पञ्चविंशोऽध्यायः । अथातो मिश्रकचिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः :।।१।।
Now we shall discourse on the medical treatment of a variety of disease (Misraka-Chikitsa). 1
पाल्यामयास्तु वित्राव्या इत्युक्तं प्रानिबोध तान् । परिपोटस्तथोत्पात उन्मन्थो दुःखवर्धनः ।।२।। पञ्चमः परिलेही च कर्णपाल्यां गदाः स्मृताः ॥३॥
It has been stated before that blood-letting is the remedy in diseases of the Pali (ear-lobes ). Now hear me describing in detail the treatment of those affections which are confined to the lobes of the ears. They are five in number and are called the Paripota, Utpata, Unmantha, Duhkha Vardhana and the Parilehi. 2-3
सौकुमार्याच्चिरोत्सृष्टे सहसाऽभिप्रवर्धिते । कर्णशोफो भवेत् पाल्यां सरुजः परिपोटवान् । कृष्णारुणनिभः स्तब्धः स वातात् परिपोटकः ॥४॥
Causes and Symptoms: If the lobe of an ear be suddenly pulled and kept in that position for a long time, a numbed and painful swelling of a blackish red colour is produced on the lobe, owing to its soft and delicate nature. This is found to spontaneously burst or crack and is called the Paripotaka, which should be ascribed to the action of the deranged Vayu (of the system). 4
गुर्वाभरणसंयोगात् ताडनाद् घर्षणादपि । शोफ: पाल्यां भवेच्छयावो दाहपाकरुगन्वितः । रक्तो वा रक्तपित्ताभ्यामुत्पातः स गदो मतः ।।५।।
A inf swellin attended with a burning sensation and suppuration, appearing in the lobe of the ear, owing to the friction and movements of a heavy ornament worn in the lobe is originated from the vitiated condition of the blood and the Pitta. Its colour is either brown or red and is called the Utpata. 5
बलाद् वर्धयतः कर्णं पाल्यां वायुः प्रकुप्यति । गृहीत्वा सकफं कुर्याच्छोकं तद्वर्णवेदनम् । उन्मन्थकः सकण्डूको विकारः कफवातजः।।६।।
Pulling the ear-lobes down by force tends to enrage the Vayu (of the localities) which in union with (the deranged) Kapha gives rise to a painful swelling in those regions, attended with itching and tinged with the specific colours¹ and symptoms of the Dosas involved. The disease is called the Unmantha and is originated through the concerted action of the deranged Vayu and the Kapha. 6
वर्धमाने यदा कर्णे कण्डूदाहरुगन्वितः ।
शोफो भवति पाकश्च त्वक्स्थोऽसौ दुःखवर्धनः ।।७।।
A swelling in an ear-lobe attended with pain, burning and itching sensations owing to its being (pulled down and) lengthened, when found to suppurate (in the end) is called the Dukha-varahana; it restricts itself only to the skin ( of the affected part). 7
1. Madhva in his compilation reads “स्तब्धमवेदनम्” (that the swelling is attended with a numbness and no pain) in place of “तद्वर्णवेदनम्” Vagbhata also supports this. Ed.
2. Madhava adds “an unsuccessful perforation ( in the ear-lobe ) ” to be an additional cause of the disease. He also reads “त्रिदोष”, ie, “due to the concerted action of the three Dosas in place of “त्वक्स्थोऽसौ” Madhava has Vagbhata’s support in this. -Ed.
