sannipātasamucchrayāt|191|

... caturthaM kShayajaM shRuNu | 

atIva cintanAccaiva shokAtkrodhAdbhayAttathA ||181|| IrShyotkaNThAmadodvegAn [1] sadA vishati yo naraH | kRusho vA sevate rUkShamannapAnaM tathauShadham ||182|| durbalaprakRutishcaiva nirAhAro bhavedyadi | asAtmyabhojanAccApi [2] hRudaye yo vyavasthitaH ||183|| rasaH pradhAnadhAturhi kShIyetAshu tato nRuNAm | raktAdayashca kShIyante dhAtavastasya dehinaH ||184|| shukrAvasAnAstebhyo~api shukraM dhAma paraM matam | cetaso vA~atiharSheNa vyavAyaM sevate~ati yaH ||185|| tasyAshu kShIyate shukraM tataH prApnoti sa~gkShayam | ghoraM vyAdhimavApnoti maraNaM vA sa gacchati ||186|| shukraM tasmAdvisheSheNa rakShyamArogyamicchatA | evaM nidAnali~ggAbhyAmuktaM klaibyaM caturvidham ||187|| kecit klaibye tvasAdhye dve dhvajabha~ggakShayodbhave | vadanti shephasashchedAdvRuShaNotpATanena ca ||188|| mAtApitrorbIjadoShAdashubhaishcAkRutAtmanaH | garbhasthasya yadA doShAH prApya retovahAHsirAH ||189|| shoShayantyAshu tannAshAdretashcApyupahanyate | tatra sampUrNasarvA~ggaH sa bhavatyapumAn pumAn ||190|| ete tvasAdhyA vyAkhyAtAH sannipAtasamucchrayAt |191| Let’s understand fourth (type) is kshayaja (due to deficiency)— Excess stress, grief, rage, apprehension, envy, curiosity, intoxication, & agitation; emaciated, regular consumer of arid food and medicines, fasting by the debilitated & scanty intake of food, leads diminished rasa at hrudaya. The principal dhatus diminish rapidly resulting in deficiency of rakatadi dhatu (sequentially) in the person; till it affects shukra dhatu. Shukra dhatu is the superior among all the dhatus. In case the person indulges in coitus due to over exhilaration of mind, it leads to immediate loss of semen causing overall kshaya; which may further cause serious illness or death. Therefore shukra (semen) shall be conserved especially for those willing to conserve the health. Thus four types of the impotency have been described with the etiology and symptomatology. As per some other opinion, the two types of impotency, erectile dysfunction and kshayaja are incurable, also by penilectomy and orchidectomy. Doshas due to beejadosha (genetic defects) of parents and ominous past conduct when penetrate into the virile semen system, it causes destruction of virile semen, leading to an impotent man even after endowment of complete organs. These are known as incurable due to provocation of sannipata (aggravation of all three dosha) .(181-191) Management of klaibya (impotency): चिकित्सितमतस्तूर्ध्वं समासव्यासतः शृणु ||१९१|| शुक्रदोषेषु निर्दिष्टं भेषजं यन्मयाऽनघ! | क्लैब्योपशान्तये कुर्यात् क्षीणक्षतहितं च यत् ||१९२|| बस्तयः क्षीरसर्पींषि वृष्ययोगाश्च ये मताः | रसायनप्रयोगाश्च सर्वानेतान् प्रयोजयेत् ||१९३|| समीक्ष्य देहदोषाग्निबलं भेषजकालवित् | व्यवायहेतुजे क्लैब्ये तथा धातुविपर्ययात् [१] ||१९४|| दैवव्यपाश्रयं चैव भेषजं चाभिचारजे [२] | समासेनैतदुद्दिष्टं भेषजं क्लैब्यशान्तये ||१९५|| cikitsitamatastūrdhvaṁ samāsavyāsataḥ śr̥ṇu||191|| śukradōṣēṣu nirdiṣṭaṁ bhēṣajaṁ yanmayā'nagha!| klaibyōpaśāntayē kuryāt kṣīṇakṣatahitaṁ ca yat||192|| bastayaḥ kṣīrasarpīṁṣi vr̥ṣyayōgāśca yē matāḥ| rasāyanaprayōgāśca sarvānētān prayōjayēt||193|| samīkṣya dēhadōṣāgnibalaṁ bhēṣajakālavit| vyavāyahētujē klaibyē tathā dhātuviparyayāt [1] ||194|| daivavyapāśrayaṁ caiva bhēṣajaṁ cābhicārajē [2] | samāsēnaitaduddiṣṭaṁ bhēṣajaṁ klaibyaśāntayē||195||

cikitsitamatastUrdhvaM samAsavyAsataH shRuNu ||191|| 

shukradoSheShu nirdiShTaM bheShajaM yanmayA~anagha! | klaibyopashAntaye kuryAt kShINakShatahitaM ca yat ||192|| bastayaH kShIrasarpIMShi vRuShyayogAshca ye matAH | rasAyanaprayogAshca sarvAnetAn prayojayet ||193|| samIkShya dehadoShAgnibalaM bheShajakAlavit | vyavAyahetuje klaibye tathA dhAtuviparyayAt [1] ||194|| daivavyapAshrayaM caiva bheShajaM cAbhicAraje [2] | samAsenaitaduddiShTaM bheShajaM klaibyashAntaye ||195|| Let’s understand general and specific treatments of above mentioned (diseases)— Whatever remedy mentioned by me for the shukra (semen) disorders as well as the remedy beneficial for the kshataksheena shall be applied for the alleviation of impotency. Indications are basti, ksheera-sarpi (combination of milk and ghee), vrushya yoga (aphrodisiac), & rasayana prayoga (rejuvenating medicines); all together shall be administered here for the treatment of impotency, caused by excess coitus, dhatu viparyaya (opposite qualities of body tissues), considering deha-bala (strength of the patient), dosha–bala (degree of dosha vitiation), agni-bala (power of agni) & bheshaj-kala (time of medicine administration). Daivavyapashrya (spiritual) treatment modalities indicated in the impotency caused by exorcism. Altogether is the objective to alleviate the impotency.(192-195) विस्तरेण प्रवक्ष्यामि क्लैब्यानां भेषजं पुनः | सुस्विन्नस्निग्धगात्रस्य स्नेहयुक्तं विरेचनम् ||१९६|| अन्नाशनं ततः कुर्यादथवाऽऽस्थापनं पुनः | प्रदद्यान्मतिमान् वैद्यस्ततस्तमनुवासयेत् ||१९७|| पलाशैरण्डमुस्ताद्यैः पश्चादास्थापयेत्ततः | वाजीकरणयोगाश्च पूर्वं ये समुदाहृताः ||१९८|| भिषजा ते प्रयोज्याः स्युः क्लैब्ये बीजोपघातजे | ध्वजभङ्गकृतं क्लैब्यं ज्ञात्वा तस्याचरेत् क्रियाम् ||१९९|| प्रदेहान् परिषेकांश्च कुर्याद्वा रक्तमोक्षणम् | स्नेहपानं च कुर्वीत सस्नेहं च विरेचनम् ||२००|| अनुवासं [१] ततः कुर्यादथवाऽऽस्थापनं पुनः | व्रणवच्च क्रियाः सर्वास्तत्र कुर्याद्विचक्षणः ||२०१|| जरासम्भवजे क्लैब्ये क्षयजे चैव कारयेत् | स्नेहस्वेदोपपन्नस्य सस्नेहं शोधनं हितम् ||२०२|| क्षीरसर्पिर्वृष्ययोगा बस्तयश्चैव यापनाः | रसायनप्रयोगाश्च तयोर्भेषजमुच्यते ||२०३|| विस्तरेणैतदुद्दिष्टं क्लैब्यानां भेषजं मया |२०४| vistarēṇa pravakṣyāmi klaibyānāṁ bhēṣajaṁ punaḥ| susvinnasnigdhagātrasya snēhayuktaṁ virēcanam||196|| annāśanaṁ tataḥ kuryādathavāsthāpanaṁ punaḥ| pradadyānmatimān vaidyastatastamanuvāsayēt||197|| palāśairaṇḍamustādyaiḥ paścādāsthāpayēttataḥ| vājīkaraṇayōgāśca pūrvaṁ yē samudāhr̥tāḥ||198|| bhiṣajā tē prayōjyāḥ syuḥ klaibyē bījōpaghātajē| dhvajabhaṅgakr̥taṁ klaibyaṁ jñātvā tasyācarēt kriyām||199|| pradēhān pariṣēkāṁśca kuryādvā raktamōkṣaṇam| snēhapānaṁ ca kurvīta sasnēhaṁ ca virēcanam||200|| anuvāsaṁ [1] tataḥ kuryādathavāsthāpanaṁ punaḥ| vraṇavacca kriyāḥ sarvāstatra kuryādvicakṣaṇaḥ||201|| jarāsambhavajē klaibyē kṣayajē caiva kārayēt| snēhasvēdōpapannasya sasnēhaṁ śōdhanaṁ hitam||202|| kṣīrasarpirvr̥ṣyayōgā bastayaścaiva yāpanāḥ| rasāyanaprayōgāśca tayōrbhēṣajamucyatē||203|| vistarēṇaitaduddiṣṭaṁ klaibyānāṁ bhēṣajaṁ mayā|204| vistareNa pravakShyAmi klaibyAnAM bheShajaM punaH | susvinnasnigdhagAtrasya snehayuktaM virecanam ||196|| annAshanaM tataH kuryAdathavA~a~asthApanaM punaH | pradadyAnmatimAn vaidyastatastamanuvAsayet ||197|| palAshairaNDamustAdyaiH pashcAdAsthApayettataH | vAjIkaraNayogAshca pUrvaM ye samudAhRutAH ||198|| bhiShajA te prayojyAH syuH klaibye bIjopaghAtaje | dhvajabha~ggakRutaM klaibyaM j~jAtvA tasyAcaret kriyAm ||199|| pradehAn pariShekAMshca kuryAdvA raktamokShaNam | snehapAnaM ca kurvIta sasnehaM ca virecanam ||200|| anuvAsaM [1] tataH kuryAdathavA~a~asthApanaM punaH | vraNavacca kriyAH sarvAstatra kuryAdvicakShaNaH ||201|| jarAsambhavaje klaibye kShayaje caiva kArayet | snehasvedopapannasya sasnehaM shodhanaM hitam ||202|| kShIrasarpirvRuShyayogA bastayashcaiva yApanAH | rasAyanaprayogAshca tayorbheShajamucyate ||203|| vistareNaitaduddiShTaM klaibyAnAM bheShajaM mayA |204| The treatment of the impotency is being redescribed in detail. Snhehan and swedana shall be done in the patient of impotency; along with the unctuous therapeutic purgation. After that either the patient shall be nourished or asthapana basti shall be given by the sound physician followed by the anuvasana basti. Asthapana basti shall be given with palasha (Butea sp), erandmoola (Ricinus root), musta (Cyprus rotundus) etc. The aphrodiasiac remedies mentioned earlier shall be used in impotency due to beejopaghata. The impotency due to erectile dysfunction shall be treated with pradeha and parisheka or snhehapana, blood letting (raktamokshana) and therapeutic induction of purgation with unctuous medications. After virechana that is therapeutic purgation asthapana or anuvasana basti shall be administered and the treatment shall be planned similar to the treatment of wounds (vrana) in erectile dysfunction. Impotency secondary to the aging shall be treated as the kshayaja with snhehana, swedana and unctuous purification therapies. Cow milk, ghee, and aphrodisiac formulations aling with yapana basti, rasayana treatment are the remedies illustrated as the remedy for the impotency.(196-204) Asrigadara (menorrhagia): यः पूर्वमुक्तः प्रदरः शृणु हेत्वादिभिस्तु तम् ||२०४|| याऽत्यर्थं सेवते नारी लवणाम्लगुरूणि च | कटून्यथ विदाहीनि स्निग्धानि पिशितानि च ||२०५|| ग्राम्यौदकानि मेद्यानि कृशरां पायसं दधि [१] | शुक्तमस्तुसुरादीनि भजन्त्याः कुपितोऽनिलः ||२०६|| रक्तं [२] प्रमाणमुत्क्रम्य गर्भाशयगताः सिराः | रजोवहाः समाश्रित्य रक्तमादाय तद्रजः ||२०७|| यस्माद्विवर्धयत्याशु रसभावाद्विमानता [३] | तस्मादसृग्दरं प्राहुरेतत्तन्त्रविशारदाः ||२०८|| रजः प्रदीर्यते यस्मात् प्रदरस्तेन स स्मृतः | सामान्यतः समुद्दिष्टं कारणं लिङ्गमेव च ||२०९|| yaḥ pūrvamuktaḥ pradaraḥ śr̥ṇu hētvādibhistu tam||204|| yā'tyarthaṁ sēvatē nārī lavaṇāmlagurūṇi ca| kaṭūnyatha vidāhīni snigdhāni piśitāni ca||205|| grāmyaudakāni mēdyāni kr̥śarāṁ pāyasaṁ dadhi [1] | śuktamastusurādīni bhajantyāḥ kupitō'nilaḥ||206|| raktaṁ [2] pramāṇamutkramya garbhāśayagatāḥ sirāḥ| rajōvahāḥ samāśritya raktamādāya tadrajaḥ||207|| yasmādvivardhayatyāśu rasabhāvādvimānatā [3] | tasmādasr̥gdaraṁ prāhurētattantraviśāradāḥ||208|| rajaḥ pradīryatē yasmāt pradarastēna sa smr̥taḥ| sāmānyataḥ samuddiṣṭaṁ kāraṇaṁ liṅgamēva ca||209||

yaH pUrvamuktaH pradaraH shRuNu hetvAdibhistu tam ||204|| yA~atyarthaM sevate nArI lavaNAmlagurUNi ca | kaTUnyatha vidAhIni snigdhAni pishitAni ca ||205|| grAmyaudakAni medyAni kRusharAM pAyasaM dadhi [1] | shuktamastusurAdIni bhajantyAH kupito~anilaH ||206|| raktaM [2] pramANamutkramya garbhAshayagatAH sirAH | rajovahAH samAshritya raktamAdAya tadrajaH ||207|| yasmAdvivardhayatyAshu rasabhAvAdvimAnatA [3] | tasmAdasRugdaraM prAhuretattantravishAradAH ||208|| rajaH pradIryate yasmAt pradarastena sa smRutaH | sAmAnyataH samuddiShTaM kAraNaM li~ggameva ca ||209||

Now listen about the pradara (menorrhagia) which has been mentioned earlier with its etiology etc. The woman who consumes excessive salty, sour, food heavy to digest, bitter, pungent, fatty diets, meat of domestic and aquatic animals, cooked rice with pulse (krishira), rice cooked with milk (payasa), curd, vinegar (shukta), curd water, alcohol etc. causes vata dosha vitiation along with vitiated rakta (because of above factors) increases its amount and such increased rakta stays in the artava vaha strotas and hence immediately increases the menstrual blood. The increased raja is by virtue of mixture with increased rakta. The erudite (experts) named it as ‘Asrigdara’ and because of excessive flow of menstrual blood it is called pradara (menorrhagia). The general causes and symptoms of pradara are directed here. (204-209) Four types of pradara: चतुर्विधं व्यासतस्तु वाताद्यैः सन्निपाततः | अतःपरं प्रवक्ष्यामि हेत्वाकृतिभिषग्जितम् ||२१०|| caturvidhaṁ vyāsatastu vātādyaiḥ sannipātataḥ| ataḥparaṁ pravakṣyāmi hētvākr̥tibhiṣagjitam||210||

caturvidhaM vyAsatastu vAtAdyaiH sannipAtataH | ataHparaM pravakShyAmi hetvAkRutibhiShagjitam ||210||

By description, Pradara is classified in for types. Three by single dosha (vataja, pittaja, kaphaja) and the fourth type is by all three doshas (sannipataja). After this, I am describing the causes, symptoms and treatment of pradara roga. (210) Vata dominant pradara: रूक्षादिभिर्मारुतस्तु रक्तमादाय पूर्ववत् | कुपितः प्रदरं कुर्याल्लक्षणं तस्य मे शृणु ||२११|| फेनिलं तनु रूक्षं च श्यावं चारुणमेव च | किंशुकोदकसङ्काशं सरुजं वाऽथ नीरुजम् ||२१२|| कटिवङ्क्षणहृत्पार्श्वपृष्ठश्रोणिषु मारुतः | कुरुते वेदनां तीव्रामेतद्वातात्मकं विदुः ||२१३|| rūkṣādibhirmārutastu raktamādāya pūrvavat| kupitaḥ pradaraṁ kuryāllakṣaṇaṁ tasya mē śr̥ṇu||211|| phēnilaṁ tanu rūkṣaṁ ca śyāvaṁ cāruṇamēva ca| kiṁśukōdakasaṅkāśaṁ sarujaṁ vā'tha nīrujam||212|| kaṭivaṅkṣaṇahr̥tpārśvapr̥ṣṭhaśrōṇiṣu mārutaḥ| kurutē vēdanāṁ tīvrāmētadvātātmakaṁ viduḥ||213||

rUkShAdibhirmArutastu raktamAdAya pUrvavat | kupitaH pradaraM kuryAllakShaNaM tasya me shRuNu ||211|| kiMshukodakasa~gkAshaM sarujaM vA~atha nIrujam ||212|| kaTiva~gkShaNahRutpArshvapRuShThashroNiShu mArutaH | kurute vedanAM tIvrAmetadvAtAtmakaM viduH ||213||

