षोडशोऽध्यायः । अथातो विद्रधीनां चिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः । ॥ १ ॥ ।।१।।
Now we shall discourse on the medical treatment of Abscesses and Tumours ( Vidradhi ). As stated by Lord Dhanvantari. 1
उक्ता विद्रधयः षड्ये तेष्वसाध्यस्तु सर्वजः । शेषेष्वामेषु कर्त्तव्या त्वरितं शोफवत् क्रिया ॥ २ ॥
Of the six types of Vidradhis the one of the Sanni-patika type should be regarded as incurable. In all other types curative measures¹ should be speedily resorted to in their unsuppurated stage, as in the treatment of a case of Sopha (inflammatory swelling or boil). 2
वातघ्नमूलकल्कैस्तु घृततैलवसायुतैः । सुखोष्णो बहलो लेपः प्रयोज्यो वातविद्रधौ ॥ ३ ॥
सानूपौदकमांसस्तु काकोल्यादिः सतर्पणः । स्नेहाम्लसिद्धो लवणः प्रयोज्यश्चोपनाहने ।। ४ ।।
वेशवारैः सकुशरैः पयोभिः पायसैस्तथा । स्वेदयेत् सततञ्चापि निर्हरेच्चापि शोणितम् ।। ५ ।।
Treatment of Vataja – Vidradhi : In a case of Vataja Vidradhi, a compact or thick plaster (Alepa) composed of pasted Murangi1. Commencing with Apatarpana up to purgative measures ( Chikitsa, chapter.-1).
¡roots,¹ mixed with clarified butter, oil and lard (Vasa), should be applied lukewarm. The flesh of the animals which are swampy as well as aquatic should be boiled with the drugs of the Kakolyadi group, Kanjika, salt, barley powder and Sneha (clarified butter, etc.), should be applied as a poultice (Upanaha), and the affected part should be astantly fomented with ( warm ) Vesavara, Krsara, milk and Payasa. Blood-letting should also be resorted to. 3-5
स चेदेवमुपक्रान्तः पाकायाभिमुखो यदि । तं पाचयित्वा शस्त्रेण भिन्द्याद भिन्नञ्च शोधयेत् ॥ ६ ॥
प्रक्षाल्य लवणोत्तरैः । पञ्चमूलकषायेण तैलैर्भद्रादिमधुक-संयुक्तैः वैरेचनिकयुक्तेन पृथक्पर्ण्यादिसिद्धेन त्रैवृतेन च त्रैवृतेन विशोध्य प्रतिपूरयेत् ॥ ७ ॥ च। च रोपयेत् ।। ८ ।।
If, in spite of the use of the preceding remedies. uppuration should begin to set in, suppurating measures should be resorted to and the abscess (finally) lanced with a knife. Cleansing measures should then be applied to the (incidental) ulcer. After incision, the ulcer should be washed with a decoction of the Pancha-mula; and an oil cooked with the drugs of the Bhadra-darvadi group and Yasti-madhu. and mixed with an abundant quantity of salt, should be used in filling (healing up) the cavity of the wound. The cleansing of the ulcer should be effected with the powdered Vairecanika (purgative) drugs mixed with Traivrta and the healing should be effected with Traivrta cooked with the drugs of the Prthak-parnyadi group. 6-8
पैत्तिकं प्रदिह्यात्श र्करालाजा-मधुकैः क्षीरपिष्टैर्वा सारिवायुतैः । पयस्योशीरचन्दनैः।। ९ ।।
1. Both Dalhana and Cakrapani Datta read Vataghna’ in place of “Murangi” of the text. Dalhana explains the term “Vataghna” as the “Bhadra-darvadi group’ and Siva-dasa, the commentator of Charaka, explains it as the Dasamula’. Both of them, however, say that the different reading is Surangi” meaning ‘‘sobhanjana.” “Murangi” also means “Sobhanjana.” –Ep. 61
2. “Traivrta” is a technical term and means clarified butter mixed with the three other lardacious substances, viz., oil, lard and marrow, Vide Chikitsa Sthana. Chapter– V.
