चतुर्द्दशोऽध्यायः । अथात उदराणां चिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the medical treatment of dropsy with an abnormal condition of the abdomen (Udara). As it was stated by Lord Dhanvantari. 1
अष्टावुदराणि पूर्वमुद्दिष्टानि । तेष्वसाध्यं बद्धगुदं परित्रावि च, अवशिष्टानि कृच्छ्रसाध्यानि, सर्वाण्येव च प्रत्याख्यायोपक्रमेत । तेष्वाद्यश्चतुर्वर्गो भेषजसाध्य, उत्तर शस्त्रसाध्यः, कालप्रकर्षात् सर्वाण्येव शस्त्रसाध्यानि वर्जयितव्यानि वा ॥ २ ॥
Of the eight different types of Udara, described before, those separately known as the Baddha-guda and the Parisravi should be understood as incurable, the rest being equally hard to cure. Hence the medical treatment of all cases of Udara (abdominal dropsy) should be resorted to without holding out any positive hope of recovery. The first four types of the disease (as metioned in the list of enumeration), may prove amenable to medicine; but the rest would require surgical treatment. All the types of the disease, however, would, with the progress of time, require a surgical operation, or (attaining an incurable stage ) they may worthy to be abdondned. 2
उदरी तु गुर्वभिष्यन्दिरुक्षविदाहिस्निग्धपिशितपरिषेकावगाहान् परिहरेत् । शालिषष्टिकयवगोधूमनीवारान् नित्यमश्नीयात् ॥ ३ ॥
Diet of articles forbidden: A patient, afflicted with an attack of Udara, should forego the use of heavy (indigestible), or emollient fare, of all kinds of meats and of those that produce a state of extreme dryness in the system, or produce a slimy secretion from the channels (of the Dosas and the vital principles) of the body, or give rise to a sort of digestive acid reaction (acid transformation in the stomach) and refrain from bathing and using effusions. Meals consisting of well cooked Sastika rice, barley, wheat, or Nivara seeds should be the daily diet of such a patient. 3
तत्र वातोदरिणं विदारिगन्धादिसिद्धेन सर्पिषा स्नेहयित्वा, तिल्वकविपक्वेनानुलोम्य, चित्राफलतैलप्रगाढेन विदारिगन्धादिकषायेणास्थापयेदनुवासयेच्च, शाल्वणेन चोपनाहयेदुदरम् । भोजयेच्चैनं विदारिगन्धादिसिद्धेन क्षीरेण जाङ्गलरसेन च, अभीक्ष्णं स्वेदयेत् ॥ ४ ॥
Treatment of the Vataja type: In a case of Vataja Udara, the body of the patient should be anointed with clarified butter cooked with the drugs of the Vidari-gandhadi group, while the one cooked with Tilvaka should be used as purgatives (Anuloma). A compound made of a copious quantity of oil of Citra seeds, mixed with a decoction of the drugs of the Vidari-gandhadi group, should be used as Asthapana and Anuvasana measures. The Salvanna Upanaha (poultice) should be applied to the abdomen. Milk cooked with the drugs of the Vidari-gandhadi group, or the soup of the flesh of Jangala animals should be given to the patient with his meal and the affected region should be frequently fomented. 4
पित्तोदरिणन्तु मधुरगणविपक्वेन सर्पिषा स्नेहयित्वा, श्यामात्रिफलात्रिवृद्विपक्वेनानुलोम्य, शर्करामधुघृतप्रगाढेन न्यग्रोधादिकषायेणास्थापयेदनुवासयेच्च, पायसेनोपनाहयेदुदरं, भोजयेच्चैनं विदारिगन्धादिसिद्धेन पयसा ॥ ५ ॥
Treatment of the Pittaja Type: In a case of Pittaja Udara, the patient should be anointed with clarified butter cooked with the drugs of the Madhura (Kakolyadi) group. Similarly, clarified butter cooked with Syama, Triphala and Trivrt should be used as purgatives and the decoction of the drugs of the Nyagrodhadi group mixed with a copious quantity of sugar, honey and clarified butter, should be used as Anuvasana and Asthapana measures. The abdomen should be poulticed with Payasa (porridge prepared with rice and milk) and the diet should consist of boiled rice and milk, cooked with the drugs of the Vidarigandhadi group. 5
श्लेष्मोदरिणन्तु पिप्पल्यादिकषायसिद्धेन सर्पिषोपस्नेह्य, स्नुहीक्षीरविपक्वेनानुलोम्य, त्रिकटुकभूत्रक्षारतैलप्रगाढेन मुष्ककादिकषायेणास्थापयेदनुवासयेच्च, शणातसीधातकीकिण्वसर्षपमूलकबीजकल्कैश्लोपनाहयेदुदरं, भोजयेच्चैनं त्रिकटुकप्रगाढेन कुलत्थयूषेण पायसेन वा, स्वेदयेच्चाभीक्ष्णम् ॥ ६ ॥