The vitiated vayu due to intake of rough diet, along with rakta (blood) causes pradara roga as aforesaid etiology . Now listen to the symptoms of pradara. The menstrual blood is frothy, thin, rough, dark (blackish), reddish, resembling water of palash flower in colour, comes with or without pain. During menstruation, intense pain occurs in waist, groin, cardiac region, back, flanks and pelvic region this should be known as vataja pradara. (211-213) Pitta dominant pradara: अम्लोष्णलवणक्षारैः पित्तं प्रकुपितं यदा | पूर्ववत् प्रदरं कुर्यात् पैत्तिकं लिङ्गतः शृणु ||२१४|| सनीलमथवा पीतमत्युष्णमसितं तथा | नितान्तरक्तं स्रवति मुहुर्मुहुरथार्तिमत् ||२१५|| दाहरागतृषामोहज्वरभ्रमसमायुतम् | असृग्दरं पैत्तिकं स्याच्छ्लैष्मिकं तु प्रवक्ष्यते ||२१६|| amlōṣṇalavaṇakṣāraiḥ pittaṁ prakupitaṁ yadā| pūrvavat pradaraṁ kuryāt paittikaṁ liṅgataḥ śr̥ṇu||214|| sanīlamathavā pītamatyuṣṇamasitaṁ tathā| nitāntaraktaṁ sravati muhurmuhurathārtimat||215|| dāharāgatr̥ṣāmōhajvarabhramasamāyutam| asr̥gdaraṁ paittikaṁ syācchlaiṣmikaṁ tu pravakṣyatē||216||

amloShNalavaNakShAraiH pittaM prakupitaM yadA | pUrvavat pradaraM kuryAt paittikaM li~ggataH shRuNu ||214|| sanIlamathavA pItamatyuShNamasitaM tathA | nitAntaraktaM sravati muhurmuhurathArtimat ||215|| dAharAgatRuShAmohajvarabhramasamAyutam | asRugdaraM paittikaM syAcchlaiShmikaM tu pravakShyate ||216||

Pitta is aggravated by intake of sour, hot, salty things in excess, causes the pradara like aforesaid etiology. After this, listen about the symptoms of pittaja pradara. The menstrual blood is bluish, yellow or blackish in colour, very hot, and it is discharged in profuse amount frequently with pain, burning, redness, thirst, mental confusion, fever and dizziness, it is known as pittaja pradara. Now kaphaja pradara will be described. (214-216) Kapha dominant pradara: गुर्वादिभिर्हेतुभिश्च पूर्ववत् कुपितः कफः | प्रदरं कुरुते तस्य लक्षणं तत्त्वतः शृणु ||२१७|| पिच्छिलं पाण्डुवर्णं च गुरु स्निग्धं च शीतलम् | स्रवत्यसृक् श्लेष्मलं च घनं मन्दरुजाकरम् ||२१८|| छर्द्यरोचकहृल्लासश्वासकाससमन्वितम् | (वक्ष्यते [४] क्षीरदोषाणां सामान्यमिह कारणम् ||२१९|| यत्तदेव त्रिदोषस्य कारणं प्रदरस्य तु | ) gurvādibhirhētubhiśca pūrvavat kupitaḥ kaphaḥ| pradaraṁ kurutē tasya lakṣaṇaṁ tattvataḥ śr̥ṇu||217|| picchilaṁ pāṇḍuvarṇaṁ ca guru snigdhaṁ ca śītalam| sravatyasr̥k ślēṣmalaṁ ca ghanaṁ mandarujākaram||218|| chardyarōcakahr̥llāsaśvāsakāsasamanvitam| (vakṣyatē [4] kṣīradōṣāṇāṁ sāmānyamiha kāraṇam||219|| yattadēva tridōṣasya kāraṇaṁ pradarasya tu)|

gurvAdibhirhetubhishca pUrvavat kupitaH kaphaH | pradaraM kurute tasya lakShaNaM tattvataH shRuNu ||217|| picchilaM pANDuvarNaM ca guru snigdhaM ca shItalam | sravatyasRuk shleShmalaM ca ghanaM mandarujAkaram ||218|| chardyarocakahRullAsashvAsakAsasamanvitam | (vakShyate [4] kShIradoShANAM sAmAnyamiha kAraNam ||219|| yattadeva tridoShasya kAraNaM pradarasya tu | )

The vitiated kapha due to intake of heavy food or diet causes the pradara like condition and listen the exact symptoms of it. The menstrual blood flows out as greasy (slimy), pale, heavy, unctuous, cold, mixed with kapha, viscous and with mild pain. It is associated with vomiting, loss of appetite, alacrity or nausea, breathlessness and cough. (Further the general causes of vitiated milk will be described which are the causes of tridoshaja pradara). (217-219) Sannipataja Pradara: त्रिलिङ्गसंयुतं विद्यान्नैकावस्थमसृग्दरम् ||२२०|| नारी त्वतिपरिक्लिष्टा यदा प्रक्षीणशोणिता | सर्वहेतुसमाचारादतिवृद्धस्तदाऽनिलः ||२२१|| रक्तमार्गेण सृजति प्रत्यनीकबलं [५] कफम् | दुर्गन्धं पिच्छिलं पीतं विदग्धं पित्ततेजसा ||२२२|| वसां मेदश्च यावद्धि समुपादाय वेगवान् | सृजत्यपत्यमार्गेण सर्पिर्मज्जवसोपमम् ||२२३||

triliṅgasaṁyutaṁ vidyānnaikāvasthamasr̥gdaram||220|| nārī tvatiparikliṣṭā yadā prakṣīṇaśōṇitā| sarvahētusamācārādativr̥ddhastadā'nilaḥ||221|| raktamārgēṇa sr̥jati pratyanīkabalaṁ [5] kapham| durgandhaṁ picchilaṁ pītaṁ vidagdhaṁ pittatējasā||222|| vasāṁ mēdaśca yāvaddhi samupādāya vēgavān| sr̥jatyapatyamārgēṇa sarpirmajjavasōpamam||223||

trili~ggasaMyutaM vidyAnnaikAvasthamasRugdaram ||220|| nArI tvatiparikliShTA yadA prakShINashoNitA | sarvahetusamAcArAdativRuddhastadA~anilaH ||221|| raktamArgeNa sRujati pratyanIkabalaM [5] kapham | durgandhaM picchilaM pItaM vidagdhaM pittatejasA ||222|| vasAM medashca yAvaddhi samupAdAya vegavAn | sRujatyapatyamArgeNa sarpirmajjavasopamam ||223||

If the different symptoms which are mentioned for vata, pitta and kapha are present collectively then it is said to be sannipataja pradara. When a women who is severely ill and anaemic is indulged in consuming diet capable of aggravating all doshas, the intensely aggravated vayu due to use of all etiological factors, pushes out the kapha, responsible for discharge from the vagina which is foul smelling, slimy and yellow due to burning with the heat of pitta. Along with this, the yoni also expels with force the muscle and fat, burnt with pitta hence resembling like marrow and blood or ghrita. (220-223) Signs of incurability in pradara: शश्वत् स्रवत्यथास्रावं तृष्णादाहज्वरान्विताम् | क्षीणरक्तां दुर्बलां स तामसाध्यां विवर्जयेत् ||२२४|| śaśvat sravatyathāsrāvaṁ tr̥ṣṇādāhajvarānvitām| kṣīṇaraktāṁ durbalāṁ sa tāmasādhyāṁ vivarjayēt||224|| shashvat sravatyathAsrAvaM tRuShNAdAhajvarAnvitAm | kShINaraktAM durbalAM sa tAmasAdhyAM vivarjayet ||224|| If there is continuous discharge from the vagina of woman and associated with thirst, burning sensation and fever and if she is anaemic and weak then her pradara roga is incurable, and it should not be treated. (224) Characteristics of normal menstruation: मासान्निष्पिच्छदाहार्ति पञ्चरात्रानुबन्धि च | नैवातिबहु नात्यल्पमार्तवं शुद्धमादिशेत् ||२२५|| गुञ्जाफलसवर्णं च पद्मालक्तकसन्निभम् [१] | इन्द्रगोपकसङ्काशमार्तवं शुद्धमादिशेत् ||२२६|| māsānniṣpicchadāhārti pañcarātrānubandhi ca| naivātibahu nātyalpamārtavaṁ śuddhamādiśēt||225|| guñjāphalasavarṇaṁ ca padmālaktakasannibham [1] | indragōpakasaṅkāśamārtavaṁ śuddhamādiśēt||226|| mAsAnniShpicchadAhArti pa~jcarAtrAnubandhi ca | naivAtibahu nAtyalpamArtavaM shuddhamAdishet ||225|| gu~jjAphalasavarNaM ca padmAlaktakasannibham [1] | indragopakasa~gkAshamArtavaM shuddhamAdishet ||226||

If menstrual discharge (artava) comes after a month without stickiness (sliminess), burning sensation and pain, persists for five days, neither too little nor excess in quantity then it is considered as free from doshas or normal. In colour, artava (menstrual blood) should be red like gunja fruit, red lotus flower or mahavara or red as indragopaka insect, such artava is considered as normal menstrual blood. (225-226) Treatment of pradara: योनीनां वातलाद्यानां यदुक्तमिह भेषजम् | चतुर्णां प्रदराणां च तत् सर्वं कारयेद्भिषक् ||२२७|| yōnīnāṁ vātalādyānāṁ yaduktamiha bhēṣajam| caturṇāṁ pradarāṇāṁ ca tat sarvaṁ kārayēdbhiṣak||227||

yonInAM vAtalAdyAnAM yaduktamiha bheShajam | caturNAM pradarANAM ca tat sarvaM kArayedbhiShak ||227|| The treatment of vatala and other yonivyapad which has been mentioned earlier in this chapter, should also be administered all four types of pradara roga respectively.(227) रक्तातिसारिणां यच्च तथा शोणितपित्तिनाम् | रक्तार्शसां च यत् प्रोक्तं भेषजं तच्च कारयेत् ||२२८|| raktātisāriṇāṁ yacca tathā śōṇitapittinām| raktārśasāṁ ca yat prōktaṁ bhēṣajaṁ tacca kārayēt||228||

raktAtisAriNAM yacca tathA shoNitapittinAm | raktArshasAM ca yat proktaM bheShajaM tacca kArayet ||228|| The treatment which is advised for raktatisara (diarrhoea with expulsion of blood), raktapitta (internal haemorrhage) and raktarsha (bleeding piles) should be administered in pradara roga.(228) Stanya dushti (abnormalities of breast milk and lactation): धात्रीस्तनस्तन्यसम्पदुक्ता विस्तरतः पुरा | स्तन्यसञ्जननं चैव स्तन्यस्य च विशोधनम् ||२२९|| वातादिदुष्टे लिङ्गं च क्षीणस्य च चिकित्सितम् | तत्सर्वमुक्तं ये त्वष्टौ क्षीरदोषाः प्रकीर्तिताः ||२३०|| वातादिष्वेव तान् विद्याच्छास्त्रचक्षुर्भिषक्तमः | त्रिविधास्तु यतः शिष्यास्ततो वक्ष्यामि विस्तरम् ||२३१| dhātrīstanastanyasampaduktā vistarataḥ purā| stanyasañjananaṁ caiva stanyasya ca viśōdhanam||229|| vātādiduṣṭē liṅgaṁ ca kṣīṇasya ca cikitsitam| tatsarvamuktaṁ yē tvaṣṭau kṣīradōṣāḥ prakīrtitāḥ||230|| vātādiṣvēva tān vidyācchāstracakṣurbhiṣaktamaḥ| trividhāstu yataḥ śiṣyāstatō vakṣyāmi vistaram||231|| | dhAtrIstanastanyasampaduktA vistarataH purA | stanyasa~jjananaM caiva stanyasya ca vishodhanam ||229|| vAtAdiduShTe li~ggaM ca kShINasya ca cikitsitam | tatsarvamuktaM ye tvaShTau kShIradoShAH prakIrtitAH ||230|| vAtAdiShveva tAn vidyAcchAstracakShurbhiShaktamaH | trividhAstu yataH shiShyAstato vakShyAmi vistaram ||231||

The excellent characteristics of foster mother (wet nurse), breast and breast milk have been described earlier. The stanya samjanana (galactogogue), purification of milk, symptoms of breast milk vitiated by vatadi dosha, symptoms and treatment of poor breast milk production, eight types of milk defects have been mentioned earlier. The eight types of breast milk morbidities are also caused by vata etc. dosha, which is known to physician well versed in knowledge of Ayurveda. Disciples are of three types, pravara (with high intelligence), madhyama (with mediocre intelligence) and avara (with low intelligence). Hence, for the knowledge of all three types of disciples, the details of these eight types of morbidities of breast milk is described in detail hereafter. (229-231) Causes of Stanya dushti (abnormal breast milk): अजीर्णासात्म्यविषमविरुद्धात्यर्थभोजनात् | लवणाम्लकटुक्षारप्रक्लिन्नानां च सेवनात् ||२३२|| मनःशरीरसन्तापादस्वप्नान्निशि चिन्तनात् | प्राप्तवेगप्रतीघातादप्राप्तोदीरणेन च ||२३३|| परमान्नं गुडकृतं कृशरां दधि मन्दकम् [१] | अभिष्यन्दीनि मांसानि ग्राम्यानूपौदकानि च ||२३४|| भुक्त्वा भुक्त्वा दिवास्वप्नान्मद्यस्यातिनिषेवणात् | अनायासादभीघातात् [२] क्रोधाच्चातङ्ककर्शनैः ||२३५|| दोषाः क्षीरवहाः प्राप्य सिराः स्तन्यं प्रदूष्य च | कुर्युरष्टविधं भूयो दोषतस्तन्निबोध मे ||२३६||

ajīrṇāsātmyaviṣamaviruddhātyarthabhōjanāt| lavaṇāmlakaṭukṣārapraklinnānāṁ ca sēvanāt||232|| manaḥśarīrasantāpādasvapnānniśi cintanāt| prāptavēgapratīghātādaprāptōdīraṇēna ca||233|| paramānnaṁ guḍakr̥taṁ kr̥śarāṁ dadhi mandakam [1] | abhiṣyandīni māṁsāni grāmyānūpaudakāni ca||234|| bhuktvā bhuktvā divāsvapnānmadyasyātiniṣēvaṇāt| anāyāsādabhīghātāt [2] krōdhāccātaṅkakarśanaiḥ||235|| dōṣāḥ kṣīravahāḥ prāpya sirāḥ stanyaṁ pradūṣya ca| kuryuraṣṭavidhaṁ bhūyō dōṣatastannibōdha mē||236|| ajIrNAsAtmyaviShamaviruddhAtyarthabhojanAt | lavaNAmlakaTukShArapraklinnAnAM ca sevanAt ||232|| manaHsharIrasantApAdasvapnAnnishi cintanAt | prAptavegapratIghAtAdaprAptodIraNena ca ||233|| paramAnnaM guDakRutaM kRusharAM dadhi mandakam [1] | abhiShyandIni mAMsAni grAmyAnUpaudakAni ca ||234|| bhuktvA bhuktvA divAsvapnAnmadyasyAtiniShevaNAt | anAyAsAdabhIghAtAt [2] krodhAccAta~gkakarshanaiH ||235|| doShAH kShIravahAH prApya sirAH stanyaM pradUShya ca | kuryuraShTavidhaM bhUyo doShatastannibodha me ||236|| Due to intake of food during indigestion, unsuitable, irregular, excessive and contradictory food, excessive intake of salty, sour, pungent, alkaline and rotten substances, mental and physical stress, insomnia, awakening at night, anxiety, suppression of urges and propulsion of non occurring urges, frequent intake of parmanna (milk pudding), eatable substances prepared with jaggery and rice cooked with pulse (khichari), curd, slowly formed curd or which is not fully fermented, kapha stimulating food, meat of domestic, marshy and aquatic animals, daily sleeping during day time, excess use of wine, lack of physical stress, injury, anger and suffering from chronic illness, emaciation of body, all these factors leads to aggravation of vatadi doshas and reaches the milk carrying vessels and vitiate the breast milk, thus causing eight types of defects. The clinical features of vitiated breast milk by different doshas will be described further which you may understand. (232-236) Signs of vitiation of breast milk as per dosha dominance: वैरस्यं फेनसङ्घातो रौक्ष्यं चेत्यनिलात्मके | पित्ताद्वैवर्ण्यदौर्गन्ध्ये स्नेहपैच्छिल्यगौरवम् ||२३७|| कफाद्भवति रूक्षाद्यैरनिलः स्वैः प्रकोपणैः | क्रुद्धः क्षीराशयं प्राप्य रसं स्तन्यस्य [३] दूषयेत् ||२३८|| vairasyaṁ phēnasaṅghātō raukṣyaṁ cētyanilātmakē| pittādvaivarṇyadaurgandhyē snēhapaicchilyagauravam||237||

kaphādbhavati rūkṣādyairanilaḥ svaiḥ prakōpaṇaiḥ| kruddhaḥ kṣīrāśayaṁ prāpya rasaṁ stanyasya [3] dūṣayēt||238||

vairasyaM phenasa~gghAto raukShyaM cetyanilAtmake | pittAdvaivarNyadaurgandhye snehapaicchilyagauravam ||237|| kaphAdbhavati rUkShAdyairanilaH svaiH prakopaNaiH | kruddhaH kShIrAshayaM prApya rasaM stanyasya [3] dUShayet ||238|| The breast milk vitiated by vata dosha shows abnormal taste, presence of froth and roughness; whereas pitta vitiated breast milk becomes discoloured and foul smelling. Due to kapha, the breast milk becomes excessive unctuous, slimy and heavy in digestion. Vayu and other doshas are vitiated by intake of ununctuous and other dietary factors. These vitiated doshas reach breast and affect the taste of milk. (237-238)

