सप्तदशोऽध्यायः ।अथात आमपक्वैषणीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discuss the Chapter which deals with the mode of distinguishing between suppurating and non-suppurating swellings. ama-pakvaisaniya adhyaya. 1
शोफसमुत्थाना ग्रन्थिविद्रध्यलजीप्रभृतयः प्रायेण व्याध्योऽभिधास्यन्ते अनेकाकृतयः, तैर्विलक्षणः पृथुर्ग्रथितः समो विषमो वा त्वङ्मांसस्थायी दोषसङ्घातः शरीरैकदेशोत्थितः शोफ इत्युच्यते ॥२॥
Diseases such as, Granthi (Aneurism), Vidradhi, (abscess) and Alaji (inflammation of the edge of the cornea) etc. are ushered in by a preliminary swelling which subsequently develops symptoms peculiar to each of them. These diseases differ in their symptoms and outward shape. A swelling which may appear at any part of the body, and is round, elevated, even, or uneven in its (surface ) is called a Sotha (swelling). It restricts itself to the skin and flesh of its locality and is characterised by the several or concerted action of the deranged bodily humours. 2
स षड्विधो वातपित्तकफशोणितसन्निपातागन्तुनिमित्तः । तस्य दोषरूपव्यञ्जनैर्लक्षणानि व्याख्यास्यामः । तत्र, वातशोफोऽरुणः कृष्णो वा परुषो मृदुरनवस्थितास्तोदादयश्चात्र वेदनाविशेषा भवन्ति । पित्तशोफः पीतो मृदुः सरक्तो वा शीघ्रानुसारी, ओषादयश्चात्र वेदनाविशेषा भवन्ति। श्लेष्मशोफः पाण्डुः शुक्लो वा कठिन: शीतः स्निग्धो मन्दानुसारी, कण्ड्वादयश्चात्र वेदनाविशेषा भवन्ति । सर्व्ववर्णवेदनः सन्निपातजः। पित्तवच्छोणितजोऽतिकृष्णश्च । पित्तरक्तलक्षण आगन्तुर्लोहितावभासश्च ॥३॥
The Sothas (swelling) admit of being divided into six different types according as they are caused by the action of the deranged Vayu, Pitta, Kapha or blood, or are due to the concerted action of the three fundamental humours of the body, or are traumatic origin.
Now we shall describe the symptoms which mark the respective actions of the humours in a swelling. A swelling due to the action of the deranged Vayu assumes a reddish or blackish hue and is shifting in its character. It feels rough and soft to the touch, and is marked by a sort of aching pain (peculiar to the deranged Vayu) which vanishes at intervals. A swelling, due to the action of the deranged Pitta, assumes a yellowish hue. It is soft and fluctuates under pressure, and is marked by an accumulation of blood in its body. It swiftly shifts from one part of the body to another, accompanied by a burning, sucking pain. A swelling, brought about through the deranged condition of the Kapha, assumes a grey or whitish colour. The skin becomes glossy and cold, and the swelling very slowly changes its original site, if it shifts at all, accompanied by pain and itchhing. A swelling engendered through the concerted action of the three bodily humours successively mannifests the symptoms and assumes the colours respectively peculiar to each of them. The symptoms which mark a swelling due to the action of the vitiated blood are identical with those which are exhibited in a swelling of the Pittaja type with the exception of the blackness of the part (and an increase of heat). A swelling due to an external blow (traumatic) manifests symptoms peculiar to the Pittaja and blood-origined types. 3
स यदा बाह्याभ्यन्तरैः क्रियाविशेषैर्न सम्भावितः प्रशमयितुं क्रियाविपर्य्ययाद् बहुत्वाद् वा दोषाणाम् तदा पाकाभिमुखो भवति । तस्यामस्य पच्यमानस्य पक्वस्य च लक्षणमुच्यमानमुपधारय ॥४॥ तत्र, मन्दोष्मता त्वक्सवर्णता शीतशोफता स्थैर्य्यं मन्दवेदनताल्पशोफता चामलक्षणमुद्दिष्टम् ॥५॥
A swelling, which does not yield to internal and external remedies on account of an excessive accumulation of the deranged local humours, or through the insufficient or contrary effects of the remedical agents, shows sign of suppuration.
