अष्टादशोऽध्यायः । अथातो ग्रन्थ्यपच्यर्बुदगलगण्डचिकित्सितं यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥ :।।१।। व्याख्यास्यामः,
Now we shall discourse on the medical treatment of Glandular Swellings, etc. (Granthi), Scurvy (Apaci), Tumour, etc. (Arbuda) and Goitre (Gala-ganda). 1
ग्रन्थिष्वथामेषु भिषग् विदध्याच्छोफक्रियां विस्तरशो विधिज्ञः | रक्षेद्बलञ्चापि नरस्य नित्यं तद्रक्षितं व्याधिबलं निहन्ति ।। २ ।।
तैलं पिबेत् सर्पिरथो द्वयं वा दत्त्वा वसां वा त्रिवृतं विदध्यात् ।। अपेहिवाता- दशमूलसिद्धं वैद्यश्चतुःस्नेहमथो द्वयं वा ।। ३ ।।
General treatment of Granthi : In the non-suppurated or acute (inflammatory) stage of Granthi, an experienced physician should prescribe the measures¹ laid down in connection with (inflammatory) swellings (Sopha) in general. As bodily strength arrests the progress of the disease, the strength of the patient should hence be always carefully guarded against suffering any diminution in that respect. The patient should be made to drink oil, or clarified butter, or both; or he should be made to drink lard, oil and clarified butter, mixed together.2
1. Beginning with Apatarpana up to the purgative measures. 2. Oil, clarified butter and lard mixed together is technically called the “Trivrta”– Dalhana.
In the case of a vataja Granthi, a potion of oil cooked with the decoction and paste (Kalka) of the Vayu-subduing drugs should be prescribed for the patient; in Apehivata (Prasarani) and Dasa-mula cooked with the four kinds of lardacious or emollient substances (oil, clarified butter, lard and marrow), or with any two of them should be prescribed. 2-3 हिं
स्राथ रोहिण्यमृताऽथ भार्गी- श्योनाकबिल्वागुरुकृष्णगन्धाः । गोजी च पिष्टा सह तालपत्र्या ग्रन्थौ विधेयोऽनिलजे प्रलेपः ॥ ४ ॥
स्वेदोपनाहान् विविधांश्च कुर्यात् तथा प्रसिद्धानपरांश्च लेपान्। विदार्य वा पक्वमपोह्य पूयं प्रक्षाल्य बिल्वार्कनरेन्द्रतोयैः ॥ ५॥
तिलैः सपञ्चाङ्गलपत्रमिश्रैः संशोधयेत् सैन्धवसम्प्रयुक्तैः । शुद्धं व्रणं वाऽप्युपरोपयेत्तुतैलेन रास्नासरलान्वितेन । विडङ्गयष्टीमधुकामृताभिः सिद्धेन वा क्षीरसमन्वितेन । ॥ ६॥
Treatment of Vataja Granthi: A medicinal plaster composed of Hinsra, Rohini, Amrta, Bhargi, Syonaka, Bilva, Aguru, Krsnagandha, Goji and Tala-patri (Tala-parni-D. R) pasted together, should be applied (to the inflamed gland) in the Vataja type of Granthi Different kinds of fomentation (Sveda), poulticing (Upanaha) and medicinal plasters (Lepa), possessed of the efficacy of subduing the deranged Vayu, should be likewise resorted to. A suppurated swelling should be opened and the pus drained. Then the incised wound should be washed with a decoction of Bilva,¹ Arka and Narendra (Aragvadha) and purified (disinfected) with a plaster consisting of sesamum and the leaves of the Panchangula (castor oil plants), together with Saindhava salt. After the purification, it should be healed up by applying a medicated oil, mixed with the powders of Rasna and Sarala; or by a medicated oil prepared by cooking it with Vidanga, Yasti-madhu and Amrta and cow’s milk. 4-6
the case of a pittaja Granthi, clarified butter cooked with the decoction and Kalka of the Pitta-subduing drugs should be administered in the same manner; while in the case of a Kaphaja Granthi, oil cooked with the decoction and Kalka of the Kapha-subduing drugs should be taken by the patient. But in a case of Granthi due to the concerted action of the two, or three of the Dosas, any compound medicated oil, prepared by cooking any two, three, or four of the oily substances, viz., oil, clarified butter, lard and marrow, with the decoction and Kalka of those drugs which are antidotes to the said Dosas, should be prescribed for the patient as drinks.