Signs of vata vitiation in breast milk and baby: विरसं वातसंसृष्टं कृशीभवति तत् पिबन् | न चास्य स्वदते क्षीरं कृच्छ्रेण च विवर्धते ||२३९|| virasaṁ vātasaṁsr̥ṣṭaṁ kr̥śībhavati tat piban| na cāsya [4] svadatē kṣīraṁ kr̥cchrēṇa ca vivardhatē||239|| virasaM vAtasaMsRuShTaM kRushIbhavati tat piban | na cAsya [4] svadate kShIraM kRucchreNa ca vivardhate ||239|| The child who feeds on the milk of abnormal taste affected by the vata, becomes very weak. The child does not enjoy the taste of milk and thus his growth gets impaired.(239) तथैव वायुः कुपितः स्तन्यमन्तर्विलोडयन् | करोति फेनसङ्घातं तत्तु [५] कृच्छ्रात् प्रवर्तते ||२४०|| tathaiva vāyuḥ kupitaḥ stanyamantarvilōḍayan| karōti phēnasaṅghātaṁ tattu [5] kr̥cchrāt pravartatē||240|| tathaiva vAyuH kupitaH stanyamantarviloDayan | karoti phenasa~gghAtaM tattu [5] kRucchrAt pravartate ||240|| The aggravated vayu reaches the breast and churns the milk by which excessive froth is produced and hence such milk flows out of breast with great difficulty.(240) तेन क्षामस्वरो बालो बद्धविण्मूत्रमारुतः | वातिकं शीर्षरोगं वा पीनसं वाऽधिगच्छति ||२४१|| tēna kṣāmasvarō bālō baddhaviṇmūtramārutaḥ| vātikaṁ śīrṣarōgaṁ vā pīnasaṁ vā'dhigacchati||241|| tena kShAmasvaro bAlo baddhaviNmUtramArutaH | vAtikaM shIrSharogaM vA pInasaM vA~adhigacchati ||241|| Consuming the frothy milk, the child’s voice becomes feeble. His stool, urine and flatus are retained. He suffers from shirorogas due to vata and pinasa (chronic coryza). (241) पूर्ववत् कुपितः स्तन्ये स्नेहं शोषयतेऽनिलः | रूक्षं तत् पिबतो रौक्ष्याद्बलह्रासः प्रजायते ||२४२|| pūrvavat kupitaḥ stanyē snēhaṁ śōṣayatē'nilaḥ| rūkṣaṁ tat pibatō raukṣyādbalahrāsaḥ prajāyatē||242|| pUrvavat kupitaH stanye snehaM shoShayate~anilaH | rUkShaM tat pibato raukShyAdbalahrAsaH prajAyate ||242||

The vitiated vayu due to consumption of rough food items, dries up unctuousness or fat of milk. If the child takes this harsh or rough milk, it causes the decrease in strength. (242) Signs of pitta vitiation in breast milk and baby: पित्तमुष्णादिभिः क्रुद्धं स्तन्याशयमभिप्लुतम् | करोति स्तन्यवैवर्ण्यं नीलपीतासितादिकम् ||२४३|| pittamuṣṇādibhiḥ kruddhaṁ stanyāśayamabhiplutam| karōti stanyavaivarṇyaṁ nīlapītāsitādikam||243|| pittamuShNAdibhiH kruddhaM stanyAshayamabhiplutam | karoti stanyavaivarNyaM nIlapItAsitAdikam ||243||

The vitiated pitta due to intake of hot items etc. reaches in the seat of milk and produces the discoloured milk such as blue, yellow, black.(243) विवर्णगात्रः स्विन्नः स्यात्तृष्णालुर्भिन्नविट् शिशुः | नित्यमुष्णशरीरश्च नाभिनन्दति तं स्तनम् ||२४४|| vivarṇagātraḥ svinnaḥ syāttr̥ṣṇālurbhinnaviṭ śiśuḥ| nityamuṣṇaśarīraśca nābhinandati taṁ stanam||244|| vivarNagAtraH svinnaH syAttRuShNAlurbhinnaviT shishuH | nityamuShNasharIrashca nAbhinandati taM stanam ||244||

The child refuses to take the such abnormal coloured milk. If he consumes, his body becomes of abnormal complexion, excessive perspiration, excessive feeling of thirst, thin stool (diarrhoea) and constant warmness. (244) पूर्ववत् कुपिते पित्ते दौर्गन्ध्यं क्षीरमृच्छति | पाण्ड्वामयस्तत्पिबतः कामला च भवेच्छिशोः ||२४५|| pūrvavat kupitē pittē daurgandhyaṁ kṣīramr̥cchati| pāṇḍvāmayastatpibataḥ kāmalā ca bhavēcchiśōḥ||245|| pUrvavat kupite pitte daurgandhyaM kShIramRucchati | pANDvAmayastatpibataH kAmalA ca bhavecchishoH ||245||

The vitiated pitta due to intake of pitta aggravating factors produces the foul smell in the milk. If the child takes this milk then he suffers from anaemia and jaundice.(245) Signs of kapha vitiation in breast milk and baby: क्रुद्धो गुर्वादिभिः श्लेष्मा क्षीराशयगतः स्त्रियाः | स्नेहान्वितत्वात्तत्क्षीरमतिस्निग्धं करोति तु ||२४६|| kruddhō gurvādibhiḥ ślēṣmā kṣīrāśayagataḥ striyāḥ| snēhānvitatvāttatkṣīramatisnigdhaṁ karōti tu||246|| kruddho gurvAdibhiH shleShmA kShIrAshayagataH striyAH | snehAnvitatvAttatkShIramatisnigdhaM karoti tu ||246|| The vitiated kapha due to intake of heavy substances or food items etc. reaches the breast of woman and makes it too unctuous because of its own unctuous quality.(246) छर्दनः कुन्थनस्तेन लालालुर्जायते शिशुः | नित्योपदिग्धैः स्रोतोभिर्निद्राक्लमसमन्वितः [६] ||२४७|| श्वासकासपरीतस्तु प्रसेकतमकान्वितः | chardanaḥ kunthanastēna lālālurjāyatē śiśuḥ| nityōpadigdhaiḥ srōtōbhirnidrāklamasamanvitaḥ [6] ||247|| śvāsakāsaparītastu prasēkatamakānvitaḥ| chardanaH kunthanastena lAlAlurjAyate shishuH | nityopadigdhaiH srotobhirnidrAklamasamanvitaH [6] ||247|| shvAsakAsaparItastu prasekatamakAnvitaH |

The child who takes or consumes this too unctuous (atisnigdha) milk suffers from vomiting, gripping pain, and excessive salivation. As the channels are constantly filled or smeared with kapha, the child suffers from sleep, exhaustion, breathlessness, cough, excessive dribbling of saliva and darkness (tamaka).(247) अभिभूय कफः स्तन्यं पिच्छिलं कुरुते यदा ||२४८|| लालालुः शूनवक्त्राक्षिर्जडः स्यात्तत् पिबञ्छिशुः | abhibhūya kaphaḥ stanyaṁ picchilaṁ kurutē yadā||248|| lālāluḥ śūnavaktrākṣirjaḍaḥ syāttat pibañchiśuḥ| abhibhUya kaphaH stanyaM picchilaM kurute yadA ||248|| lAlAluH shUnavaktrAkShirjaDaH syAttat piba~jchishuH |

When kapha is vitiated or predominates with its own factors, it makes the breast milk slimy. The child who takes this slimy milk suffers from the salivation, swelling of face and dull eyes.(248) कफः क्षीराशयगतो गुरुत्वात् क्षीरगौरवम् ||२४९|| करोति [७] गुरु तत् पीत्वा बालो हृद्रोगमृच्छति | अन्यांश्च विविधात्रोगान्कुर्यात्क्षीरसमाश्रितान् ||२५०|| kaphaḥ kṣīrāśayagatō gurutvāt kṣīragauravam||249|| karōti [7] guru tat pītvā bālō hr̥drōgamr̥cchati| anyāṁśca vividhātrōgānkuryātkṣīrasamāśritān||250|| kaphaH kShIrAshayagato gurutvAt kShIragauravam ||249|| karoti [7] guru tat pItvA bAlo hRudrogamRucchati | anyAMshca vividhAtrogAnkuryAtkShIrasamAshritAn ||250|| Kapha due to its heaviness reaches breast and causes heaviness in the milk. The child suffers from heart diseases after taking this milk. Other various disorders are caused by the heavy milk.(250)

Treatment of diseases due to vitiated breast milk: क्षीरे वातादिभिर्दुष्टे सम्भवन्ति तदात्मकाः | तत्रादौ स्तन्यशुद्ध्यर्थं धात्रीं स्नेहोपपादिताम् ||२५१|| संस्वेद्य विधिवद्वैद्यो वमनेनोपपादयेत् | kṣīrē vātādibhirduṣṭē sambhavanti tadātmakāḥ| tatrādau stanyaśuddhyarthaṁ dhātrīṁ snēhōpapāditām||251|| saṁsvēdya vidhivadvaidyō vamanēnōpapādayēt| kShIre vAtAdibhirduShTe sambhavanti tadAtmakAH | tatrAdau stanyashuddhyarthaM dhAtrIM snehopapAditAm ||251|| saMsvedya vidhivadvaidyo vamanenopapAdayet |

When the breast milk is vitiated by aggravated vata and other doshas, other various disorders specific to such doshas afflict the child. The vaidya needs to purify the breast milk and for this, the mother or wet nurse should given massage and fomentation in a proper way and after that emesis should be done. (251) वचाप्रियङ्गुयष्ट्याह्वफलवत्सकसर्षपैः ||२५२|| कल्कैर्निम्बपटोलानां क्वाथैः सलवणैर्वमेत् | vacāpriyaṅguyaṣṭyāhvaphalavatsakasarṣapaiḥ||252|| kalkairnimbapaṭōlānāṁ kvāthaiḥ salavaṇairvamēt| vacApriya~gguyaShTyAhvaphalavatsakasarShapaiH ||252|| kalkairnimbapaTolAnAM kvAthaiH salavaNairvamet |

The paste of vacha, priyangu, mulethi, madanaphala, kutaja and yellow mustard with saindhav lavana, mixed in the decoction of nimba and patola should be given to the wet nurse for the emesis. (252) सम्यग्वान्तां यथान्यायं कृतसंसर्जनां ततः ||२५३|| दोषकालबलापेक्षी स्नेहयित्वा विरेचयेत् | samyagvāntāṁ yathānyāyaṁ kr̥tasaṁsarjanāṁ tataḥ||253|| dōṣakālabalāpēkṣī snēhayitvā virēcayēt| samyagvAntAM yathAnyAyaM kRutasaMsarjanAM tataH ||253|| doShakAlabalApekShI snehayitvA virecayet |

After proper emesis, dhatri (wet nurse) should be administered samsarjana kriya (diet as prescribed). She should be given purgation therapy after proper oleation, considering the dosha, season and strength of patient. (253) त्रिवृतामभयां वाऽपि त्रिफलारससंयुताम् ||२५४|| पाययेन्मधुसंयुक्तामभयां वाऽपि केवलाम् | (पाययेन्मूत्रसंयुक्तां विरेकार्थं च शास्त्रवित् [८] ) ||२५५|| trivr̥tāmabhayāṁ vā'pi triphalārasasaṁyutām||254|| pāyayēnmadhusaṁyuktāmabhayāṁ vā'pi kēvalām| (pāyayēnmūtrasaṁyuktāṁ virēkārthaṁ ca śāstravit [8] )||255|| trivRutAmabhayAM vA~api triphalArasasaMyutAm ||254|| pAyayenmadhusaMyuktAmabhayAM vA~api kevalAm | (pAyayenmUtrasaMyuktAM virekArthaM ca shAstravit [8] ) ||255||

She should be given the paste of nishoth or haritaki mixed with the decoction of triphala or honey or only powder of haritaki mixed with cow’s urine can be given. (254-255) सम्यग्विरिक्तां मतिमान् कृतसंसर्जनां पुनः | ततो दोषावशेषघ्नैरन्नपानैरुपाचरेत् [९] ||२५६|| samyagviriktāṁ matimān kr̥tasaṁsarjanāṁ punaḥ| tatō dōṣāvaśēṣaghnairannapānairupācarēt [9] ||256|| samyagviriktAM matimAn kRutasaMsarjanAM punaH | tato doShAvasheShaghnairannapAnairupAcaret [9] ||256||

After proper purgation, again she should be given proper dietetic regimens (sansarjana kriya should be performed) and for removal of the remaining doshas, suitable diet and drinks should be given as follows. (256) शालयः षष्टिका वा स्युः श्यामाका भोजने हिताः | प्रियङ्गवः कोरदूषा यवा वेणुयवास्तथा ||२५७||

śālayaḥ ṣaṣṭikā vā syuḥ śyāmākā bhōjanē hitāḥ| priyaṅgavaḥ kōradūṣā yavā vēṇuyavāstathā||257|| shAlayaH ShaShTikA vA syuH shyAmAkA bhojane hitAH | priya~ggavaH koradUShA yavA veNuyavAstathA ||257||

Shali rice, shashthi rice or shyama rice, priyangu, kodrava, barley, bamboo and yava are beneficial diet.(257) वंशवेत्रकलायाश्च शाकार्थे [१०] स्नेहसंस्कृताः | मुद्गान् मसूरान् यूषार्थे कुलत्थांश्च प्रकल्पयेत् ||२५८|| vaṁśavētrakalāyāśca śākārthē [10] snēhasaṁskr̥tāḥ| mudgān masūrān yūṣārthē kulatthāṁśca prakalpayēt||258|| vaMshavetrakalAyAshca shAkArthe [10] snehasaMskRutAH | mudgAn masUrAn yUShArthe kulatthAMshca prakalpayet ||258||

For shaka, (vegetable preparation) the bamboo shoots, vetra and peas processed with ghrita or oil should be taken. Green gram, lentils and kulattha should be used for yusha (vegetarian soup). (258) निम्बवेत्राग्रकुलकवार्ताकामलकैः शृतान् | सव्योषसैन्धवान् यूषान्दापयेत्स्तन्यशोधनान् ||२५९|| शशान् कपिञ्जलानेणान् संस्कृतांश्च प्रदापयेत् | nimbavētrāgrakulakavārtākāmalakaiḥ śr̥tān| savyōṣasaindhavān yūṣāndāpayētstanyaśōdhanān||259|| śaśān kapiñjalānēṇān saṁskr̥tāṁśca pradāpayēt| nimbavetrAgrakulakavArtAkAmalakaiH shRutAn | savyoShasaindhavAn yUShAndApayetstanyashodhanAn ||259|| shashAn kapi~jjalAneNAn saMskRutAMshca pradApayet |