Now hear me described the symptoms, which respectively mark an unsuppurated, suppurating or suuppurated swelling. The unsuppurated of immature stage continues as long as the skin of the swelling retains its natural hue, marked by a little pain and heat in its inside, and coldness, hardness and a slight elevation of its surface. 4-5
सूचीभिरिव निस्तुद्यते, दश्यत इव पिपीलिकाभिस्ताभिश्च संसर्प्यत इव, छिद्यत इव शस्त्रेण, भिद्यत इव शक्तिभिः, ताडयत इव दण्डेन, पीडचत इव पाणिना, घटयत इव चाङ्गल्या, दह्यते पच्यत इव च क्षाराग्निीभ्याम्, ओषचोषपरिदाहाश्च भवन्ति; वृश्चिकविद्ध इव च स्थानासनशयनेषु न शान्तिमुपैति । आध्मातबस्तिरिवाततश्च शोफो भवति, त्वग्वैवर्ण्य शोफाभिवृद्धिर्ज्वरदाहपिपासा भक्तारुचिश्च पच्यमानलिङ्गम् ॥६॥
The suppurating stage gives rise to a sensation of pricking pain in the affected locality. The swelling seems as if it is being pricked with needles, or bitten or wandered over by a host of ants, or cut with a knife, or pierced with a spear, or thrashed with a club, or pressed with the hand, or scraped round with fingers, or burnt with a fire or an alkali. The patient complains of a sort of sucking, burning pain in the swelling of a fixed or shifting character. The patient, as if stung by a scorpion, does not find comfort in any place or position. The hue of the local skin is changed and the swelling goes on increasing like an inflated leathher bag; and fever, thirst, a burning sensation and aversion to food etc. gradually supervene. 6
वेदनोपशान्तिः पाण्डुताल्पशोफता वलीप्रादुर्भावस्त्वक्परिपुटनं निम्नदर्शनमङ्गुल्यावपीड़िते प्रत्युन्नमनं, बस्ताविवोदकसञ्चरणं पूयस्य प्रपीडयत्येकमन्तमन्ते चावपीडिते, मुहुर्मुहुस्तोदः कण्डूरुन्नतता व्याघेः उपद्रवशान्तिर्भक्ताभिकाङ्गा च पक्वलिङ्गम् ॥७॥
The suppurated stage is marked by an amelioration of the local pain and a yellowishness of the skin over the swelling, which cracks and seems too big, thus giving rise to folds in the integument. The swelling exhibits fluctuation under pressure and shows perceptible signs of diminution. Moreover, it yields to pressure and reaches its former height when the pressure is removed. The pus or the suppurated matter changes its place, or shifts from one part of the swelling to another under pressure like water in a bloated leather bag. The distressing symptoms gradually subside; the patient again evinces a desire for food, and feels a constant inclination for scratching the affected part which is characterised by a sort of aching pain. 7
कफजेषु तु रोगेषु गम्भीरगतित्वादभिघातजेषु च केषुचिदसमस्तं पक्वलक्षणं दृष्ट्वा पक्वमपक्वमिति मन्यमानो भिषङ्मोहमुपैति । यत्र हि त्वक्सवर्णता शीतशोफता स्थौल्यमल्परुजताश्मवच्च घनता, न तत्र मोहमुपेयादिति ॥८॥
Sometimes, as in cases of traumatic swelling or in those brought about by a deranged condition of the Kapha, the suppurating process is restricted to the deeper tissues of the affected part and hence fail to exhibit its characteristic symptoms- a fact which often misleads a physician (surgeon) as regards the true state (lit:- whether suppurated or not) of the accompanying swelling. But the knowledge that a process of suppuration, occurring in the deeper tissues of an affected part, is accompanied by alleviation of the pain and swelling which becomes as compact as a stone and cold to the touch, and the local skin resuming its natural colour, would unquestionably ward off all apprehensions for error of judgment. 8
भवन्ति चात्र
आमं विपच्यमानञ्च सम्यकृपक्वञ्च यो भिषक् । जानीयात् स भवेद् वैद्यः शेषास्तस्करवृत्तयः ।। ९ ।।
वाताद्गते नास्ति रुजा न पाकः पित्तागते नास्ति कफाच्च पूयः । तस्मात् समस्ताः परिपाककाले पचन्ति शोफांस्त्रय एव दोषाः ।।१०।।
Authoritative verses on the subject : A physician ( surgeon) who is fully conversant with the symptoms which are respectively exhibited by (an inflammatory ) swelling in its unsuppurated, suppurating and suppurated stages, is alone worthy of the epithet; the rest are but impostors. Since there can be no pain without the intervention of the deranged Vayu; and no suppuration can set in without the action of the deranged Pitta; nor pus, without the action of the deranged Kapha; it is evident that a suppurated swelling is marked by the combined and simultaneous action of the three deranged humours of the body. 9-10
कालान्तरेणाभ्युदितन्तु पित्तं कृत्वा वशे वातकफौ प्रसह्य । पचत्यतः शोणितमेव पाको मतोऽपरेषां विदुषां द्वितीयः ।।११।।
According to certain authorities, the deranged Pitta gets the preponderance over the local Vayu and Kapha, and transforms the blood into pus out of its own preponderant energy. 11
तत्रामच्छेदे मांसशिरास्नाय्वस्थिसन्धिव्यापादनमतिमात्रं शोणितातिप्रवृत्तिः वेदनाप्रादुर्भावोऽवदरणमनेकोपद्रवदर्शनं क्षतविद्रधिर्वा भवति । स यदा भयमोहाभ्यां पक्वमप्यपक्वमिति मन्यमानश्चिरमुपेक्षते व्याधिं वैद्यस्तदा गम्भीरानुगतो द्वारमलभमानः पूयः स्वमाश्रयमवदार्य्योत्सङ्गं महान्तमवकाशं कृत्वा नार्डी जनयित्वा कृच्छ्रसाध्यो भवत्यसाध्यो वेति ॥१२॥
The incision or opening of a swelling in its inflammatory or unsuppurated (lit. immature, unripe) stage is attended with the destruction of the local flesh, ligament, bone, vein, or joint, and is usually followed by excessive haemorrhage. The incidental wound becomes extremely painful. Many distressing symptoms begin to manifest themselves in succession and cavities are formed inside the wound which may lapse into a case of Ksata-Vidradhi (a type of ulcerated abscess).