Treatment of the Kaphaja Type: In a case of Kaphaja Udara, the patient should be anointed with clarified butter, cooked with the decoction of the drugs of the Pippalyadi group. Likewise, clarified butter, cooked with the milky juice of Snuhi plants, should be used as purgatives; and the decoction of the drugs of the Muskakadi group, with a copious quantity of Trikatu, cow’s urine, Kshara (Yava-kshara) and oil, should be applied as Anuvasana and Asthapana measures. A poultice (Upanaha) prepared of Sana seeds, Atasi seeds, Dhataki (flower), mustard Mulaku seeds and Kinva should be applied (hot) to the abdomen. The diet should consist of (boiled rice well-mixed with ) Kulattha soup (Yusa), profusely seasoned with powdered Trikatu, or of Payasa; and the abdomen should be frequently fomented. 6
दूष्योदरिणन्तु प्रत्याख्याय सप्तलाशङ्खनीस्वरससिद्धेन सर्पिषा विरेचयेन्मासमर्धमासं वा, महावृक्षक्षीरसुरागोमूत्रसिद्धेन वा; शुद्धकोष्ठन्तु मद्येनाश्वमारकगुञ्जाकाकादनीमूलकल्कं पाययेत्, इक्षुकाण्डानि वा कृष्णसर्पेण दंशयित्वा भक्षयेद् वल्लीफलानि वा, मूलजं कन्दजं वा विषमासेवयेत् । तेनागदो भवत्यन्यं वा भावमापद्यते ॥ ७ ॥
Treatment of Dusyodara : In a case Dusyodara, the patient should be treated without giving any hope of a positive cure. Purgatives with clarified butter, cooked with the expressed juice of the Saptala and Samkhini, should be first administered (continuously) for a fortnight or even a month; or clarified butter, cooked with the milky juice of the Maha-vrksa, and with wine and cow’s urine, should be similarly used as a purgative. A Kalka made up of the roots of the Asvamaraka, Guftja and Kakadani mixed with wine (Sura), should be given after the bowels had begun to move freely. As an alternative, a Krsna-Sarpa (black lance-hooded cobra) should be enraged to bite a sugarcane and this piece of sugarcane should be given to the patient to chew (and suck); or the fruits of creepers (Valli-phala) should be used ( in the preceding manner); or poisonous’ roots and bulbs should be prescribed, whereby the disease may be cured or may take a different turn. 7
भवति चात्र । ● कुपितानिलमूलत्वात् सञ्चितत्वान्मलस्य च । सर्वोदरेषु शंसन्ति बहुशस्त्वनुलोमनम् ॥ ८ ॥
Memorable Verse : A case of abdominal dropsy (Udara) of whatsoever type should be presumed to have its origin in an aggravation of the bodily Vayu and an accumulation of faecal matter in the bowels; hence frequent use of Anulomana (purgatives, etc.) is recommended in this disease. 8
अत ऊर्ध्वं सामान्ययोगान् वक्ष्यामः । तद्यथाएरण्डतैलमहरहर्मासं द्वौ वा केवलमूलत्रयुक्तं क्षीरयुक्तं क सेवेतोदकवर्जी, माहिषं वा मूत्रं क्षीरेण निराहारः सप्तरात्रम्, उष्ट्रीक्षीराहारो वाऽन्नवारिवर्जी पक्षं पिप्पलीं वा मासं पूर्वोक्तेन विधानेनासेवेत | सैन्धवाजमोदायुक्तं वा निकुम्भतैलम् । आर्द्रकशृङ्गवेररसपात्रशतसिद्धं वा वातशूलेऽवचार्यम् । शृङ्गवेररसविपक्वं क्षीरमासेवेत । चव्यशृङ्गवेरकल्कं वा पयसा सरलदेवदारुचित्रकमेव वा । सुरङ्गीशालपर्णीश्यामापुनर्नवाकल्कं वा, ज्योतिष्कफलतैलं वा क्षीरेण स्वर्जिकाहिङ्गमिश्रं पिबेत् ॥ ९ ॥
General Treatment: Now we shall describe a few general medicinal compounds (which may be used with advantage in cases of Udara ). They are as follows:–Castor oil with milk or with the urine of a cow should be taken for a month or two. No water should be taken during the period, or the patient should forego the use of water and all other food, but drink only the urine of a she-buffalo and (cow’s) milk²
1. If this be not done, the patient is sure to die: but it is not certain whether he would get any relief from this treatment. It being, however, possible in some cases to save the life of a patient by the application of this medicine, it should be used, as the last resort with the permission of the king. –Dalhana.