The soup which is used for purification of milk, should be prepared with tender leaves of neem and vetra, parvala leaves, brinjal and amalaka added with dry zinger (shunthi), pepper, pippali and rock salt. Processed meat of rabbits, grey partridge or sparrow, and of deer should be given to the wet nurse. (259) शार्ङ्गेष्टासप्तपर्णत्वगश्वगन्धाशृतं जलम् ||२६०|| पाययेताथवा स्तन्यशुद्धये रोहिणीशृतम् | śārṅgēṣṭāsaptaparṇatvagaśvagandhāśr̥taṁ jalam||260|| pāyayētāthavā stanyaśuddhayē rōhiṇīśr̥tam| shAr~ggeShTAsaptaparNatvagashvagandhAshRutaM jalam ||260|| pAyayetAthavA stanyashuddhaye rohiNIshRutam |

For purification of breast milk of dhatri; decoction of kakajangha, bark of chhativan (sapta parna) and ashwagandha or simply decoction of katuki (rohini) should be given to drink.(260) अमृतासप्तपर्णत्वक्क्वाथं चैव सनागरम् ||२६१|| किराततिक्तकक्वाथं श्लोकपादेरितान् पिबेत् | त्रीनेतान्स्तन्यशुद्ध्यर्थमिति सामान्यभेषजम् ||२६२||

amr̥tāsaptaparṇatvakkvāthaṁ caiva sanāgaram||261|| kirātatiktakakvāthaṁ ślōkapādēritān pibēt| trīnētānstanyaśuddhyarthamiti sāmānyabhēṣajam||262|| amRutAsaptaparNatvakkvAthaM caiva sanAgaram ||261|| kirAtatiktakakvAthaM shlokapAderitAn pibet | trInetAnstanyashuddhyarthamiti sAmAnyabheShajam ||262||

The decoction of guduchi and bark of saptaparna or decoction of dry zinger (shunthi) or decoction of chiraita (kiratatikta) should be given to the dhatri for purification of milk. Thus the general medicines are described here for the purification of milk. (261-262) कीर्तितं स्तन्यदोषाणां पृथगन्यं निबोधत | पाययेद्विरसक्षीरां द्राक्षामधुकसारिवाः ||२६३|| श्लक्ष्णपिष्टां पयस्यां च समालोड्य सुखाम्बुना | kīrtitaṁ stanyadōṣāṇāṁ pr̥thaganyaṁ nibōdhata| pāyayēdvirasakṣīrāṁ drākṣāmadhukasārivāḥ||263|| ślakṣṇapiṣṭāṁ payasyāṁ ca samālōḍya sukhāmbunā|

kIrtitaM stanyadoShANAM pRuthaganyaM nibodhata | pAyayedvirasakShIrAM drAkShAmadhukasArivAH ||263|| shlakShNapiShTAM payasyAM ca samAloDya sukhAmbunA |

Now listen the treatment of other specific defects of the breast milk. The woman having milk of abnormal taste should be given fine paste of munakka, mulethi, sariva and ksheeravidari mixed with luke warm water. (263) पञ्चकोलकुलत्थैश्च पिष्टैरालेपयेत् स्तनौ ||२६४|| शुष्कौ प्रक्षाल्य निर्दुह्यात्तथा स्तन्यं विशुध्यति | pañcakōlakulatthaiśca piṣṭairālēpayēt stanau||264|| śuṣkau prakṣālya nirduhyāttathā stanyaṁ viśudhyati| pa~jcakolakulatthaishca piShTairAlepayet stanau ||264|| shuShkau prakShAlya nirduhyAttathA stanyaM vishudhyati |

The paste of panchakola and kulathi should be applied locally on the breast and when the paste dries, it should be washed with warm water and milk to be expressed from the breast. Thus the affected milk gets purified. (264) फेनसङ्घातवत्क्षीरं यस्यास्तां पाययेत् स्त्रियम् ||२६५|| पाठानागरशार्ङ्गेष्टामूर्वाः [११] पिष्ट्वा सुखाम्बुना | phēnasaṅghātavatkṣīraṁ yasyāstāṁ pāyayēt striyam||265|| pāṭhānāgaraśārṅgēṣṭāmūrvāḥ [11] piṣṭvā sukhāmbunā| phenasa~gghAtavatkShIraM yasyAstAM pAyayet striyam ||265|| pAThAnAgarashAr~ggeShTAmUrvAH [11] piShTvA sukhAmbunA |

The woman whose milk gets frothy, she should be given drink the paste of patha, sunthi, kakajangha and murva with warm water. (265) अञ्जनं नागरं [१२] दारु बिल्वमूलं प्रियङ्गवः ||२६६|| स्तनयोः पूर्ववत् कार्यं लेपनं क्षीरशोधनम् | añjanaṁ nāgaraṁ [12] dāru bilvamūlaṁ priyaṅgavaḥ||266|| stanayōḥ pūrvavat kāryaṁ lēpanaṁ kṣīraśōdhanam| a~jjanaM nAgaraM [12] dAru bilvamUlaM priya~ggavaH ||266|| stanayoH pUrvavat kAryaM lepanaM kShIrashodhanam |

In the woman having the thick frothy milk, the paste of anjana, shunthi, devadaru, crust of bilva root and fruit of priyangu should be applied on the breast to purify the milk. (As mentioned before after the paste dries, the breast should be cleaned with warm water and breast milk should be expressed out).(266) किराततिक्तकं शुण्ठीं सामृतां क्वाथयेद्भिषक् ||२६७|| तं क्वाथं पाययेद्धात्रीं स्तन्यदोषनिबर्हणम् | kirātatiktakaṁ śuṇṭhīṁ sāmr̥tāṁ kvāthayēdbhiṣak||267|| taṁ kvāthaṁ pāyayēddhātrīṁ stanyadōṣanibarhaṇam| kirAtatiktakaM shuNThIM sAmRutAM kvAthayedbhiShak ||267|| taM kvAthaM pAyayeddhAtrIM stanyadoShanibarhaNam |

The vaidya should prescribe the decoction of guduchi, chiraita and shunhti to the wet nurse to purify the frothy breast milk. (267) स्तनौ चालेपयेत् पिष्टैर्यवगोधूमसर्षपैः ||२६८|| stanau cālēpayēt piṣṭairyavagōdhūmasarṣapaiḥ||268|| stanau cAlepayet piShTairyavagodhUmasarShapaiH ||268||

The paste of barley, wheat and mustard seed should be applied on the breast in the manner described previously.(268) षड्विरेकाश्रितीयोक्तैरौषधैः स्तन्यशोधनैः | रूक्षक्षीरा [१३] पिबेत् क्षीरं तैर्वा सिद्धं घृतं पिबेत् ||२६९|| ṣaḍvirēkāśritīyōktairauṣadhaiḥ stanyaśōdhanaiḥ| rūkṣakṣīrā [13] pibēt kṣīraṁ tairvā siddhaṁ ghr̥taṁ pibēt||269|| ShaDvirekAshritIyoktairauShadhaiH stanyashodhanaiH | rUkShakShIrA [13] pibet kShIraM tairvA siddhaM ghRutaM pibet ||269||

The woman having ununctuous milk should be given the milk or ghrita processed with ten stanya shodhana drugs, which are mentioned in fourth chapter of Sutra sthana named shadvirekashritiya.(269) पूर्ववज्जीवकाद्यं च पञ्चमूलं प्रलेपनम् | स्तनयोः संविधातव्यं सुखोष्णं स्तन्यशोधनम् ||२७०|| pūrvavajjīvakādyaṁ ca pañcamūlaṁ pralēpanam| stanayōḥ saṁvidhātavyaṁ sukhōṣṇaṁ stanyaśōdhanam||270|| pUrvavajjIvakAdyaM ca pa~jcamUlaM pralepanam | stanayoH saMvidhAtavyaM sukhoShNaM stanyashodhanam ||270|| As earlier the luke warm paste of jivaniya varga and five drugs of brihat panchamula should be applied over the breast for purification of breast milk. (Washing of breast and manual expression of milk after drying of paste).(270) यष्टीमधुकमृद्वीकापयस्यासिन्धुवारिकाः | शीताम्बुना पिबेत्कल्कं क्षीरवैवर्ण्यनाशनम् ||२७१|| yaṣṭīmadhukamr̥dvīkāpayasyāsindhuvārikāḥ| śītāmbunā pibētkalkaṁ kṣīravaivarṇyanāśanam||271|| yaShTImadhukamRudvIkApayasyAsindhuvArikAH | shItAmbunA pibetkalkaM kShIravaivarNyanAshanam ||271||

To remove the discolouration of milk the dhatri (wetnurse) should take the paste of mulethi, draksha, ksheera vidari, sindubar with cold water. (271) द्राक्षामधुककल्केन स्तनौ चास्याः प्रलेपयेत् | प्रक्षाल्य वारिणा चैव निर्दुह्यात्तौ [१४] पुनः पुनः ||२७२|| drākṣāmadhukakalkēna stanau cāsyāḥ pralēpayēt| prakṣālya vāriṇā caiva nirduhyāttau [14] punaḥ punaḥ||272|| drAkShAmadhukakalkena stanau cAsyAH pralepayet | prakShAlya vAriNA caiva nirduhyAttau [14] punaH punaH ||272||

The paste of madhuka should be applied on the breasts of the dhatri and after drying it is washed with warm water and milk should be expressed repeatedly.(272) विषाणिकाजशृङ्ग्यौ च त्रिफलां रजनीं वचाम् | पिबेच्छीताम्बुना पिष्ट्वा क्षीरदौर्गन्ध्यनाशिनीम् ||२७३|| viṣāṇikājaśr̥ṅgyau ca triphalāṁ rajanīṁ vacām| pibēcchītāmbunā piṣṭvā kṣīradaurgandhyanāśinīm||273|| viShANikAjashRu~ggyau ca triphalAM rajanIM vacAm | pibecchItAmbunA piShTvA kShIradaurgandhyanAshinIm ||273||

To remove the foul smell from milk, the paste of aja shringi, meshashringi, triphala, haridra and vacha should be taken with cold water. (273) लिह्याद्वाऽप्यभयाचूर्णं सव्योषं माक्षिकप्लुतम् | क्षीरदौर्गन्ध्यनाशार्थं धात्री पथ्याशिनी तथा ||२७४|| lihyādvā'pyabhayācūrṇaṁ savyōṣaṁ mākṣikaplutam| kṣīradaurgandhyanāśārthaṁ dhātrī pathyāśinī tathā||274|| lihyAdvA~apyabhayAcUrNaM savyoShaM mAkShikaplutam | kShIradaurgandhyanAshArthaM dhAtrI pathyAshinI tathA ||274||

Or the wet nurse should follow the wholesome diet chart and should take the powder of shunthi, pippali, maricha and haritaki, mixed with honey to alleviate the foul smell from the breast milk. (274) सारिवोशीरमञ्जिष्ठाश्लेष्मातककुचन्दनैः | पत्राम्बुचन्दनोशीरैः [१५] स्तनौ चास्याः प्रलेपयेत् ||२७५|| sārivōśīramañjiṣṭhāślēṣmātakakucandanaiḥ| patrāmbucandanōśīraiḥ [15] stanau cāsyāḥ pralēpayēt||275|| sArivoshIrama~jjiShThAshleShmAtakakucandanaiH | patrAmbucandanoshIraiH [15] stanau cAsyAH pralepayet ||275||

The paste of sariva, ushira, manjishtha, bark of sshlesmantaka, rakta chandan or the paste of tejpatra, sugandha bala or rakta chandan, ushira should be applied on the breasts and when it is dried, the breast should be washed with water and milk to be expressed to remove foul smell from breast milk. (275) स्निग्धक्षीरा [१६] दारुमुस्तपाठाः पिष्ट्वा सुखाम्बुना | पीत्वा ससैन्धवाः क्षिप्रं क्षीरशुद्धिमवाप्नुयात् ||२७६|| snigdhakṣīrā [16] dārumustapāṭhāḥ piṣṭvā sukhāmbunā| pītvā sasaindhavāḥ kṣipraṁ kṣīraśuddhimavāpnuyāt||276|| snigdhakShIrA [16] dArumustapAThAH piShTvA sukhAmbunA | pItvA sasaindhavAH kShipraM kShIrashuddhimavApnuyAt ||276||

The woman whose milk is too unctuous, she should take the powder of devadaru, musta, patha with rock salt and should drink with luke warm water to purify the breast milk quickly.(276) पाययेत् पिच्छिलक्षीरां शार्ङ्गेष्टामभयां वचाम् | मुस्तनागरपाठाश्च पीताः स्तन्यविशोधनाः ||२७७|| pāyayēt picchilakṣīrāṁ śārṅgēṣṭāmabhayāṁ vacām| mustanāgarapāṭhāśca pītāḥ stanyaviśōdhanāḥ||277|| pAyayet picchilakShIrAM shAr~ggeShTAmabhayAM vacAm | mustanAgarapAThAshca pItAH stanyavishodhanAH ||277||

The paste or decoction of kakamachi, haritaki, vacha, musta, shunthi and patha should be given to drink to the woman whose milk is slimy or for purification of milk.(277) तक्रारिष्टं पिबेच्चापि यदुक्तं गुदजापहम् | विदारीबिल्वमधुकैः स्तनौ चास्याः प्रलेपयेत् ||२७८|| takrāriṣṭaṁ pibēccāpi yaduktaṁ gudajāpaham| vidārībilvamadhukaiḥ stanau cāsyāḥ pralēpayēt||278|| takrAriShTaM pibeccApi yaduktaM gudajApaham | vidArIbilvamadhukaiH stanau cAsyAH pralepayet ||278||

To purify the slimy milk the dhatri (wet nurse) should take the takrarishta as prescribed in treatment of piles. She should apply the paste of vidarikanda, crust of bilva’s root and mulethi on her breasts.(278) त्रायमाणामृतानिम्बपटोलत्रिफलाशृतम् | गुरुक्षीरा पिबेदाशु स्तन्यदोषविशुद्धये ||२७९|| trāyamāṇāmr̥tānimbapaṭōlatriphalāśr̥tam| gurukṣīrā pibēdāśu stanyadōṣaviśuddhayē||279|| trAyamANAmRutAnimbapaTolatriphalAshRutam | gurukShIrA pibedAshu stanyadoShavishuddhaye ||279||

The woman having heavy milk should take the decoction of trayamana, guduchi, bark of nimba, patola leaves, triphala for purification of defects of breast milk quickly.(279) पिबेद्वा पिप्पलीमूलचव्यचित्रकनागरम् | बलानागरशार्ङ्गेष्टामूर्वाभिर्लेपयेत् स्तनौ ||२८०|| पृश्निपर्णीपयस्याभ्यां स्तनौ चास्याः प्रलेपयेत् | pibēdvā pippalīmūlacavyacitrakanāgaram| balānāgaraśārṅgēṣṭāmūrvābhirlēpayēt stanau||280|| pr̥śniparṇīpayasyābhyāṁ stanau cāsyāḥ pralēpayēt| pibedvA pippalImUlacavyacitrakanAgaram | balAnAgarashAr~ggeShTAmUrvAbhirlepayet stanau ||280|| pRushniparNIpayasyAbhyAM stanau cAsyAH pralepayet |

Or she should drink the decoction of pippali mula, chavya, chitraka, shunthi or apply the paste of bala, shunthi, kakamachi and murva or similarly application of paste of pithivan and ksheer vidari should be done on her breasts.(280) अष्टावेते क्षीरदोषा हेतुलक्षणभेषजैः ||२८१|| निर्दिष्टाः क्षीरदोषोत्थास्तथोक्ताः केचिदामयाः |२८२| aṣṭāvētē kṣīradōṣā hētulakṣaṇabhēṣajaiḥ||281|| nirdiṣṭāḥ kṣīradōṣōtthāstathōktāḥ kēcidāmayāḥ|282| aShTAvete kShIradoShA hetulakShaNabheShajaiH ||281|| nirdiShTAH kShIradoShotthAstathoktAH kecidAmayAH |282|