कफासक्क्रिमयः कुर्यु: सर्षपाभा विकारिणीः । स्त्राविणी: पिडका: पाल्यां कण्डूदाहरुगन्विताः ॥ ८ ॥ कफासक्क्रिमिसम्भूतः विसर्पत्रितस्ततः । लिह्यात् सशष्कुल पालीं परिलेहीति स स्मृतः ॥ ९ ॥
Small exuding pustules resembling mustard-seeds (in size) and attended with pain, burning and itching sensations, appear in the lobes of the ears owing to the action of the vitiated blood or the deranged Kapha or to the presence of parasites (in those localities). The disease soon spreads itself (and assumes an erysipelatious character). It is called the Parilehi from the fact of its eating away the affected lobe with the entire helix. 8-9
पाल्यामया ह्यमी घोरा नरस्याप्रतिकारिणः । मिथ्याहारविहारस्य पालीं हिंस्युरुपेक्षिताः ।।१०।। तस्मादाशु भिषक् तेषु स्नेहादिक्रममाचरेत् । तथाऽभ्यङ्गपरीषेक-प्रदेहासग्विमोक्षणम् ।।११।।
General Treatment: These dreadful diseases (which invade the lobes of the ears) are highly dangerous and tend to destroy and eat away the affected appendages if not properly attended to at the outset and specially when the patient is addicted to unwholesome food and drink and to an injudicious conduct of life. Hence a physician should speedily remedy these complaints with applications of medicated Sneha, Sveda. etc., ointments, washes, plasters, poultices and blood-letting.¹ This is the general treatment of those diseases. 10-11
सामान्यतो विशेषाच्च वक्ष्याम्यभ्यञ्जनं प्रति । ॥ १२ ॥ खरमञ्जरियष्ट्याह्न – सैन्धवामरदारुभिः 1 सुपिष्टै: साश्वगन्धैश्च मूलकावल्गुजैः फलैः ।।१३।। सर्पिस्तैलवसामज्ज- मधूच्छिष्टानि पाचयेत् । सक्षीराण्यथ तैः पालीं प्रदिह्यात् परिपोटके ।।१४।।
1. In cases of the predominance of the Vayu, anointment, Anuvasana and poultices should be resorted to. In cases of Pitta-predominance, purgatives should be applied. Emetics should be applied in cases of Kapha-predominance and lastly blood-letting, purgatives and washes, etc., should be resorted to in cases of the affection being due to the concerted action of the vitiated blood and the Pitta.
Specific Treatment: Now we shall describe the medical remedies which should be specially used in anointing (the affected parts in these diseases). Drugs, such as Khara-Manjari, Yasti-madhu. Saindhava, Deva-daru, Asva-gandha and the seeds of Mulaka and of Avalguja should be pasted together and cooked with a compound of milk, oil, clarified butter, lard, marrow and wax. This preparation should be applied lukewarm to the affected lobe in a case of the Pari-potaka type. 12-14
मञ्जिष्ठातिलयष्ट्याह्व-सारिवोत्पलपद्मकैः । सरोक्षैः सकदम्बैश्च बलाजम्ब्वाम्रपल्लवैः ।
सिद्धं धान्याम्लसंयुक्तं तैलमुत्पातनाशनम् ॥ १५ ॥
Manjistha, Sesamum, Yasti madhu, Sariva, Utpala, PadmaKasta, Rodhra, Kadamba and the tender leaves of the Bala, Jambu and amra ( mango ) should be cooked together with (an adequate quantity of) oil and Dhanyamla (Kanjika). This oil proves curative in a case of Utpata. 15
