त्रयोविंशोऽध्यायः । अथातो शोफानां चिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः।।१।।
Now we shall discourse on the (symptoms and) medical treatment of swellings (Sopha). 1
षड्विधोऽवयवसमुत्थः शोफोऽभिहितो लक्षणतः प्रतीकारतश्च । सर्वसरस्तु पञ्चविधः । तद्यथा – वातपित्तश्लेष्मसन्निपातविषनिमित्तः ।। २ ।।
The six kinds of swelling (Sopha) appearing in the particular parts of the body have already been described with the variations in their symptoins and the medical treatment to be pursued in each case. But the swelling known as the Sarva-sara Sopha (general Anasarca) may be divided into five subheads. They are as follows, namely, the Vataja, Pittaja, Kaphaja, Sannipataja and Visaja (i.e, the one due to the introduction of any extraneous poison into the system). 2
Sopha Karana – Causes of Swelling
तत्रातितर्पितस्याध्वगमनादतिमात्रमभ्यवहरतो वा पिष्टान्नहरितकशाकलवणानि क्षीणस्य वाऽतिमात्रमम्लमुपसेवमानस्य मृत्पक्वलोष्टकटशर्करानूपौदकमांससेवनादजीर्णिनो वा ग्राम्यधर्मसेवनाद् विरुद्धाहारसेवनात् वा हस्त्यश्वोष्ट्ररथपदातिसंक्षोभणादयो सितस्य दोषा धातून् प्रदूष्य श्वयथुमापादयन्त्यखिले शरीरे ।। ३ ।। 1
1. See Sutra-sthana, Chapter XVII.
Their causes : The Dosas ( morbific principles) become aggravated and give rise to swellings (Sopha) of the body by such causes, as by undertaking a journey on foot immediately after a meal, or by the use of Harita-sakas (potherbs, cakes and salts in inordinate quantities, or by the excessive use of acids by weak and emaciated persons, or by the use of clay, baked or unbaked, of lime-stones, or of the flesh of aquatic animals, or of those inhabiting swampy places. dyspeptic patients, excessive sexual intercourse, use of meals consisting of incompatible articles and lastly by the joltings when riding on elephants, horses. camels in vehicles. etc., or on persons on the part of dyspeptic patients. 3
तत्र वातश्वयथुररुणः कृष्णो वा मृदुरनवस्थितास्तोदादयश्चात्र वेदनाविशेषाः । पित्तश्वयथुः पीतो रक्तो वा शीघ्रानुसारी, ओषचोषादयश्चात्र वेदनाविशेषाः, श्लेष्मश्वयथुः पाण्डुः शुक्लो वा स्निग्धः कठिनः शीतो मन्दानुसारी, कण्ड्वादयश्चात्र वेदनाविशेषाः । सन्निपातश्वयथुः सर्ववर्णवेदनः ।। ४ ।।
Specific Symptoms : A swelling (Sopha) of the Vataja type is vermilion or black-coloured and is attended with softness and a pricking pain in the swelling which disappears at intervals. A swelling of the Pittaja type assumes a blood-red or yellow colour, swiftly expands and is attended with a burning and drawing pain (Cosa). A swelling of the Kaphaja type assumes a white or greyish colour. becomes hard, cold to the touch and glossy, is slow in its growth, and is attended with itching, pain, etc. A swelling of the Sannipatika type (due to the concerted action of all the three Dosas of the body) exhibits all the symptoms which specifically belong to each of the three abovesaid types. 4
Symptoms of Visaja-Sopha
विषनिमित्तस्तु गरोपयोगाद् दुष्टतोयसेवनात् प्रकोथोदकावगाहनात् सविषसत्त्वदिग्धचूर्णेनावचूर्णनाद्वा सविषमूत्रपुरीषशुक्रस्पृष्टानां वा तृणकाष्ठादीनां संस्पर्शनात्, स तु मृदुः क्षिप्रोत्थानोऽवलम्बी चलोऽचलो वा दाहपाकप्रायश्च भवति ।। ५ ।।
Symptoms of Visaja-Sopha: A swelling (Sopha) which results from the contact or introduction of a (weakened) chemical poison (Gara) with or into the body, or from the use of polluted water, or by bathing in a foul and stagnant pool or tank, or by dusting the body with the powders of substances poisoned by any poisonous animal, or from the contact with weeds and plants, which have become poisoned by the urine, foecal matter, or semen of poisonous animals, is called a Visaja swelling. The swelling is soft, pendent and presistent, expands rapidly and moves gradually (from one part of the body to the other). and is attended with a burning sensation and suppuration. 5