Thus these eight defects of breast milk have been described here with their causes, symptoms and treatment and some ailments caused by the defects of milk have also described here. (281-282) Principles of management in pediatrics: दोषदूष्यमलाश्चैव महतां व्याधयश्च ये ||२८२|| त एव सर्वे [१] बालानां मात्रा त्वल्पतरा मता | निवृत्तिर्वमनादीनां मृदुत्वं परतन्त्रताम् ||२८३|| वाक्चेष्टयोरसामर्थ्यं वीक्ष्य बालेषु शास्त्रवित् | भेषजं स्वल्पमात्रं तु यथाव्याधि प्रयोजयेत् ||२८४|| मधुराणि कषायाणि क्षीरवन्ति मृदूनि च | प्रयोजयेद्भिषग्बाले मतिमानप्रमादतः ||२८५|| अत्यर्थस्निग्धरूक्षोष्णमम्लं कटुविपाकि च | गुरु चौषधपानान्नमेतद्बालेषु गर्हितम् ||२८६|| समासात् सर्वरोगाणामेतद्बालेषु भेषजम् | निर्दिष्टं शास्त्रविद्वैद्यः प्रविविच्य [२] प्रयोजयेत् ||२८७|| dōṣadūṣyamalāścaiva mahatāṁ vyādhayaśca yē||282|| ta ēva sarvē [1] bālānāṁ mātrā tvalpatarā matā| nivr̥ttirvamanādīnāṁ mr̥dutvaṁ paratantratām||283|| vākcēṣṭayōrasāmarthyaṁ vīkṣya bālēṣu śāstravit| bhēṣajaṁ svalpamātraṁ tu yathāvyādhi prayōjayēt||284|| madhurāṇi kaṣāyāṇi kṣīravanti mr̥dūni ca| prayōjayēdbhiṣagbālē matimānapramādataḥ||285|| atyarthasnigdharūkṣōṣṇamamlaṁ kaṭuvipāki ca| guru cauṣadhapānānnamētadbālēṣu garhitam||286|| samāsāt sarvarōgāṇāmētadbālēṣu bhēṣajam| nirdiṣṭaṁ śāstravidvaidyaḥ pravivicya [2] prayōjayēt||287||

doShadUShyamalAshcaiva mahatAM vyAdhayashca ye ||282|| 

ta eva sarve [1] bAlAnAM mAtrA tvalpatarA matA | nivRuttirvamanAdInAM mRudutvaM paratantratAm ||283|| vAkceShTayorasAmarthyaM vIkShya bAleShu shAstravit | bheShajaM svalpamAtraM tu yathAvyAdhi prayojayet ||284|| madhurANi kaShAyANi kShIravanti mRudUni ca | prayojayedbhiShagbAle matimAnapramAdataH ||285|| atyarthasnigdharUkShoShNamamlaM kaTuvipAki ca | guru cauShadhapAnAnnametadbAleShu garhitam ||286|| samAsAt sarvarogANAmetadbAleShu bheShajam | nirdiShTaM shAstravidvaidyaH pravivicya [2] prayojayet ||287|| The vitiation of dosha, body elements, mala and the diseases which affect adults also affect children similarly, but in lesser degree. The paediatrician should not administer emesis like purification procedures in children due to tender nature, dependency, inability to fully express themselves in speech and gestures. He should give only small doses of medicines as per the disease. Sweet decoction, medicated milk and medicines with mild potency shall be administered in children by wise pediatrician. The medicines, food and beverages with excess unctuousness, dryness, hot potency, sour, pungent in post digestive effect, and heavy to digest property are contraindicated in children. Thus, in brief, the directions regarding the treatment of all the diseases occurring in children, and the physician well versed in science should treat the diseases after meticulously differentiating these factors (mentioned above).(282-287)

Importance of chikitsa sthana: भवन्ति चात्र- इति सर्वविकाराणामुक्तमेतच्चिकित्सितम् | स्थानमेतद्धि तन्त्रस्य रहस्यं परमुत्तमम् [१] ||२८८|| bhavanti cātra- iti sarvavikārāṇāmuktamētaccikitsitam| sthānamētaddhi tantrasya rahasyaṁ paramuttamam [1] ||288||

bhavanti cAtra- 

iti sarvavikArANAmuktametaccikitsitam | sthAnametaddhi tantrasya rahasyaM paramuttamam [1] ||288|| Thus has been expounded the therapeutics of all diseases; and this section of chikitsa (management) contains the most essential part of this treatise. (288) Contributors of the treatise: अस्मिन् सप्तदशाध्यायाः कल्पाः सिद्धय एव च | नासाद्यन्तेऽग्निवेशस्य तन्त्रे चरकसंस्कृते ||२८९|| तानेतान् कापिलबलिः शेषान् दृढबलोऽकरोत् | तन्त्रस्यास्य महार्थस्य पूरणार्थं यथातथम् ||२९०|| asmin saptadaśādhyāyāḥ kalpāḥ siddhaya ēva ca| nāsādyantē'gnivēśasya tantrē carakasaṁskr̥tē||289|| tānētān kāpilabaliḥ śēṣān dr̥ḍhabalō'karōt| tantrasyāsya mahārthasya pūraṇārthaṁ yathātatham||290|| asmin saptadashAdhyAyAH kalpAH siddhaya eva ca | nAsAdyante~agniveshasya tantre carakasaMskRute ||289|| tAnetAn kApilabaliH sheShAn dRuDhabalo~akarot | tantrasyAsya mahArthasya pUraNArthaM yathAtatham ||290|| Seventeen chapters of chikitsa sthana, all chapters of kalpa sthana and siddhi sthana are not found in treatise composed by Agnivesha and revised by Charaka. These chapters have been added by Dridhabala, Son of Kapilabali to fulfil the aim of completion of this great treatise. (289-290) Guiding principles to understand anukta vyadhi (untold diseases that are not mentioned here): रोगा येऽप्यत्र नोद्दिष्टा बहुत्वान्नामरूपतः | तेषामप्येतदेव स्याद्दोषादीन् वीक्ष्य भेषजम् ||२९१|| rōgā yē'pyatra nōddiṣṭā bahutvānnāmarūpataḥ| tēṣāmapyētadēva syāddōṣādīn vīkṣya bhēṣajam||291|| rogA ye~apyatra noddiShTA bahutvAnnAmarUpataH | teShAmapyetadeva syAddoShAdIn vIkShya bheShajam ||291|| The disease which are not described here due to their various names and clinical presentations shall also be treated according to the dominance of dosha etc.factors (as mentioned earlier). (291) दोषदूष्यनिदानानां विपरीतं हितं ध्रुवम् | उक्तानुक्तान् गदान् सर्वान् सम्यग्युक्तं नियच्छति ||२९२|| dōṣadūṣyanidānānāṁ viparītaṁ hitaṁ dhruvam| uktānuktān gadān sarvān samyagyuktaṁ niyacchati||292||

doShadUShyanidAnAnAM viparItaM hitaM dhruvam | 

uktAnuktAn gadAn sarvAn samyagyuktaM niyacchati ||292|| The treatment that is opposite to dosha, dushya and nidana (causative factors) is always beneficial. The diseases that are told and untold here can be treated with proper implementation of this principle. (292) देशकालप्रमाणानां सात्म्यासात्म्यस्य चैव हि | सम्यग्योगोऽन्यथा ह्येषां पथ्यमप्यन्यथा भवेत् ||२९३|| dēśakālapramāṇānāṁ sātmyāsātmyasya caiva hi| samyagyōgō'nyathā hyēṣāṁ pathyamapyanyathā bhavēt||293||

deshakAlapramANAnAM sAtmyAsAtmyasya caiva hi | 

samyagyogo~anyathA hyeShAM pathyamapyanyathA bhavet ||293|| The medicines shall be prescribed after due consideration of desha (habitat), kala (season), pramana (dosage), satmya (adaptability) and asatmya (non-adaptability). If this is properly considered, then it is pathya (beneficial to body systems).Otherwise it is non-beneficial. (293) Routes of administration of medicine: आस्यादामाशयस्थान् हि रोगान् नस्तःशिरोगतान् | गुदात् पक्वाशयस्थांश्च हन्त्याशु [१] दत्तमौषधम् ||२९४|| शरीरावयवोत्थेषु विसर्पपिडकादिषु | यथादेशं [२] प्रदेहादि शमनं स्याद्विशेषतः ||२९५|| āsyādāmāśayasthān hi rōgān nastaḥśirōgatān| gudāt pakvāśayasthāṁśca hantyāśu [1] dattamauṣadham||294|| śarīrāvayavōtthēṣu visarpapiḍakādiṣu| yathādēśaṁ [2] pradēhādi śamanaṁ syādviśēṣataḥ||295||

AsyAdAmAshayasthAn hi rogAn nastaHshirogatAn | 

gudAt pakvAshayasthAMshca hantyAshu [1] dattamauShadham ||294|| sharIrAvayavottheShu visarpapiDakAdiShu | yathAdeshaM [2] pradehAdi shamanaM syAdvisheShataH ||295|| If the doshas are located in stomach, then medicines shall be administered orally; if at head region, then through nose; and if at colon then medicines quickly act if given per rectum. The doshas at other body parts and diseases originated from them like visarpa, pidaka etc, shall be treated with pradeha etc. specific local pacification procedures. (294-295) Factors to be considered for medicine administration: दिनातुरौषधव्याधिजीर्णलिङ्गर्त्ववेक्षणम् [१] | कालं बिद्याद्दिनावेक्षः पूर्वाह्णे वमनं यथा ||२९६|| dināturauṣadhavyādhijīrṇaliṅgartvavēkṣaṇam [1] | kālaṁ vidyāddināvēkṣaḥ pūrvāhṇē vamanaṁ yathā||296||

dinAturauShadhavyAdhijIrNali~ggartvavekShaNam [1] | kAlaM bidyAddinAvekShaH pUrvAhNe vamanaM yathA ||296|| Medicines must be administered taking into consideration day (time), patient, type of medicine, disease, digestive status, and season. The time of administration of medicine depends on the day like emetics should be given early in the morning. (296) Aushadha sevana kala (time of administration of medicine): रोग्यवेक्षो यथा प्रातर्निरन्नो बलवान् पिबेत् | भेषजं लघुपथ्यान्नैर्युक्तमद्यात्तु दुर्बलः ||२९७|| rōgyavēkṣō yathā prātarnirannō balavān pibēt| bhēṣajaṁ laghupathyānnairyuktamadyāttu durbalaḥ||297|| rogyavekSho yathA prAtarniranno balavAn pibet | bheShajaM laghupathyAnnairyuktamadyAttu durbalaH ||297|| The time of administration and the type of medicine must be decided as per the condition and diseased status of the patient. Patient in good condition who is strong should consume medicine early in the morning prior to morning meals and a person who is weak should take medicines along with food which is very light to get digested. (297) Ten slots of consuming medicines: भैषज्यकालो भुक्तादौ मध्ये पश्चान्मुहुर्मुहुः | सामुद्गं भक्तसंयुक्तं ग्रासग्रासान्तरे दश ||२९८|| bhaiṣajyakālō bhuktādau madhyē paścānmuhurmuhuḥ| sāmudgaṁ bhaktasaṁyuktaṁ grāsagrāsāntarē daśa||298||

bhaiShajyakAlo bhuktAdau madhye pashcAnmuhurmuhuH | sAmudgaM bhaktasaMyuktaM grAsagrAsAntare dasha ||298|| Ten slots or times of consuming medicines are described which are as follows. Two timing which are described in previous sutra, before meals, in between meals, at end of meals, frequently, at the end of meal and again consuming meals, medicine mixed with the morsel, along with each morsel and administrating in between each morsel.(298) Relation between time of administration and type of vitiated vata dosha: अपाने विगुणे पूर्वं, समाने मध्यभोजनम् | व्याने [२] तु प्रातरशितमुदाने भोजनोत्तरम् ||२९९|| apānē viguṇē pūrvaṁ, samānē madhyabhōjanam| vyānē [2] tu prātaraśitamudānē bhōjanōttaram||299|| apAne viguNe pUrvaM, samAne madhyabhojanam | vyAne [2] tu prAtarashitamudAne bhojanottaram ||299|| In vitiation of apana vayu medicines must be consumed before food , in vitiation of samana vayu food must be consumed in between meals, in vyana vayu vitiation early morning medication is advised and in udana vayu vitiation medicine is advised after meals. (299)

वायौ प्राणे प्रदुष्टे तु ग्रासग्रासान्तरिष्यते | श्वासकासपिपासासु त्ववचार्यं मुहुर्मुहुः ||३००|| vāyau prāṇē praduṣṭē tu grāsagrāsāntariṣyatē| śvāsakāsapipāsāsu tvavacāryaṁ muhurmuhuḥ||300||

vAyau prANe praduShTe tu grAsagrAsAntariShyate | shvAsakAsapipAsAsu tvavacAryaM muhurmuhuH ||300|| When prana vayu is vitiated medicines is to be advocated along with each morsel and in between two morsel. In diseases like shwas, kasa, pippasa (thirst) frequent doses of medicines must be given. (300) सामुद्गं हिक्किने देयं लघुनाऽन्नेन संयुतम् | सम्भोज्यं त्वौषधं भोज्यैर्विचित्रैररुचौ हितम् ||३०१|| sāmudgaṁ hikkinē dēyaṁ laghunā'nnēna saṁyutam| sambhōjyaṁ tvauṣadhaṁ bhōjyairvicitrairarucau hitam||301||

sAmudgaM hikkine deyaM laghunA~annena saMyutam | sambhojyaM tvauShadhaM bhojyairvicitrairarucau hitam ||301||

In diseases like hikka, medicines are to be used before and after, along with light meal to get digested. In patient with anorexia, medicines are to be given with meals.(301) ज्वरे पेयाः कषायाश्च क्षीरं सर्पिर्विरेचनम् | षडहे षडहे देयं कालं वीक्ष्यामयस्य च ||३०२|| jvarē pēyāḥ kaṣāyāśca kṣīraṁ sarpirvirēcanam| ṣaḍahē ṣaḍahē dēyaṁ kālaṁ vīkṣyāmayasya ca||302|| jvare peyAH kaShAyAshca kShIraM sarpirvirecanam | ShaDahe ShaDahe deyaM kAlaM vIkShyAmayasya ca ||302|| Peya , kashaya ( decoction) , kshira (medicated milk), medicated ghee and purgation must be advocated every six days taking into consideration status of the disease. (302) Signs of complete digestion: क्षुद्वेगमोक्षौ लघुता विशुद्धिर्जीर्णलक्षणम् | तदा भेषजमादेयं स्याद्धि दोषवदन्यथा ||३०३|| kṣudvēgamōkṣau laghutā viśuddhirjīrṇalakṣaṇam| tadā bhēṣajamādēyaṁ syāddhi dōṣavadanyathā||303||

kShudvegamokShau laghutA vishuddhirjIrNalakShaNam | tadA bheShajamAdeyaM syAddhi doShavadanyathA ||303||

Good appetite, natural passage of urges like stools and urine, lightness in the body and unobstructed vata dosha are the symptoms of jeerna (complete digestion). Above mentioned medicines are to be advocated when such symptoms arrive. If medications are given with such type of symptoms they pacify the disease and when given without such symptoms they vitiate the doshas.(303)

चयादयश्च दोषाणां वर्ज्यं सेव्यं च यत्र यत् | 

ऋताववेक्ष्यं यत् कर्म पूर्वं सर्वमुदाहृतम् ||३०४|| cayādayaśca dōṣāṇāṁ varjyaṁ sēvyaṁ ca yatra yat| r̥tāvavēkṣyaṁ yat karma pūrvaṁ sarvamudāhr̥tam||304||

cayAdayashca doShANAM varjyaM sevyaM ca yatra yat | RutAvavekShyaM yat karma pUrvaM sarvamudAhRutam ||304|| Which dosha are vitiated in which season, i.e the pattern of vitiation of dosha as per the seasonal variation, and what are the dietary do’s and don’ts and which treatment should be administered in which season is well elaborated previously in Sutrasthana. (304) (उपक्रमाणां [३] करणं प्रतिषेधे च कारणम् | व्याख्यातमबलानां सविकल्पानामवेक्षणे ||३०५|| (upakramāṇāṁ [3] karaṇaṁ pratiṣēdhē ca kāraṇam| vyākhyātamabalānāṁ savikalpānāmavēkṣaṇē||305||

(upakramANAM [3] karaNaM pratiShedhe ca kAraNam | vyAkhyAtamabalAnAM savikalpAnAmavekShaNe ||305||