2. The milk here. says Dalhana on the authority of Jejjata should be buffalo’s milk. But, according to Vagbhuta and Sivadasa, the commentator of Cakradatta, cow’s milk should be used.
1 for seven days or he should live upon the milk of a she-camel alone, foregoing the use of rice and water and submit himself to a course of Pippali for one month in the manner described before (under the treatment of Maha-Vatavyadhi), or take the oil of the Nikumbha with Saindhava-salt and powdered Ajamoda dissolved in it. The said oil (of Nikumbha), cooked with a hundred Patra weight of the expressed juice of Ardraka and Srngavera (fresh ginger), should be applied in the event of there being any Sula (colic pain), due to the action of the deranged and aggravated Vayu. Milk, boiled with the expressed juice of Srngavera (fresh ginger), should be taken. A paste-compound of Cavya and Srigavera, or paste-compound of Sarala, Deva-daru and Citraka (with milk), or a paste-compound of surangi, Salaparni, Syama and Punarnava (with milk), or the oil of Jyotiska seed, mixed with milk, Svarjika and Asafoetida, should be administered to the patient. 9
गुडद्वितीयां वा हरीतकीं भक्षयेत्, स्नुहीक्षीरभावितानां वा पिप्पलीनां सहस्त्रं कालेन, पथ्याकृष्णाचूर्णं वा स्नुहीक्षीरभावितमुत्कारिकां पक्वां दापयेत् ॥ १० ॥
He should take Haritaki with treacle, or a thousand Pippali soaked (twenty one times) with the milky juice of the Snuhi plant (in the manner of Bhavana saturation), should be gradually consumed. Powdered Pippali and Haritaki should be soaked with the milky juice of the Snuhi plant (and dried in the sun). Utkarika should now be prepared with this compound and given to the patient. 10
हरीतकीचूर्णं प्रस्थमाढके घृतस्यावाप्याङ्गारेष्वभिविलाप्य खजेनाभिमथ्यानुगुप्तं कृत्वाऽर्धमासं यवपल्ले वासयेत्, ततश्चोद्धृत्य परित्राव्य हरीतकीक्वाथाम्लदधीन्यावाप्य विपचेत्, तद्यथायोगं मासमर्धमासं वा पाययेत् ॥ ११ ॥
The Haritaki Ghrita : A Prastha measure of powdered Haritaki should be mixed with an Adhaka measure of clarified butter and heated over a charcoal fire by stirring it up quickly with a ladle; when well mixed, the compound should be poured into an earthen pitcher, which should be kept well corked and buried in a heap of barley for a
1. The Pippalis should be taken with milk only in the present instance fortnight. The pitcher should then be taken out and the compound should be strained and cooked again with an adequate¹ quantity of the decoction of Haritaki, Kanji ( fermented rice-gruel) and curd. The patient should use this medicine for a month or a fortnight in proper doses and with adequate vehicles. 11
गव्ये पयसि महावृक्षक्षीरमावाप्य विपचेत्, विपक्वञ्चावतार्य शीतीभूतं मन्थानेनाभिमथ्य नवनीतमादाय भूयो महावृक्षक्षीरेणैव विपचेत्, तद्यथायोगं मासं मासार्द्ध वा पाययेत् ॥ १२ ॥
The Maha-vrksa Ghrita : A quantity of the milky juice (one fourth of the cow’s milk in quantity) of the Maha-vrksa (Snuhi-plant), should be boiled with cow’s milk. Then it should be removed from the oven, cooled down and churned (with a churning rod). The butter thus prepared and cooked again with the milky exudations of the Mahavrksa (and an adequate quantity of water) should be given to the patient for a month or a fortnight in adequate doses and with proper vehicles. 12
चव्य-चित्रक- दन्त्यतिविषाकुष्ठसारिवा-त्रिफलाजमोदाहरिद्राशङ्घिनीत्रिवृत्त्रिकटुकानामर्धकार्षिका भागा, राजवृक्षफलमज्ज्ञामष्टौ कर्षा: महावृक्षक्षीरपले द्वे, गवां क्षीरमूत्रयोरष्टावष्टौ पलानि, एतत् सर्वं घृतप्रस्थे समावाप्य विपचेत् । तद्यथायोगं मासमर्धमासं वा पाययेत् ।।१३।।
The Chavyadi Ghrita : Half a Karsa (one Tola) measure of each of the following drugs. viz. Cavya, Citraka, Danti, Ativisa, Kustha, sariva, Triphla, Ajmoda, Haridra, Sankhini, Trivrt and Trikatu, together with an eight Karsa measure of the inner pulps of the fruit ( seeds) of the Raja-vrksa, two Pala weight of the milky juice of the Maha-vrksa, eight Pala weight of cow’s milk and eight Pala weight of cow’s urine, should be cooked with a Prastha measure (four seers ) of clarified butter. The medicated Ghrita, thus prepared, should be given in convenient doses to the patient for the period of a month or a fortnight. 13