तालपत्र्यश्वगन्धार्क-बाकुचीफलसैन्धवैः तैलं कुलीरगोधाभ्यां वसया सह पाचितम् ।।१६।। सरलालाङ्गलीभ्याञ्च हितमुन्मन्थनाशनम् ।
तथाश्मन्तकजम्ब्वाम्र पत्रक्वाथेन सेचनम् ।।१७।।
Similarly (a medicated) oil cooked with Talapatri, Asvagandha, Arka, Bakuci-seeds, Saindhava, Sarala,’ Langali, lard of a Karkata ( crab ) and of a Godha ( a kind of lizard), proves beneficial in cases of Unmantha. The affected lobes should be washed (Secana) with a decoction of the leaves of the Asmantaka, Jambu and Amra ( in such cases). 16-17
प्रपौण्डरीकमधुक-मञ्जिष्ठारजनीद्वयैः चूर्णैरुद्वर्त्तनैः पालीं तैलाक्तामवचूर्णयेत् ।।१८।।
लाक्षाविडङ्गकल्केन तैलं पक्त्वावचारयेत् । स्विन्नां गोमयपिण्डेन प्रदिह्यात् परिलेहिके । ॥१९ ।।
पिष्टैर्विडङ्गैरथवा त्रिवृच्छयामार्कसंयुतैः। करजेङ्गुदिबीजैर्वा कुटजारग्वधायुतैः ।।२०।।
1. Sarala here means Dhupa-kastha, according to Dalhana,
सर्वैर्वा सार्षपं तैलं सिद्धं मरिचसंयुतम् । सनिम्बपत्रैरभ्यङ्गे मधूच्छिष्टान्वितं हितम् ॥ २१ ॥
In a case of Parilehi, the affected lobe (Pali) should be dusted with powdered Parpaundarika, Yasti-madhu, Manjistha and the two kinds of Haridra after lubricating it with the oil cooked with the Kalkas of Laksa and Vidanga. It should be as well fomented with heated cow-dung and plastered with the lukewarm pastes of Vidanga alone, or in combination with Trivrt, Syama and Arka pasted together ( with cow’s urine), or with the pastes of Karainja-seed, Ingudi-seed, Kutaja and Aragvadha (pasted with cow’s urine ). Mustard oil cooked’ with the admixture of all the foregoing drugs and with Marica, Nimba-leaves and wax, proves efficacious as unguents (in such cases). 18-21
पालीषु व्याधियुक्तासु तन्वीषु कठिनासु च । पुष्टचर्थं मार्छवार्थञ्च कुर्यादभ्यञ्जनं हितम् ।।२२।।
In cases where the ear-lobes are affected and have become either thin, or hard, an ointment should be applied to them in order respectively to increase their growth, or to soften them. 22
लोपाकानूपमज्जानं वसां तैलं नवं पचेद् दशगुणं क्षीरमावाप्य मधुरं अपामार्गाश्वगन्धे च तथा लाक्षारसं तत् सिद्धं परिपूतञ्च स्वनुगुप्तं निधापयेत् ॥ २४ ॥ तेनाभ्यञ्जचात् सदा पालीं सुस्विन्नामतिमर्दिताम् । एतेन पाल्यो वर्धन्ते निरुजो निरुपद्रवाः । मृव्य: पुष्टाः समाः स्निग्धा जायन्ते भूषणक्षमाः ॥ २५ ॥ शुभम् । घृतम् । गणम् ।।२३।।
The marrow of a jackal and of an animal frequenting and living in swampy ground (anupa, such as a buffalo, ctc.), together with lard, oil and fresh clarified butter, should be cooked with a quantity of milk weighing ten times of their combined weight and with the drugs of the Madhura (Kakolyadi) group, Asva-gandha and Apamarga and Laksa- Rasa (decoction or infusion of Laksa). The oil thus prepared should be filtered and preserved carefully in an earthen pitcher. The affected earlobes should constantly fomented and well-lubricated with it. The use of this medicated oil helps the growth of the ear-lobes and makes them healthy, soft, smooth, painless, evenly developed and capable of bearing the weight of earpendants. 23-25
1. Dalhana says that this oil should be cooked with cow’s urine weighing four times as much as the oil.
Treatment of Palita
नीलीदलं भृङ्गरजोऽर्जुनत्वक् पिण्डीतकं कृष्णमयोरजश्च । बीजोद्भवं साहचरञ्च पुष्पं पथ्याक्षधात्रीसहितं विचूर्ण्य |॥ २६ ॥ एकीकृतं सर्वमिदं प्रमाय पङ्केन तुल्यं नलिनीभवेन । संयोज्य पक्षं कलसे निधाय लौहे घटे सद्मनि सापिधाने । अनेन तैलं विपचेद् विमिश्रं रसेन भृङ्गत्रिफलाभवेन । आसन्नपाके च परीक्षणार्थं पत्रं बलाकाभवमाक्षिपेच्च ।। २७ ।। भवेद् यदा तद् भ्रमराङ्गनीलं तदा विपक्वं विनिधाय पात्रे । कृष्णायसे मासमवस्थितं तदभ्यङ्गयोगात् पलितानि हन्यात् || २८ ॥
Treatment of Palita: The expressed juice of the Bhrigaraja and (the decoction of) Triphala, powders of indigo leaves, Arjuna-bark, Bhrnga-raja, Pinditaka, black-iron, flowers of the Bija and of Saha-cara, Haritaki, Bibhitaka and Amalaka mixed together and pasted with a quantity of mud found adherent to lotus-bulbs weighing as much as the combined weight of the aforesaid drugs should be kept in an iron-pitcher well covered and preserved inside a room for a fortnight. After this period it should be cooked with (an adequate quantity of) oil and with expressed juice¹ of the Bhriga-raja and (a decoction of) Triphala. For the purpose of ascertaining the proper cooking of the oil, a (white) feather of a Balaka ( crane) should be dipped into it, and satisfactory preparation should be judged from the deep blue colour imparted to the feather. The oil should be then preserved in a black-iron pitcher for a month. Used as anointments, this oil arrests a premature greyness of the hair. 26-28
1. In the cases of cooking an oil, the liquid substance to be used, should be, as a general rule, four times as much as the oil; but in this case, the expressed juice of Bhrnga-raja and (the decoction of) Triphala should be ontinued to be added, so long as the feather does not become deep blue.
सैरीयजम्ब्वर्जुनकाश्मरीजं पुष्पं तिलान् मार्कवचूतबीजे । कर्बमकण्टकार्यों पुनर्नवे कासीसपिण्डीतकबीजसारम् ॥ २९ ॥ फलत्रयं लोहरजोऽञ्जनञ्च यष्ट्याह्वयं नीरजसारिवे च । पिष्ट्वाऽथ सर्वं सह मोदयन्त्या साराम्भसा बीजकसम्भवेन । ॥ ३० ॥ साराम्भसः सप्तभिरेव पश्चात् प्रस्थैः समालोडच दशाहगुप्तम् । लौहे सुपात्रे विनिधाय तैलमक्षोद्भवं तच्च पचेत् प्रयत्नात् ||३१ ।। पक्वञ्च लौहेऽभिनवे निधाय नस्यं विदध्यात् परिशुद्धकायः । अभ्यङ्गयोगैश्च नियुज्यमानं भुञ्जीत माषान् कृशरामथो वा ||३२|| मासोपरिष्टाद् घनकुञ्चिताग्रा: केशा भवन्ति भ्रमराञ्जनाभाः । केशास्तथान्ये खलतौ भवेयुर्जरा न चैनं सहसाऽभ्युपैति || ३३ ।। बलं परं सम्भवतीन्द्रियाणां भवेच्च वक्तुं बलिभिर्विमुक्तम् । नाकामिनेऽनर्थिनि नाकृताय नैवारये तैलमिदं प्रदेयम् ||३४ ।।
The flowers of the Sairiya, Jambu. Arjuna and of the KAshmari. sesamum Bhriga-raja-seeds. mango-stones. Punarnava¹ mud, Kantakari, Kasisa, marrow of the seeds of Madana, Triphala powdered iron. Rasanjana, Yasti-madhu, Nilotpala, Sariva, and Madayanti² should be pasted together with the decoction of the Sara (pith) of the Bijaka. It should then be mixed with seven Prastha measures of the decoction of the Sara of Bijaka and preserved for ten days in a covered iron vessel. This compound should then be carefully cooked with an Adhaka measure of Bibhitaka-oil and again preserved in a new iron-pitcher for a month. Then after cleansing the system of the patient, the oil thus prepared should be used as errhines ( Nasya) and in anointing the head, and the patient should be advised to live on diet consisting of Masa-pulse, or of Krsara. In the course of a month, it imparts a (deep black) gloss to hairs like that of a black bee, or that of Rasanjana and makes it grow thick and curly. It cures baldness, arrests the susceptibility of the system to an attack of premature decay, removes the wrinkles of the face, and invigorates the sense-organs in the performance of their proper and respective functions. This oil should not be given to a man who does not wish to use it, nor to an indigent person, nor to an ungrateful wretch, nor to an enemy. 29-34