पाक्यैः जीवनीयघृतैर्वाऽपि क्षीरैरिक्षुरसैस्तथा । सेचयेच्छर्करायुतैः ।। १० ।।
लिह्यान्मधुद्रवम् । त्रिवृद्धरीतकीनाञ्च चूर्णं जलौकोभिर्हरेच्चासृक् पक्वञ्चापाटय बुद्धिमान् ।। ११ ।।
क्षीरवृक्षकषायेण प्रक्षाल्यौदकजेन वा । तिलैः सयष्टिमधुकैः सक्षौद्रैः सर्पिषा युतैः । उपदिय प्रतनुना वाससा वेष्टयेद् व्रणम् ।। १२ ।।
प्रपौण्डरीकमञ्जिष्ठा-मधुकोशीरपद्मकैः सहरिद्रैः कृतं सर्पि: सक्षीरं व्रणरोपणम् ।।
क्षीरशुक्लापृथक्पर्णी-समङ्गारोध्रचन्दनैः न्यग्रोधादिप्रवालेषु तेषां त्वक्ष्वथवा कृतम् ।। १३ ।। शीतकषायैर्वा
Treatment of Pittaja Vidradhi: In a case of Pittaja Vidradhi a plaster (Pradeha) composed of sugar, fried paddy, Yasti-Madhu and Sariva pasted with milk should be applied. As an alternative, a plaster composed of Payasya, Usira and (red) sandal wood pasted with milk should be used. Cold infusions of Pakya (Yava-kshara), sugarcanejuice and milk, and Jivaniya-Ghrita mixed with sugar should be used in infusing the abscess. The patient should be advised to lick a lambative composed of powdered Haritaki and Trivrt saturated with honey; and leeches should be applied (to an unsuppurated) abscess for letting out the blood. An intelligent surgeon should (lance a suppurated abscess and) wash the incidental ulcer with a decoction of Ksira-Vrksa or of aquatic bulbs. Poultices of sesamum and Yasti-Madhu mixed with honey and clarified butter should then be applied to it and bandaged with piece of thin linen. Clarified butter cooked with Prapaundarika, Manjistha, Yasti – Madhu, USira, Padmaka, Haridra and milk, should be used to heal up the cavity of a Pittaja ulcer by (inducing granulation). As an alternative, clarified butter cooked with Ksira-Sukla, Prthak-parni, Samanga, Rodhra, Candana and the tender leaves and bark of the drugs of the Nyagrodhadi group should be employed for the same end. 9-13
नक्तमालस्य पत्राणि तरुणानि फलानि च। सुमनायाश्च पत्राणि पटोलारिष्टयोस्तथा ।। १४ ।।
द्वे हरिद्रे मधूच्छिष्टं मधुकं तिक्तरोहिणी । प्रियङ्गः कुशमूलञ्च निचुलस्य त्वगेव च ।। १५ ।।
मञ्जिष्ठाचन्दनोशीरमुत्पलं सारिवा त्रिवृत् कार्षिकैर्भागैर्घृतप्रस्थं विपाचयेत् ।। १६ ।।
एतेषां दुष्टव्रणप्रशमनं सद्यश्छिन्नव्रणानाञ्च करञ्जाद्यमिदं शुभम् ॥ १७ ॥
दुष्टव्रणाश्च ये केचिद् ये चोत्सृष्टक्रिया व्रणाः । नाड्यो गम्भीरिका याश्च सद्यश्छिन्नास्तथैव च || १८ ||
अग्निक्षारकृताश्चैव ये व्रणा दारुणा अपि । करञ्जाद्येन हविषा प्रशाम्यन्ति न संशयः ।। १९ ।। नाडीव्रणविशोधनम् ।
Karanjadya Ghrita: A Karsa measure of each of the following drugs, viz., the tender leaves and fruits of the Naktamala, the leaves of the Sumana (Jati flower), Patola and of Arista, Haridra, DaruHaridra, wax, Yasti – Madhu, Tikta – Rohini, Priyangu, Kusa-roots, Nicula-bark, Manjistha sandal wood, Usira, Utpala, Sariva and Trivrt should be cooked with a Prastha measure of clarified butter. This medicated Ghrita is called the Karanjadya Ghrita, and it will cure malignant ulcers (Dusta-Vrana) and act as a purifier in sinus and recent ulcers, etc., burns and scalds, deep sores and even deep-seated sinuses. 14-19
इष्टकासिकतालोष्ट गोशकृत्तुषपांशुभिः । मूत्रैरुष्णैश्च सततं स्वेदयेत् श्लेष्मविद्रधिम् ।। २० ।।
कषायपानैर्वमनैरालेपैरुपनाहनैः हरेद् दोषानभीक्ष्णञ्चाप्यलाब्वाऽसृक् तथैव च ।। २१ ।।
आरग्वधकषायेण धावयेत् । पक्वञ्चापाट्य हरिद्रात्रिवृताशक्तु-तिलैर्मधुसमायुतैः पूरयित्वा व्रणं सम्यग् बध्नीयात् कीर्तितं यथा ॥ २२ ॥
ततः कुलत्थिकादन्ती-त्रिवृच्छयामार्कतिल्वकैः । कुर्य्यात् तैलं सगोमूत्रं हितं तत्र ससैन्धवम् ॥ २३ ॥
1. Chakrapani Datta in his compilation does not include Priyangu, Kusa-roots and Nicula-bark in the list but he reads both the kinds of sariva, i.e., Anantamula and syama-lata.