On the other hand, a fully suppurated swelling, left unopened for a long time out of fear or ignorance by the attending physician, is attended with symptoms which are fraught with dreadful consequences. The accumulated pus, unable to find an outlet, is infiltrated and attacks the deeper tissues of the affected part, and forms large cavities or sinuses in their inside, thus converting the disease into one of a difficult or incurable type. 12
भवन्ति चात्र यश्छिनत्त्यामामज्ञानाद् श्वपचाविव मन्तव्यौ प्राक् शस्त्रकर्म्मणश्चेष्टं भोजयेदातुरं भिषक् । मद्यपं पाययेन्मद्यं तीक्ष्णं यो वेदनाऽसहः ।।१४।। न मूर्च्छत्यन्नसंयोगान्मत्तः शस्त्रं न बुध्यते । तस्मादवश्यं भोक्तव्यं रोगेषूक्तेषु कर्म्मणि ।। १५ ।।
प्राणो ह्याभ्यन्तरो नृणां बाह्यप्राणगुणान्वितः । धारयत्यविरोधेन शरीरं पाञ्चभौतिकम् ।। १६ ।।
यश्च पक्वमुपेक्षते । तावनिश्चितकारिणौ । । १३ ।।
Authoritative verses on the subject : They physician (surgeon) who opens an unsuppurated or unripe swelling out of ignorance, as well as the man who neglects a fully suppurated one, should be looked upon as the vilest Candala for his wrong or incorrect diagnosis. The patient should be provided with a meal before the surgical operation, or strong wine should be given him, if he is found to be addicted to the habit of taking any. The effect of a good meal under the circumstance will be to keep up the strength of the patient and to guard against his swooning during the operation, while the effect of wine will be to make him unconscious of the pain. The rule as regards the feeding and anaesthetising (wine giving) of the patient should be strictly adhered to, since the internal vital principle of a man is invigorated by the strength of his body which is the product of lymph-chyle, the essence of food, and the quintessence of the five material principles. 13-16
समुच्छ्रितः विशालमूलो अल्पो महान् वा क्रियया पाकमुपैति विषमो विना यः शोफः । विदग्धः यात्यवगाढदोषः ।।१७कृच्छ्रतां
।।
A swelling, no matter whether limited or extensive, spontaneously runs on to suppuration, if not medicinally treated, or left to nature. The base of such a swelling goes on extending. It becomes unequally suppurated and reaches an unequal elevation, thus affecting the deeper tissues of the part and swiftly ruunning into one of an incurable type. 17
आलेपविस्रावणशोधनैश्च प्रयुक्तैर्यदि शीघ्र सम्यक् पच्येत पिण्डितश्योपरि सममल्पमूलः नोपशाम्येत् । चोन्नतः समासाद्य यथैव स्यात् ।।१८।। कक्षं वह्निर्वाय्वीरितः प्रसह्य । तथैव हि खादतीह ।।१९।। मांसं शिराः स्नायु सन्दहति पूयोऽप्यविनिःसृतो
A swelling, which does not yield to the application of medicated plasters or to corrective or blood-letting measures, speedily and uniformly suppurates, and is marked by a small and restricted base and a circular or conical elevation. As a blazing fire fed by gusts of favourable wind soon consumes a withered forest, so the incarcerated pus, in the absence of any outlet, attacks and eats away the healthy flesh, veins and nerves of an organism. 18-19
आदौ विम्लापनं कुर्य्याद् द्वितीयमवसेचनम् । तृतीयमुपनाहञ्च चतुर्थी पाटनक्रियाम् ॥ पञ्चमं शोधनं कुर्य्यात् षष्ठं रोपणमिष्यते । एते क्रमा व्रणस्योक्ताः सप्तमं वैकृतापहम् ||२०||
Surgical acts in connection with an abscess (Sotha) may be divided into seven kinds such as 1. mutilation (Vimlapana) of the swelling by massage, 2. Avasecana (bleeding or application of leeches). 3. Upanaha (poulticing) 4. Patana (opening or incision) 5. Sodhana (purification of the internal morbid matter of an incised boil with corrective medicines ) 6. Ropana (healing) and 7. Vaikritapaham (restoring of the natural colour of the skin to the cicatrix ). 20
इति सुश्रुतसंहितायां सूत्रस्थाने आमपक्वैषणीयो नाम सप्तदशोऽध्यायः ॥१७॥
Thus ends the seventeenth Chapter of the Sutrasthana in the Susruta Samhita which treats of how to distinguish between suppurating and non-suppurating swellings.