1. According to Dalhana, the reading would have been “पुनर्नवे” i.e, the two kinds of Punarnava.
2. One Karsa measure of each of the aforesaid drugs should be taken.
Treatment of Vyanga
लाक्षा रोध्रं द्वे हरिद्रे शिलाले कुष्ठं नागं गैरिका वर्णकाश्च । मञ्जिष्ठोग्रा स्यात् सुराष्ट्रोद्भवा च पत्त ङ्गं वै रोचना चाञ्जनञ्च ।।३५ ।। हेमाङ्गत्वक् पाण्डुपत्रं वटस्य कालीयं स्यात् पद्मकं पद्ममध्यम्। रक्तं श्वेतं चन्दनं पारदञ्च काकोल्यादिः क्षीरपिष्टश्च वर्गः ॥३६॥ मेदो मज्जा सिक्थकं गोघृतञ्च दुग्धं क्वाथः क्षीरिणाञ्च द्रुमाणाम् । एतत् सर्वं पक्वमैकध्यतस्तु वक्ताभ्यङ्गे सर्पिरुक्तं प्रधानम् ॥ ३७॥ हन्याद् व्यङ्गं नीलिकाञ्चातिवृद्धां वक्ते जाताः स्फोटिकाश्चापि काश्चित् । पद्माकारं निर्वलीकञ्च वक्तुं कुर्यादेतत् पीनगण्डं मनोज्ञम् ||३८ ।। राज्ञामेतद् योषिताञ्चापि नित्यं कुर्याद् वैद्यस्तत्समानां नृणाञ्च । कुष्ठघ्नं वै सर्पिरतत् प्रधानं येषां पादे सन्ति वैपादिकाश्च ॥ ३९ ॥ हरीतकीचूर्णमरिष्टपत्रं चूतत्वचं दाडिमपुष्पवृन्तम् । पत्रञ्च दद्यान्मदयन्तिकाया
लेपोऽङ्गरागो नरदेवयोग्यः ॥ ४० ॥
Treatment of Vyanga, etc. : Laksa, Rodhra, the two kinds of Haridra, Manahsila, Haritala, Kustha, Naga ( lead), Gairika, Varnaka, Manjistha, Vaca. Saurastra-mrttika, Pattanga, Gorocana, Rasanjana, bark of Hemanga (Campaka), the tender leaves of Vata, Kaliya Kastha, Padma-kastha, the filaments of a lotus, both red and white candana, Mercury¹ and the drugs of the Kakolyadi group should be pasted together with milk. The paste, thus prepared, as well as lard, marrow, wax, clarified butter, milk and a decoction of the drugs of the Ksira trees should be cooked together. This medicated clarified butter, is the best of all the unguents that may be applied to the face. It cures the most difficult cases of Vyanga and Nilika, and removes all tans, specks, marks, moles, eruptions, etc., from the face. It imparts smoothness to the wrinkled skin, gives a healthy plumpness and bloom to the checks, and makes the face as 1. This is the first time that we come across the mention and use of “Parada” (Mercury) iri the Susruta Sanhita. beautiful as a lotus. It should be recommended to kings and to the ladies of the royal court, as well as to persons of the same rank. It acts as a good remedy for Skin DIseases (Kustha). and may be as well applied in cases of Vipadika. The use of a cosmetic compound consisting of powdered Haritaki, leaves of Nimba, the bark of mango, stems of the pomegranate, and the flowers and leaves of Madhyantika pasted together, imparts a good-like effulgence to the complexion of a man. 35-40
Thus ends the Twenty-fifth Chapter of the Chikitsa Sthana in the Susruta Samhita which deals with the treatment of a variety of diseases.