Treatment of Kaphaja Vidradhi: In a case of Kaphaja Vidradhi, the seat of affection should be fomented with a heated brick, sand, stone, cow-dung, husks, ashes and cow’s urine. The Dosas involved in such a case should be curbed down by a constant use of medicinal decoctions, emetics. plasters ( Alepa ) and poultices (Upanaha). The vitiated blood of the locality should be cuffed out with an Alabuyantra (gourd). The abscess when suppurated should be (lanced and ) washed with a decoction of Aragvadha. The sore of such an ulcer should be filled up (healed) with a medicinal compound consisting of the paste of Haridra, Trivrt, Saktu, sesamum and honey and bandaged in the manner described before. After that, a medicated oil properly cooked with a paste of Kullattha, Danti, Trivrt, Syama, Arka, Tilvaka, cow’s urine and rock-salt should be applied in such a case. 20-23
पित्तविद्रधिवत् सर्वाः क्रिया निरवशेषतः । विद्रध्योः कुशलः कुर्याद्रक्तागन्तुनिमित्तयोः ॥ २४ ॥
Treatment of Agantuja and Raktaja Vidradhi : In a cas of abscess of traumatic (Agantuja) origin, or due to the vitiated condition of the blood (Raktaja), all the measures and remedies laid down in connection with those of the Pittaja type should be employed by a skilled surgeon. 24
वरुणादिगणक्वाथमपक्वेऽभ्यन्तरोत्थिते ऊषकादिप्रतीवापं पिबेद् विद्रधिशान्तये ॥ २५ ॥
अनयोवर्गयोः सिद्धं सर्पिर्वैरेचनेन च । अचिराद् विद्रधिं हन्ति प्रातः प्रातर्निषेवितम् ॥ २६ ॥
एभिरेव गणैश्चापि संसिद्धं स्नेहसंयुतम् । कार्यमास्थापनं क्षिप्रं तथैवाप्यनुवासनम् ॥ २७ ॥
पानालेपनभोज्येषु मधुशिग्रुगुमोऽपि वा। दत्तावापो यथादोषमपक्वं हन्ति विद्रधिम् ॥ २८ ॥
तोयधान्याम्लमूत्रैस्तु पेयो वाऽपि सुरादिभिः । यथादोषगणक्वाथैः पिबेद् वाऽपि शिलाजतु ।
प्रधानं गुग्गुलुञ्चापि शुण्ठीञ्च सुरदारु च ।। २९ ।।
In Cakradatta, the reading is “मूत्रैपिष्टै:” i.c, pasted in cow’s urine, instead of “मूत्रैरुष्णै:” Sivadasa, the commentator, however holds that this reading is not authoritative, though he says that some commentators have accepted it.