भवन्ति चात्र । दोषा: श्वयशुमूर्ध्वं हि कुर्वन्त्यामाशयस्थिताः । पक्वाशयस्था मध्ये च वर्चः स्थानगतास्त्वधः । कृत्स्नं देहमनुप्राप्ताः कुर्युः सर्वसरं तथा ।। ६ ।।
Memorable Verse: The aggravated Dosas of the body confined in the stomach (Amasaya) give rise to a swelling in the upper part of the body. Confined in the intestines (Pakvasaya), they give rise to a swelling in the middle part of the body. If they are confined in the receptacle of the foeces (Malasaya), the lower part of the body becomes swollen. The swelling extends all over the body in the event of their (Dosas) being diffused throughout the organism. 6
Prognosis of swelling
श्वयथुर्मध्यदेशे यः स कष्टः सर्वगश्च यः । अर्धङ्गेऽरिष्टभूतश्च यश्चोर्ध्वं परिसर्पति ।। ७ ।।
श्वासः पिपासा दौर्बल्यं ज्वरश्छर्द्दिररोचकः । हिक्कातीसारकासाश्च शूनं सङ्घपयन्ति हि ॥८॥
Prognosis : An oedematous swelling (Sopha) occuring in the middle part (trunk) of the body or extending all over it may be cured with difficulty as well as the one which first occurs at either (the upper or lower) half of the body and tends to extend upward. A case of swelling attended with dyspnoea, thirst, weakness, fever, vomiting. hiccough, dysentery, colic ( Sula), and a want of relish for food is extremely hard to cure and soon proves fatal. 7-8
सामान्यतो विशेषाच्च तेषां वक्ष्यामि भेषजम् ।। ९ ।। परिहरेयुरम्ललवणदधिगुडवसापयस्तैलघृतशोफिनः सर्व एव पिष्टमयगुरुणि ।। १० ।।
We shall now proceed to describe their general and specific remedies. The Oedematus patients should avoid use acids, salts, milk, curd, treacle, lard, water, oil, clarified butter, cakes and all kinds of heavy (in digestion) edibles in all the types of oedema (Sopha).9-10
The Special Treatment of Sopha
तत्र वातश्वयथौ त्रैवृतमेरण्डतैलं वा मासमर्धमासं वा पाययेत्, न्यग्रोधादिककषायसिद्धं सर्पिः पित्तश्वयथौ, आरग्वधादिसिद्धं श्लेष्मश्वयथौ, सन्निपातश्वयथौ स्नुहीक्षीरपात्रं द्वादशभिरम्लपात्रैः प्रतिसंसृष्टं दन्तीप्रतिवापं सर्पिः पाचयित्वा पाययेत् | विषनिमित्तेषु कल्पेषु प्रतीकारः ।। ११ ।।
The Special Treatment of Sopha: Traivrta (Ghrita) or castor oil should be administered for a month or a fortnight to the patient suffering from the Vataja type of oedema (Sopha). Clarified butter cooked with the decoction of the drugs of the Nyagrodhadi and the Aragvadhadi groups should be respectively prescribed in the Pittaja and Kaphaja types. In the Sannipataja type, the patient should be made to drink a potion of clarified butter cooked with a Patra¹ measures of the milky exudation of the Snuhi plant and twelve Patra measures of fermented rice gruel (Kanjika) with an adequate quantity of Danti as a Kalka. The remedy in regard to a swelling due to the action of poison (Visaja) imbibed into the system will be duly described in the Kalpa Sthana. 11
अथातः सामान्यचिकित्सितं व्याख्यास्यामः
तिल्वकघृतचतुर्थानि यान्युक्तान्युदरेषु ततोऽन्यतममुपयुज्यमानं श्ववयथुमपहन्ति । मूत्रवर्त्तिक्रियां वा सेवयेत्, नवायसं वाहरहर्मधुना । विडङ्गातिविषाकुटजफलभद्रदारुनागरमरिचचूर्णं वा धरणमुष्णाम्बुना, त्रिकटुक्षारायश्चूर्णानि वा त्रिफलाकषायेण, मूत्रं वा तुल्यक्षीरं, हरीतकीं वा तुल्यगुडामुपयुञ्जीत । देवदारुशुण्ठीं वा गुग्गुलुं वा मूत्रेण वर्षाभूकषायानुपानं वा, तुल्यगुडं शृङ्गवेरं वा, वर्षाभूकषायं मूलकल्कं वा सशृङ्गवेरं पयोऽनुपानमहरहर्मासं, व्योषवर्षाभूकषायसिद्धेन वा सर्पिषा मुद्गोलुम्बान् भक्षयेत्, पिप्पलीपिप्पलीमूलचव्यचित्रकमयूर – वर्षाभूसिद्धं वा क्षीरं पिबेत् । सहौषधमुरङ्गीमूलसिद्धं वा, त्रिकटुकैरण्डश्यामामूलसिद्धं वा, वर्षाभूभृङ्गवेरसहादेवदारुसिद्धं वा, तथाउला