1. Some read “बिल्वार्क गणादितीयैः” and explain that the decoctions of the Bilvadi and the Arkadi groups are to be taken for the purpose.
जलौकसः पित्तकृते हितास्तु क्षीरोदकाभ्यां परिषेचनञ्च । काकोलिवर्गस्य च शीतलानि पिबेत् कषायाणि सशर्कराणि ।। ७ ।।
द्राक्षारसेनेक्षुरसेन वाऽपि चूर्णं पिबेच्चापि हरीतकीनाम् । मधूकजम्ब्वर्जुनवेतसानां त्वग्भिः प्रदेहानवचारयेत् ।
सशकरैर्वा तृणशून्यकन्दैर्दिह्यादभीक्ष्णं मुचुलुन्दजैर्वा ॥ ८ ॥
विदार्य वा पक्वमपोह्य पूयं धावेत् कषायेण वनस्पतीनाम् । तिलैः सयष्टीमधुकैर्विशोध्य सर्पिः प्रयोज्यं मधुरैर्विपक्वम् ।। ९ ।।
आलेपयेत् अमर्मजातं Treatment of Pittaja Granthi : In a case of the Pittaja type of the disease, leeches should be applied to the affected part, which should be further affused with milk and water. The patient should be made to drink a cold decoction of the drugs of the Kakolyadi group with the addition of sugar; or he should take the powders of Haritaki through the medium of grape-juice, or of the expressed juice of sugarcane. Hot plasters, prepared by pasting together the bark of the Madhuka (flower) tree, and of the Jambu tree, Arjuna tree, and Vetasa creeper. As an alternative, hot plasters compounded of the roots of the Trna-sunya (Ketaki), or Mucukunda mixed with sugar should be constantly applied to the affected part. The Granthi should be opened when fully suppurated, and the pus be let out; after which it should be washed with a decoction of the bark of the Vanaspati.¹ The incidental ulcer should then be purified with a plaster composed of sesamum and Yasti-madhu; and lastly it should be healed up with clarified butter cooked with the drugs of the Madhura (Kakolyadi) group. 7-9 हृतेषु दोषेषु यथानुपूर्व्या ग्रन्थौ भिषक् श्लेष्मसमुत्थिते तु ।
स्विन्नस्य कुर्यादङ्गुष्ठलोहोपलवेणुदण्डैः ।। १० ।।
विम्लापनमेव विकङ्कतारग्वधकाकणन्ती-काकादनीतापसवृक्षमूलैः पिण्डफलार्कभार्गी-करञ्जकालामदनैश्च
शममप्रयान्तमपक्वमेवापहरेद् विद्वान् ॥ ११ ।।
विदार्य । दहेत् स्थिते चासृजि सिद्धकर्मा सद्यःक्षतोक्तञ्च विधिं विदध्यात् ॥ १२ ॥
या मांसकन्द्यः कठिना बृहत्यस्तास्वेव योज्यश्च विधिर्विधिज्ञैः । शस्त्रेण वाऽऽपाटय सुपक्वमाशु प्रक्षालयेत् पथ्यतमैः कषायैः ॥ १३ ॥