The contraindicated treatment in certain period are explained well, as well as management of a weak patient and a strong patient is very well elaborated. (305) मुहुर्मुहुश्च रोगाणामवस्थामातुरस्य च | अवेक्षमाणस्तु भीषक् चिकित्सायां न मुह्यति) ||३०६|| इत्येवं षड्विधं कालमनवेक्ष्य भिषग्जितम् | प्रयुक्तमहिताय स्यात् सस्यस्याकालवर्षवत् ||३०७|| muhurmuhuśca rōgāṇāmavasthāmāturasya ca| avēkṣamāṇastu bhiṣak cikitsāyāṁ na muhyati)||306|| ityēvaṁ ṣaḍvidhaṁ kālamanavēkṣya bhiṣagjitam| prayuktamahitāya syāt sasyasyākālavarṣavat||307||

muhurmuhushca rogANAmavasthAmAturasya ca | avekShamANastu bhIShak cikitsAyAM na muhyati) ||306|| ityevaM ShaDvidhaM kAlamanavekShya bhiShagjitam | prayuktamahitAya syAt sasyasyAkAlavarShavat ||307|| That vaidya who keenly looks towards the status of the patient and status of the disease and then treats the patient never makes a mistake while managing the patient. The vaidya who does not follow the above six dosage timings of administration of medicines would not treat the disease properly and as unseasonal rain damages the crops; same way the medicines given at the wrong time damages health of patient. (306-307) Kala (season, state and time): व्याधीनामृत्वहोरात्रवयसां भोजनस्य च | विशेषो भिद्यते यस्तु कालावेक्षः स उच्यते ||३०८|| वसन्ते श्लेष्मजा रोगाः शरत्काले तु पित्तजाः | वर्षासु वातिकाश्चैव प्रायः प्रादुर्भवन्ति हि ||३०९|| vyādhīnāmr̥tvahōrātravayasāṁ bhōjanasya ca| viśēṣō bhidyatē yastu kālāvēkṣaḥ sa ucyatē||308|| vasantē ślēṣmajā rōgāḥ śaratkālē tu pittajāḥ| varṣāsu vātikāścaiva prāyaḥ prādurbhavanti hi||309||

vyAdhInAmRutvahorAtravayasAM bhojanasya ca | visheSho bhidyate yastu kAlAvekShaH sa ucyate ||308|| vasante shleShmajA rogAH sharatkAle tu pittajAH | varShAsu vAtikAshcaiva prAyaH prAdurbhavanti hi ||309||

One who classifies ritu ( season), day, night, age and time of meals depending upon time is called as kalaveksha. In general, kaphaja disorders are manifested in vasanta ritu; pittaja disorders appear during sharada ritu and vataja disorders manifest during varsha ritu. (308-309) Circadian rhythm of dosha disorders: निशान्ते दिवसान्ते च वर्षान्ते वातजा गदाः | प्रातः क्षपादौ कफजास्तयोर्मध्ये तु पित्तजाः ||३१०|| niśāntē divasāntē ca varṣāntē vātajā gadāḥ| prātaḥ kṣapādau kaphajāstayōrmadhyē tu pittajāḥ||310|| nishAnte divasAnte ca varShAnte vAtajA gadAH | prAtaH kShapAdau kaphajAstayormadhye tu pittajAH ||310||

End of night, end  of day, end of rainy season time is prone for vataja disorders. Beginning of day,  morning and evening times is susceptible  for kaphaja disorders and middle time of day  is prone for pittaja disorders.(310) 

वयोन्तमध्यप्रथमे वातपित्तकफामयाः | बलवन्तो भवन्त्येव स्वभावाद्वयसो नृणाम् ||३११|| vayōntamadhyaprathamē vātapittakaphāmayāḥ| balavantō bhavantyēva svabhāvādvayasō nr̥ṇām||311||

vayontamadhyaprathame vAtapittakaphAmayAH | balavanto bhavantyeva svabhAvAdvayaso nRuNAm ||311||

Human age has been divided into prathama, madhya and anta age. In prathama vaya(childhood), there is predominance of kapha; in madhya vaya (youth and adulthood), there is predominance of pitta and in anta vaya (old age), there is predominance of vata dosha. These doshas have a natural predominance as per the age of the person.(311) जीर्णान्ते वातजा रोगा जीर्यमाणे तु पित्तजाः | श्लेष्मजा भुक्तमात्रे तु लभन्ते प्रायशो बलम् ||३१२|| jīrṇāntē vātajā rōgā jīryamāṇē tu pittajāḥ| ślēṣmajā bhuktamātrē tu labhantē prāyaśō balam||312|| jIrNAnte vAtajA rogA jIryamANe tu pittajAH | shleShmajA bhuktamAtre tu labhante prAyasho balam ||312|| Taking into consideration the time of digestion of food, when it gets completely digested, that is at the end of food digestion vata dosha disorders occur; in middle of digestion pitta dosha disorders manifest and immediately when food is under process of digestion kapha dosha dominant disorder may appear.(312) Importance of proper dosage: नाल्पं हन्त्यौषधं व्याधिं यथाऽऽपोऽल्पा महानलम् | दोषवच्चातिमात्रं स्यात्सस्यस्यात्युदकं यथा ||३१३|| सम्प्रधार्य बलं तस्मादामयस्यौषधस्य च | नैवातिबहु नात्यल्पं भैषज्यमवचारयेत् ||३१४|| nālpaṁ hantyauṣadhaṁ vyādhiṁ yathāpō'lpā mahānalam| dōṣavaccātimātraṁ syātsasyasyātyudakaṁ yathā||313|| sampradhārya balaṁ tasmādāmayasyauṣadhasya ca| naivātibahu nātyalpaṁ bhaiṣajyamavacārayēt||314|| nAlpaM hantyauShadhaM vyAdhiM yathA~a~apo~alpA mahAnalam | doShavaccAtimAtraM syAtsasyasyAtyudakaM yathA ||313|| sampradhArya balaM tasmAdAmayasyauShadhasya ca | naivAtibahu nAtyalpaM bhaiShajyamavacArayet ||314|| As very small quantity of water can’t extinguish big fire, similarly small doses (insufficient dose) of medicine can’t inhibit or treat disease. Similarly excess water in field damages crop, the same way excess of medicine damages health of a person. Hence medicine should be given as per the status of disease; neither should it be given in very higher dose nor in very smaller doses to treat disease.(313-314) Satmya (adaptability) as per habitat: औचित्याद्यस्य यत् सात्म्यं देशस्य पुरुषस्य च | अपथ्यमपि नैकान्तात्तत्त्यजंल्लभते सुखम् ||३१५|| बाह्लीकाः पह्लवाश्चीनाः शूलीका यवनाः शकाः | मांसगोधूममाध्वीकशस्त्रवैश्वानरोचिताः ||३१६|| मत्स्यसात्म्यास्तथा [१] प्राच्याः क्षीरसात्म्याश्च सैन्धवाः | अश्मकावन्तिकानां [२] तु तैलाम्लं सात्म्यमुच्यते ||३१७|| कन्दमूलफलं [३] सात्म्यं विद्यान्मलयवासिनाम् | सात्म्यं दक्षिणतः पेया मन्थश्चोत्तरपश्चिमे [४] ||३१८|| मध्यदेशे भवेत् सात्म्यं यवगोधूमगोरसाः | तेषां तत्सात्म्ययुक्तानि भैषजान्यवचारयेत् ||३१९|| सात्म्यं ह्याशु बलं धत्ते नातिदोषं च बह्वपि |३२०| योगैरेव चिकित्सन् हि देशाद्यज्ञोऽपराध्यति ||३२०|| aucityādyasya yat sātmyaṁ dēśasya puruṣasya ca| apathyamapi naikāntāttattyajaṁllabhatē sukham||315|| bāhlīkāḥ pahlavāścīnāḥ śūlīkā yavanāḥ śakāḥ| māṁsagōdhūmamādhvīkaśastravaiśvānarōcitāḥ||316|| matsyasātmyāstathā [1] prācyāḥ kṣīrasātmyāśca saindhavāḥ| aśmakāvantikānāṁ [2] tu tailāmlaṁ sātmyamucyatē||317|| kandamūlaphalaṁ [3] sātmyaṁ vidyānmalayavāsinām| sātmyaṁ dakṣiṇataḥ pēyā manthaścōttarapaścimē [4] ||318|| madhyadēśē bhavēt sātmyaṁ yavagōdhūmagōrasāḥ| tēṣāṁ tatsātmyayuktāni bhaiṣajānyavacārayēt||319|| sātmyaṁ hyāśu balaṁ dhattē nātidōṣaṁ ca bahvapi| yōgairēva cikitsan hi dēśādyajñō'parādhyati||320|| aucityAdyasya yat sAtmyaM deshasya puruShasya ca | apathyamapi naikAntAttattyajaMllabhate sukham ||315|| bAhlIkAH pahlavAshcInAH shUlIkA yavanAH shakAH | mAMsagodhUmamAdhvIkashastravaishvAnarocitAH ||316|| matsyasAtmyAstathA [1] prAcyAH kShIrasAtmyAshca saindhavAH | ashmakAvantikAnAM [2] tu tailAmlaM sAtmyamucyate ||317|| kandamUlaphalaM [3] sAtmyaM vidyAnmalayavAsinAm | sAtmyaM dakShiNataH peyA manthashcottarapashcime [4] ||318|| madhyadeshe bhavet sAtmyaM yavagodhUmagorasAH | teShAM tatsAtmyayuktAni bhaiShajAnyavacArayet ||319|| sAtmyaM hyAshu balaM dhatte nAtidoShaM ca bahvapi |320| yogaireva cikitsan hi deshAdyaj~jo~aparAdhyati ||320|| Any food substance which is habituated to a particular person and which are not conducive or not wholesome to body and mind is called as apathya. Any person who is consuming such type of food or who is following unwholesome behavior should not instantly hold it. If any unwholesome food is prohibited instantly the person is not benefitted from it. Balhik means people living in balakha bukhara, shadwal, shulik, yawan and shaka are satmya to mamsa ( meat), godhuma(wheat), madhvik ( Alcoholic beverges) surgery and agnikarma (cauterization). Satmya is those daily activities and food which have become habitual to body. People from east are habituated to milk while people living in sindha desha are satmya to fish. Ashmak, and Avantika (Ujjain) residing people are satmya to oil and ghee. People from Vidyanamalaya (Malbar region ) are satmya to kanda (rhizomes , tuber) roots and fruits. People from north are satmya to peya , and people from south are satmya to mantha. People from central part are satmya to yava, godhuma and gorasa (milk). Medicines must be administered along with the food which is satmya to the patient . Medicines given with satmya food nourish the body fast and do not create much untoward effects. Medicines given without consideration of desha and kala and administered as mentioned in yoga ( formulation) may lead to wrong management. (315-320)

Viparitarthakari chikitsa (contradictory treatment): वयोबलशरीरादिभेदा हि बहवो मताः [१] |३२१| तथाऽन्तःसन्धिमार्गाणां दोषाणां गूढचारिणाम् ||३२१|| भवेत् कदाचित् कार्याऽपि विरुद्धाभिमता क्रिया | पित्तमन्तर्गतं गूढं [१] स्वेदसेकोपनाहनैः ||३२२|| नीयते बहिरुष्णैर्हि तथोष्णं शमयन्ति ते | बाह्यैश्च शीतैः सेकाद्यैरूष्माऽन्तर्याति पीडितः ||३२३|| सोऽन्तर्गूढं कफं हन्ति शीतं शीतैस्तथा जयेत् | श्लक्ष्णपिष्टो घनो लेपश्चन्दनस्यापि दाहकृत् ||३२४|| त्वग्गतस्योष्मणो रोधाच्छीतकृच्चान्यथाऽगुरोः | छर्दिघ्नी मक्षिकाविष्ठा मक्षिकैव तु वामयेत् ||३२५|| द्रव्येषु स्विन्नजग्धेषु चैव तेष्वेव विक्रिया |३२६|

vayōbalaśarīrādibhēdā hi bahavō matāḥ [1] |321| tathā'ntaḥsandhimārgāṇāṁ dōṣāṇāṁ gūḍhacāriṇām||321|| bhavēt kadācit kāryā'pi viruddhābhimatā kriyā| pittamantargataṁ gūḍhaṁ [1] svēdasēkōpanāhanaiḥ||322|| nīyatē bahiruṣṇairhi tathōṣṇaṁ śamayanti tē| bāhyaiśca śītaiḥ sēkādyairūṣmā'ntaryāti pīḍitaḥ||323|| sō'ntargūḍhaṁ kaphaṁ hanti śītaṁ śītaistathā jayēt| ślakṣṇapiṣṭō ghanō lēpaścandanasyāpi dāhakr̥t||324|| tvaggatasyōṣmaṇō rōdhācchītakr̥ccānyathā'gurōḥ| chardighnī makṣikāviṣṭhā makṣikaiva tu vāmayēt||325|| dravyēṣu svinnajagdhēṣu caiva tēṣvēva vikriyā| tasmāddōṣauṣadhādīni parīkṣya daśa tattvataḥ||326|| vayobalasharIrAdibhedA hi bahavo matAH [1] |321| tathA~antaHsandhimArgANAM doShANAM gUDhacAriNAm ||321|| bhavet kadAcit kAryA~api viruddhAbhimatA kriyA | pittamantargataM gUDhaM [1] svedasekopanAhanaiH ||322|| nIyate bahiruShNairhi tathoShNaM shamayanti te | bAhyaishca shItaiH sekAdyairUShmA~antaryAti pIDitaH ||323|| so~antargUDhaM kaphaM hanti shItaM shItaistathA jayet | shlakShNapiShTo ghano lepashcandanasyApi dAhakRut ||324|| tvaggatasyoShmaNo rodhAcchItakRuccAnyathA~aguroH | chardighnI makShikAviShThA makShikaiva tu vAmayet ||325|| dravyeShu svinnajagdheShu caiva teShveva vikriyA |326| tasmAddoShauShadhAdIni parIkShya dasha tattvataH ||326||

Medicines should be advised, taking into consideration the dushyas, doshas, and different types of factors related to the status of the body. The doshas which are situated in the deeper tissues are also of different types and these doshas move through the different types of channels which are connected to each other. To manage any disease which is deeply seated into the tissue, many procedures much seems to be opposite as per the classical text are to be advocated. For example pitta which is ushna (hot) in nature is treated by sheeta (cold) procedures, but in deep seated boil the pitta which is ushna in nature and vitiated is to be treated by giving hot fomentation or poultice. If cold procedures are implemented in this condition it will worsen the condition. Similarly if deep seated kapha dosha is to be treated sheeta procedures must be implemented. Lepas made out of sheeta dravyas like chandan are applied the inner heat will not be released and this heat can make cough dry. Though chandana is sheeta dravya, lepa made out of superfine powder of chandan applied on the lesion will block the heat coming out from the skin. This accumulated heat creates burning at the sight. In opposite, If lepa of agaru which is hot in nature and is applied, will impart coldness in that part. It is known that stool of fish has vomiting inhibiting activity but fish if consumed induces vomiting. Food substances if boiled or baked changes their properties. Thus it’s important for a vaidya, that he should not depend only on the properties of the yoga (formulation) but must consider all the ten factors discussed earlier along with different type of factors their classification and some exceptional rules while treating disorders. (321-326)

निवृत्तोऽपि पुनर्व्याधिः स्वल्पेनायाति हेतुना ||३२७|| क्षीणे मार्गीकृते देहे शेषः सूक्ष्म इवानलः | तस्मात्तमनुबध्नीयात् प्रयोगेणानपायिना ||३२८|| सिद्ध्यर्थं प्राक्प्रयुक्तस्य सिद्धस्याप्यौषधस्य तु |३२९| काठिन्यादूनभावाद्वा दोषोऽन्तः कुपितो महान् ||३२९|| पथ्यैर्मृद्वल्पतां नीतो मृदुदोषकरो भवेत् | पथ्यमप्यश्नतस्तस्माद्यो व्याधिरुपजायते ||३३०|| ज्ञात्वैवं वृद्धिमभ्यासमथवा तस्य कारयेत् |३३१| सातत्यात्स्वाद्वभावाद्वा पथ्यं द्वेष्यत्वमागतम् ||३३१|| कल्पनाविधिभिस्तैस्तैः प्रियत्वं गमयेत् पुनः | मनसोऽर्थानुकूल्याद्धि तुष्टिरूर्जा रुचिर्बलम् ||३३२|| सुखोपभोगता च स्याद्व्याधेश्चातो बलक्षयः | लौल्याद्दोषक्षयाद्व्याधेर्वैधर्म्याच्चापि या रुचिः ||३३३|| तासु पथ्योपचारः स्याद्योगेनाद्यं विकल्पयेत् |३३४|

kuryāccikitsitaṁ prājñō na yōgairēva kēvalam| nivr̥ttō'pi punarvyādhiḥ svalpēnāyāti hētunā||327|| kṣīṇē mārgīkr̥tē dēhē śēṣaḥ sūkṣma ivānalaḥ| tasmāttamanubadhnīyāt prayōgēṇānapāyinā||328|| siddhyarthaṁ prākprayuktasya siddhasyāpyauṣadhasya tu| kāṭhinyādūnabhāvādvā dōṣō'ntaḥ kupitō mahān||329|| pathyairmr̥dvalpatāṁ nītō mr̥dudōṣakarō bhavēt| pathyamapyaśnatastasmādyō vyādhirupajāyatē||330|| jñātvaivaṁ vr̥ddhimabhyāsamathavā tasya kārayēt|331| sātatyātsvādvabhāvādvā pathyaṁ dvēṣyatvamāgatam||331|| kalpanāvidhibhistaistaiḥ priyatvaṁ gamayēt punaḥ| manasō'rthānukūlyāddhi tuṣṭirūrjā rucirbalam||332|| sukhōpabhōgatā ca syādvyādhēścātō balakṣayaḥ| laulyāddōṣakṣayādvyādhērvaidharmyāccāpi yā ruciḥ||333|| tāsu pathyōpacāraḥ syādyōgēnādyaṁ vikalpayēt| kuryAccikitsitaM prAj~jo na yogaireva kevalam | nivRutto~api punarvyAdhiH svalpenAyAti hetunA ||327|| kShINe mArgIkRute dehe sheShaH sUkShma ivAnalaH | tasmAttamanubadhnIyAt prayogeNAnapAyinA ||328|| siddhyarthaM prAkprayuktasya siddhasyApyauShadhasya tu |329| kAThinyAdUnabhAvAdvA doSho~antaH kupito mahAn ||329|| pathyairmRudvalpatAM nIto mRududoShakaro bhavet | pathyamapyashnatastasmAdyo vyAdhirupajAyate ||330|| j~jAtvaivaM vRuddhimabhyAsamathavA tasya kArayet |331|

sAtatyAtsvAdvabhAvAdvA pathyaM dveShyatvamAgatam ||331|| 

kalpanAvidhibhistaistaiH priyatvaM gamayet punaH | manaso~arthAnukUlyAddhi tuShTirUrjA rucirbalam ||332|| sukhopabhogatA ca syAdvyAdheshcAto balakShayaH | laulyAddoShakShayAdvyAdhervaidharmyAccApi yA ruciH ||333|| tAsu pathyopacAraH syAdyogenAdyaM vikalpayet |334|

