अथातो इति ग्रन्थ्यर्बुदश्लीपदापचीनाडीप्रतिषेधं व्याख्यास्यामः । स्माहुरात्रेयादयो महर्षयः । ह
We shall now expound the Granthi-arbuda-slipada apaci nadi pratisedha adhyaya-treatment of granthi-arbuda, slipada apaci and nadi (vrana); thus said Atreya and other great sages.
Granthi chikitsa – treatment of benign tumour
ग्रन्थिष्वामेषु कर्तव्या यथास्वं शोफवत् क्रिया | बृहतीचित्रकव्याघ्रीकणासिद्धेन सर्पिषा ॥ १ ॥
स्नेहयेच्छुद्धिकामं च, तीक्ष्णैः शुद्धस्य लेपनम् । संस्वेद्य बहुशो ग्रन्थिं विमृद्नीयात् पुनः पुनः ॥ २ ॥
एष वाते विशेषेण क्रमः, पित्तास्त्रजे पुनः । जलौकसो हिमं सर्वं, कफजे वातिको विधिः ॥ ३ ॥
For granthi (benign tumours ) which is unripe, the treat ment is like that of any sopha (swelling).
The patient requiring purificatory therapies should be given oleation therapy first with ghee prepared with brhati; citraka, vyaghri and kana; after he gets purified, application of paste of drugs of penetrating action should be done (on the tumour); the tumour should be given fomentation many times and squeezed (by the hands) again and again. this is the method of treatment especially for tumour of vata origin.
For those arising from pitta and asrk (blood) application of leeches (to suck blood) and all cold therapies are beneficial; for that of kapha origin, the treatment prescribed for that of vata origin itself is suitable. 1-3.
तथाऽप्यपक्कं छित्त्वैनं स्थिते रक्तेऽग्निना दहेत् । साध्वशेषं, सशेषो हि पुनराप्यायते ध्रुवम् ॥ ४ ॥
That which has not become ripe, inspite of all these should be cut (excised) and when bleeding stops it should be burnt by fire (thermal cautery ) leaving no residue/remnant, because such a residue/remnant is sure to develop again into a tumour. 4.
मांसव्रणोद्भवौ ग्रन्थी यापयेदेवमेव च ।
Both mamsa granthi (tumour of muscle tissue) and vrana granthi (tumour sequel to an ulcer) should also be treated in the same ( above) way. 5a.
कार्यं मेदोभवेऽप्येतत्ततैः फालादिभिश्चि तम् ॥ ५ ॥ प्रमृद्यात्तिलदिग्धेन छन्नं द्विगुणवाससा ।
शस्त्रेण पाटयित्वा वा दहेन्मदसि सूते ॥ ६ ॥
Even in medoja granthi (tumour of fat tissue) that same treatment; it shoold be given a coating of the paste of tila, covered with two layers of cloth and then touched with heated metal plates etc; or it be cut (excised) completely and burnt by fire (thermal cautery). 5b-6.
सिराग्रन्थौ नवे पेयं तैलं साहचरं, तथा । उपनाहोऽनिलहरैर्बस्तिकर्म सिराव्यधः ॥७॥
In siragranthi (tumour of veins) which is new, sahacara taila should be given to drink; upanaha (warm poultice) with drugs which mitigate vata; basti ( enema therapy) and siravyadha (venesection) should be done. 7.
