Rectal Speculum

Now we shall describe the dimensions of the Yantras (and the materials of which they are made of). The instrument may be made of iron, ivory, horn or wood. It should be made to resemble the teat of a cow. In the case of a male patient, it should be four fingers in length and five fingers in circumference; whereas in the case of a female patient, the length should be commensurate with that of the palm of the hand (of the same length as before - D. R.) and six fingers in circumference. The instrument should be provided with two separate apertures in its inside, one for seeing the interior of the rectum and the other for applying an alkali, or actual cautery (Agni) to the polypus, since it is impossible to apply fire and alkali through the same aperture. The circumference of the aperture in the upper three fingers of the instrument should be like that of a thumb. There should be a bulb-like protrusion of the same width, at the bottom, and above it a space of half a finger's width. Thus we have briefly described the shape of the instrument. 9-ro.

Alepa (Plasters)

Now we shall describe the plasters to be applied to the haemorrhoids (to cause their spontaneous dropping off). The first consists of pulverised turmeric mixed with the milky exudation of the Snuhi tree. The second contains of the cock-evacuations and pulverised Gunjá, turmeric and Pippali pasted with the urine and bile of a cow. The third is compounded of Danti, Chitraka, Suvarchiká and Lángali pounded together and made into a paste with cow's bile. The fourth consists of Pippali, rock-salt, S'irisha-seeds and Kushtha pasted with the milky juice of an Arka, or Snuhi plant. An oil cooked in combination with Kásisa (sulphate of iron), Haritála (yellow orpiment), rock-salt, As'vamáraka, Vidanga, Putika, Kritavcdhana, Jambu, Arka, Uttamárani, Danti, Chitraka, Alarka and Snuhi-milk, and used as an unguent, leads to the falling off of the polypus, 11.

Internal Piles

Now we shall describe the remedial measures which bring about the falling off of the invisible (internal) haemorrhoids. The patient should take Haritaki with treacle every morning; or a hundred Haritakis should be boiled in a Drona measure of cow's urine and the patient, observing a strict continence, should take with honey every morning as many of them as suit his constitution; or he should be made to take every day a paste made of the roots of Apámárga with the washings of rice and with honey. S'atávari pasted with an adequate quantity of milk or ( a Karsha measure of) the powders of Chitraka mixed with a copious quantity of good Sidhu wine, or a gruel (Mantha) (neither extremely thick nor thin), or powdered barley or wheat mixed with Takra and Bhallátaka powder, should be administered without any salt. A quantity of Takra should be kept in an earthen pitcher, plastered inside with a paste of Chitraka roots, and given to the patient in food and drinks whether fermented or not. A Takra should also be separately prepared as in the preceding manner with Bhárgi, Asphotá, barley, Amalaka and Guduchi and administered similarly; this is called the Takra-kalpa (butter-milk compound). 12.

A medicated Takra should also be prepared with Pippali, Pippali-mula, Chavya, Chitraka, Vidanga, S'unthi and Haritaki, in the manner described above, (and given to the patient), who should abstain from taking any solid food, but live only on (this) Takra for a period of one full month; or he should be given milk boiled with a decoction of S'ringavera, Punarnavá and Chitraka, or a condensed decoction (Phánita) of the bark of Kutaja roots mixed with an after-throw of the powdered drugs of the Pippalyádi group and honey. The patient should be made to partake of the medicinal compound known as the Hingvádi-churna, * described in the chapter on Mahá-Váta-vyádhi, and be made to live either on milk, or on Takra. As an alternative, he should take Kuhnásha boiled in Kshárodaka (alkaline water) prepared from Chitraka-roots and made saline with a liberal after-throw of Yava-kshara; or he should take milk boiled with the Kshárodaka (alkaline water) prepared from Chitraka-roots, or Kulmásha boiled with the alkaline water prepared from the ashes of burnt Palása; or he should drink frequent potions of clarified butter mixed with the alkali made of the ashes of either Patola, Apámárga, Vrikati, or Palásá wood; or drink Takra mixed with the Kalka of the roots of Kutaja and of Vandáka; or take the alkaline water of Putika mixed with a Kalka of Chitraka, Putika and Nágara; or use the clarified butter boiled in an alkaline solution † with the powdered drugs of the Pippalyádi group, added to it by way of an after-throw; or he should take every morning one or two Palas of black sesamum (according as required), with cold water. These measures prove remedial in cases of haemorrhoids and tend to improve the digestion. 13.

* In a preponderance of Váyu and Kapha, Takra should be taken as diet; whereas milk should be taken in a case of the preponderance of vitiated blood.

† During the period when the above mentioned alkaline preparations are used, the diet of the patient should consist of clarified butter, milk and meat-soup for fear of the loss of the Ojo-Dhátu.