1. Each of the three things (liquids) should be four times as much as the clarified butter.
2. In the absence of any mention about the quantity of water to be added four times as much of water should be added for the completion of the preparation according to the general maxim.
एतानि तिल्वकघृतचतुर्थानि सर्पीष्युदरगुल्मविद्रध्यष्ठीलानाहकुष्ठोन्मादापस्मारेषूपयोज्यानि विरेचनार्थम् । मूत्रासवारिष्टसुराश्चाभीक्ष्णं महावृक्षक्षीरसंभृताः सेवेत, विरेचनद्रव्यकषायं वा शृङ्गवेरदेवदारु – प्रगाढम् ॥ १४ ॥
The aforesaid three Ghritas (Haritaki Ghrita, Maha-vrksa Ghrita and Cavyadi-Ghrita) and the fourth Tilvaka-Ghrita ( mentioned in the chapter dealing with Vata-vyadi) should be employed, whenever purgatives would be necessary in cases of Udara, internal tumour (Gulma), abscess, Asthila, Anaha, Kustha, insanity and epilepsy.
Frequent use of (cow’s) urine or (any kind of) asava, Arista or wine cooked with the milky exudation of Maha-vrksa¹ is recommended. A decoction of purgative drugs, thickened with an admixture, in copious quantity, of powdered Suthi and Deva-daru, may be used with advantage in this desease. 14
वमनविरेचनद्रव्याणां पालिका भागाः पिप्पल्यादिवचादि-हरिद्रादिपरिपठितानाञ्च द्रव्याणां श्लक्ष्णपिष्टानां यथोक्तानाञ्च लवणानाम् । तत् सर्वं मूत्रगणे प्रक्षिप्य महावृक्षक्षीरप्रस्थञ्च मृद्वग्निनाऽवघट्टयन् विपचेदप्रदग्धकल्कम् । तत् साधुसिद्धमवतार्य शीतीभूतमक्षमात्रा गुटिका वर्त्तयेत्; तासामेकां द्वे तिस्रो वा गुटिका बलापेक्षया मासांस्त्रींश्चतुरो वा सेवेत । एषाऽऽनाहवर्त्तिक्रिया विशेषेण महाव्याधिषूपयुज्यते, कोष्ठजांश्च कृमीनपहन्ति, कासश्वासकृमि कुष्ठप्रतिश्यायारोचकाविपाकोदावर्त्तीश्च नाशयति ॥ १५ ॥
Anaha Varti : A Pala weight of the emetic and purgative drugs and the same weight of the fine powders of the drugs of each of the Vacadi, Pipplyadi and the Haridradi group, and all the officinal kinds of salt should be mixed (with four or eight times that of) the urine (of a cow, buffalo, etc.). Then this (mixture) compound should be boiled and cooked over a gentle fire with a Prastha measure of the milky juice of Maha-vrksa by constantly stirring it with a ladle. Precaution should
1. Dalhana explains the sentence as follows :
Asavas, Aristas and Suras should be prepared with urine (instead of the liquid i.e. water) and the milky exudation of Maha-vyksa (as an after-throw), and should be constantly used. be taken so that the Kalkas may not be scorched or burnt. This medicinal compound, when properly prepared, should be removed from the fire and when cooled should then be made into pills (Gutika), each being an Aksa (two Tolas) in weight. These pills should be given once, twice or thrice daily according to the exigency of the case and the capacity of the patient for a period of three or four consecutive months. The medicine is known as the Anaha-varti, and is specially beneficial in cases of Maha-vyadhi, and is equally efficacious in destroying intestinal worms. These pills, if regularly used, prove beneficial in cases of cough, asthma, Kustha, parasites, catarrh indigestion, aversion to food and Udavarta. 15