1. The Vanaspati class consists of Vata, Plaksa, Asvattha and Udumbara trees.
संशोधनैस्तञ्च विशोधयेत्तुः क्षारोत्तरैः क्षौद्रगुडप्रगाढैः । शुद्धे च तैलं त्वचारणीयं विडङ्गपाठारजनीविपक्वम् ॥ १४ ॥
Treatment of Kaphaja Granthi: In a case of the Khaphaja type of the disease, the Dosas should be first eliminated from the system with the regular and successive measures. The affected part (Granthi) should then be fomented and firmly pressed (Vimlapana) and rubbed with either the thumb, or a piece of iron rod, or stone, or with a bamboo rod in order to bring about its resolution. A plaster composed of the roots of the Vikamkata,² Aragvadha, Kakananti (Gunja), Kakadani (Vayasa-tinduka), and Tapasa Vrksa (Ingudi) and with Pinda-phala (Tiktalavu). Arka,³ Bhargi, Karanja, Kala and Madana, pasted together, should be applied to it by an erudite physician. A glandular swelling (Kaphaja Granthi) on any part of the body other than a vital and vulnerable one (Marma) and not otherwise) resolved and absorbed should be cut open even in its non-suppurated stage and the glands removed. The expert surgeon should then cauterize the incidental wound after the cessation of the bleeding and treat it in the manner of the Sadyo-Vrana treatment. These remedies should be employed by the experienced physician, where the swelling would be found to have assumed a large, stiff, elevated and fleshy aspect (bulging from the deeper tissues of the flesh). A Kaphaja Granthi should be opened with an incision as soon as it becomes fully suppurated and should then be washed with a decoction of appropriate medicinal drugs. The incidental ulcer should be purified (disinfected) with a purifying remedy prepared with a profuse quantity of Yava-kshara, honey and clarified butter; and finally it should be healed up by the application of an oil, cooked with Vidanga, Patha and Rohini. 10-14
हुताशतप्तेन मुहुः प्रमृज्याल्लोहेन धीमानदहन् हिताय ॥ १५॥
1. These are the applications of Sneha, fomentation, emetics, purgatives, Asthapana, Siro-virecana and blood letting.
2. Dulhana explains “Vikamkat” as “Kant-karika”, but it means Sruva (called Vainch in Bengal) and Sivadasa also explains it as such.–Ed.
3.Cakradatta does not read “Arka” in the list.
4.Applications of honey, clarified butter, etc.
प्रलिप्य दावमथ लाक्षया वा प्रतप्तया स्वेदनमस्य कार्यम् । निपात्य वा शस्त्रमपोह्य मेदो दहेत् सुपक्वं त्वथवा विदार्य ॥ १६ ॥
प्रक्षाल्य मूत्रेण तिलैः सुपिष्टैः सुवर्चिकाद्यैर्हरितालमिश्रैः । ससैन्धवैः क्षौद्रघृतप्रगाढैः क्षारोत्तरैरेनमभिप्रशोध्य ।
तैलं विदध्याद् द्विकरञ्जगुञ्जा-वंशावलेखेङ्गदमूत्रसिद्धम् ॥ १७ ॥
Treatment of Medoja Granthi: In a case of Medoja Granthi (originated from the vitiated condition of the bodily fat) a plaster of pasted sesamum, placed inside the folds of a piece of linen, should be applied to the seat of the affected part and fomentations with hot ironrods should be frequently applied, inasmuch as application of heat (lit. — fire) is efficacious in such cases. As an alternative, the affected part should be fomented with a ladle, pasted with heated shellac (Laksa ). The Granthi ( in its non-suppurated stage) should be opened by an incision and the fat removed; the incidental ulcer should then be (actually) cauterized. On the other hand, the Granthi, when fully suppurated, should be incised and washed with the urine (of a cow). Then a paste, composed of sesamun, Suvarcika, Haritala and rocksalt, pounded together and mixed with honey, clarified butter and an abundant quantity of Yava-kshara, should be applied to the incidental wound for purifying purposes. Oil, cooked with the two kinds of Karanja.Gunja, the green scrapings of bamboo, Ingudi and the urine of a cow, should be used to heal the ulcer. 15-17
जीमूतकैः कोशवतीफलैश्च दन्तीद्रवन्तीत्रिवृतासु चैव । सर्पिः कृतं हन्त्यपचीं प्रवृद्धां द्विधाप्रवृत्तं तदुदारवीर्यम् ॥ १८ ॥
Treatment of Apaci: Clarified butter cooked with the fruit of Jimutaka and Kosa-vati and with (the roots of) Danti, Dravanti and Trivrt, is a very powerful and efficacious remedy.² Administered internally as well as externally, it leads to the cure of the advanced cases of Apaci. 18
1. Cow’s urine measuring four times the oil should be taken in the preparation of this medicated oil.
2. In preparing this medicated Ghrita, the quantity of clarified butter should be taken four times as much as the combined weight of the Kalka (paste). These should be boiled with water, taken four times as much as the quantity of clarified butter. Some authorities, however, are of opinion that both the paste (Kalka) and the decoction of the drugs are to be taken in its preparation.