As a small sparkle of fire flare ups when it comes in contact with wind or wood and gets converted into huge flames of fire similarly already a weak body in which previously a disease pathology has occurred and disease has recovered, whenever gets chance may again relapse. Hence for the better results of the medicines given before to treat the disease, pathya (wholesome diet) must be followed after the disease is completely treated. If strong or weak medicament has vitiated doshas, they can be pacified by following wholesome diet. If disease status aggravates even when followed by wholesome diet, diet pattern should be changed which can help to inhibit the disease. If patient is bored from taking the same food or does not relish the food, then food should be prepared by different methods which will be liked by the patient. If the food and other objects are liked by patient then only he gets satisfaction, enthusiasm, energy, taste, strength and happiness which reduces the influence of disease. Greediness in eating, due to the inactivity of doshas or wrong disease process leads to loss of taste and appetite which can be corrected by whole some diet and activity or change in the previously advised diet.(327-333) Summary: तत्र श्लोकाः- विंशतिर्व्यापदो योनेर्निदानं लिङ्गमेव च ||३३४|| चिकित्सा चापि निर्दिष्टा शिष्याणां हितकाम्यया | शुक्रदोषास्तथा चाष्टौ निदानाकृतिभेषजैः ||३३५|| क्लैब्यान्युक्तानि चत्वारि चत्वारः प्रदरास्तथा | तेषां निदानं लिङ्गं च भैषज्यं चैव कीर्तितम् ||३३६|| क्षीरदोषास्तथा चाष्टौ हेतुलिङ्गभिषग्जितैः | रेतसो रजसश्चैव कीर्तितं शुद्धिलक्षणम् ||३३७|| उक्तानुक्तचिकित्सा च सम्यग्योगस्तथैव च | देशादिगुणशंसा [१] च कालः षङ्विध एव च ||३३८|| देशे देशे च यत् सात्म्यं यथा वैद्योऽपराध्यति

चिकित्सा चापि निर्दिष्टा दोषाणां गूढचारिणाम् ||३३९|| 

यो हि सम्यङ्ग जानाति शास्त्रं शास्त्रार्थमेव च | न कुर्यात् स क्रियां चित्रमचक्षुरिव चित्रकृत् ||३४०|| अग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते | चिकित्सितमिदं स्थानं षष्ठं परिसमापितम् ||३४१|| tatra ślōkāḥ- viṁśatirvyāpadō yōnērnidānaṁ liṅgamēva ca||334|| cikitsā cāpi nirdiṣṭā śiṣyāṇāṁ hitakāmyayā| śukradōṣāstathā cāṣṭau nidānākr̥tibhēṣajaiḥ||335|| klaibyānyuktāni catvāri catvāraḥ pradarāstathā| tēṣāṁ nidānaṁ liṅgaṁ ca bhaiṣajyaṁ caiva kīrtitam||336|| kṣīradōṣāstathā cāṣṭau hētuliṅgabhiṣagjitaiḥ| rētasō rajasaścaiva kīrtitaṁ śuddhilakṣaṇam||337|| uktānuktacikitsā ca samyagyōgastathaiva ca| dēśādiguṇaśaṁsā [1] ca kālaḥ ṣaṅvidha ēva ca||338|| dēśē dēśē ca yat sātmyaṁ yathā vaidyō'parādhyati| cikitsā cāpi nirdiṣṭā dōṣāṇāṁ gūḍhacāriṇām||339|| yō hi samyaṅna jānāti śāstraṁ śāstrārthamēva ca| na kuryāt sa kriyāṁ citramacakṣuriva citrakr̥t||340|| agnivēśakr̥tē tantrē carakapratisaṁskr̥tē| cikitsitamidaṁ sthānaṁ ṣaṣṭhaṁ parisamāpitam||341|| tatra shlokAH- viMshatirvyApado yonernidAnaM li~ggameva ca ||334|| shukradoShAstathA cAShTau nidAnAkRutibheShajaiH ||335|| klaibyAnyuktAni catvAri catvAraH pradarAstathA | teShAM nidAnaM li~ggaM ca bhaiShajyaM caiva kIrtitam ||336|| kShIradoShAstathA cAShTau hetuli~ggabhiShagjitaiH | retaso rajasashcaiva kIrtitaM shuddhilakShaNam ||337|| uktAnuktacikitsA ca samyagyogastathaiva ca | deshAdiguNashaMsA [1] ca kAlaH Sha~gvidha eva ca ||338|| deshe deshe ca yat sAtmyaM yathA vaidyo~aparAdhyati | cikitsA cApi nirdiShTA doShANAM gUDhacAriNAm ||339|| yo hi samya~gga jAnAti shAstraM shAstrArthameva ca | na kuryAt sa kriyAM citramacakShuriva citrakRut ||340|| agniveshakRute tantre carakapratisaMskRute | cikitsitamidaM sthAnaM ShaShThaM parisamApitam ||341|| In this chapter of Yonivyapad Chikitsa twenty types of yoni roga, their causes symptoms and treatment, eight types of disorders of veerya (semen), their causes symptoms and treatment, four types of infertility and four types of pradara ( vaginal discharges) their causes symptoms and treatment, eight types of disorders of breast milk their causes symptoms and its short and detail treatment, Symptoms of shuddha shukra (normal semen) and shudhha artav (menstrual bleeding), management of explained and unexplained diseases, importance of place and time in treatment, six type of classification regarding time in general or the period regarding day, month, season etc, satmya of people residing in different area, how vaidya can cause error in conducting any treatment or procedure and treatment of deep seated doshas. As a blind person cannot draw a good portrait, similarly that vaidya who doesn’t understand science and its interpretation cannot treat disease in a proper manner. (334-341)

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने योनिव्यापच्चिकित्सितं नाम त्रिंशोऽध्यायः ||३०|| 

श्रीचरकसंहितायां चिकित्सितस्थानं समाप्तम् ||३१|| ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē yōnivyāpaccikitsitaṁnāma triṁśō'dhyāyaḥ||30|| iti carakasaṁhitāyāṁ ṣaṣṭhaṁ cikitsitasthānaṁ sampūrṇam|

ityagniveshakRute tantre carakapratisaMskRute~aprApte dRuDhabalasampUrite cikitsAsthAne yonivyApaccikitsitaM nAma triMsho~adhyAyaH ||30|| 

shrIcarakasaMhitAyAM cikitsitasthAnaM samAptam ||31|| Thus ends the thirtheeth chapter of Chikitsa sthana in the treatise by Agnivesha, revised by Charaka and redacted by Dridhabala. Tattva vimarsha: • The faulty lifestyle habits, vitiated menstrual blood, defects in beeja (ovum, causing hereditary or congenital defects) and the destiny are four causative factors for diseases of female genital tract. • In addition to above, manifestation of yonivyapat (diseases of female genital tract) depends upon the vitiation of doshas due to their own causative factors. • The manifestation of diseases of female genital tract can occur in two ways viz. structural abnormalities and functional abnormalities. This leads to defects in menstruation, difficulty in sexual intercourse, inability to conceive i.e. infertility or abortion. • The diseases of female genital tract are influenced by various physiological factors like age, maturity, menstruation, sexual intercourse, pregnancy, labour, menopause and suppression of natural urges. • Vata plays important role in all conditions of yonivyapat, because the genital tract is inherent seat of vata dosha. • The genetic defects in female genital tract are mainly caused by improper diet and lifestyle of mother during pregnancy and vitiation of vata dosha. • Assessment of dominance of dosha must be done before starting treatment of yonivyapat, because the treatment and procedures are highly specific to vitiation of dosha. • The treatment is based upon assessment of dominance of dosha, its purification, general pacification and local procedures with dosha alleviating medicines. • The purification procedures advocated in females shall always be mild in nature. Strong purification is contra-indicated in females. • The local examination of female genital tract, vaginal discharge, vaginal structure (unctuousness or dryness, stiffness or flaccidity, displacement) shall always be done before designing treatment protocol. • In rakta yoni (bleeding through the vagina), the colour of bleeding should be observed for the association of doshas and haemostatic drugs should be used according to the involvement of doshas. (86) • When the genital tract is purified and the seeds (sperm and ovum) are normal (in their own form), undamaged, then the jivatama or consciousness wants to come into the foetus (garbha) then women conceive. (125) • In males, the shukra (semen) gets ejaculated as a result of excitement and is the sign of masculinity. The seed as an effect of delighted coitus, has been described as shukra (semen), is the male characteristic. As the seed has capacity of reproduction in favourable conditions, the shukra possess capacity of reproduction. • Improper diet, improper lifestyle, psychological factors and improper sexual habits impair quality and quantity of shukra dhatu. • Fenilam (frothy), tanu (slender), ruksham (arid), vivarnam (discolored), pooti (putrid), pichhilam (slimy), afflicted with other dhatus, & precipitant are the eight shukra disorders affected by vitiated dosha. • Retah (virile semen) that is snigdha (unctuousness), ghana (viscous), picchila (slimy), madhura (sweet), avidahi (non-blazing), looking like white crystal quartz; are characteristics of normal (semen). • In case of diseases of semen, treatment principles with use of formulations mentioned in vajikarana (aphrodisiac), raktapitta and yonivyapada are applied. • Impotency is caused by the beeja-upaghata (hereditary/congenital defect), dhwajopaghata (erectile dysfunction), jaraya (senility), shukrasamkshaya (diminished semen). • The treatment mentioned for the shukra (semen) disorders as well as kshataksheena shall be applied for alleviation of impotency. Indications are basti, ksheera-sarpi (combination of milk and ghee), vrushya yoga(aphrodisiac), & rasayana prayoga (rejuvenating medicines); all together shall be administered for the treatment of impotency, caused by excess coitus, dhatu viparyaya, considering deha-bala (strength of the patient), dosha–bala (degree of dosha vitiation), agni-bala (power of agni) & bheshaj-kala (time of medicine administration). • The vitiated dosha affect menstrual blood and increase quantity and duration of menstruation leading to pradara. The clinical manifestations of pradara depend upon dosha dominance involved in pathogenesis. • If menstrual discharge (artava) comes after a month without stickiness (sliminess), burning sensation and pain, persists for five days, neither too little nor excess in quantity then it is considered as free from doshas or normal. In colour, artava (menstrual blood) should be red like gunja fruit, red lotus flower or mahavara or red as indragopaka insect, such artava is considered as normal menstrual blood. (225-226) • The treatment of pradara is as per principles of management for raktatisara (diarrhoea with expulsion of blood), raktapitta (internal haemorrhage) and raktarsha (bleeding piles). • The breast milk can be affected by vitiated dosha due to improper diet and lifestyle of mother or wet nurse. The clinical manifestation is observed in change in colour and consistency of breast milk, signs on the breast milk fed baby and mother too. The treatment of mother or wet nurse is done in order to treat the defects. • The vitiation of dosha, body elements, mala and the diseases which affect adults also affect children similarly, but to lesser degree. • The paediatrician should not administer emesis like purification procedures in children due to tender nature, dependency, inability to fully express themselves in speech and gestures. He should give only small doses of medicines as per the disease. Sweet decoction, medicated milk and medicines with mild potency shall be administered in children by wise pediatrician. The medicines, food and beverages with excess unctuousness, dryness, hot potency, sour, pungent in post digestive effect, and heavy to digest property are contraindicated in children. (282-286) • The new diseases which are not described in this text due to their various names and clinical presentations shall also be treated according to the dominance of dosha etc.factors(as mentioned earlier). (291) • The treatment that is opposite to dosha, dushya and nidana (causative factors) is always beneficial. • The medicines shall be prescribed after due consideration of desha (habitat), kala (season), pramana (dosage), satmya (adaptability) and asatmya (non-adaptability). If this is properly considered, then it is pathya (beneficial to body systems).Otherwise it is non-beneficial. (293) • The medicines shall always be administered through nearest route to the site of affliction. If the doshas are located in stomach, then medicines shall be administered orally; if at head region, then through nose; and if at colon then medicines quickly act if given per rectum. The doshas at other body parts and diseases originated from them like visarpa, pidaka etc, shall be treated with pradeha etc. specific local pacification procedures. (294-295) • Medicines must be administered taking into consideration day (time), the diseased person, type of medicine, disease, digestive status, and season. The time of administration of medicine depends on the day like emetics should be given early in the morning.(296) • The time of administration of drug depends upon circadian rhythm of dosha, status of digestion, interaction with food and type of vata vitiated in body. • In vitiation of apana vayu medicines must be consumed before food , in vitiation of samana vayu food must be consumed in between meals, in vyana vayu vitiation, early morning medication is advised and in udana vayu vitiation medicine is advised after meals. When prana vayu is vitiated medicines is to be advocated along with each morsel and in between two morsel. In diseases like shwas, kasa, pipasa (thirst) frequent doses of medicines must be given. • Good appetite, natural passage of urges like stools and urine, lightness in the body and unobstructed vata dosha are the symptoms of jeerna (complete digestion). • Generally kaphaja disorders are manifested in vasanta ritu; pittaja disorders appear during sharada ritu and vataja disorders manifest during varsha ritu. (308-309) • End of night, end of day, end of rainy season time is prone for vataja disorders. Beginning of day, morning and evening times is susceptible for kaphaja disorders and middle time of day is prone for pittaja disorders.(310) • In prathama vaya (childhood), there is predominance of kapha; in madhya vaya (youth and adulthood), there is predominance of pitta and in anta vaya (old age), there is predominance of vata dosha. These doshas have a natural predominance as per the age of the person.(311) • Taking into consideration the time of digestion of food, when it gets completely digested, that is at the end of food digestion vata dosha disorders occur; in middle of digestion pitta dosha disorders manifest and immediately when food is under process of digestion kapha dosha dominant disorder may appear.(312) • The treatment shall always consider adaptability of an individual to food, lifestyle and medicines as per desha(habitat). • The disease can relapse even after exposure to small amount of causative factors in an individual with weak strength. Hence for the better results of the medicines given before to treat the disease, pathya (wholesome diet) must be followed after the disease is completely treated. • The feeling of satisfaction, enthusiasm, energy, taste, strength and happiness through food and other subjects reduces the influence of disease.