स्नेहोपनाहौ कुर्याच्च सदा चाप्यनुलोमनम् ।। ३० ।।
Treatment of internal Vidradhi: A case of an unsuppurated internal abscess yields to the use of a potion consisting of a decoction of the drugs of the Varunadi group saturated with the powders (Kalka) of those of the Usakadi group. Clarified butter cooked with the decoction of the drugs of the two preceding groups, as well as clarified butter cooked with purgative drugs, taken every morning, will cure an internal abscess in a very short time. The decoctions of the above groups should be mixed with Sneha (oil or clarified butter) and speedily used as an Asthapana as well as an Anuvasana measure. The bark of Madhu-sigru mixed with the powders of the drugs antidotal to the Dosas involved in the case, being administered in food and drink and used as a plaster, proves curative in a case of an internal abscess in its unsuppurated stage. As an alternative, the said drug (i.e., Madhusigru) should be taken with water, Dhanyamla, cow’s urine, or Sura (wine). Purified silajatu, Guggulu, Sunthi and Deva-daru, dissolved in the decoction of the drugs antidotal to the aggravated Dosas involved in the case, should be administered. Applications of poultices. Sneha-Karma (emollient measures), as well as Anulomana (Vayusubduing) measures should be frequently resorted to in such cases. 25-30
यथोद्दिष्टां सिरां विध्येत् कफजे विद्रधौ भिषक् । रक्तपित्तानिलोत्थेषु केचिद् बाहौ वदन्ति तु ।। ३१ ।।
The veins (Sira) should be opened in a case of the Kaphaja type of abscess as directed before; while some authorities advise to open the veins at the arms in cases of Raktaja, Vataja and Pittaja types. 31
पक्वं वा वहिरुन्नद्धं भित्त्वा व्रणवदाचरेत् । स्स्रुतेषूर्ध्वमधो वाऽपि मैरेयाम्लसुरासवैः ॥ ३२ ॥
पेयो वरुणकादिस्तु मधुशिग्रुद्रुमोऽपि वा। ससिद्धार्थकमोदनम् ।। ३३ ।।
शिगुमूलजले सिद्धं यवकोलकुलत्थानां यूषैर्भुञ्जीत मानवः ।
प्रातः प्रातश्च सेवेत मात्रया तैल्वकं घृतम् । त्रिवृतादिगणक्वाथ-सिद्धं वाऽप्युपशान्तये ॥ ३४ ॥
नोपगच्छेद् यथा पाकं प्रयतेत तथा भिषक् । पर्यागते विद्रौ तु सिद्धिनैकान्तिकी स्मृता ।। ३५ ।।
Treatment of Suppurated internal Vidradhi : A suppurated internal Vidradhi having bulged up (above the surface of the body) should be opened with a knife and treated in the manner of an (incidental) ulcer. Whether the pus drains through the lower or the upper channel of the body (rectum or mouth) the patient should be made to take the drugs of the Varunadi group of Madhu-sigru mixed with (a copious quantity of) Maireya, Sura, Asava, or Kanjika. The diet should consist of rice boiled and cooked with white mustard seed in the decoction of Madhu-sigru and taken with the soup of barley, Kola and Kulattha pulse. The Tilyaka Ghrita (Chikitsa Sthana, ch. IV.), or clarified butter cooked with the decoction of the Trivrtadi group, should be taken every morning in adequate doses to get relief. Particular care should be taken by the physician to guard against the suppuration of an internal abscess, since suppuration in such cases leads but to a slender hope of success. 32-35
प्रत्याख्याय तु कुर्वीत मज्जजातन्तु विद्रधिम् । स्नेहस्वेदोपपन्नानां कुर्याद्रक्तावसेचनम्।
विद्रध्युक्तां क्रियां कुर्यात् पक्वे वाऽस्थि तु भेदयेत् ।। ३६ ||
निःशल्यमथ विज्ञाय कर्त्तव्यं व्रणशोधनम् । बुद्धिमान् ।। ३८ ।।
तिनिसैन्धवम् । विद्रधिव्रणरोपणम्।। ३९ ।। धावेत् तिक्तकषायेण तिक्तं सर्पिस्तथा हितम् ॥ ३७॥
यदि मज्जपरित्रावो न निवर्त्तेत देहिनः । कुर्यात् संशोधनीयानि प्रियङ्गुधातकीरोध कट्फलं एतैस्तैलं विपक्तव्यं कपायादीनि
Treatment of Majja-jata Vidradhi: The medical treatment of a patient, afflicted with a Majja-jata abscess (abscess affecting the marrow), should be taken in hand without holding out any definite hope of recovery (as a proper course of treatment in such cases does not invariably prove successful). Sneha-karma (anointments, etc.) and fomentations should be first resorted to, after which blood-letting should be made; and the remedial measures of the present chapter should be then employed. When it reaches the suppurating stage, the bone should be operated upon, and after the full elimination of the pus and the putrid matter from the incised ulcer, purifying remedies should be employed. The incidental ulcer should be washed with the decoction of the bitter drugs and the Tikta-Sarpis¹ should be used. An intelligent physician should apply the decoction of the drugs of the Samsodhaniya group, if the oozing out of the marrow is not arrested. A medicated oil cooked with Priyangu, Dhataki, Rodhra, Katphala, Nemi2 and Saindhava salt should be used in healing up an ulcer incidental to an opened up Vidradhi. 36-39
sta uya-fearai fafchfrunzera factufafchfoudi ara षोडशोऽध्यायः ॥ १६ ॥
Thus ends the sixteenth Chapter of the Chikitsa Sthana in the Susruta Samhita which deals with the treatment of abscess.