Arbuda chikitsa – treatment of malignant tumour
अर्बुदे ग्रन्थिवत् कुर्यात् यथास्वं सुतरां हितम् ।
[ अजाशकृच्छिग्रुमूललाक्षासुरस (लवणक्षार) काञ्जिकैः । वस्त्रबद्धैरुपस्वेद्य मर्दयित्वा प्रलेपयेत् ॥१॥
उपोदकापत्रपिण्ड्या छदैराच्छादितं घनम् । निवेश्य पट्टं बध्नीयाच्छाम्यत्येवं नवार्बुदम् ॥ २ ॥
जीर्णे चार्कच्छदसुधासामुद्रगुडकाञ्जिकैः । प्रच्छाने पिण्डिका बद्धा ग्रन्थ्यर्बुदविलायनी ॥ ३ ॥ ]
For arbuda (malignant tumours) also the same treatment advocated for granthi (benign tumour) are beneficial. (Excreta of a goat, root of sigru, laksa, surasa, lavana and ksara are cooked in formented gruel tied in a cloth and applied warm over the tumour, covered with thick leaves of upodaka and then bandaged. By this, arbuda of recent onset subside. In case of chronic tumours; covering it with leaves of arka, sudha, samudra ( lavana ), guda and kanijika, pracchana (letting out the blood by making incisions on the skin) after tieing at the calves make for dissolving/ disappearance of tumours). 1-3.
Slipada chikitsa – treatment of filariasis
श्लीपदे निलजे विध्येत् स्निग्धस्विन्नोपनाहिते ॥ ८ ॥
सिरामुपरि गुल्फस्य द्वयङ्गुले, पाययेच्च तम्। मासमेरण्डजं तैलं गोमूत्रेण समन्वितम् ॥ ९॥
जीर्णे जीर्णान्नमश्नीयाच्छुण्ठीशृतपयोन्वितम् । त्रैवृतं वा पिबेदवमशान्तावग्निना दहेत् ॥ १० ॥
In slipada caused by vata after administering oleation ( anointing) sudation (fomentation ) and poulticing, the vein situated two angula above the heel should be cut (and blood let out); the patient should be asked to drink eranda taila along with cow’s urine for one month after it is well digested, he should eat old rice boiled well along with decoction of sunthi and milk, or drink the decoction of trivrit along with milk. If by these methods the disease does not subside, then it should be burnt by fire ( thermal cautery).
गुल्फस्याधः सिरामोक्षः पैत्ते सर्वं च पित्तजित् ।
In slipada of pitta origin, venesection below the heel and all other pitta mitigating treatments should be done.
सिरामष्ठके विध्वा कफजे शीलयेद्यवान् ॥ ११ ॥
सक्षौद्राणि कषायाणि वर्द्धमानास्तथाऽभयाः । लिम्पेतत्सर्षपवार्ताकिमूलाभ्यां धन्वयाऽथवा ॥ १२ ॥
In slipada of kapha origin, the vein near the big toe should be cut, use yava ( barley) (as food) decoction of drugs of astringent taste mixed with honey; use abhaya in daily increasing doses, apply the paste of sarsapa and vartakimula or of dhanva to the leg. 11b-12.
Apaci chikitsa – treatment of scrofula
ऊर्ध्वाधः शोधनं पेयमपच्यां साधितं घृतम् । दन्तीद्रवन्तीत्रिवृताजालिनीदेवदालिभिः शीलयेत्कफमेदोघ्नं सिरयाऽपहरेद्रक्तं ॥१३॥
धूमगण्डूषनावनम् । पिबेन्मूत्रेण तार्क्ष्यजम् ॥ १४॥
In Apaci purification of the body both in its upper and lower routes; drinking of ghee prepared with danti, dravanti, trivrt, jalini and devadali; inhalation of smoke, holding liquids in the mouth and nasal medication which mitigate kapha and medas (fat), blood letting from the vein, and drink tarksyaja (rasanjana) mixed with cow’s urine. 13-14.
( पलमर्द्धपलं वाऽपि कर्ष वाऽप्युष्णवारिणा ।
काञ्चनारत्वचं पीत्वा गण्डमालां व्यपोहति ॥ १ ॥
(Drinking the fresh juice of bark of kancanara in doses of one pala, half pala or karsa every day along with warm water, the person gets cured of gandamala.). 1.