निर्गुण्डिजातीबरिहिष्ठयुक्तं जीमूतकं माक्षिकसैन्धवाढ्यम् । अभिप्रतप्तं वमनं प्रगाढं दुष्टापचीषूत्तममादिशन्ति ॥ १९ ॥
कैडर्यबिम्बीकरवीरसिद्धं तैलं हितं मूर्धविरेचनञ्च । शाखोटकस्य स्वरसेन सिद्धं तैलं हितं नस्यविरेचनेषु ॥ २० ॥
मधूकसारश्च हितोऽवपीडे फलानि शिग्रोः खरमञ्जरेर्वा ॥ २१ ॥
A strong emetic composed of Nirgundi, Jati (flower) and Barihistha (Bala) together with Jimutaka, profusely mixed with honey and Saindhava, should be given warm to the patient. It is a very powerful emetic, and leads to the recovery of even a malignant form of Apaci. An oil, cooked with the pastes (Kalka) of Kaidarya Bimbi and Karavira, may be profitably used as an errhine (Siro-virecana). Oil cooked with the expressed juice of Sakhotaka may also be used profitably as an errhine.2 Avapida errhines (used in drops into the nostrils should be applied with Madhuka-sara, Sigru-seeds and Apamarga-seeds. 19-21
ग्रन्थीनमर्मप्रभवानपक्वानुद्धृत्य चाग्निं विदधीत पश्चात् । क्षारेण वाऽपि प्रतिसारयेत् तु संलिख्य शस्त्रेण यथोपदेशम् ॥ २२ ॥
A glandular swelling Granthi, occurring in any part of the body other than a Marma should be opened in its non-suppurated stage and cauterized with fire; or it should be rubbed with an alkalis after scarification as already advised. 22
पार्ष्णिं प्रति द्वे दश चाङ्गुलानि मित्त्वेन्द्रबस्तिं परिवर्ज्य धीमान् । विदार्य मत्स्याण्डनिभानि वैद्यो निष्कृष्य जालान्यनलं विदध्यात् ॥ २३ ॥
A length of twelve fingers should be measured (Mitva) from and above the Parsni, i.e, the posterior side of the ankle (and the space of Indra-basti above this part should be ascertained). The Indra-basti ( occupying a space of half a finger, or, according to others, two fingers)
1. Some read ‘Nirgundi’ after it.
2. This medicated oil should be cooked without any Kalka. But some are of opinion that both the decoction and the Kalka of Sakhotaka should be used. 3. Madhuka-sara mixed with tepid water and the expressed juice of Sigru-seeds and of Apamarga-seeds should be used.
4. In cases of the preponderance of Vayu and of Kapha.
5. In cases of the preponderance of Pitta having been carefully avoided, an excision (on the opposite side of the affection) should be made and the spawn-like glands having been removed (therefrom), the excisioned part should be cauterised with fire. 23
आ गुल्फकर्णात् सुमितस्य जन्तोस्तस्याष्टभागं खुडकाद् विभज्य | atur fare: सुरराजबस्तेर्हित्वाक्षिमात्रं त्वपरे वदन्ति ॥ २४ ॥
Others say that the excision should be made straight above the ankle (Ghona) after carefully avoiding the space of Indra-basti, measuring two fingers (and to make sure an additional space of half a finger should be left out), which would be found out by taking oneeighth part (of the Jangha, i.e., the leg–excluding the foot and measuring twenty fingers) from the Khudaka (ankle-joint) of which the (two) Gulphas (ankles) look like the (two) ears.¹ 24
1. There is a good deal of difference as to the reading and explanation of this passage amongst the different commentators. The different explanations arise from the different interpretation put upon the word “af” in the Text,”fot face , etc.” The words “fff” may mean either of the following. (1) On the opposite side of the Parsni. Vagbhata subscribes to this view. (2) On the opposite (i.e., the other) Parsni, that is to say, if the affection be on the right side of the body the operation should be made on the Parsni of the left leg and so on. Brddha Vagbhata subscribes to this interpretation in the clearest language. (3) In the region of the Parsni. i.e., on the dorsal side of the leg.
The different commentators, again, do not agree as to the seat and extent of the excision. Some say that the operation should be made above the Indra-vasti and the extent should be two fingers in length. Vagbhata seems to subscribe to this view. Others hold that the operation should be made below the Indra-vasti and extent should be two fingers’ length: Dalhana is of this opinion. A third class of commentators assert that the whole extent of the length from above the Parsni up to the Indra basti should be opened.
As to the extent of the Indra-basti, again there is a differnce. According to Dalhana it occupies a space of two fingers. But Jejjata holds that it occupies a space of half a finger only. The Indra-basti (Marma) is situated twelve fingers above (i.e., in the thirteenth finger of) the Parsni. The reading in the printed editions of the text is “f”, whereas Vrnda and Cakradatta read “f”. Dalhana’s reading also evidently is “f”. “f” would be quite redundant and as “मित्वा” gives a better meaning, we accept this reading.
Now we come to the second stanza. Commentators differ more in the exposition of this stanza than of the former. By the expression “-” is meant by some commentators from the Gulpha to the Karna.” Others, however, mean to take it as an adjective to “” and explain it as meaning “from above
मणिबन्धोपरिष्टाद् वा कुर्याद्रेखात्रयं भिषक् । अङ्गुल्यन्तरितं सम्यगपचीनां निवृत्तये ॥ २५ ॥
As an alternative, the region of the wrist (Mani-bandha) should be branded by a physician with three mark lines, one finger, apart, for a radical cure of Apaci. 25
चूर्णस्य काले प्रचलाककाक-गोधाहिकूर्मप्रभवां मसीन्तु । दद्याच्च तैलेन सहेङ्गदीनां यद् वक्ष्यते श्लीपदिनाञ्च तैलम् ॥ २६ ॥
विरेचनं धूममुपाददीत भवेच्च नित्यं यवमुद्गभोजी ॥ २७॥
The ashes (Masi) of the skins of a peacock, cow, lizard (Godha) and snake and of tortoise shells should be dusted (over an Apaci after lubricating it) with the (expressed) oil of the Ingudi. Medicated oils to be described under the treatment of Slipada (elephantiasis) and Vairecanika fumes should also be applied in a case of Apaci and the diet should consist of cooked barley and Mudga pulse. 26-27
कर्कारुकैर्वारुकनारिकेल-प्रियालपञ्चाङ्गुलबीजचूर्णैः क्षीरघृताम्बुसिद्धैरुष्णैः । वातार्बुदं सतैलैरुपनाहयेत् तु । कुर्याच्च मुख्यान्युपनाहनानि सिद्धैश्च मांसैरथ वेसवारैः ॥ २८ ॥ स्वेदं विदध्यात् कुशलस्तु नाडया शृङ्गेण रक्तं बहुशो हरेच्च वातघ्ननिर्यूहपयोऽम्लभागैः सिद्धं शताख्यं त्रिवृतं पिबेद् वा ॥ २९ ॥
Treatment of Vataja Arbuda : In a case of Vataja Arbuda, a poultice composed of Karkaruka, Ervaruka, coconut, Priyala and castor seeds, boiled with milk, water and clarified butter, and mixed
the Khulaka whereof the Gulphas look like the Karnas.” As regards the expression “घोणर्जुवेध:”, some are inclined to think that the excision should be made straight above the Ghona (i.e., the posterior part and especially the big. vein there which looks like the nose (Ghona) of the ankle-joint).
Others, however, read it as “घोणार्जवेऽध:” and explain it (घोणार्जवे + अध:) as meaning “in a straight line with the Ghona (which may mean either the nose or the big vein (Kandara) at the heel looking like the nose (Ghona) of the ankle-joint and below the Indra-basti”
Dalhana says that the part to be excisioned, according to the first stanza, is below the Indra-basti and that, according to the second is above the Indra-basti. We also think that the seat of the Indra-basti should be carefully avoided and an excision should be made both above and below the Indra-vasti, according to the requirements in each case.
