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Sushruta SamhitaChikitsasthanaPrameha Pidaka Chikitsa - Treatment of Diabetic wound ulcer - Sushrutasamhita Chikitsasthana...

Prameha Pidaka Chikitsa – Treatment of Diabetic wound ulcer – Sushrutasamhita Chikitsasthana Chapter 12

द्वादशोऽध्यायः । अथातः प्रमेहपिडकाचिकित्सितं व्याख्यास्यामः यथोवाच भगवान् धन्वन्तरिः ।।१।।

Now we shall discourse on the medical treatment of the abscess or eruptions which mark the sequel of a case of Prameha (Prameha Pidaka). As it was stated by Lord Dhanvantari. 1

शराविकाद्या नव पिडका: प्रागुक्ताः, ताः प्राणवतोऽल्पास्त्वङ्मांसप्राप्ता मृद्वयोऽल्परुजः क्षिप्रपाकभेदिन्यश्च साध्याः ॥ २ ॥

The nine kinds of abscesses (Pidakas), such as Saravika, etc., have been described before. Of such abscesses those, appearing in a strong person but small in size, affecting (only) the Tvak (skin) and the flesh, soft to the touch, slightly painful, quickly suppurative and bursting, are curable. 2

ताभिरुपद्रुतं प्रमेहिणमुपचरेत् । तत्र पूर्वरूपेष्वपतर्पणं वनस्पतिकषायं बस्तमूत्रञ्चोपदिशेत्। एवमकुर्व्वतस्तस्य मधुराहारस्य मूत्रं स्वेदः श्लेष्मा च मधुरीभवति, प्रमेहश्चाभिव्यक्तो भवति । तत्रोभयतः संशोधनमासेवेत । एवमकुर्व्वतस्तस्य दोषाः प्रवृद्धा मांसशोणिते प्रदूष्य शोफं जनयन्त्युपद्रवान् वा कांश्चित् । तत्रोक्तः प्रतीकारः सिरामोक्षश्च ॥ ३ ॥

Patients suffering from Prameha and afflicted with the above kinds of abscesses (Pidakas) should be treated (in the following manner). Measures, such as fastings (Apatarpana), etc., decoctions 1. Astringent drugs of fig. tree (Vata-tree), etc. and the urine of a she-goat, should be employed in the premonitory stage of the disease. The urine, perspiration and the Slesma (sputum, etc.), soon acquire a sweetish taste, if the aforesaid preliminary measures are not resorted to and if the patient goes on using sweet articles of food in utter disregard of the instructions, thus developing fully the specific indications of Prameha. In this stage the system of the patient should be cleansed (Samsodhana) with both emetics and purgatives. If the disease is not checked (even at this stage) with the aforesaid measures (emetics and purgatives), the aggravated Dosas of the body go on increasing in intensity and tend to affect or vitiate the flesh and the blood and produce an inflamatory swelling of the body, or bring on other supervening distresses in their train, venesection as well as the a fore said remedies and measures should be resorted to in such cases. 3

एवमकुर्वतस्तस्य शोफो वृद्धोऽतिमात्ररुजो विदाहमापद्यते । तत्र शस्त्रप्रणिधानमुक्तं व्रणक्रियोपसेवा च । एवमकुर्वतस्तस्य पूयोऽभ्यन्तरमवदार्योत्सङ्गं महान्तमवकाशं कृत्वा प्रवृद्धो भवत्यसाध्यः, तस्मादादित एव प्रमेहिणमुपक्रमेत ॥ ४ ॥

The swelling increases in size attended with excessive pain and burning sensation, if the aforesaid remedies be not employed at this stage of the disease. Surgical operations and other remedial measures, described in connection with abscesses or inflammatory swellings (Vrana) in general, should be resorted to in such cases. If these remedial measures be not done (at this stage), the pus enters into the deeper tissues of the locality, creates large cavities in its inside, and is accumulated there and the abscess (Vrana) becomes incurable. ‘ Hence a case of Prameha should be remedied at its very outset. 4

भल्लातकबिल्वाम्बुपिप्पलीमूलोदकीर्यावर्षाभूपुनर्नवाचित्रकशटी-स्नुहीवरुणकपुष्करदन्तीपथ्या दशपलोन्मिता: यवकोलकुलत्थांश्च प्रास्थिकान् सलिलद्रोणे निष्क्वाथ्य चतुर्भागावशिष्टेऽवतार्य्य वचात्रिवृत्कम्पिल्लकभार्गीनिचुलशुण्ठीगजपिप्पलीविडङ्गरोघ्रशिरीषाणां भागै

1. On the failure of the above treatment it would spontaneously burst out and secrete pus and force its way inside, which would lead gradually to widen its mouth or fissure, and help its running into an incurable stage. –Dalhana.

विपाचयेत् मेहश्वयथुकुष्ठगुल्मोदरार्शः प्लीहविद्रधि पिडकानां नाशनं नाम्ना धान्वन्तरम् ॥ ५ ॥ रर्धपलिकैर्घृतप्रस्थं

Dhanvantara-Ghrita : Ten Pala weight of each of these drugs, viz., Bhallataka, Bilva, Ambu, roots of Pippali, Udakiryya, Prakiryya’, Varsabhu, Punarnava, Citraka, Sati, Snuhi, Varunaka, Puskara, Danti and Haritaki and one Prastha measure of each of the following, viz., barley, Kola and kullattha pulse should be boiled with a Drona measure of water. The decoction should be boiled down to its quarter part, removed from the fire, and strained. It should then be cooked with a Prastha measure (four seers) of clarified butter with half a Pala weight of each of the following drugs, viz., Vaca, Trivrt, Kampilla, Bhargi, Nicula, Sunthi Gaja- Pippali, Vidanga and Sirisa as Kalka. It is called the Dhanvantara-Ghrita³ and covers within the range of its therapeutic application Meha (urinary diseases ) , swelling (Sotha), KUstha, Gulma, Ascites, haemorrhoids, enlargement of the spleen, carbuncles (Pidaka) and abscess. 5

दुर्विरेच्या हि मधुमेहिनो भवन्ति मेदोऽभिव्याप्तशरीत्वात्, तस्मात् तीक्ष्णमेतेषां शोधनं कुर्वीत | पिडकापीडिता: सोपद्रवाः सर्व एव प्रमेहा मूत्रादिमाधुर्य्ये मधुगन्धसामान्यात् पारिभाषिकीं मधुमेहतां लभन्ते। न चैतान् कथञ्चिदपि स्वेदयेत्, मेदोबहुत्वादेतेषां विशीर्यते देहः स्वेदेन। रसायनीनाञ्च दौर्बल्यान्नोर्ध्वमुत्तिष्ठन्ति प्रमेहिणां दोषाः, ततो मधुमेहिनामधःकाये पिडकाः प्रादुर्भवन्ति । अपक्वानां तु पिडकानां शोफवत् प्रतीकारः, पक्वानां व्रणवदिति । तैलन्तु व्रणरोपणमेवादौ कुर्वीत ॥ ६ ॥

Ordinary purgatives fail to produce any satisfactory effect in cases of Madhu-Meha owing to the excessive accumulation and

1. “Udakirya and Prakinya” are the two kinds of Karanja.

2. “Varsabhu and punarnava” are the two kinds of Punarnava (ie, red and white).

3. According to Dalhana, the introduction of this medicated Ghrita into the text is an interpolation. Since Jejjata has not explained it in his commentary, Dalhana does not explain it. Cakradatta, however, mentions this Ghrita in his compilation, though with some additions and alternations under the treatment of Prameha pervasion of Medas (fat) in the organism of the patient. Hence strong Sodhana (purgatives) should be employed in such cases. In all types of Meha, attended with Pidaka (eruptions or abscesses) and other complications, the perspiration and expectorations, etc. of a Pramehapatient acquire a sweet taste and smell like that of honey. Hence they are technically known as Madhu-Meha (to all intents and purposes. Fomentation (of any kind) is forbidden in the case of a patient suffering from Madhu-Meha, since it might lead to the gradual emaciation of his frame by drying up the organic fat (Medas), which is usually found to abound in his organism. the aggravated Dosas of the body fail to make an upward passage in the organism of a Prameha-patient owing to the weakness of the channels of chyle, blood, Kapha and Pitta (as well as for an exhausted condition of the nerves in his body) and the Dosas are thus forced to course in and confine themselves into the lower part of the body where their incarceration helps the easy formation of Pidakas (abscesses), etc. Such a Pidaka should be remedied with the measures described in connection with Vranas, as soon as the process of suppuration would set in; whereas it should be treated as a swelling in its unsuppurated stage. Medicated oils should be likewise employed for the purposes of healing (Ropana), etc. 6

आरग्वधादिकषायमुत्सादनार्थे, शालसारादिकषायं परिषेचने, पिप्पल्यादिकषायं पानभोजनेषु, पाठाचित्रक – शार्ङ्गष्टा-क्षुद्रा – बृहतीसारिवासोमवल्कसप्तपर्णारग्वधकुटजमूलचूर्णानि मधुमिश्राणि प्राश्नीयात् । शालसारादिवर्गकषायं चतुर्भागावशिष्टमवतार्य परित्राव्य पुनरुपनीय साधयेत्, सिध्यति चामलकरोथ्रप्रियङ्गदन्तीकृष्णायस्ताम्रचूर्णान्यावपेत्, एतदनुपदग्धं लेहीभूतमवतार्य्यानुगुप्तं निदध्यात् । ततो यथायोगमुपयुञ्जीत । एष लेहः सर्वमेहानां हन्ता ॥ ७ ॥

A decoction of the drugs of the Aragvadhadi group should be used for the purpose of raising up (Utsadana) the cavity of the incidental ulcer; that of the Sala-saradi group should be used for sprinkling purposes; that of the drugs of the Pippalyadi group should be given as food and drinks. A pulverised compound of Patha, Citraka, Sarmgasta, Ksudra, Vrhati, Sariva, Soma-valka, Saptaparna, Aragvadha and Kutaja roots mixed with honey should be internally given to the patient.

Sala-saradi Avaleha : A decoction of (one hundred Pala weight of) the drugs of the Sala-saradi group should be made by boiling it (in sixteen times weight of water) down to a quarter part (of the water) and then duly filtered (through a piece of linen). It should be cooked again very carefully, so that it may not be burnt; powders of Amalaka’, Rodhra, Priyangu, Danti, black-iron and copper should then be added to it just before the completion of the cooking, so that it may be reduced to the consistency of an Avaleha (lambative). It should then be removed from the fire and kept in a closed earthen pitcher. The patient should take an adequate dose of this medicine as it is a sovereign remedy for all types of Prameha. 7

त्रिफलाचित्रकत्रिकटुविडङ्गमुस्तानां नव भागास्तावन्त एव कृष्णायश्चूर्णस्य, तत्सर्वमैकध्यं कृत्वा यथायोगं मात्रां सर्पिर्मधुभ्यां संसृज्योपयुञ्जीत । एतत् नवायसम् । एतेन जाठर्यं न भवति, सन्नोऽग्निराप्यायते, दुर्नामशोथपाण्डुकुष्ठरोगाविपाककासश्वासप्रमेहाश्च न भवन्ति ॥ ८ ॥

Navayasa-Curna: Equal parts of the powders of the following nine drugs, viz., Triphala, Citraka, Trikatu, Vidanga and Musta, and nine parts of powdered black-iron² should be mixed together and taken in adequate doses with honey and clarified butter. This is called the Navayasa Curna, which proves curative in adbdominal diseases, improves the impaired digestion and acts as a prophylactic against haemorhoids, swelling, anaemia, Kustha, indigestion, cough, asthma and Prameha, etc. 8

शालसारादिनिर्यूहे चतुर्थांशावशेषिते । परिस्रुते ततः शीते मधु माक्षिकमावपेत् ।। ९ ।। ९

1. Cakradatta reads “siva” in place of “amalaka” and does not include “Priyangu” in the list. According to some commentators the total weight of the after-throw (Praksepa) would be a quarter part of the total weight of the drugs boiled; whereas, according to others, the different drugs for Praksepa would weight one Pala each.

2. Charaka and Cakrapani Datta insert this medicine among the curatives of “Pandu-roga”. Sivadasa (the commentator ) advises to take “Mandurairon” instead of “black-iron”. In the practical field also we derive great and good effects in cases of spleen and liver diseases and specially in cases of, infantile liver and heart diseases. –Ed.

यावदालोहसंक्षयात् ।। १३ ।। च। फाणितीभावमापत्रं गुडं शोधितमेव श्लक्ष्णपिष्टानि चूर्णानि पिप्पल्यादिगणस्य च ।। १० ।। ऐकध्यमावपेत् कुम्भे संस्कृते घृतभाविते । पिप्पलीचूर्णमधुभिः प्रलिप्तेऽन्तः शुचौ दृढे ।। ११ ।। श्लक्ष्णानि तीक्ष्णलोहस्य तत्र पत्राणि बुद्धिमान् । खदिराङ्गारतप्तानि बहुश: सन्निपातयेत् ।। १२ ।। सुपिधानन्तु तं कृत्वा यवपल्ले निधापयेत् । मासांस्त्रींश्चतुरो वाऽपि वाऽपि ततो जातरसं तं तु प्रातः प्रातर्यथाबलम् । निषेवेत यथायोगमाहारञ्चास्य कल्पयेत् ।। १४ ।। कार्यकृद् बलिनामेष सन्नस्याग्नेः प्रसाधकः । शोफनुद् गुल्महृत् कुष्ठ-मेहपाण्ड्वामयापहः ।। १५ ।। प्लीहोदरहरः शीघ्रं विषमज्वरनाशनः । अभिष्यन्दापहरणो लोहारिष्टो महागुणः ।। १६ ।।

Loharista: A decoction of the drugs of the Sala-saradi group should be made by boiling it down to a quarter part (of the original quantity of water ). Then it should be duly filtered; when cooled, a quantity (i.e., fifty Pala weight) of Maksika-honey should be added to it. A quantity of purified treacle² reduced to the consistency of Phanita as well as fine powders of the drugs of Pippalyadi group should be mixed with it. A strong and well cleansed (earthen) pitcher

1. Dalhana says that fifty Pala weight of each of the two substances- Madhvasava and Phanita, and twenty five Pala weight of each of the following substances, viz., the powders of the drugs of the Pippalyadi group and steel-foils, should be taken in preparing it. But Gayadasa explains that such a quantity of old and matured honey should be mixed with the decoction as will sweeten it; the same quantity of old and matured Phanita treacle should be taken; the powders of Pippalyadi group should be added to it till it gets a slight astringent (Kasaya) taste.

Some commentators, however, hold that the honey, the powders of the drugs of the Pippalyadi group and of the steel-foils should be each a quarter part of the decoction in weight.

Dalhana explains the term “Madhu’ as the Asava prepared of honey. Gavadasa. however, explains it simply as honey.

2. The Phanita should be refined by dissolving it in the decoction of the drugs of the sala-saradi group and then filtere. Dalhana.

saturated with clarified butter should be purified (in the usual way) and its interior plastered with coating of honey and powdered Pippali made into a thin paste. The medicinal compound prepared as above should be kept in the pitcher. After that, thin foils of steel made redhot in a fire of Khadira wood should be immersed into the compound prepared before. Then the pitcher with the steel-foils immersed into its contents should be kept buried in a heap of barley for three or four months or until the steel-foils are entirely eaten away by the medicine and the characteristic flavour is produced. It should be used in proper doses every morning and a suitable diet should be given to the patient after its use. It reduces fat, improves the impaired digestion and proves efficacious in cases of swellings, internal tumours, Kustha, Meha, anaemia (Plihodara), irregular fever and excessive splnomegaly urination (dribbling of urine). This preparation is called Loharista¹ and it is a highly efficacious remedy. 9-16

प्रमेहिणो यदा मूत्रमपिच्छिलमनाविलम् । विशदं तिक्तकटुकं तदाऽऽरोग्यं प्रचक्षते ।। १७ ।।

Traits of cure: The cure of Prameha-patients should be understood from the non-slimy and unturbid condition of the urine and from its clear transparent aspect and bitter or pungent taste. 17

इति सुश्रुत-संहितायां चिकित्सितस्थाने प्रमेहपिडकाचिकित्सितं नाम द्वादशोऽध्यायः ॥ १२॥

Thus ends the twelfth Chapter of the Chikitsa Sthana in the Susruta Samhita which deals with the medical treatment of Prameha-Pidaka.


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