ग्रन्थीनपक्वानालिम्पेन्नाकुलीपटुनागरैः ! स्विन्नान् लवणपोटल्या कठिनाननु मर्दयेत् ॥ १५ ॥
Tumours (of gandamala) which are unripe should be smeared with the paste of nakuli, patu and nagara, fomented with salt poultice and then the hard tumours massaged softly. 15.
शमीमूलकशिग्रूणां बीजैः सयवसर्षषैः । लेपः पिष्टोऽम्लतक्रेण ग्रन्थिगण्डविलायनः ॥ १६ ॥
Seeds of sami, mulaka and sigru, mixed with yava and sarsapa macerated with sour buttermilk and this paste applied over the tumour makes that liquified. 16.
( क्षुण्णानि निम्बपत्राणि क्लृप्तैर्भल्लातकैः सह । शरावसम्पुटे दग्ध्वा सार्धं सिद्धार्थकैः समैः ॥ १ ॥ एतच्छागाम्बुना पिष्टं गण्डमालाप्रलेपनम् ।)
(Leaves of nimba and of bhallataka cut to bits, burnt to ashes within sealed earthen saucers and mixed with half its quantity of siddharthaka, macerated with goat’s urine and applied to gandamala ( is beneficial)). 1.
पाकोन्मुखान् स्स्रुतास्त्रस्य पित्तश्लेष्महरैर्जयेत् । अपक्कानेव वोद्धृत्य क्षाराग्निभ्यामुपाचरेत् ॥ १७॥
Those which are undergoing ripening (suppuration) should be treated with blood letting and therapies which mitigate pittaaslesma (kapha) or the unripe ones should be removed and treated by the use of ksara and agni (alkaline and thermal cauterisation). 17.
काकादनीलाङ्गलिकानहिकोत्तुण्डिकीफलैः ।
जीमूतबीजकर्कोटीविशालाकृतवेधनैः ॥ १८ ॥
पाठान्वितैः पलार्धांशैर्विषकर्षयुतैः पचेत् । प्रस्थं करञ्जतैलस्य निर्गुण्डीस्वरसाढके ॥ १९ ॥ ।।
अनेन माला गण्डानां चिरजा पूयवाहिनी । सिध्यत्यसाध्यकल्पाऽपि पानाभ्यञ्जननावनैः ॥ २० ॥
Medicated oil is prepared with the decoction of kakadani, langalika, nahika, uttandikiphala, seeds of jimuta, karkoti, visala krtavedhan and patha each half pala; visa one karsa; karanja taila one prastha and fresh juice of nirgundi one adhaka. By the use of this oil for drinking, anointing on the tumour and nasal medication, gandamala which (scrofula) which are chronic, which exdue pus, present incurable features-all become cured.
तैलं लाङ्गलिकीकन्दकल्कपादं चतुर्गुणे । निर्गुण्डीस्वरसे पक्कं नस्याद्यैरपचीप्रणुत् ॥ २१ ॥
Medicated oil prepared with decoction of langalika, paste of the same in one-fourth part along with four parts of fresh juice of nirgundi used as nasal drops etc. cures apaci. 21.
भद्रश्रीदारुमरिचद्विहरिद्रात्रिवृद्धनैः मनः शिलालनलदविशालाकरवीरकैः
गोमूत्रपिष्टैः पलिकैर्विषस्यार्धपलेन च। ब्राह्मीरसार्कजक्षीरगोशकृद्रससंयुतम् । ॥ २२॥ ॥ २३ ॥
प्रस्थं सर्षपतैलस्य सिद्धमाशु व्यपोहति । पानाद्यैः शीलितं कुष्ठदुष्टनाडीव्रणापचीः ॥ २४ ॥
Medicated oil prepared with the paste of one pala each of bhadrasri, daru, marica, the two haridra, trivrt, ghana, manassila, ala, nalada, visala and karavira made with cow’s urine; bisa half-pala, juice of brahmi, arka ksira ( milky sap of arka), juice of fresh cow dung and one prastha of sarsapa taila. This used for drinking etc. (anointing, nasal medication) habitually cures leprosy. foul ulcers, sinus ulcers and apaci ( small tumours). 22-24.
वचाहरीतकीलाक्षाकटुरोहिणिचन्दनैः तैलं प्रसाधितं पीतं समूलामपचीं जयेत् ॥ २५ ॥
Medicated oil prepared with vaca, haritaki, laksa, katurohini, and candana consumed daily destroys apaci from its root even. 25.
शरपुङ्खोद्भवं मूलं पिष्टं तन्दुलवारिणा । नस्याल्लेपाच्च दुष्टारुरपचीविषजन्तुजित् ॥ २६ ॥
Root of sarapunkha mecerated with rice wash and used for nasal medication and external application cures bad ulcers, apaci and poisonous worms. 26.
मूलैरुत्तमकारण्या: पीलुपर्ण्या: सहाचरात् । सरोथ्राभययष्ट्याह्वशताह्वाद्वीपिदारुभिः तैलं क्षीरसमं सिद्धं नस्येऽभ्यङ्गे च पूजितम् । ॥२७॥
Medicated oil prepared with the roots of uttamarani, piluparni and sahacara, added with rodhra, abhaya, yasthyahva, satahva, dvipi and daru and equal quantity of milk is best for use for nasal drops and anointing. 27-28a.
गोव्यजाश्वखुरा दग्धाः कटुतैलेन लेपनम् ॥ २८ ॥ ऐङ्गुदेन दु कृष्णाहिर्वायसो वा स्यवं मृतः।
Ash of hoof of cow, goat or horse mixed with katu taila should be applied externally or the ash of a black snake or crow which has died of its own accord mixed with ingudi taila may be applied. 28b-29a.
इत्यशान्तौ गदस्यान्यपार्श्वजङ्घासमाश्रितम् ॥ २९ ॥ बस्तेरूर्ध्वमधस्ताद्वा मेदो हृत्वाऽग्निना दहेत् ।
स्थितस्योर्ध्वं पदं मित्वा तन्मानेन च पार्ष्णितः ॥ ३० ॥
Leaving away twelve angula (fingers breadth) from the heel and going upward, to the place of indrabasti and avoiding it, the calf muscle should be torn ( cut) open, the small tumour resembling eggs of the fish removed out from the net work of muscles-this is the saying of Susruta. 31b.
आ गुल्फकर्णात्सुमितस्य जन्तोस्तस्याष्टभागं खुडकाद्विभज्य |
घ्राणार्जवेऽधः सुरराजबस्तेर्भित्त्वाऽक्षमात्रं त्वपरे वदन्ति ॥ ३२ ॥
Dividing the total length of man from his heel to the ear and keeping one eighth part of it (at the bottom and discarding the major part at the top) or measuring from the tip of the nose to the indrabasti and taking one eighth part of it (is the site for conducting the operation) say some others.
Notes : The “indrabasti” is the name of marma (vital spot), belonging to mamsa marma, kalantara pranahara kind present in the middle of the foreleg. Ancient physicians held the view that small tumors will be developing simultaneously with the development of glands in the neck (apaci / gandamala) and as a part of treatment, surgical removal of glands in the calf muscles has been decribed in the above verses.
Nadh vrana chikitsa – treatment of sinus ulcer
उपनाह्यानिलान्नाडीं पाटितां साधु लेपयेत् । प्रत्यक्पुष्पीफलयुतैस्तिलैः पिष्टैः ससैन्धवैः ॥ ३३ ॥
If the disease does not subside by these treatments then the medas (fat) present in the calf muscle of the leg opposite to the side of the disease (apaci) should be taken out and the site burnt by fire. 29b-30a.
तत ऊर्ध्वं हरेद् ग्रन्थीनित्याह भगवान्निमिः ।
The patient is made to stand extending his leg measuring the distance from the heel (up to the middle of the calf muscles), the granthi ( tumour) present there should be removed-thus said the worshipful Nimi. 30b-31a.
पाष्णि प्रति द्वादश चाङ्गुलानि मुक्त्वेन्द्रबस्ति च गदान्यपार्श्वे ।
विदार्य मत्स्याण्डनिभानि मध्याज्जालानि कर्णेदिति सुश्रुतोक्तिः ॥ ३१ ॥
पैत्तीं तु तिलमञ्जिष्ठानागदन्तीनिशाद्वयैः श्लैष्मिकीं तिलसौराष्ट्रीनिकुम्भारिष्टसैन्धवैः ॥ ३४ ॥
Nadi vrana (sinus ulcer) caused by anila (vata) should be fomented with warm poultice, cut open and applied with the paste of fruits of pratyak puspi, tila and saindhava; that caused by pitta with the paste of manjistha, nagadanti and the two nisa; that caused by slesma ( kapha) with the paste of tila, saurastri, nikumbha, arista and saindhava. 33-34.
शल्यजां तिलमध्वाज्यैर्लेपयेच्छिन्नशोधिताम् ।
That due to foreign body should be cut open, cleaned and applied with the paste of tila, honey and ghee. 35a.
अशस्त्रकृत्यामेषिण्या भित्त्वाऽन्ते सम्यगेषिताम् ॥ ३५ ॥ क्षारपीतेन सूत्रेण बहुशो दारयेद् गतिम् ।
That which cannot be cut by the knife should be split with the help of a probe, the passage cleared and a thread soaked in solution of alkali inserted into it, many times making the channel clear and wide. 35b-36a.
व्रणेषु दुष्टसूक्ष्मास्यगम्भीरादिषु या वर्त्यो यानि तैलानि तन्नाडीष्वपि शस्यते । साधनम् ॥ ३६॥
The treatment advocated for ulcers which have bad (exudation) and small mouth and are deep seated, the same treatments, the same medicinal wicks and oils are also beneficial even in sinus ulcers. 36b-37a.
पिष्टं चञ्चूफलं लेपान्नाडीव्रणहरं परम् ॥ ३७ ॥
Paste of cancuphala is best for application for cure of sinus ulcer. 37b.
घोण्टाफलत्वक् लवणं सलाक्षं बूकस्य पत्रं वनितापयश्च । स्नुगर्कदुग्धान्वित एष कल्को वर्तीकृतो हन्त्यचिरेण नाडीम् ॥ ३८ ॥
Bark of ghontaphala, lavana, laksa, leaves of buka, woman’s milk, sap of snuk and of arka made into a paste and then into a wick and used, cures sinus ulcer very soon. 38.
सामुद्रसौवर्चलसिन्धुजन्मसुपक्वघोण्टाफलवेश्मधूमाः । आम्रातगायत्रिजपल्लवाश्च कटंकटेर्यवथ चेतकी च ॥ ३९ ॥
कल्केऽभ्यङ्गे चुर्णे वर्त्यां चैतेषु शील्यमानेषु । अगतिरिव नश्यति गतिश्चपला चपलेषु भूतिरिव ॥ ४० ॥
Samudra, sauvarcala, sindhujanma (saindhava), bark of well ripe fruit of ghonta, vesma dhuma (agara dhuma), amrata, tender leaves of gayatri, katankateri ( haridra ) and cetaki (kanguni)-these together made use of in the form of paste for bathing, powder, medicinal wick, etc. make for disappearance of the sinus ulcers just like wealth in a man of 39-40. unstedy nature.
इति श्रीवैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां
ग्रन्थ्यर्बुदश्लीपदापचीनाडीप्रतिषेधो नाम त्रिंशोऽध्यायः ॥ ३० ॥ षष्ठ उत्तरस्थाने
Thus ends the chapter Granthi-arbuda-slipada-apacinadi pratisedha-the thirtieth in Uttarasthana of Astanga hrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