मदनफलमज्जकुटज- जीमूतकेक्ष्वाकु-धामार्गवत्रिवृत्त्रिकटुसर्षपलवणानि महावृक्षक्षीरमूत्रयोरन्यतरेण पिष्ट्वाङ्गुष्ठमात्रां वर्त्तिं कृत्वोदरिण आनाहे तैललवणाभ्यक्तगुदस्यैकां द्वे वा पायौ निदध्यात्। एषाऽऽनाहवर्त्तिक्रिया वातमूत्रपुरीषोदावर्त्ताध्मानानाहेषु विधेया ॥ १६ ॥
Second Anaha-Varti: The inner pulp of the seeds of Madana fruits with Kutaja, Jimutaka, Iksvaku ( bitter gourd), Dhamargava, Trivrt, Trikatu, mustard seed and rock salt, should be pasted together with either the milky juice of Maha-vrksa or with the urine of a cow, and the paste should be made into thumb-shaped plugs (Varti). In a case of Anaha of the patient already suffering from Udara, the outer end of his anus should be lubricated with oil and salt and one or two of the plugs should be inserted therein. The application of this Anahavarti should as well be applied in cases of Udavarta, due to a suppression or retention of stool, urine, and Vata (flatus) and in cases of tympanities (Adhmana) and distension of the abdomen (Anaha). 16
प्लीहोदरिणः स्निग्धस्विन्नस्य दध्ना भुक्तवतो वामबाहौ कूर्पराभ्यन्तरतः सिरां विध्येत्, विमर्दयेत् पाणिना प्लीहानं रुधिरस्यन्दनार्थम् । ततः संशुद्धदेहं समुद्रशुक्तिकाक्षारं पयसा पाययेत् । हिङ्गुसौवर्चिकाक्षारेण स्रुतेन पलाशक्षारेण वा यवक्षारम् । पारिजातकेक्षुरकापामार्गक्षारं वा तैलसंसृष्टम् । शोभाञ्जनकषायं वा पिप्पलीसैन्धवचित्रकयुक्तम्, पूतिकरञ्जक्षारं वाऽम्लस्स्रुतं विडलवणपिप्पलीप्रगाढम् ॥ १७ ॥
Treatment of Plihodara: In a case of Plihodara, application 1. Dropsical swelling of the abdomen owing to an enlargement of the spleen. Sneha (oil, etc.) and Sveda (fomentations) should be made and the patient should be fed on boiled rice mixed with milk-curd. Then the vein (Sira) inside the elbow of his left hand, should be duly opened. The spleen should be rubbed with the hand for the proper out-flow of its deranged blood (for the relief of that enlarged organ). Then having properly cleansed his system, the physician should advise the patient to take the alkali of marine oyster-shells through the medium of milk. As an alternative, Yava-kshara should be given to him with Sauvarcika and Hingu, or with filtered alkali (made with the ashes) of Palasa wood. As an alternative, the alkali of Parijataka, Iksvaku and Apamarga, mixed with oil, should be prescribed; or the decoction of Sobhanjana, mixed with Citraka, Saindhava and Pippali or the alkali of Putikaranja, filtered with Kanjika and mixed with a copious quantity of Vid salt (black salt) and powdered Pippali should be administered. 17
पिप्पलीपिप्पलीमूलचित्रकशृङ्गवेरयवक्षारसैन्धवानां पालिका भागा: घृतप्रस्थं तत्तुल्यं क्षीरं तदैकध्यं विपाचयेत् । एतत् षट्पलक नाम सर्पिः प्लीहाग्निसङ्गगुल्मोदरोदावर्त्तश्वयथुपाण्डुरोग-कासश्वासप्रतिश्यायोर्ध्ववातविषमज्वरानपहन्ति । मन्दाग्निर्वा हिङ्ग्वादिकं चूर्णमुपयुञ्जीत । यकुद्दाल्येउप्येष एव क्रियाविभागः । विशेषतस्तु दक्षिणबाहौ सिराव्यधः ॥ १८ ