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Sushruta SamhitaChikitsasthanaDvivraniya Chikitsa - Treatment of two kinds of inflamed ulcers - Sushrutasamhita...

Dvivraniya Chikitsa – Treatment of two kinds of inflamed ulcers – Sushrutasamhita Chikitsasthana Chapter 1

प्रथमोऽध्यायः । अथातो द्विव्रणीयचिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ।। १ ।।

Now we shall discourse on the medical treatment of the two kinds of inflamed ulcers (Dvivraniya Chikitsa). 1

द्वौ व्रणौ भवतः – शारीर आगन्तुश्चेति । तयोः शारीरः पवनपित्तकफशोणितसन्निपातनिमित्तः । आगन्तुरपि पुरुष पशुपक्षिव्यालसरीसृपप्रपतनपीडनप्रहाराग्निक्षारविषतीक्ष्णौषधशकलकपालशृङ्गचक्रेघुपरशुशक्तिकुन्ताद्यायुधाभिघातनिमित्तः । तत्र तुल्ये व्रणसामान्ये द्विकारणोत्थनप्रयोजनसामर्थ्याद द्विव्रणीय इत्युच्यते ॥ २ ॥

Ulcers may be grouped under two heads according as they are Idiopathic or Traumatic in their origin. The first group includes within its boundary all ulcers which are caused through the vitiated condition of the blood or the several deranged conditions of the Vayu, Pitta and Kapha, or are due to their concerted action (Sannipata), while the second group embraces those which are caused by the bites of men, beasts, birds, ferocious animals, reptiles or lizards, or by afall, pressure and blow, or by fire, alkali, poison, or irritant drugs, or through injuries inflicted by pointed wood, skeletal bones’, horns, discus, arrows, axes, 1. Fragments of broken pottery. -Dalhanu. tridents, or Kuntas (a kind of shovel), or such other weapons. Although both these classes of ulcers possess many features in common, they have been grouped under two distinct heads on account of the diversity of their origin, the difference in remedial measures to be adopted in their treatment, and the variation in their treatment, and the variation in their strength and tenacity. Hence the chapter is called Dvivraniya. 2

सर्व्वस्मिन्नेवागन्तुव्रणे तत्कालमेव क्षतोष्मणः प्रसृतस्योपशमार्थं पित्तवच्छीतक्रियावचारणविधिविशेषः सन्धानार्थञ्च मधुघृतप्रयोग इत्येतद् द्विकारणोत्थानप्रयोजनम् । उत्तरकालन्तु दोषोपप्लवविशेषाच्छारीरवत् प्रतीकारः ॥ ३ ॥

In all cases of traumatic ulcers, cooling measures should be at once resorted to, just after (the fall or blow or stroke), for the cooling of the expanding (radiating) heat of the incidental ulcer, in the manner laid down in respect of (the pacification of enraged) Pitta, and a compound of honey and clarified butter should be applied on the wounded locality for the adhesion (Sandhana) of the lacerated parts, (and for the pacification, i.e., restoration to normal state, of the local blood and Vayu aggravated through an obstruction of their passage). Hence arises the necessity of making the two-fold classification of ulcers. After that (a week) a traumatic ulcer should be treated as an idiopathic one (to all intents and purposes, inasmuch as it is found to be associated with deranged Vayu, Pitta or Kapha. Hence at that stage the medical treatment of both the forms of ulcer is (practically) the same. 3

दोषोपप्लवविशेषः पुनः समासतः पञ्चदशप्रकारः, प्रसरणसामर्थ्यात्, यथोक्तो व्रणप्रश्नाधिकारे । शुद्धत्वात् षोडशप्रकार इत्येके ॥ ४॥

In short, ulcers are further subdivided (particularly) into fifteen groups, according to the presence of the morbific diathesis (deranged Vayu, Pitta, Kapha and blood therein), either seperately or in combinations as described (before) in the Chapter on Vrana-Prasana. (Sutra Sthana. Ch. XXI). Several authorities, by adding the simple uncomplicated ulcers (un-associated with any the morbific principles of the deranged Vayu, Pitta, etc.) to the list, hold the number of types to be sixteen. ( Practically they are in-numerable, according to the combinations made of the deranged Vayu, etc. and the different Dhatus of the system). 4

तस्य लक्षणं द्विविधं – सामान्यं वैशेषिकञ्च । तत्र सामान्यं रुक् । व्रण गात्रविचूर्णने व्रणयतीति व्रणः । विशेषलक्षणं पुनर्वातादिलिङ्गविशेषः ॥५॥ .

symptoms of ulcer may be divided into two kinds viz., General and Specific. Pain is the general characteristic (of all forms of ulcer), while the symptoms, which are exhibited in each case accfording to the virtue of the deranged Vayu, Pitta, etc., involved therein, are called the Specific ones. A Vrana is so named from its etymology (the term being derived from the root Vrana–to break) and signifies a cracked or broken condition of the skin and flesh of the afflicted part) of the body. 5

तत्र श्यावारुणाभस्तनुः शीतः पिच्छिलोऽल्पस्त्रावी रुक्षश्चटचटायनशीलः स्फुरणायामतोदभेदवेदनाबहुलो निर्मांसश्चेति वातात्॥६॥

क्षिप्रजः पीतनीलाभः किंशुकोदकाभोष्णस्त्रावी दाहपाकरागविकारकारी पीतपिडकाजुष्टश्चेति पित्तात् ॥ ७॥

प्रततचण्डकण्डूबहुलः स्थूलौष्ठः स्तब्धसिरास्नायुजालावततः कठिनः पाण्ड्वभासो मन्दवेदनः शुक्लशीतसान्द्रपिच्छिलास्त्रावी गुरुश्चेति कफात्॥८॥

प्रवालदलनिचयप्रकाश: कृष्णस्फोटपिडकाजालोपचितस्तुरङ्गस्थानगन्धिः सवेदनो धूमायनशीलो रक्तस्त्रावी पित्तलिङ्गश्चेति रक्तात् ॥ ९॥

The Vataja-Ulcer : The ulcer assumes a brown or vermilion colour and exudes a thin, slimy, scauty and cold secretion, largely attended with tension, throbbing and a sort of pricking and piercing pain ( in its inside ), which seems as if being expanded and extended. This type of ulcer does not extend much and is characterised by absence of destruction of the tissue (flesh). The Pittaja ulcer is rapid in its growth. It assumes a bluish yellow colour, exudes a hot secretion resembling the washings of Kimsuka flowers, and is attended with burning, suppuration and redness, being surrounded with eruptions of small yellow-coloured pustules. The Kaphaja ulcer is found to be extended and raised around its margin and is accompanied by an irresistible itching sensation. It is thick and compact ( in its depth), covered with a large number of vessels and membranous tissues (Sirasnayu-jala), grey in colour, slightly painful, hard and heavy, and exudes a thick, cold, white and slimy secretion. The Raktaja ulcer (resulting from a vitiated condition of the blood) looks like a lump of red coral. It is often found to be surrounded by black vesicles and pustules and to smell like a strong alkali. It becomes painful and produces a sensation, as if fumes were escaping out ( of it ). Bleeding (is present) and the specific symptoms of the Pittaja type are likewise found to suprevene. 6-9

तोददाहधूमायनप्रायः पीतारुणाभस्तद्वर्णस्त्रावी चेति वातपित्ताभ्याम् ॥ १०॥

कण्डूयनशीलः सनिस्तोदो रुक्षो गुरुर्दारुणो मुहुर्मुहुः शीतपिच्छिलाल्पत्रावी चेति वातश्लेष्मभ्याम् ॥ ११ ॥

गुरुः सदाह उष्णः पीतपाण्डुस्रावी चेति पित्तश्लेष्मभ्याम् ॥१२॥ रूक्षस्तनुस्तोदबहुल: सुप्त इव च रक्तारुणाभस्तद्वर्णस्त्रावी चेति वातशोणिताभ्याम्॥ १३॥

घृतमण्डाभो मीनधावनतोयगन्धिर्मृदुर्विसर्युष्णकृष्णस्त्रावी चेति पित्तशोणिताभ्याम् । रक्तो गुरुः स्निग्धः पिच्छिलः कण्डूप्रायः स्थिरो सरक्तपाण्डुस्रावीचेति श्लेष्मशोणिताभ्याम्॥१४-१५॥

स्फुरणतोददाहधूमायनप्रायः पीततनुरक्तस्रावी चेति वातपित्तशोणितेभ्यः । कण्डुस्फुरणचुमचुमायमानप्रायः पाण्डुघनरक्तास्त्रावी चेति वातश्लेष्मशोणितेभ्यः । दाहपाकरागकण्डूप्रायः पाण्डुघनरक्तास्त्रावी चेति श्लेष्मपित्तशोणितेभ्यः । त्रिविधवर्णवेदनास्त्रावविशेषोपेतः पवनपित्तकफेभ्यः ॥१६- १९॥

निर्दहननिर्मथनस्फुरणतोददाहपाकरागकण्डूस्वापबहुलो नानावर्णवदनास्त्रावविशेषोपेतः पवनपित्तकफशोणितेभ्यः । जिह्वातलाभो मृदुः स्निग्धः श्लक्ष्णो विगतवेदनः सुव्यवस्थितो निरास्त्रावश्चेति शुद्धो व्रण इति ॥ २०-२१ ॥

The Vata-Pittaja Type: An ulcer due to the concerted action of the deranged Vayu and Pitta is marked by a pricking and burning pain and a red or yellow colour. A sensation of fumes arising out of it (is also felt) and the ulcer exudes a secretion which partakes of the characteristic colours of boththe deranged Vayu and Pitta. An itching and piercing pain is felt in the ulcer due to the combined action of the deranged Vayu and Kapha (Kapha-Vataja type), which becomes rough, heavy and indurated, constantly discharging a cold, slimy and scanty secretion. An ulcer resulting from the deranged condition of the Pitta and Kapha (Kapha-Pittaja type) becomes heavy, hot and yellow. It is marked by a burning sensation and exudes a pale. yellow-coloured secretion. An ulcer marked by the aggravated condition of the deranged Vayu and blood (Vata-Raktaja type) is dry and thin and is largely attended with a piercing pain and anaesthesia. It is of blood red-colour and is associated with a discharge similar to the deranged Vayu and blood. An ulcer due to the combined action of the deranged Pitta and blood (Rakta-Pittaja type) is marked by a colour which resembles the surface cream of clarified butter. It smells like the washing of fish, is soft, spreading (erysipelatous), and secretes a hot blackish exudate. An ulcer due to the combined action of the deranged Kapha and blood (Kapha-Raktaja type) is red-coloured, heavy, unctuous, slimy, and indurated. It is usually marked by itching and exudes a yellowish bloody secretion. An ulcer due to the concerted action of the deranged Vayu. Pitta and blood (Vata-PItta-Raktaja type) is marked by a sort of throbbing, pricking and burning pain. It discharges a flow of thin yellowish blood and produces a sensation, as if fumes were escaping (out of its cavity). An ulcer due to the concerted action of the deranged Vayu. Kapha and blood (Vata-Slesma-Raktaja type) is usually attended with itching, throbbing and tingling sensations and thick, grey, bloodstreaked discharge. An ulcer associated with the deranged Kapha, Pitta, and blood (Kapha-Pitta-Raktaja type) is largely attended with redness, itching, suppuration and burning sensation. It emits a thick. greyish, bloody secretion. An ulcer marked by the concerted action of the deranged Vayu, Pitta and Kapha (Sannipatika) is attended with three kinds of pain, secretion and colour, similar to each of three Dosas. An ulcer associated with the combined action of the deranged Vayu, Pitta, Kapha and blood (Vata-Pitta-Kapha-Raktaja type) is attended with a sensation, as if it were being burnt and lacerated. It is largely accompanied by throbbing, itching sensation, a sort of pricking and burning pain, with complete anaesthesia in the locality together with redness, suppuration, and various other kinds of colour, pain and secretion. An ulcer (Vrana) which is of the same colour resembling with the back of the tongue is soft, glossy, smooth, painless, wellshaped and marked by the absence of any kind of secretion is called a clean ulcer (Suddha – Vrana). 10-21

तस्य व्रणस्य षष्टिरुपक्रमा भवन्ति । तद्यथा – अपतर्पणमालेपः परिषेकोऽभ्यङ्गः स्वेदो विम्लापनमुपनाह: पाचनं विस्रावणं स्नेहो वमनं विरेचनं छेदनं भेदनं दारणं लेखनमेषणमाहरणं व्यधनं विस्त्रावणं सीवनं सन्धानं पीडनं शोणितास्थापनं निर्वापणमुत्कारिका कषायो वर्त्तिः कल्कः सर्पिस्तैलं रसक्रियाऽवचूर्णनं व्रणधूपनमुत्सादनमवसादनं मृदुकर्म दारुणकर्म क्षारकर्माग्निकर्म कृष्णकर्म पाण्डुकर्म प्रतिसारणं रोमसञ्जननं लोमापहरणं वस्तिकर्मोत्तरवस्तिकर्म बन्धः पत्रदानं कृमिघ्नं बृंहणं विषघ्नं शिरोविरेचनं नस्यं कवलधारणं धूमो मधु सर्पिर्यन्त्रमाहारो रक्षाविधानमिति ॥ २२ ॥

Therapeutics: The medical (and surgical) treatment of a Vrana (ulcer) admits of being divided into sixty¹ different procedures such as Apatarpana (fasting orlow diet).alepa (plastering), Pariseka (inrigating or spraying), Abhyanga ( anointing), Sveda (fomentations, etc.), Vimlapana (resolution by massage or rubbing), Upanaha (poultice), Pacana (inducing suppuration), Visravana (evacuating or draining), Sneha (internal use of medicated oils, ghrta etc.), Vamana (emetics), Virecana (purgatives), Chedana (excision), Bhedana (opening–e.g., of an abscess), Darana (bursting by medicinal applications), Lekhana ( scraping ), Aharana ( extraction), Exana (probing), Vyadhana (puncturing–opening a vein), Vidravana (inducing discharge), Sivana (suturing), Sandhana (helpingre-union or adhesion), Pidana (pressing), Sonitasthapana (arrest of bleeding), Nirvapana (cooling application) Utkarika (massive poultices), Kasaya (washing with decoctions). Varti (lint or plug ), Kalka (paste), ( sarpi) Ghrta ( application of medicated clarified butter), Taila (application of medicated oil), Rasa

1. N.B. Authorites. however, differ in enumerating these factors, although every one of them sticks to the total number of sixty.

kriya (application of drug-extracts), Avacurnana (dusting with medicinal powders), Vrana-Dhupana (fumigation of an ulcer), Utsadana (raising of the margins or bed of an ulcer), Avasadana (destruction of exuberant granulation), Mrdu-Karma (softening). Daruna-Karma (hardening of soft parts), Ksara-Karma (application of caustics), Agni-Karma (cauterization), Krsna-Karma blackening), Pandu-Karma (making yellow-coloured cicatrices), Pratisarana (rubbing with medicinal powders), Roma-sanjanana (growing of hairs), Lomapaharana (epilation), Basti-karma (appliation of enemas), Uttara-Basti-karma (urethral and vaginal douching), Bandha (bandaging), Patradana (application of certain leaves–vide Infra), Krmighna (Vermifugal measures), Brimhana (application of restorative tonics), Visaghna (disinfectant or anti-poisonous applications), Sirovirecana (errhines), Nasya (snuff), Kavala-dharana (holding in the mouth of certain drug-masses for diseases of the oral cavity or gargling), Dhuma (smoking or vapouring), Madhu-sarpi (honey and clarified butter), Yantra (mechanical contrivances. e.g., pulleys, etc.). Ahara (diet) and Raksa-Vidhana (protection from the influence of malicious spirits). 22

तेषु कषायो वर्त्तिः कल्कः सर्पिस्तैलं रसक्रियाऽवचूर्णनमिति शोधनरोपणानि । तेष्वष्टौ शस्त्रकृत्याः । शोणितास्थापनं क्षारोऽग्निर्यन्त्रमाहारो रक्षाविधानं बन्धविधानञ्चोक्तानि । स्नेहस्वेदवमनविरेचनबस्त्युत्तरबस्तिशिरोविरेचननस्यधूमकवलधारणान्यन्यत्र वक्ष्यामः । यदन्यदवशिष्टमुपक्रमजातं तदिह वक्ष्यते ॥ २३ ॥

Of these, Kasaya, Varti, Kalka, Ghrta, Taila, Rasa-kriya and Avacurnana are the measures for the cleansing (Sodhana) of an ulcer and for helping its granulation (Ropana). The eight acts (from Chedana to Sivana) are surgical operations. We have already spoken of such acts as Sonitasthapana, Ksara-karma, Agni-karma, Yantra, Ahara, Raksa-vidhana and Bandha-Vidhana (in the Sutra-sthana). Later on, we shall discourse on Sneha, Sveda, Vamana, Virecana, Basti, Uttarabasti, Siro-virecana, Nasya, Dhuma, and Kavala-dharana. Of the remaining measures we shall speak in the present chapter. 23

पड्विधः प्रागुपदिष्ट: शोफस्तस्यैकादशोपक्रमा भवन्त्यपतर्पणादयो विरेचनान्ताः; ते च विशेषेण शोथप्रतीकारे वर्त्तन्ते, व्रणभावमापन्नस्य

चन विरुध्यन्ते । शेषास्तु प्रायेण व्रणप्रतीकारहेतव एव । अपतर्पणमाद्य उपक्रमः, एष सर्वशोफानां सामान्यः प्रधानतमश्च ॥ २४ ॥

There are six kinds of swellings (Sophas), as described before, and the following eleven measures commencing with Apatarpana and ending in Virecana, should be regarded as their cure. These are the proper remedies for a swelling and do not (cease to be efficacious in, nor) prove hostile to cases of swelling which are transformed into ulcers. The other measures should be deemed as remedial to ulcers but Apatarpana is the first, general and principal remedy in all types of swellings (Sophas). 24

भवन्ति चात्र | दोषोच्छ्रायोपशान्त्यर्थं दोषानद्धस्य देहिनः । अवेक्ष्य दोषं प्राणञ्च कार्यं स्यादपतर्पणम् ॥ २५ ॥

ऊर्ध्वमारुततृष्णाक्षुन्मुखशोषश्रमान्वितैः न । कार्यं गर्भिणीवृद्ध-बालदुर्बलभीरुभिः ।। २६ ।।

व्रणेषूग्ररुजेषु शोफेषूत्थितमात्रेषु यथास्वैरौषधैर्लेपं च । कार्येत् ।। २७ । ।

प्रत्येकश्येन यथा प्रज्वलिते वेश्मन्यम्भसा परिषेचनम् । प्रशमयत्यग्निमेवमालेपनं क्षिप्रं रुजः ।। २८ ॥

प्रह्लादने शोधने च शोफस्य हरणे तथा । उत्सादने रोपणे च लेप: स्यात् तु तदर्थकृत् ॥ २९ ॥

Memorable Verses: Apatarpana (fasting) should be prescribed in the case of a patient, full of enraged Dosas, as well as, in one having his organic principles ( Dhatus) and refuse imatters ( Malas) of the system, deranged by them, for the purpose of bringing them to their normal condition, with a regard both to their nature and to the strength. age, etc., of the patient. Persons afflicted with diseases which result from the up-coursing of the deranged Vavu (Urdhva-vata) such as cough. asthma, etc.. or with thirst, hunger, dryness of the mouth and fatigue, as well as old men, infants, weak persons, men of timid dispositions and pregnant women should never fast. A swelling and an extremely painful ulcer should be respectively treated with a proper medicated plaster at the very outset. The pain in such a case will pacify by the medicinal plaster as a blazing room or house is readily protected by means of steady watering. Such plasters give comfort to the patient (by removing the pain and leading to the absorption of the swelling), and neaves up the bed of the sore or the ulcer and contributes to its speedy purification and healing up ( granulation ). 25-29

वातशोफे तु वेदनोपशमार्थं सर्पिस्तैलधान्याम्लमांसरसवातहरौषधनिष्क्वाथैरशीतैः परिषेकान् कुर्वीत ॥ ३०॥

पित्तरक्ताभिघातविषनिमित्तेषु क्षीरघृतमधुशर्करोदकेक्षुरसमधुरौषधक्षीरवृक्षनिष्क्वाथैरनुष्णै: परिषेकान् कुर्वीत ॥ ३१॥

श्लेष्मशोफे तु तैलमूत्रक्षारोदकसुराशुक्तकफघ्नौषधनिष्क्वाथैरशीतैः परिषेकान् कुर्वीत ॥ ३२॥

In the case of a swelling brought on by the deranged Vayu, the affected part should be washed or sprinkled (Pariseka) with a warm lotion of clarified butter, oil. Dhanyamla and essence of meat or with a decoction of the drugs that tend to pacify the enraged Vayu and to relieve the pain. A swelling due to the action of the deranged Pitta or blood or to the effect of a trauma or poison should be washed or sprinkled with a lotion of milk, clarified butter, honey and sugar dissolved in water, the expressed juice of sugar-cane and cold decotion of the drugs of the Madhura group (Kakolyadi-gana) and the KsiraVrksas. A Kaphaja swelling on the body should be washed or sprinkled with a luke-warm lotion of oil, cow’s urine. alkaline solution, wine (Sura), Sukta and with a decoction of drugs that destroy the deranged Kapha. 30-32

यथाऽम्बुभिः सिच्यमानः शान्तिमग्निर्नियच्छति । दोषाग्निरेवं सहसा परिषेकेण शाम्यति ॥ ३३ ॥

Metrical Text: As a fire is put out by jets of water; so the fire of the deranged morbific principles (dosagni) of the body are speedily subdued and put down by the application of (medicinal lotions) washes. 32

अभ्यङ्गस्तु दोषमालोक्योपयुक्तो दोषोपशमं मृदुताञ्च करोति ।। ३३ ।।

An anointing (Abhyanga), daly prescribed and used with a full regard to the nature of the aggravated Dosas, leads to their pacification ( restoration to the normal condition ) and to softness (subsidence) of the swelling. 34

स्वेदविम्लापनादीनां क्रियाणां प्राक् स उच्यते । पश्चात् कर्मसु चादिष्टः स च विस्त्रावणादिषु ।। ३५ ।।

रुजावतां दारुणानां कठिनानां तथैव शोफानां स्वेदनं कार्यं ये चाप्येवंविधा व्रणाः ||३६ ॥

स्थिराणां रुजतां मन्दं कार्यं विम्लापनं भवेत् । अभ्यज्य स्वेदयित्वा तु वेणुना वा शनैः शनैः ।

विमर्दयेद् भिषक् प्राज्ञस्तलेनाङ्गुष्ठकेन वा ।। ३७ ।।

शोफयोरुपनाहन्तु कुर्यादामविदग्धयोः। अविदग्धः शमं याति विदग्धः पाकमेति च ॥ ३८ ॥

निवर्तते यः शोफो विरेकान्तरुपक्रमैः । तस्य सम्पाचनं कुर्यात् समाहृत्यौषधानि तु ।। ३९ ।।

दधितक्रसुराशुक्त-धान्याम्लैर्योजितानि तु। स्निग्धानि लवणीकृत्य पचेदुत्कारिकां शुभाम् ।

सैरण्डपत्रया शोफं नाहयेदुष्णया पाकायाभिमुखो तया ।। ४०।। हितं सम्भोजनञ्चापि यदि ॥ ४१ ।। ।।

Metrical Texts : An application of an anointment (Abhyanga) should precede the measures of fomentation, resolution, etc., while it should follow all evacuating measures. A painful, extended and indurated swelling, as well as an ulcer of a similar nature, should be fomented, while an act of Vimlapana (resolution by gentle massage) should be done in respect of a fixed or unfluctuating swelling attended with little or no pain whatsoever. A wise physician should first annoint and foment the part and then gently and slowly press it with a bambooreed or with the back of his thumb or palm. A non-suppurated swelling or one that is partially suppurated should be treated with poultice (Upanaha) which would lead to its resolution or suppuration, as the case might be, A swelling, not resolved or not subsiding even after the adoption of the measures beginning with Apatarpana and ending in Virecana (in the given list), should be caused to suppurate with the drugs enumerated in the chapter of Mis raka, such as curd, whey, wine (Sura), Sukta and Dhanyamla (akind of fermented paddy gruel). They should be formed into a paste and the paste should be cooked into an efficacious poultice-like composition (Utkarika), and mixed with salt and oil or clarified butter, it should be applied over the affected part (swelling) and bandaged with the leaves of an Eranda plant when suppuration starts the patinet should be allowed to take a wholesome (i.e., which does not produce Kapha) diet. 35-41

वेदनोपशमार्थाय तथा पाकशमाय अचिरोत्पतिते शोफे कुर्याच्छोणितमोक्षणम् ॥ ४२ ॥

सशोफे कठिने श्यामे सरक्ते वेदनावति । संरब्धे विषमे चापि व्रणे विस्त्रावणं हितम् ॥ ४३ ॥

सविषे च विशेषेण जलौकोभिः पदैस्तथा । वेदनायाः प्रशान्त्यर्थं पाकस्याप्राप्तये तथा ॥४४॥

सोपद्रवाणां रुक्षाणां कृशानां व्रणशोषिणाम् । यथास्वमौषधैः सिद्धं स्नेहपानं विधीयते ॥ ४५ ॥

उत्सन्नमांसशोफे तु कफजुष्टे विशेषतः । संक्लिष्टश्यामरुधिरे व्रणे प्रच्छर्दनं हितम् ॥ ४६॥

वातपित्तप्रदुष्टेषु दीर्घकालानुबन्धिषु | विरेचनं प्रशंसन्ति व्रणेषु व्रणकोविदाः ॥ ४७ ॥

अपाकेषु तु रोगेषु कठिनेषु स्थिरेषु च। स्नायुकोथादिषु तथा च्छेदनं प्राप्तमुच्यते ।। ४८ ।।

अन्तः पूयेष्ववक्तेषु तथैवोत्सङ्गवत्स्वपि गतिमत्सु च रोगेषु भेदनं प्राप्तमुच्यते ।। ४९ ।।

Blood-letting : Blood-letting should be resorted to in a case of newly formed swelling for its resolution and for alleviating the pain. Bleeding (Visravana) is recommended in the case of an ulcer which is indurated, marked by a considerable swelling and inflammation and is reddish black or red-coloured, extremely painful, gagged in its shape and considerably extended at its base (congested), specially in the case of a poisonous ulcer, for the subsidence of the pain and for warding off a process of suppuration therein, either by applying leeches or by opening (a vein in the locality) by means of an instrument. An ulcerpatient of a dry or parched temperament affected with distressing complications or ulcer-cachexia should be made to drink an emulsive potion cooked with (a decoction of) appropriate drugs to alleviate pain and suppuration. A patient afflicted with an ulcer with an elevated margin and attended with swelling and specially marked by the presence of the deranged Kapha and by a flow of blackish red blood should be treated with emetics. Ulcer-experts recommend purgatives to a patient afflicted with an old or long-standing ulcer, attended with a deranged condition of the Vayu and Pitta. An excision should be made into an ulcer which refuses to suppurate and which is of a hard and indurated character attended with sloughing of the local nerves and ligaments (Snayu ). An opening or excision (Bhedana) should be made into an ulcer (Vrana) in the inside of which pus has accumalated and makes it heave up and which not finding any outlet consequently eats into the underlying tissues and makes fissures and cavities. 42-49

बालवृद्धासहक्षीण-भीरूणां योषितामपि । मर्मोपरि च जातेषु रोगेषूक्तेषु दारणम् ॥ ५० ॥

सुपक्वे पिण्डिते शोफे पीडनैरवपीडिते। पाकोद्वृत्तेषु दोषेषु तत् तु कार्यं विजानता ! सुपिष्टैर्दारणद्रव्यैर्युक्तैः क्षारेण वा पुनः ।। ५१ ।।

Measures which contribute to a spontaneous bursting by medicinal applications (Darana) of a swelling should be adopted in the case of an infant or an old or enfeebled patient, or of one incapable of bearing the pain (of a surgical operation). or of a person of a timid disposition, as well as in the case of a woman, and in the case of swellings which appear on the vulnerable parts (Marmas) of the body. Remedies which lead to the spontaneous bursting of a swelling should be applied by a wise physicain to a well-supprated swelling drawn up and with all its pus gathered to a head; or an alkaline substance should be applied on its surface and a bursting should be effected when the Dosas are found to be just aggravated by the incarcerated pus. 50-51

कठिनान् स्थूलवृत्तौष्ठान् दीयमाणान् पुनः पुनः । कठिनोत्सन्नमांसांश्च लेखनेनाचरेद् भिषक् ॥५२॥

समं लिखेत् सुलिखितं लिखेन्निरवशेषतः । वर्त्मनान्तु प्रमाणेन समं शस्त्रेण निर्लिखेत् ।। ५३ ।।

क्षौमं प्लोतं पिचुं फेनं यावशूकं ससैन्धवम् । कर्कशानि च पत्राणि लेखनार्थे प्रदापयेत् ॥ ५४॥

An ulcer which is indurated, whose edges are thick and rounded, which has been repeatedly burst open, and the flesh of whose cavity is hard and elevated, should be scrapeed by a surgeon; or, in other words, and indurated ulcer should be deeply, scraped, one with thick and rounded edges should be excessively scraped, while the one which has been repeatedly burst open should be entirely scraped off. An ulcer with a hard and elevated bed should be scraped evenly and longitudinally along the length of its cavity. Ksauma (cloth made of the fibres of an Atasi plant), a linen (Plota) or a cotton pad ( Picu), or such alkaline substances as nitrate of Potasa, Samudra-phena, rock-salt, or rough leaves of trees (e.g.. those of Udumbara, etc.) should be used for scrapping. 52-54

नाडीव्रणान् शल्यगर्भानुन्मार्ग्युत्सङ्गिन: शनैः । करीरबालाङ्गलिभिरेषण्या वैषयेद् भिषक् ॥ ५५ ॥

नेत्रवर्त्मगुदाभ्यास-नाड्योऽवक्ताः सशोणिताः। चुच्चूपोदकजैः श्लक्ष्णैः करीरैरेषयेत् तु ताः । ॥ ५६ ।।

संवृतासंवृतास्येषु व्रणेषु मतिमान् भिषक् । यथोक्तमाहरेच्छल्यं प्राप्तोद्धरणलक्षणम्।।५७।।

रोगे व्यधनसाध्ये तु यथोद्देशं प्रमाणतः । शस्त्रं निदध्यात् दोषञ्च स्त्रावयेत् कीर्त्तितं यथा ॥ ५८ ॥

अपाकोपढता ये च मांसस्था विवृताश्च ये। यथोक्तं सीवनं तेषु कार्यं सन्धानमेव च ॥ ५९॥ पूयगर्भानणुद्वारान् व्रणान् मर्मगतानपि।

यथोक्तैः पीडनद्रव्यैः समन्तात्शु ष्यमाणमुपेक्षेत प्रदेहं पीडनं परिपीडयेत् ।। ६० ।। प्रति।

न चाभिमुखभालिम्पेत् तथा दोषः प्रसिच्यते ।। ६१ ।।

The cavities or courses of a sinus, or of an ulcer which had any foreign matter lying imbedded in its inside, or which takes a crooked

1. This scraping off of the ulcer should be done by an instrument of Surgery and not by any rough leaf or the like, mentioned hereafter. or round about direction, as well as of the one formed into cavities within its interior, should be probled by gently introducing the tender fibres of bamboo sprouts (Karira), a (lock of) hair, a finger, or an indicator into its inside. The course of a sinus occuring about the anus or in the region of the eyes (Netra-Vartma) should be probed with the slender fibres of Cuccu, Upodaka, or Karira, in the event of their mouths being narrow and attended with bleeding. The Salya (incarcerated pus, etc.) should be extricated, whether the mouth of the sinus is constricted or otherwise, in conformity with the directions laid down before on that behalf. In diseases amenable to acts of puncturing (Vyadhana), the knife should be inserted into the seat of the disease to a proper depth and extent, to be determined by its situation in the body, and the Dosas (pus, etc.) should be let out, as stated before. Ulcers with a wide mouth, unattended with any symptoms of suppuration, and occurring in a fleshy part of the body, should be sutured up, and the adhesion (Sandhana) of the edges should likewise be effeted, as directed before. A plaster composed of drugs (capable of drawing out and secreting the pus), as described before, should be applied around the mouth of an ulcer seated in any of the Marmas (vulnerable parts). or full of pus in its inside, with a narrow-mouthed aperture. The plaster should be removed when it is dry, and should not be applied on the orifice of the ulcer, as it would, in that case, interfere with the spontaneous secretion of pus (Dosa). 55-61

तैस्तैर्निमित्तैर्बहुधा शोणिते प्रस्तुते भृशम् । कार्यं यथोक्तं वैद्येन शोणितास्थापनं भवेत् ।। ६२ ।

दाहपाकज्वरवतां व्रणानां व्रणानां पित्तकोपतः । रक्तेन चाभिभूतानां कार्यं निर्वापणं भवेत् ।। ६३ ।।

यथोक्तैः शीतलद्रव्यैः क्षीरपिष्टैघृताप्लुतैः । दिह्यादबहलान् सेकान् सुशीतांश्चावचारयेत् ॥ ६४ ॥

An excessive haemorrhage incidental to such acts, as excessive hurting of the vein, etc., should be arrested with suitable styptic¹ measures and remedies (Sonitasthapana). An ulcer attended with fever, suppuration and burning sensation due to the excited state of the

1. Styptic measures are of four kinds–Sandhana, Skandana, Pacana, and Dahana. See Sutra-Sthana, deranged Pitta and congestion of blood should be allayed (Nirvapana-literally putting out) with suitable and proper medicinal remedies. It should be allayed with compounds made up of the proper cooling drugs (of the Misraka chapter), pasted with milk and lubricated with clarified butter. Cooling plasters (Lepa) should then be applied as well. 62-64

व्रणेषु क्षीणमांसेषु तनुस्त्राविष्वपाकिषु । तोदकाठिन्यपारुष्यशूलवेषथुमत्सु वातघ्नवर्गेऽम्लगणे काकोल्यादिगणे तथा ।

स्नैहिकेषु च बीजेषु पचेदुत्कारिकां शुभाम् । तेषाञ्च स्वेदनं कार्यम्.. .. स्थिराणां वेदनावताम् । च।। ६५ ।।

दुर्गन्धानां क्लेदवतां पिच्छिलानां विशेषतः । कषायै: शोधनं कार्यं शोधनैः प्रागुदीरितैः ॥ ६७ ।। ।। ६६॥

An ulcer whose flesh is eaten away, which discharges a thin secretion, or is non-suppurating in its character, and is marked by roughness, hardness, shivering and the presence of an aching and piercing pain, should be fomented with a poultice-like efficacious preparation (Utkarika) cooked with the drugs of Vayu-subduing properties, those included within the Amla-varga, and those which belong to the Kakolyadi group, and with the oily seeds (such as linseed, sesamum, mustard, castor, etc.). An indurated, painful, faetid, moist and slimy ulcer should be washed with a disinfectant or purifying lotion consisting of a decoction of the drugs mentioned before for the purpose. 65-67

पूतिमांसप्रतिच्छन्नान् महादोषांश्च कल्कीकृतैर्यथालाभं वर्त्तिद्रव्यैः अन्तः

शल्यानणुमुखान् गम्भीरान् मांससंश्रितान् । शोधनद्रव्ययुक्ताभिर्वर्त्तिभिस्तान् सर्पपस्नेहयुक्तेन धीमांस्तैलेन यथाक्रमम् ।। ६८।।

शोधयेत् । पुरोदितैः ।। ६९॥

पित्तप्रदुष्टान् गम्भीरान् दाहपाकप्रपीडितान् । कार्पासीफलमिश्रेण उत्सन्नमांसानस्निग्धानल्पस्त्रावान् जयेच्छोधनसर्पिषा ॥ ७० ॥

व्रणांस्तथा । शोधयेत् ।। ७१ ।।

तैलेनाशुध्यमानानां शोधनीयां रसक्रियाम् । व्रणानां स्थिरमांसानां कुर्याद् द्रव्यैरुदीरितैः ॥ ७२ ॥

कषाये विधिवत् तेषां कृते चाधिश्रयेत् पुनः । सुराष्ट्रजां सकासीसां दद्याच्चापि मनः शिलाम् ॥ ७३ ॥

हरितालञ्च मतिमांस्ततस्तामवचारयेत् । सक्षौद्रामतिमर्दिताम् ।

मातुलुङ्गरसोपेतां व्रणेषु दत्त्वा तां तिष्ठेत् त्रींस्त्रींश्च दिवसान् परम् ॥ ७४ ॥

Plugs or lints plastered with a paste of the purifying drugs (enumerated before) should be inserted into an ulcer associated with any foreign matter (e.g., pus) lying embedded in it, or into one with a deep but narrow opening, or into one situated in a fleshy part of the body. An ulcer full of putrefied flesh and marked by the action of the highly deranged Dosas (Vayu and Kapha) should be purified with a paste of the aforesaid available drugs making up the plug. An ulcer of a Pittaja origin, which is deep-seated and attended with a burning sensation and with suppuration, should be purified with the application of a medicated clarified butter, prepared with the purifying drugs with an admixture of Karpasa-phala¹. An intelligent Surgeon should purify an ulcer with raised flesh, and which is dry and is attended with scanty secretion with an application of medicated mustard oil. An indurated ulcer, refusing to be purified with the foregoing medicated oils, should be purified with a duly prepared decoction of the drugs enumerated before (Sutra. chap. 38, — the Salasaradi group) and prepared in the following manner of Rasa-kriya. A decoction of the said drugs duly prepared should be saturated with an after-throw of Haritala, Manahsila, Kasisa and Saurastra earth, and well compounded together; the preparation should also be mixed with the expressed juice of Matulunga and with honey. The medicine thus prepared should be applied to the ulcer on every third day. 68-74

मेदोजुष्टानगम्भीरान् दुर्गन्धांश्चूर्णशोधनैः । उपाचरेद् भिषक् प्राज्ञः श्लक्ष्णै: शोधनवर्तिजैः ।। ७५ ।।

1. The total weight of the purifying drugs should be equal to that of the Karpasaphala alone and they should be boiled together with four times quantity of clarified butter and with sixteen times of water.

शुद्धलक्षणयुक्तानां कषायं रोपणं तत्र कार्यं यथोद्दिष्टैर्द्रव्यैर्वैद्येन हितम् । जानता ।। ७६ ।।

अवेदनानां शुद्धानां गम्भीराणां तथैव च । रोपणवर्त्त्यङ्गकृता हिता रोपणवर्त्तयः ।। ७७।।

Deep¹ and foul-smelling ulcers covered with layers of deranged fat (phlegmonous ulcer) should be purified by the learned physician with the powders of the drugs with which the purifying plug or the lint has been enjoined to be plastered (Ajagandha, etc.). Decoctions of the drugs which are possessed of the virtue of setting in a process of granulation (Ropana) in an ulcer, such as Vata, etc., as stated before, should be used by a surgeon (Vaidya) after it had been found to have been thoroughly purified. Medicated plugs, composed of drugs possessing healing properties (such as, Soma, Amrta, Asvagandha, etc.) should be inserted in deep-seated ulcers. when cleansed and unattended with pain. 75-77

मांसस्थानामरोहताम् । अपेतपूतिमांसानां कल्कः संरोहण: कार्यस्तिलजो कार्यस्तिलजो मधुसंयुतः ।। ७८ ॥

स माधुर्यात् तथौष्ण्याच्च स्नेहाच्चानिलनाशनः । कषायभावान्माधुर्यात् तिक्तत्वाच्चापि पित्तहृत् ।

औष्ण्यात् कषायभावाच्च तिक्तत्वाच्च कफे हितः ।। ७९ ।।

शोधयेद् रोपयेच्चापि युक्तः शोधनरोपणैः ।

निम्बपत्रमधुभ्यान्तु पूर्वाभ्यां सर्पिषा चापि युक्तः तिलवद् यवकल्कन्तु संशोधनः स्मृतः । युक्तश्चाप्युपरोपणः ।। ८० ।।

केचिदाहुर्मनीषिणः ।। ८१ ।। पाचयेत् । शमयेदविदग्धञ्च विदग्धमपि पक्वं भिनत्ति भिन्नञ्च शोधयेद् रोपयेच्च तम् || ८२ ||

A Kalka or a levigated paste of sesamum and honey (mentioned in the Misraka Chapter) should be applied for the purpose of healing up an ulcer situated in a muscular part from which all putrefied flesh has been removed or sloughed off. This paste (of sesamum) tends to allay the deranged Vayu through its sweet taste, oleaginousness and 1. There is a different reading of “Agambhira” in place of Gambhira” but Gayi thinks the emendation undesirable.

heat-making potency; subdues the deranged Pitta throughits astringent, sweet and bitter taste and proves beneficial even in the case of the deranged Kapha through its heat-producing potency and bitter and astringent taste. An application of the levigated paste of sesamum mixed with the drugs of purifying and healing properties tends to purity and heal up an ulcer. An application of the levigated paste of sesamum mixed with honey and Nimba-leaves leads to the purification of sores; whereas an application of the same paste (i.e., sesamun. honey and leaves of Nimba), mixed with clarified butter tends to heal up the ulcer. Several authorities attribute the same virtue to a barleypaste.¹ Levigated pastes of barley or of sesamum contribute to the resolution or subsidence of a non-suppurated swelling, fully suppurate one which is partially suppurated, lead to the spontaneous bursting of a fully suppurated one, and purify as well as heal up one which has already burst out 78-82

पित्तरक्तविषागन्तून् गम्भीरानपि च व्रणान् । रोपयेद् रोपणीयेन क्षीरसिद्धेन सर्पिषा ।। ८३ ।।

कफवाताभिभूतानां व्रणानां मतिमान् भिषक् । कारयेद् रोपणं तैलं भेषजैस्तद् यथोदितैः ॥ ८४ ।।

An ulcer, which is due to the effects of poison, vitiated blood, or aggravated Pitta, and which is deep-seated or is of traumatic origin, should be healed up with a medicated clarified butter prepared with the drugs of healing virtues (Ropaniya-enumerated before) and milk. An ulcer marked by an aggravated condition of the deranged Vayu and Kapha should be healed up with the application of an oil, boiled and prepared with the proper purifying drugs mentioned before. 83-84

अबन्ध्यानां चलस्थानां शुद्धानाञ्च प्रदुष्यताम् । द्विहरिद्रायुतां कुर्याद् रोपणार्थां रसक्रियाम् ॥ ८५ ॥

समानां स्थिरमांसानां त्वक्स्थानां रोपणं भिषक् । चूर्णं विदध्यान्मतिमान् प्राक्स्थानोक्तो विधिर्यथा || ८६ ||

Rasa-kriya² with the two kinds of Haridra should be resorted to

1. Jejjato and Gayadasa interpret the term to mean barley-paste mixed with sesamum.”

2. The decoction of Triphala and the drugs of the Nyagrodhadi group should be for the purpose of healing up an ulcer, in which bandaging is forbidden ( such as those due to the deranged Pitta or blood, or to blow, etc. or to the effects of poison), and an ulcer appearing on the moveable joints, which, though exhibiting all the features of a well-cleansed sore, has not been marked by any process of healthy granulation¹. Healing medicinal powders should be used in the case, of an ulcer which is confined to the skin, and is firm-fleshed and marked by the absence of any irregularity in its shape (i.e., not uneven in its margin). The mode of applying medicinal powders, as stated in the Sutra-sthana, should be adopted in the present instance. 85-86

शोधनो रोपणश्चैव विधिर्योऽयं प्रकीर्त्तितः । सर्वव्रणानां सामान्येनोक्तो दोषाविशेषतः ॥ ८७।।

एष आगमसिद्धत्वात् तथैव फलदर्शनात् । मन्त्रवत् संप्रयोक्तव्यो न मीमांस्यः कथञ्चन ॥ ८८ ।।

स्वबुद्धचा चापि विभजेत् कषायादिषु सप्तसु । भेषजानि यथायोगं यान्युक्तानि पुरा मया ।। ८९ ।।

Thea healing and purifying measures described above should be deemed equally applicable and efficacious in cases of ulcers in general with regard to their Dosas (both idiopathic and traumatic). The success of these measures has been witnessed in thousands of cases and has been recorded in the Sastras (authorised works on medicine). Hence they should be used as incantations without any doubt as to their tested and infallible efficacy. An intelligent physician should employ the drugs, mentioned before, in any of the seven forms (either in the shape of a decoction, or a plug, or a paste, or through the medium of medicated oils and clarified butter, or in the shape of Rasa-kriya, or as powders), according to the requirements of each case. 87-89

आद्ये द्वे पञ्चमूल्यौ तु गणो यश्चानिलापहः ।

स वातदुष्टे दातव्यः कषायादिषु सप्तसु ।। ९० ।।

duly prepared, filtered and then condensed to the consistency of treacle. Powders of Haridra and Daru-haridra should be then thrown into it. In the end, the whole preparation should be well-stirred, mixed with honey and applied. This is what is called Rasa-kriya.

1. Several editions read though cleansed yet ungranulating ulcers.”

न्यग्रोधादिर्गणो यस्तु काकोल्यादिश्च यः स्मृतः । तौ पित्तदुष्टे दातव्यौ कषयादिषु सप्तसु ।। ९१ ।।

आरग्वधादिस्तु गणो यश्चोष्णः परिकीर्त्तितः । तौ देयौ कफदुष्टे तु.. ।। ९२ ।।

..संसृष्टे संयुता गणाः ।। ९३ ।।

The drugs which constitute the two groups of Pancha-mulas ( major and minor), as well as those of the Vayu-subduing group, should be employed in the case of an ulcer due to the aggravated Vayu in any of the seven forms–decoction, etc. Similarly the drugs which are included within the groups of Nyagrodhadi or Kakolyadi should be used in any of those seven forms, in the case of an ulcer due to the aggravated Pitta (for the purification and healing thereof). Drugs which form the group of Aragvadhadi as well as those which have been described as heat-making in their potency, should be used in any of those seven aforesaid forms, in the case of an ulcer due to the deranged Kapha. The drugs of two or three of those groups, should be combinedly used in any of those seven forms, in connection with an ulcer marked by the aggravated condition of any two or three of the deranged Dosas respectively. 90-93

वातात्मकानुग्ररुजान् सास्त्रावानपि च व्रणान् । सक्षौमयवसर्पिर्भिधूपनाङ्गैश्च धूपयेत् ॥ १४ ॥

Fumigation Vataja uicers with severe pain and secretion should be fumigated with the fumes of Ksauma, barley, clarified butter and other proper fumigating substances (such as turpentine and resin (gum of sala tree). 94

परिशुष्काल्पमांसानां गम्भीराणां तथैव च । कुर्यादुत्सादनीयानि सर्पांष्यालेपनानि च ।। ९५ ।।

मांसाशिनाञ्च मांसानि भक्षयेद् विधिवन्नरः । विशुद्धमनसस्तस्य मांसं मांसेन वर्धते ।। ९६ ।।

Utsadana-Kriya (Elevation): Medicated plasters (consisting of Apamarga, Asvagandha.etc.) and medicated clarified butter (prepared with the same drugs should be used in ulcers (due to the aggravated Vayu and marked by the absence of any secretion, and affecting a considerably smaller area or depth of flesh, as well as in those (due to the deranged and aggravated Pitta and) seated deep into the flesh, for the purpose of raising up (filling up) the beds or cavities thereof. Meat of carnivorous animals should be taken in the proper manner by the patient, inasmuch as meat properly partaken of in a calm and joyful frame of mind adds to the bodily flesh of its partaker. 95-96

उत्सन्नमृदुमांसानां व्रणानामवसादनम् । कुर्याद् द्रव्यैर्यथोद्दिष्टैश्चूर्णितैर्मधुना सह ।। ९७ ।।

Avasadana (destruction of super-growths) : Proper drugs or articles (such as sulphate of copper, etc.) powdered and pasted with honey should be applied for destroying the soft marginal growths of an ulcer found to be more elevated than the surrounding surface of the affected locality. 97

कठिनानाममांसानां दुष्टानां मातरिश्वना । मृद्वी क्रिया विधातव्या शोणितञ्चापि मोक्षयेत् ।

वातघ्नौषधसंयुक्तान् स्नेहान् सेकांश्च कारयेत् ।। ९८ ।।

Mrdu-Karma (softening) : In respect of indurated and fleshless (not seated in a part of the body where flesh abounds) ulcers marked by a deranged condition of Vayu, softening measures (with the help of repeated application of lotions and plasters composed of sweet and demulcent substances mixed with salt in a tepid or luke-warm state) and blood-letting’ should be resorted to. Sprinkling ( Seka) and application of clarified butter or oil prepared with the Vayu-subduing drugs should also be resorted to. 98

व्रणेषु मृदुमांसेषु दारुणीकरणं हितम्। धवप्रियङ्ग्वशोकानां रोहिण्याश्च त्वचस्तथा । । ९९ । ।

त्रिफलाधातकीपुष्प-रोध्रसर्जरसान् समान् । कृत्वा सूक्ष्माणि चूर्णानि व्रणं तैरवचूर्णयेत् ।। १०० ।।

Daruna-Karma (Indication of Fibrosis) : The employment of hardening measures (Daruna-karma) is efficacious in connection with

1. Blood-letting should be resorted to in the event of any vitiated blood being found to have been involved in the case; but in the event of a similar participation of any deranged Kapha, oils and lotions composed of the Vayudestroying drugs should be made use of. soft ulcers and in the following manner. Barks of Dhava, Priyangu, Asoka, Rohini, Triphala, Dhataki flowers, Lodhra and Sarjarasa. taken in equal parts and pounded into fine powders, should be strewn over the ulcer, i.e., the ulcer should be dusted with the same. 99-100

उत्सन्नमांसान् कठिनान् कण्डूयुक्तांश्चिरोत्थितान् । तथैव खलु दुःशोध्याञ्छोधयेत् क्षारकर्मणा ।। १०१ । ।

Ksara-Karma (Potential cauterization): The measure of applying alkali should be adopted for the purification of the sore of a longstanding ulcer which is of an indurated characgter with its margin raised higher (than the surrounding skin), and is marked by itching and a stubborn resistance to all purifying medicines. 101

स्त्रवतोऽश्मभवान् मूत्रं ये चान्ये रक्तवाहिनः । निःशेषच्छिन्नसन्धींश्च साधयेदग्निकर्मणा ।। १०२ ।।

Agni – Karma (actual cauterization) : An ulcer incidental to an act of lithotomic operation allowing the urine to dribble out through its fissure, or one marked by excessive bleeding, or in which the connecting ends have been completely severed. should be cauterised with fire. 102

दुरूढत्वात् तु शुक्लानां कृष्णकर्म हितं भवेत् । भल्लातकान् वासयेत् तु क्षीरे प्राङ्‌मूत्रभावितान् ।। १०३ ।।

ततो द्विधा च्छेदयित्वा लौहे कुम्भे निधापयेत् । कुम्भेऽन्यस्मिन् निखाते तु तं कुम्भमथ योजयेत् ।। १०४ ।।

मुखं मुखेन सन्धाय गोमयैर्दाहयेत् ततः । यः स्नेहश्च्यवते तस्माद् ग्राहयेत् तं शनैर्भिषक् ।। १०५ ।।

ग्राम्यानूपशफान् दग्ध्वा सूक्ष्मचूर्णानि कारयेत् । तैलेनानेन संसृष्टं शुक्लमालेपयेद् व्रणम् ।। १०६ ।।

भल्लातकविधानेन सारस्नेहांस्तु कारयेत् । ये च केचित् फलस्नेहा विधानं तेषु पूर्ववत् ।। १०७ ।।

Krsna-Karma: The blackening of a white cicatrix, which is the result of a bad or defective granulation, should be made (after the complete healing up of the ulcer) in the following manner. Sufficient number of Bhalla-taka seeds should be first soaked in the urine of a cow (and then dried in the sun, this process should be repeated for seven days consecutively), after which they should be kept (a week) immersed in milk. After which the Bhallataka seeds should be cut into two pieces and kept in iron pitcher and that should be buried in the ground with a thin and perforated lid placed over its mouth, and the pitcher containing the seeds should be placed upon it with its mouth downward (so that the mouths of the two pitchers might meet), and then the meeting place should be firmly joined ith clay). This being done a cow-dung fire should be lit around the upper pitcher. The oily matter (melted by the heat) and dribbling down from the Bhallataka seeds into the underground pitcher should be slowly and carefully collected. The hoofs of village animals (such as horses, etc.) and those which live in swamps (Anupas-such as buffaloes, etc.) should be burnt and pounded together into extremely fine powder. The oil (of the Bhallataka seeds collected as above) should then be mixed with this powder, and applied to the white cicatrix. Similarly, the oily essence of the piths of some kinds of wood, as well as of some kinds of fruit (Phala-sneha ) prepared in the manner of the Bhallataka oil (and mixed with the powdered ashes of hoofs) should be used for the blackening of a cicatrix. 103-107

दुरूढत्वात् तु कृष्णानां पाण्डुकर्म हितं भवेत् । सप्तरात्रं स्थितं क्षीरे छागले रोहिणीफलम् ।

तेनैव पिष्टं सुश्लक्ष्णं सवर्णकरणं हितम् ।। १०८ ।।

नवं कपालिकाचूर्णं वैदुलं सर्जनाम च। कासीसं मधुकञ्चैव कपित्थमुद्धृते क्षौद्रयुक्तं प्रलेपयेत् ।। १०९ ।।

मूत्रेणाजेन पूरयेत् । मांसे कासीसं रोचनां तुत्थं हरितालं मनःशिलाम् ।। ११० ।।

वेणुनिर्लेखनञ्चापि प्रपुन्नाडरसाञ्जनम् । अधस्तादर्जुनस्यैतन्मासं भूमौ निधापयेत् । कृष्णमालेपयेद्व्रणम् ।। १११ ।।

मासादूर्ध्वं ततस्तेन कुक्कुटाण्डकपालानि कतकं मधुकं समम् । तथा समुद्रमण्डूकी-मणिचूर्णञ्च दापयेत् ।

गुटिका मूत्रपिष्टास्ता व्रणानां प्रतिसारणम् ।। ११२ ।।

Pandu-karana : The natural and healthy colour (Pandu) of the surrounding skin should be imparted to a cicatrix which has assumed a black colour owing to the faulty healing up of the sore in the following manner. The fruit of the Rohini¹ should be immersed in goat’s milk for seven nights and, afterwards finely pasted with the same milk, should be applied to the skin. This measure is called Pandu-karana (imparting a yellow or natural skin-colour to the cicatrix). To attain the same result, the powder of a new earthen pot, Vetasa roots, Sala roots, Sulphate of iron, and Madhuka (Yastimadhu) pasted together with honey may be used. As an alternative, the hollow rind of the Kapittha fruit, from which the pulp has been removed, should be filled with the urine of a goat together with Kasisa (Sulphate of iron), Rocana, Tuttha (Sulphate of copper). Haritala, Manhsila, scrapings of raw bamboo skin, Prapunnada (seeds of Cakunde), and Rasanjana and buried a month beneath the roots of an Arjuna tree after which it should be taken out and applied to the black cicatrix. The shell of a hen’s egg, Kataka, Madhuka, (Yasti-madhu), sea-oysters and crystals² (pearls according to Jejjata and Brahmadeva) taken in equal parts should be pounded and pasted with the urine of a cow and made into boluses which should be rubbed over the cicatrix. 108-112

हस्तिदन्तमसीं कृत्वा मुख्यञ्चैव रसाञ्जनम्। रोमाण्येतेन जायन्ते लेपात् पाणितलेष्वपि ।। ११३ ।।

चतुष्पदानां त्वग्रोम-खुरशृङ्गास्थिभस्मना । तैलाक्ता चूर्णिता भूमिर्भवेद् रोमवती पुनः ।। ११४ ।।

कासीसं नक्तमालस्य पल्लवांश्चैव संहरेत् । कपित्थरसपिष्टानि रोमसञ्जननं परम् ।। ११५ ।।

Roma-sanjanana – hair-producers: The burnt ashes of ivory and pure Rasanjaja (black antimony) pounded (and pasted with goat’s milk) should be applied to the spot where the appearance of hair (Lomotpatti) is desired. An application of this plaster would lead to the appearance of hair even on the palms of the hands. Another alternative

1. Rohini according to some commentators, means a kind of Haritaki; according to others, it means Katu-tumbi.

2. Burnt ashes of sea-oysters and pearls etc., should be used.

This is also a remedy for giving a natural colour to the skin. is a pulverised compound consisting of the burnt ashes of the bones, nails, hair, skin, hoofs and horns of any quadruped, over a part of the body, previously anointed ( rubbed) with oil, which would lead to the appearance of hair in that region. And lastly, a plaster composed of Sulphate of iron, and tender Karanja leaves pasted with the expressed juice of Kapittha, would be attended with the same result. 113-115

रोमाकीर्णो व्रणो यस्तु न सम्यगुपरोहति । क्षुरकर्त्तरिसन्दंशैस्तस्य रोमाणि निर्हरेत् ॥ १९६ ।।

शङ्खचूर्णस्य भागौ द्वौ हरितालञ्च भागिकम् । शुक्तेन सह पिष्टानि लोमशातनमुत्तमम् ॥ १९७ ॥

तैलं भल्लातकस्याथ स्नुहीक्षीरं तथैव च । प्रगृह्यैकत्र मतिमान् रोमशातनमुत्तमम् ।। ११८ ।।

कदलीदीर्घवृन्ताभ्यां भस्मालं लवणं शमी । बीजं शीतोदपिष्टं वा रोमशातनमाचरेत् ।। १९९ ।।

बीजमैङ्गुदम् । दग्ध्वा तद् भस्मतैलाम्बु सूर्यपक्वं कचान्तकृत् ।। १२० ।। आगारगोधिकापुच्छं, रम्भाऽऽलं

Hair-depilators: The hair of an ulcerated part of the body found to interfere with the satisfactory healing up of the ulcer, should be shaved with a razor or clipped with scissors, or rooted out with the help of forceps. As an alternative, an application of a plaster consisting of two parts of pulverised (burnt ashes of) conch-shell and one part of Haritala (yellow orpiment or yellow oxide of arsenic) pasted with Sukta (an acid gruel) over the desired spot, would be attended with the same result. A compound made of the oil of Bhallataka mixed with the milky exudation of Snuhi, should be used by an intelligent physician as a depilatory measure. As an alternative, the burnt ashes of the stems of plantain leaves and Dirghavrnta ( Syonaka) mixed with rock-salt, Haritala and the seeds of Sami, pasted with cold water, should be deemed a good hair-depilatory.¹ A plaster composed of the ashes of the tail of a domestic lizard, plantain, Haritala (oxide of arsenic), and the seeds of Ingudi burnt together and pasted with oil and water, and baked in the sun may also be used for the eradicating of hair in the affected locality. 116-120

1. According to some this may be used internally for the purpose.

वातदुष्टो व्रणो यस्तु रूक्षश्चात्यर्थवेदनः । अध:काये विशेषेण तत्र बस्तिर्विधीयते ।। १२१ ।।

मूत्रदोषे शुक्रदोषेऽश्मरीव्रणे | मूत्राघाते तथैवार्त्तवदोषे च बस्तिरप्युत्तरो हितः ।। १२२ । । ।।

यस्माच्छुध्यति बन्धेन व्रणो याति च मार्दवम् । रोहत्यपि च निःशङ्कस्तस्माद् बन्धो विधीयते ।। १२३ ।।

Basti-Karma : A medicated Basti (enema) should be applied to the rectum in the case of an ulcer marked by an aggravated condition of the deranged Vayu which is extremely dry and is attended with an excruciating pain occurring specially in the lower region of the body. A measure of Uttara-basti (Vaginal or Urethral douche) should be adopted in the cases of strictures and other disorders connected with urine, semen and menstruation, as well as in cases of gravel¹ in case these are due to an ulcer. An ulcer is purified, softened and healed up by bandaging leaving no room for the apprehension of a relapse. Hence bandaging is recommended. 121-123

स्थिराणामल्पमांसानां रौक्ष्यादनुपरोहताम् । पत्रदानं भवेत् कार्यं यथादोषं यथर्त्तु च ।। १२४ ।।

एरण्डभूर्जपूतीक-हरिद्राणान्तु वातजे । पत्रमाश्वबलं यच्च काश्मरीपत्रमेव च ।। १२५ ।।

पत्राणि क्षीरवृक्षाणामौदकानि तथैव च। दूषिते रक्तपित्ताभ्यां व्रणे दद्याद् विचक्षणः ।। १२६ ।।

पाठामूर्वागुडूचीनां काकमाचीहरिद्रयोः । पत्रञ्च शुकनासाया योजयेत् कफजे व्रणे ॥ १२७ ॥

अकर्कशमविच्छिन्नमजीर्णं सुकुमारकम् । अजन्तुजग्धं मृदु च पत्रं गुणवदुच्यते । । १२८ ।।

स्नेहमौषधसारञ्च पत्रान्तरीकृतः । पट्टः नादत्ते यत् ततः पत्रं लेपस्योपरि दापयेत् ।। १२९ । ।

शैत्यौष्ण्यजननार्थाय स्नेहसंग्रहणाय च। दत्तौषधेषु दातव्यं पत्रं वैद्येन जानता ।। १३० ।।

1. D. R. Some read Tathanile” in place of “Ashmari-vyrana” “Tathanile” means and in cases of (aggravated) Vayu.

Patradana (application of leaves on an ulcer): Leaves possessed of proper medicinal virtues taking into consideration the particular Dosa and season of the year should be tied (over the medicinal plaster applied) over an ulcer of non-shifting or non-changing character and not affecting a large depth of flesh and which refuses to be healed up owing to its extreme dryness. An ulcer of the deranged Vayu should be tied over with the leaves of the Eranda, Bhurja, Putika, or Haridra plants. An ulcer marked by an aggravated condition of the deranged Pitta, or incidental to a vitiated condition of the blood, should be tied in the aforesaid manner with the leaves of the Asvabala KAshmari, the Ksira trees (milk-exuding trees), aquatic plants. An ulcer due to the deranged and aggravated Kapha, should be tied over with the leaves of the Patha, Murva, Guduchi, Kaka-maci, Haridra or of the Sukanasa. Only those leaves which are not rough, nor torn, nor old and decomposed, nor worm-eaten and which are soft and tender should, be used for purposes of Patradana. The rationale of such a procedure (Patra-bandha) is that the leaves tied by an intelligent physician in the manner above indicated serve to generate heat or cold and retain the liniment or medicated oil in their seat of application. 124-130

मक्षिका व्रणजातस्य निःक्षिपन्ति यदा कृमीन् । श्वयथुर्भक्षिते तैस्तु जायते तीव्रा रुजो विचित्राश्च रक्तास्त्रावश्च सुरसादिर्हितस्तत्र धावने पूरणे सप्तपर्णकरञ्जार्क निम्बराजादनत्वचः भृशदारुणः ।। १३९ । । जायते । तथा ।। १३२ ।। i हिता गोमूत्रपिष्टाश्च सेक: क्षारोदकेन वा ॥ १३३ ।। प्रच्छाद्य मांसपेश्या च कृमीनपहरेद् व्रणान् । विंशतिं कृमिजातीस्तु वक्ष्याम्युपरि भागशः ।। १३४ ।।

