This paper analyses and comments on the Guhyasamāja Piṇḍikṛta-sādhana, a ritual practice manual for the Guhyasamāja Highest Yoga Tantra, attributed to Nāgārjuna. It is based on a correlated translation of the Sanskrit and Tibetan versions of the text prepared for the purpose. Various opinions concerning the author and the date of the original setting down of the text (800- 950CE) are examined and the contents of the sādhana are explained and put into the context of other sādhanas and the corpus of Guhyasamāja texts. Particular attention has been given to making the translation of the visualizations of the architecture and the deities themselves clear by providing tables and illustrations. The philosophical background of the text is investigated and the way in which that was subtly altered by subsequent commentators when it no longer fitted the later “philosophical climate” is made clear. The continuity of the practice is discussed, from its inception to the present day.