1. A Patra measure is equal to eight seers.
बूविभीतकफलकल्कं वा तण्डुलाम्बुना ।। १२ ।।
The general remedies: Now we shall describe the general remedies (which are applicable in cases of Sotha). Any of the four Ghritas ending with the Tilvaka Ghrita which have already been mentioned under the treatment of Udara would prove remedial in a case of Svayathu (Oedematous Swelling). The use of (the officinal) urine and the applications of the (medicated) Vartis are likewise recommended. The patient should be made to take every day the medicine. Known as the Navayasa¹ through the medium of honey. He should be made to take a Dharana weight of the compound of powdered Vidanga, Ativisa, Kutaja-truit, Bhadra-daru, Nagara and Marica in tepid water. Trikatu, Yava-kshara and powdered iron should be mixed together and administered through the medium of the decoction of Triphala; or, cow’s milk and cow’s urine, in equal proportions should be taken. As an alternative, treacle and Haritaki mixed in equal proportions should be administered. Deva-daru and Sunthi may be given; or Guggulu’ dissolved in cow’s urine or in the decoction of Varsabhu. Equal parts of treacle and Srigavera’ may as well be prescribed; or the roots of the Varsabhu pasted with the decoction of the same drug and mixed with powdered Sunthi dissolved in milk should be given to the patient every day for a month. He should take Mudga pulse fried with the clarified butter prepared by cooking it with the decoction of Trikatu and Varsabhu. Milk boiled with Pippali, Pippali-roots, Cavya, Citraka, Mayura (Apamarga) and Varsabhi, or with Sunthi and Surangi-roots, or with Trikatu, Erandaroots and Syama-roots, or with Varsabhu, Sunthi, Saha and Deva-daru should be given to the patient. A paste of Alabu and Vibhitaka dissolved in the washings of rice, should likewise be administered. 12
क्षारपिप्पलीमरिचशृङ्गवेरानुसिद्धेन च मुद्गयूषेणालवणेनाल्पस्नेहेन भोजयेद् यवान्नं गोधूमान्नं वा, वृक्षकार्कनक्तमालनिम्बवर्षाभूक्वाथैश्च
1. See Chapter XXII, para. 10, Chikitsa-sthana.
2. Some commentators explain that the compound of Deva-daru and Sunthi also should be taken through the medium of cow’s urine or the decoction of Varsabhu.
3. According to Chakradatta’s reading, Deva-duru, sunthi and Guggulu should be taken together with cow’s urine.
4. The Srngavera in this compound may be either fresh or dried. –Ed.
परिषेकः, सर्षपसुवर्चलासैन्धवशार्ङ्गष्टाभिश्च प्रदेहः कार्यः । यथादोषञ्च विरेचनास्थापनानि तीक्ष्णान्यजस्त्रमुपसेवेत स्नेहस्वेदोपनाहांश्च, सिराभिश्चाभीक्ष्णं शोणितमवसेचयेदन्यत्रोपद्रवशोफादिति ।। १३ ।।
The diet of the patient should consist of cooked barley or wheat saturated with the unsalted soup of Mudga pulse, cooked with Yavakshara, Pippali, Marica and Srngavera, and prepared with only a small quantity of oil or clarified butter. A decoction or Vrksaka, Arka, Naktamala, Nimba and Varsabhu should be used in effusing (Pariseka) the affected part. It should be plastered with a compound consisting of Sarsapa, Suvarcala, Saindhava and sarigesta, pasted together. Strong purgatives, Asthapana measures and applications of Sneha, Sveda and Upanaha should be constantly employed according to the nature and intensity of the aggravated Dosas involved in the case. In a case of Sotha, other than what is the outcome or supervening symptom (Upadrava) of any other disease, the patient should be frequently bled by opening a vein of the locality. 13
भवति चात्र ।
पिष्टान्नमम्लं लवणानि मद्यं मृदं दिवास्वप्नमजाङ्गलञ्च । स्त्रियो घृतं तैलपयोगुरूणि शोफं जिघांसुः परिवर्जयेत् तु ||१४||
Memorable Verse: A patient wishing to get rid of an attack of Sopha (oedematous swelling) should refrain from taking all sorts of cakes, acid substances, liquor, clay, salts, oil, clarified butter, Water, heavy and indigestible articles of food, sleep in the day time, the flesh of animals other than that of the animals of the Jaigala group and from visiting the bed of any woman. 14
इति सुश्रुत संहितायां चिकित्सितस्थाने शोफचिकित्सितं नाम त्रयोविंशोऽध्यायः ।। २३ ।।
Thus ends the Twenty-third Chapter in the Chikitsa Sthana of the Susruta Samhita which deals with the medical treatment of Sopha.
1. Some read “गुडम,” i.e. treacle in place of “घृतम्,” i.e. clarified butter. This ading seems to be the correct one, inasmuch as it is supported by all other authoritative works on Ayurveda. –Ed.