Vermifugal: The germination of worms due to flies in an ulcer is attended with various kinds of extreme pain, swelling and bleeding in case the worms eat up the flesh. A decoction of the drugs of the Surasadi gana proves efficacious as a wash and healing medicine in such a case. The ulcer should be plastered with such drugs as the bark

1. The leaf which does not poison the Sneha and the essence of the medicinal drugs placed in a folded piece of linen (and applied over an ulcer is the proper leaf and) should be used for tying over the paste of Saptaparna, Karainja, Arka, Nimba and Rajadana pasted with the urine of a cow, or washed with an alkaline wash (for expelling the vermin from it). As an alternative, the worms should be brought out of the ulcer by placing a small piece of raw flesh on the ulcer. These vermin may be divided into twenty groups or classes, which will be fully dealt with later on. (Uttara-Tantra–ch. 54). 131-134

दीर्घकालातुराणान्तु कृशानां व्रणशोषिणाम् । बृंहणीयो विधिः सर्वः कायाग्निं परिरक्षता ॥ १३५ ।।

विषजुष्टस्य विज्ञानं विषनिश्चयमेव च। चिकित्सितञ्च वक्ष्यामि कल्पे तु प्रतिभागशः ।। १३६ ।।

Brmhana (use of restorative and constructive tonics): All kinds of tone-giving and constructive measures should be adopted in the case of a patient weak and emaciated with the troubles of a longstanding sore, taking full precaution not to tax his digestive powers. Anti-toxic (Visaghna) medicines and measures and symptoms of poisonings will be described under their respective heads in the KalpaSthana. 135-136

कण्डूमन्तः सशोफाश्च ये च जत्रूपरि व्रणाः । शिरोविरेचनं तेषु विदध्यात् कुशलो भिषक् ।। १३७ ।।

रुजावन्तोऽनिलाविष्टा रूक्षा ये चोर्ध्वजत्रुजाः । व्रणेषु तेषु कर्त्तव्यं नस्यं वैद्येन जानता ।। १३८ ।।

Siro-virecana and Nasya: Siro-virecana measures (crrhines) should be resorted to by skilful physicians in respect of ulcers situated in the clavicle regions and marked by itching and swelling. The use of medicated (fatty ) snuff (Nasya ) is recommended in cases where the ulcers would be found to be seated in the regions above the clavicles and marked by an aggravated condition of the deranged Vayu, and associated with pain, and rough in nature. 137-138

दोषप्रच्यावनार्थाय रुजादाहक्षयाय च। जिह्वादन्तसमुत्थस्य हरणार्थं मलस्य च ।। १३९ ।।

शोधनो रोपणश्चैव व्रणस्य मुखजस्य वै। उष्णो वा यदि वा शीत: कवलग्रह इष्यते ।। १४० ।।

Kavala-dharana : Medicated gargles (consisting of decoctions of drugs) of purifying or healing virtues either hot or cold¹ (according to requirements) should be used in the case of an ulcer in the mouth, for the purpose of alleviating the Dosas therein, for allaying the local pain and burning, and for removing the impurities of the teeth and the tongue. 139-140

ऊर्ध्वं जत्रुगतान् रोगान् व्रणांश्च कफवातजान् । शोफस्त्रावरुजायुक्तान् धूमपानैरुपाचरेत् ।। १४१ ।।

क्षतोष्माणो निग्रहार्थं सन्धानार्थं तथैव च । सद्योव्रणेष्वायतेषु अवगाढास्त्वणुमुखा ये व्रणाः शल्यपीडिताः ।

निवृत्तहस्तोद्धरणा सर्पिर्विधीयते ॥ १४२ ॥ यन्त्रं यन्त्रं तेषु विधीयते ।। १४३ ।।

Dhuma-pana: Inhaling of smoke or vapours (of medicated drugs) should be prescribed in cases of ulcers of the deranged Vayu and Kapha attended with swelling, secretion and pain and situated in the region above the clavicles. App of honey and clarified butter, separately or mixed together should be prescribed in cases of extended or elongated ulcers which are traumatic or incidental in their character (Sadyo-Vrana) for allaying the heat of the ulcer and for bringing about its adhesion. Surgical instruments should be used in connection with an ulcer which is deep-seated but provided with a narrow orifice and which is due to the penetration of a Salya (shaft) and which could not be removed with the hand alone. 141-143

लघुमात्रो लघुश्चैव स्निग्ध उष्णोऽग्निदीपनः । सर्वव्रणेभ्यो देयस्तु सदाऽऽहारो विजानता ॥ १४४ ॥

निशाचरेभ्यो रक्ष्यस्तु नित्यमेव क्षतातुरः । रक्षाविधानैरुद्दिष्टैर्यमैः सनियमैस्तथा ।। १४५ ।।

The diet of an ulcer-patient should in all cases be made to consist of food which is light in quantity as well as in quality, demulcent, heatmaking (in potency) and possessed of appetising properties. 2 Protective rites should be performed for the safety of an ulcer-patient from the influences of malignant stars and spirits with the major and the minor

1. Hot gargles are recommended in cases of ulcers of the deranged Vayu and Kapha while cold ones in cases of ulcers of the aggravated Pitta and blood duties (Yama¹ and Niyama²) enjoined to be practised on his behalf. 144-145

षण्मूलोऽष्टपरिग्राही पञ्चलक्षणलक्षितः। षष्ट्या विधानैर्निर्दिष्टैश्चतुर्भिः साध्यते व्रणः ॥ १४६ ।।

The causes of ulcers are six³; their seats in the body number eight* in all; the features which characterise them are fives. The medicinal measures and remedies in respect of ulcers are sixty6 in number. And these ulcers are curable with the help or co-operation of the four necessary factors (the physician, the medicines, the nurse and the patient). 146

योऽल्पौषधकृतो योगो बहुग्रन्थभयान्मया । द्रव्याणां तत्समानानां तत्रावापो न दुष्यति ॥ १४७॥

प्रसङ्गाभिहितो यो वा बहु दुर्लभभेषजः । यथोषपत्ति तत्रापि कार्यमेव चिकित्सितम् ॥ १४८ ॥

गणोक्तमपि यद् द्रव्यं भवेद् व्याधावयौगिकम् । तदुद्धरेद् यौगिकन्तु प्रक्षिपेदप्यकीर्त्तितम् ।। १४९ ।।

The comparatively smaller number of drugs which I have mentioned (under the heads of Ropana. Sodhana, etc., in the present chapter) from fear of prolixity, may be increased in combination with other drugs or substances of similar virtue, (digestionary transformation and potency, etc.) without any apprehansion of doing any mischief thereby. Recipes consisting of rare or a large number of drugs or ingredients, should be made up with as many of them as would be

1. Five yamas: non-violence, truthfulness, non-stealing. celibacy and abstinence from wealth.

2. Five niyamas: contentment, service of the god, cleanliness, penance, and regular study of vedas.

3. The six causes of an ulcer are Vayu, Pitta, Kapha Sannipata, Sonita and Agantuka.

4. The eight seats of an ulcer are Tyak, Mansa, Sira, Snayu, Sandhi, Asthi, Kostha and Marma.

5. The five symptoms of an ulcer are due to Vata, Pitta, Kapha, Sannipata and Agantuka. The symptoms due to Sonita being identical with those due to Pitta, are not separately counted.

6. The sixty medicinal measures and remedies are those describe efor the present chapter.

available in the absence of all of them, as mentioned in the present work. A drug belonging to any particular Guna or group if separately described as non-efficacious to any specific disease, should be omitted whereas a drug not belonging to a group may be added to it if it is elsewhere laid down as positively beneficial thereto. 147-149

उपद्रवास्तु द्विविधा व्रणस्य व्रणितस्य च । तत्र गन्धादयः पञ्च व्रणस्योपद्रवाः स्मृताः ।। १५० ।।

ज्वरातीसारौ मूर्च्छा च हिक्का च्छर्दिररोचकः । श्वासकासाविपाकाश्च तृष्णा च व्रणितस्य च ।। १५१ । ।

व्रणक्रियास्वेवमासु व्यासेनीक्तास्वपि क्रियाम् । भूयोऽप्युपरि वक्ष्यामि सद्योव्रणचिकित्सिते ।। १५२ ।। ॥

Upadrava: The distressing supervening symptoms which are found to attend a case of ulcer, are of two types, first one being of ulcer and other one is of ulcer-patient. Those which confine themselves solely to the ulcer are five in all — smell, colour, etc., and those which are exclusively manifest in the patient are fever, diarrhoea, hiccup, vomiting, fainting fits, aversion to food, cough, difficult breathing, indigestion and thirst. The medical treatment of ulcers though described in detail in the present chapter, will be further dealt with in the next chapter on Sadyo-Vrama. 150-152

इति सुश्रुतसंहितायां चिकित्सितस्थाने द्विव्रणीयचिकित्सितं नाम प्रथमोऽध्यायः ॥ १ ॥

Thus ends the first Chapter of the Chikitsita-Sthana in the Susruta Samhita which deals with the treatment of the two kinds of ulcer.


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