Vidhi vimarsha: Female genital tract and its disorders: Female is considered most important to have progeny. Amongst the four factors responsible for fetus, i.e. ritu, kshetra, ambu and beeja; all four are present in female. Hence reproductive health maintainece will lead to procuring a healthy progeny. [5] General causes of Yonivyapada: The four common factors responsible for yonivyapada are mentioned as 1. Mithyaachara – Faulty diet habits and unhygieneic conditions with faulty sexual practices are responsible for vitiation of dosha leading to female reproductive system disorders. 2. Pradushta artava – Menstruation is mirror of reproductive health. Any abnormality in menstrual cycle indicates pathology in the female reproductive system. Hence pradushta artava indicates any hormonal / organic pathology leading to menstrual abnormality. 3. Beeja dosha – Congenital anomalies occurs because of sperm or ovum defect. Here the word beeja refers to both male and female gametes. 4. Daiva – The deeds of the past are also held responsible for certain conditions related with the reproductive system. The unexplained factors of certain diseases can be considered as result of poorva janma karma (deeds of past life). [8] Doshaja yonivyapad: Dosha Clinical correlation Vataja Dysmenorrhoea Endometriosis Pittaja Trichomonas vaginalis Genital infection Pelvic inflammatory disease Kaphaja Moniliais, candidiasis Sannipataja Mixed vagnitis, endometritis, Chronic infection [9-15] Other yonivyapada and their possible clinical correlation Asruja – Rakta yoni Menorrhagia because of coagulation factors leading to failure of implantation hence failure of conception anticardiolipin antibody and antiphospholipid antibody present. Arajaska Secondary pathological amenorrhoea because of poor nutritional status. In anorexia and even female athlete’s amenorrhoea Acharna Genital infections because of poor hygienic conditions Aticharana Local vulval and vaginal inflammation due to excessive intercourse. Common example is honeymmon cystits Prakacharana Vaginal tearing, ligament stretching because of sexual intercourse before adolescence Upapluta Candidia infection during pregnancy Paripluta Pelvic inflammatory disease Udavartini Primary spasmodic dysmenorrhoea Karnini Old cervical tears leading to formation of tag, polyps Putraghni Recurrent late first trimester and second trimester abortion Vamini Recurrent first trimester abortion Antarmukhi Fixed retroverted uterus Suchimukhi Congenital pinhole os of cervix Sushka Menopause or estrogen deficiency, premature menopause Sandhi Turner’s syndrome, Genetic abnormality with absent breast and uterus Mahayoni Complete genital prolapse, procidentia [16-37] The complication of these diseases is infertility due to coital, vaignal, uterine and other factors. Along with the doshas which are aggravated and responsible for causing certain ailment of reproductive system also causes ailments of nearby systems like urinary, intestinal and rectum. [38-39] Princples of Treatment of yonivyapada The general line of treatment should be targeted towards the dosha, hence vataja, pittaja, kaphaja yonivypada should be treated accordingly with snehana swedana, raktapittahara sheeta, ruksha ushna therapies respectively. In all types of gynaecological disorders, panchakarma should be administered in mild form in order to eliminate the vitiated doshas and restoring normal reproductive health. Principals of surgical corrections of congenital anomalies and and displaced organs are also given stating that the uterus which has been displaced from its original place should be regarded as shalya and the treatment of shalya is its removal. Hence this is the indication of hysterectomy in complete genital prolapse. The method of such procedure is not given in any classics. [41-46] Local treatments like douching, fomentation, keeping oil tampon, vaginal suppositories, fumigation. Indications and method of preparation of such medicines in form of oil, ghee, suppository and others are described later. Other preparations are in the form of churna, vati, kwath, oil, ghee are to be used orally or in the form of basti (medicated enema) or uttarbasti ( administration of medicine in uterus through vaginal route) are given in detail. [47-114] The importance of vata dosha in causing female reproductive tract disorders is highlighted as the location of genital organs is also the seat of apana vayu and all the functions like menstruation, pregnancy, labour are governed by apana vayu. Hence considering the crucial role of vata, the treatment should be aimed at vata alleviation along with other therapies. [114-116] The soul resides when the genital organs are cleansed with all therapies and the male and female gamet are favourable for conception and best. [126]

Male genital tract and its disorders: By retovaha srotas the pathway through which the semen flows out shall be considered; which can be correlated to the seminal vesicles and ejaculatory duct. Retovaha srotas has been discussed separately to make it understand that is is different than shukrawaha srotas. As mentioned earlier shukravaha srotas comparises of medhra (the penis) and vrushana (the scrotum), which is referred for stationary semen; while retas is the word for virile semen, that is flowing semen. Therefore the words shukra and retas have been used separately in different context as per the suitability and the intention of description. [133-139] Abnormal semen For achievement of conception, more emphasis is given on quantity and quality of sperm. Little work has been done on the change in the characteristics of semen. Although change in volume, viscosity, pH effect the sperm motility and concentration and hence can lead to reduced fertility. The causative factors of change in characteristics of semen can be genital infections, trauma, malignancy, ejaculation problems, sex abuse and some medications. The characteristics of abnormal semen: The shukra dushti has been mentioned of eight types by sushruta also though the nomenclature is different. Table : 1 Classification of shukra dushti according to Sushruta (Su. Sa. 2/2-3) and Ashtanga sangraha Classification Characteristics Clinical conditions

Vata dushta

Aruna, krishna varna, phenila, tanu, rooksha, alpa, vilambita vedana yukta Oligospermia and azospermia Injury, chronic inflammation Low fructose, obstruction in seminal vesicle Pitta dushta Neela varna, ushna, putigandha, daha chosha type of pain during ejaculation Acute prostitis Sleshma dushta Shukla varna, atipicchila, prabuta, kandu yukta, visra gandha Chronic inflammatory condition, hypofunction of male sex accessory glands Kunapa – Shonita dushta Cadaver smelling, analpa, associated with osha and chosha Haemospermia (benign prostate hypertrophy) or acute injury to external genitals. Granthi –Kapha vata dushta Clot formation Prostatic dysfunction and inflammation Putipuya - pitta kapha dushta Foul smelling, semen containing puya Pyospermia, Chalmydia infection, STD Kshina – pitta vata dushta Hypospermia and oligospermia Decreased semen volume because of obstruction in seminal vesicle. Mutrapurishagandhi - Tridosha Semen with smell of urine and faeces Carcinoma, recto – genital urinary tract fistula

[139-144] Characteristics of normal semen: The Shuddha Shukra should be white like sphatika, liquid, viscous, sweet in taste, smell of honey also should look like mixture of oil and honey. Following are the criteria for normal semen according to modern science. Normal semen Composition Most of the fluid in semen is made up of secretions from male reproductive organs. Semen contains citric acid, free amino acids, fructose, enzymes, phosphorylcholine, prostaglandin, potassium, and zinc. Recent studies have also evaluated calcium, magnesium and gold in semen. • 46 to 80 per cent of the fluid is produced by the seminal vesicles • 13 to 33 per cent by the prostate gland • 5 per cent from the testicles and epididymis • 2-5 percent from Bulbourethral and urethral glands Normal semen sample Normal semen has certain characteristics. These can be broken down into appearance, volume, smell and so forth. Appearance of human semen A normal sample has a grey-opalescent appearance. If left open for a while the semen initially clots or coagulates over the first hour and then it becomes liquefied. Volume A usual semen volume per ejaculate is around 2 to 3 ml or more. Sperm constitute approximately 10% of semen volume. Smell A chlorine smell or fishy odour in semen is normal. Taste Semen tastes slightly sweet due to a high content of fructose. The taste of semen tends to change slightly from person to person and may be affected by diet. pH of semen The pH range should be 7.2 to 7.8. This is the normal pH of the body. If the pH is lower than 7.2, it may mean that there is a low sperm counts or malformations in the reproductive tract. If the pH is above 7.8, it may indicate a urinary tract infection. Sperm concentration The normal range of sperm in semen samples is 20 million/ml or more and a total count of 40 million or more. [145-146] Present criteria of klaibya (Impotency) due to beejopaghata (Less / absence of Sperm): Oligozoospermia: When sperm concentration is < 20 million/ml. Asthenozoospermia: Fewer than 50% spermatozoa with forward progression (categories (a) and (b) or fewer than 25% spermatozoa with category (a) movement. Teratozoospermia: Fewer than 50% spermatozoa with normal morphology. Oligoasthenoteratozoospermia: Signifies disturbance of all the three variables (combination of only two prefixes may also be used). Azoospermia: No spermatozoa in the ejaculate Aspermia: No ejaculate [158-163] Erection is a neuro vasculo tissue phenomenon under hormonal control. Erectile dysfunction (ED) is defined as persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. There is increasing evidence that ED can be an early manifestation of coronary artery and peripheral vascular disease; thus ED should not be regarded only as quality of life issue but also as potential warning sign of cardiovascular diseases.- ED shares risk factors with cardiovascular disease. Lifestyle modification (intensive exercise and decrease in BMI) can improve erectile function. ED is a symptom, not a disease. Some patients may not be properly evaluated or receive treatment for an underlying disease or condition that may be causing ED. ED is common after radical prostatectomy, irrespective of the surgical technique used. ED is common after external radiotherapy and brachytherapy Common causes of ED: Vasculogenic - Cardiovascular disease - Hypertension - Diabetes mellitus - Hyperlipidaemia - Smoking - Major surgery (RP) or radiotherapy (pelvis or retroperitoneum) Neurogenic Central causes - Degenerative disorders (multiple sclerosis, Parkinson’s disease, multiple atrophy etc.) - Spinal cord trauma or diseases - Stroke - Central nervous system tumours Peripheral causes - Type 1 and 2 diabetes mellitus - Chronic renal failure - Polyneuropathy - Surgery (pelvis or retroperitoneum, radical prostatectomy, colorectal surgery, etc.) Anatomical or structural - Hypospadias, epispedias - Micropenis - Congenital curvature of the penis - La Peyronie’s disease Hormonal - Hypogonadism - Hyperprolactinemia - Hyper- and hypothyroidism - Hyper- and hypocortisolism (Cushing’s disease etc) Drug-induced - Antihypertensives (diuretics are the most common medication causing ED) - Antidepressants (selective serotonin reuptake inhibitors, tricyclics) - Antipsychotics (incl. neuroleptics) - Antiandrogens; GnRH analogues and antagonists - Recreational drugs (alcohol, heroin, cocaine, marijuana, methadone) Psychogenic - Generalised type (e.g., lack of arousability and disorders of sexual intimacy) - Situational type (e.g., partner-related, performance-related issues or due to distress) [162-167] Text word Translation Disease correlation Lingapaka Penile Inflammation Balanitis Shwayathu Swelling Mamsaabhivruddhi Warts Condyloma, Mollusum contagiosum, warts Chirat Pakam Chronic inflammation Chronic Urethritis, Prastatitis Medhra vedana Pain at Penis Urethral Calculi, Valayi kushtha? Circular skin lesions Trichomoniasis Teevra Sphota Erupting Boils Chancroid, Herpes Pulakodaka srava Exudative secretions Gonorrhea, Chlamydia Vrana Wounds Penile Cancer [168-173] Penile & Testicular diseases of Chronic Inflammatory etiology: Veneral diseases Benign and Malignant tumors of male genitalia Penile Fractures [174-175] After age 40 years, testosterone levels in men begin to decrease. This decline, alternatively referred to as the male climacteric, andropause, viropause, or partial androgen deficiency of the aging male (PADAM), may account for a number of pathophysiologic changes associated with aging. Decreased bone density, loss of lean body mass, depressed erythropoiesis, oligospermia, sexual dysfunction; cognitive deficits, memory problems, and depression have all been hypothesized to result from a reduction in serum androgen levels. The symptoms of andropause are indolent, because the nature of androgen loss with age is slow and progressive3. [179-180] Causes for Kashyaj Klaibya as per recent researches: 1. Vasal agenesis – absence of Vasa deferentia 2. Bilateral testicular atrophy 3. Ductal obstruction – Ejaculatory Duct obstruction 4. Genetic factors

Concept of shukrashmari & ejaculatory duct obstruction

Surgical measures described in the treatment of klaibya (impotency):

Medhrachheda: Partial and /or complete penectomy Vrishana patana: Orchiectomy [181-191] Times of administration of medicines: Last part of this chapter discuss the importance of pathya (wholesome diet) in treatment and dosage timings of administrations can be termed as slots and Sharangdhar samhita elaborates this time of administration in five different slots. Drugs can be administered at five designated time slots during the day as under.

 1. Kinchit suryodaya jate (just after sunrise) 
 2. Divasa bhojana (around lunch)
  3. Sayam bhojana  (around evening meal i.e. dinner)
  4. Muhurmuhu (repeated) 
   5. Nishi (at night)      [297]

The second time of administration elaborated by Sharangdhar samhita is divided into five parts that is before meals, in between meals, after meals, medicines mixed with food and before and after meals. 1. Bhojanagre (prior to start of lunch) e.g. mixture of lavana (rock salt) and ardraka (fresh ginger) 2. Bhojanamishra (drug mixed in food) e.g. Mixture of hingu (asafetida) and ghrita (ghee). 3. Bhojanamadhya (in the midst of lunch) e.g. water or any liquids 4. Bhojanante (at the end of lunch) e.g. lavanga (clove) and fruits of haritaki (Chebulic myrobalans) 5. Bhojanapurvante (before and after lunch) e.g. dhatriloha: a formulation made of dhatri (Emblica officinalis) and loha (iron) bhasma prescribed in amlapitta (acid peptic disease). [299] The time of drug administration which is related to the type of disease and status of the doshas in the body can be called as chrono therapeutics. Chronotherapeutics refers to a treatment method in which in vivo drug availability is timed to match rhythms of disease in order to optimize therapeutic outcomes and minimize side effects. It is based on the observation that there is an interdependent relationship between the peak-to-trough rhythmic activity in disease symptoms and risk factors, pharmacologic sensitivity, and pharmacokinetics of many drugs

The circadian timing system is composed of molecular clocks, which drive 24-h changes in xenobiotic metabolism and detoxification, cell cycle events, DNA repair, apoptosis, and angiogenesis. The cellular circadian clocks are coordinated by endogenous physiological rhythms, so that they tick in synchrony in the host tissues that can be damaged by anticancer agents. As a result, circadian timing can modify 2- to 10-fold the tolerability of anticancer medications in experimental models and in cancer patients. Improved efficacy is also seen when drugs are given near their respective times of best tolerability, due to (a) Inherently poor circadian entrainment of tumors and (b) Persistent circadian entrainment of healthy tissues. Conversely, host clocks are disrupted whenever anticancer drugs are administered at their most toxic time. On the other hand, circadian disruption accelerates experimental and clinical cancer processes. Gender, circadian physiology, clock genes, and cell cycle critically affect outcome on cancer chronotherapeutics. Mathematical and systems biology approaches currently develop and integrate theoretical, experimental, and technological tools in order to further optimize and personalize the circadian administration of cancer treatments.

Many biological functions wax and wane in cycles that repeat each day, month, or year. Such patterns do not reflect simply an organism’s passive response to environmental changes, such as daily cycles of light and darkness. Rather, they reflect the organism’s biological rhythms, that is, its ability to keep track of time and to direct changes in function accordingly. Biological rhythms that repeat approximately every 24 hours are called circadian rhythms (from the Latin circa, for around, and dies,for day)

The frequency of heart attacks peaks between 6 a.m. and noon asthma attacks are most prevalent at night, human babies are born predominantly in the early morning hours , . While these patterns do not necessarily indicate that the events are driven by the circadian pacemaker, they do suggest temporal order in the functioning of the human body.

This temporal organization appears to be beneficial; the human body is prepared for routine changes in state, such as awakening each morning, rather than simply reacting after shifts in demand In addition, these regular cycles in the body present considerations for diagnosis of health problems and for the timing of medical treatment

The circadian rhythms of various functions in humans, such as hormone production, body temperature, and sleepiness, are normally coordinated— i.e., they bear a specific relationship to each other. This temporal organization suggests that some biological timekeeping device must drive, regulate, or at least integrate various circadian rhythms. In mammals, considerable experimental evidence indicates that a region of the brain called the suprachiasmatic nucleus (SCN) is the circadian pacemaker? . The SCN, composed of a cluster of thousands of small nerve cells, is located within a region of the brain, the hypothalamus, that controls such basic functions as food intake and body temperature. [297]

The secretion of cortisol, a steroid hormone important for metabolism and responses to stress, fluctuates daily, peaking in the very early morning hours and falling to a negligible amount by the end of the day (181). Besides its use as a marker for the internal pacemaker, the circadian rhythm of cortisol secretion may drive other rhythms in the body and has important clinical implications.

Also, cortisol-like steroid hormones used therapeutically to treat asthma and allergies and to suppress the immune system, are best administered in the morning, when they interfere least with the body's own cortisol production. Circadian rhythms in cardiovascular function have long been recognized. Indicators of heart and blood vessel function that demonstrate daily rhythms include blood pressure, heart rate, blood volume and flow, heart muscle function, and responsiveness to hormones (84). The daily fluctuations in cardiovascular function are further illustrated by symptoms of disease. Data have shown that abnormal electrical activity in the heart and chest pains peak at approximately 4 a.m. in patients suffering from coronary heart disease (189,190). As stated earlier, the number of heart attacks has been shown to peak between 6 a.m. and noon (117,140). These temporal characteristics of cardiovascular disease indicate the importance of careful timing in their assessment, monitoring, and treatment (120). [299]

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