with oil, should be applied lukewarm (to the tumour). As an alternative, a poultice made up of boiled meat or of Vesa-vara, should be applied to it. Fomentation of the part in the manner of a Nadi-sveda (application of medicated fumes through a pipe) should be applied by an exprienced physician and the (vitiated) blood (of the locality) should be repeatedly cuffed off with a horn. Satahva or Trivrt¹, boiled with the decoction of the Vayu-subduing drugs and with milk and Kanjika, should be given to the patient. 28-29
स्वेदोपनाहा मृदवस्तु पथ्याः पित्तार्बुदे कायविरेचनञ्च । विघृष्य चोदुम्बरशाकगोजी-पत्रैर्भृशं क्षौद्रयुतैः प्रलिम्पेत् । श्लक्ष्णीकृतैः सर्जरसप्रियङ्ग्-पत्तङ्गरोध्राञ्जनयष्टिकाह्रैः ।। ३० ।। विस्राव्य चारग्वधगोजिसोमाः श्यामा च योज्याः कुशलेन लेपे । श्यामागिरिह्वाञ्जनकीरसेषु द्राक्षारसे सप्तलिकारसे च ।। ३१ ।। घृतं पिबेत् क्लीतकसंप्रसिद्धं पित्तार्बुदी तज्जठरी च जन्तुः ॥ ३२ ॥
Treatment of Pittaja Arbuda: Applications of mild fomentations and poultices (to the affected part) and of purgatives are efficacious in Pittaja Arbuda. The tumour should be well rubbed with (the rough surface of) the leaves of the Udumbara, Saka or of the Goji and it should be plastered over with the fine powders of Sarja-rasa, Priyangu, Pattaiga (red sandal wood) Rodhra, Anjana’ and Yasti-madhu, mixed with honey. As an alternative, a plaster composed of aragvadha, Goji, Soma and Syama. pasted together should be applied to it after the blood letting (Visravana). Clarified butter, cooked with Klitaka (as a Kalka) and with the decoction of Syama, Girihva, Anjanaki, Draksa and Saptalika should be prescribed for internal application in a case of Pittaja Arbuda and of abdominal dropsy (Jathara) of the Pittaja type. 30-32
शुद्धस्य जन्तोः कफजेऽर्बुदे तु रक्तेऽवसिक्ते तु ततोऽर्बुदं तत् । द्रव्याणि यान्यूर्ध्वमधश्च दोषान् हरन्ति तैः कल्ककृतैः प्रदिह्यात् ॥ ३३ ॥ कपोतपारावतविड्विमिश्रैः सकांस्यनीलैः शुकलाङ्गलाख्यैः । मूत्रैस्तु काकादनिमूलमिश्रैः क्षारप्रदिग्धैरथ वा प्रदिह्यात् ॥ ३४॥
1. 2. There is a different reading “श्वेताख्यं त्रिवृत्” in place of “शताख्यं त्रिवृतं”. In that case, roots of white Trivrt should be boiled with the decoction, etc. Cakradatta reads “Arjuna” in place of Anjana”.
निष्पावपिण्याककुलत्थकल्कैर्मांसप्रगाढैर्दधिमस्तुयुक्तैः लेपं विदध्यात् कृमयो यथाऽत्र मूर्च्छन्ति मुञ्चन्त्यथ मक्षिकाश्च । अल्पावशिष्टे कृमिभक्षिते च लिखेत् ततोऽग्निं विदधीत पश्चात् ॥ ३५ ॥
Treatment of Kaphaja Arbuda : In cases of the Kaphaja type of Arbuda blood should be let out from the affected part after the system of the patient has been cleansed (by emetics and purgatives). Then a medicinal plaster composed of the drugs, which are efficacious in correcting the Dosas, confined to the upper and lower parts of the organism, should be applied hot to the tumour. Or a plaster composed of Kansya-nila, Suka, Langalakhya and Kakadani roots, and the excreta of a Kapota and of Paravata pasted together with cow’s urine, or with alkaline water should be applied to it. The Kalkas (pastes) of Nispava (Simbi), Pinyaka (oil-cakes of sesamum) and Kulattha pulse, pasted with curd-cream and an abundunt quantity of flesh, should be used in plastering the affected part so that worms and parasites may be produced in the ulcer and flies attracted to it (and so consume the ulcer). A small portion of the ulcer, left unconsumed (an-eaten) by worms and parasites, etc., should be scarified and the ulcer should then be cauterised with fire. 33-35
यदल्पमूलं त्रपुताम्रसीस-पट्टैः समावेष्ट्य तदायसैर्वा । क्षाराग्निशस्त्राण्यसकृद्विदध्यात् प्राणानहिंसन् भिषगप्रमत्तः ॥ ३६॥
आस्फोतजातीकरवीरपत्रैः कषायमिष्टं व्रणशोधनार्थम् । शुद्धे च तैलं विदधीत भार्गी-विडङ्गपाठात्रिफलाविपक्वम् ॥३७॥
यदृच्छया चोपगतानि पाकं पाकक्रमेणोपचरेद् विधिज्ञः ॥ ३८ ॥
A comparatively superficial tumour (Arbuda) should be covered with thin leaves of zinc, copper, lead, or of iron, and cauterization with fire or with an alkali as well as surgical operations should be carefully and repeatedly resorted to, so as not to hurt, nor in any way injure the body. The incidental ulcer should be washed with the decoction of the leaves of the Asphota, Jafi, and Karavira for the purpose of purification. A medicated oil, cooked with Bhargi, Vidanga, Patha and Triphala should then be used as a healing remedy. An experienced physician
1. These are the drugs included in the emetic and purgative groups (see chap. XXXIX. Sutra Sthana) should treat a tumour, spontaneously suppurating, in the manner of a suppurated ulcer. 36-38
मेदोऽर्बुदं स्विन्नमथो विदर्य विशोध्य सीव्येद् गतरक्तमाशु । ततो हरिद्रागृहधूमरोध्र-पत्तङ्गचूर्णैः समनः शिलालैः । व्रणं प्रतिग्राह्य मधुप्रगाढैः करञ्जतैलं विदधीत शुद्धे ॥३९॥ सशेषदोषाणि हि योर्बुदानि करोति तस्याशु पुनर्भवन्ति । तस्मादशेषाणि समुद्धरेत्तु हन्युः सशेषाणि यथा हि वह्निः ॥ ४० ॥
Treatment of Medoja Arbuda : A Medoja Arbuda (fat origined tumour) should be first fomented and then incised. The blood in its inside having been cleansed it should be quickly sutured and then plastered over with a compound composed of Haridra, Grha-dhuma (soot of a room), Rodhra, Pattainga, Manah-sila and Haritala pounded together and mixed with a proper quantity of honey. After its purification, thus produced, it should be treated with the application of KaranjaTaila (prescribed before in cases of Vidradhi). Even the least particle of Dosas (pus, etc. ) in a tumour, left unremoved, would lead to a fresh growth of the excrescence and bring on death just like the least particle of an unextinguished fire. Hence it should be destroyed in its entirety. 39-40
संस्वेद्य गण्डं पवनोत्थमादौ नाडयाऽनिलघ्नौषधपत्रभङ्गैः । अम्लैः समूत्रैर्विविधैः पयोभिरुष्णैः सतैलैः पिशितैश्च विद्वान् ॥ ४१ ॥
विस्त्रावयेत् स्विन्नमतन्द्रितश्च शुद्धं व्रणञ्चाप्युपनाहयेत् तु । शणातसीमूलकशिग्नुकिण्वप्रियालमज्जानुयुतैस्तिलस्तु ॥ ४२ ॥
कालामृताशिनुपुनर्नवार्कगजादिनामाकरहाटकुष्ठैः एकैषिकावृक्षकतिल्वकैश्च सुराम्लपिष्टैरसकृत् प्रदिह्यात् ॥४३॥
तैलं पिबेच्चामृतवल्लिनिम्ब-हंसाह्वयावृक्षकपिप्पलीभिः ।
सिद्धं बलाभ्याञ्च सदेवदारु हिताय नित्यं गलगण्डरोगे ॥४४॥
Treatment of Vataja Gala-ganda: A case of the Vataja type of Gala-ganda (goitre) should be treated with fomentations of the vapours of the decoctions of tender leaves of the Vayu-subduing drugs prepared by boiling them with Kanjika, various kinds of urine and milk as well as with minced meat and oil, and should be applied in the manner of a Nadisveda. After this fomentation, the contents should be carefully drained (from inside the goitre). Then after having duly purified (the incidental ulcer), it should be plastered with a medicinal compound composed of (the seeds of) the Sana, Atasi, Mulaka, Sigru and sesamum and Kinva and the piths of the Priyala, or with that composed of Kala, Amrta, Sigru, Punarnava, Arka, Gaja-pippali, Karahata (Madana) and Kustha, or with that composed of Ekaisika, Vrksaka and Tilvaka. All of them should be pasted with Sura and Kanjika and applied hot to the affected part. The internal use of a medicated oil, cooked with Amrta, Nimba, Hamsahva, Vrksaka, Pippali, Bala, Ati-bala, and Deva-daru, always proves efficacious in a case of goitre. 41-44
स्वेदोपनाहैः कफसम्भवन्तु संस्वेद्य विस्त्रावणमेव कुर्यात् । ततोऽजगन्धातिविषाविशल्या-विषाणिकाकुष्ठशुकाह्वयाभिः । पलाशभस्मोदकपेषिताभिर्दिह्यात् सगुञ्जाभिरशीतलाभिः ॥ ४५ ॥ दशार्धसंख्यैर्लवणैश्च युक्तं तैलं पिबेन्मागधिकादिसिद्धम् । प्रच्छर्द्दनं मूर्धविरेचनञ्च धूमश्च वैरेचनिको हितस्तु ॥ ४६॥ पाकक्रमो वाऽपि सदा विधेयो वैद्यैन पाकं गतयोः कथञ्चित् ॥ ४७ ॥ कटुत्रिकक्षौद्रयुताः समूत्रा भक्ष्या यवान्नानि रसाश्च मौद्गाः । सशृङ्गवेरा: सपटोलनिम्बा हिताय देया गलगण्डरोगे ॥४८॥
Treatment of Kaphaja Gala-ganda : A case of the Kaphaja type of goitre should be treated with applications of fomentation and poultice and should be duly drained (Visrava). Then a medicinal plaster composed of Aja-gandha, Ati-visa, Visalya, Visanika, Kustha, Sukahvaya, Gunja (taken in equal parts) and pasted with the alkaline water prepared from the ashes of the Palasa wood should be applied hot to the affected part. A medicated oil cooked with the drugs of the Pippalyadi group and mixed with the five officinal kinds of salt should be taken by the patient. Emetics, errhines and inhalations of Vairecanikadhuma are beneficial in such cases. In the Vataja and the Kaphaja types of goitre (Gala-ganda), the skilful physician should employ suppurating measures in partially suppurated cases. The patient’s diet should consist of rice, barley and Mudga soup and should be taken
1. Some say that the oil should be prepared with the decoction as well as with Kalka of the said drugs. Others, however, hold that water should be used in the preparation of the oil and the said drugs should be used only as a Kalka with honey, Trikatu, cow’s urine, fresh ginger, Patolaand Nimba. 45-48
मेदः समुत्थे तु यथोपदिष्टां विध्येच्छिरां स्निग्धतनोर्नरस्य । श्यामासुधालोहपुरीषदन्ती रसाञ्जनैश्चापि हितः प्रदेहः ॥४९॥ मूत्रेण वाग्लोडच हिताय सारं प्रातः पिबेच्छालमहीरुहाणाम् । शस्त्रेण वाऽपाटय विदार्य चैनं मेदः समुद्धृत्य हिताय सीव्येत् । मज्जाज्यमेदोमधुभिर्दहेद् वा दग्धे च सर्पिर्मधु चावचार्यम् ॥ ५० ॥ कासीसतुत्थे च ततोऽत्र देये चूर्णीकृते रोचनया समेते । तैलेन चाभ्यज्य हिताय दद्यात् सारोद्भवं गोमयजञ्च भस्म | हितश्च नित्यं त्रिफलाकषायो गाढश्च बन्धो यवभोजनञ्च ॥५१॥
Treatment of Medoja Gala-ganda: In a case of a Medoja goitre (due to the deranged fat), the patient should be first made to use oleaginous substances (internally and externally) and venesection should then be resorted to, as advised before (Sharira-Sthana, Ch. VIII). A hot plaster composed of Syama ( Trivrt), Sudha, Mandura, Danti and Rasanjana pasted together should be applied to the seat of the disease. Powders of the essential parts (Sara) of a Sala tree mixed with cow’s urine may be given every morning with advantage.
As an alternative, the Goitre (Gala-ganda) should be opened, its fatty contents fully removed and the wound then sutured. Or it should be cauterised with the application of heated animal marrow, clarified butter, lard, or honey; after which it should be lubricated with clarified butter and honey (mixed together), and a pulverised compound of Kasisa, Tuttha, and Gorocana should be applied to it; or after lubricating it with oil, it should be dusted with the ashes of cow-dung and of Sala-sara. Daily washings with the decoction of Triphala, hard bandaging and a diet of barley, prove efficacious (in cases of goitre). 49-51
इति सुश्रुत संहितायां चिकित्सितस्थाने ग्रन्थपच्यर्बुद गलगण्डचिकित्सितं नामाष्टादशोऽध्यायः ।। १८ ।।
Thus ends the Eighteenth Chapter of the Chikitsa Sthana in the Susruta Samhita, which deals with the medical treatment of Glands, Scrofula, Tumour and Goitre.
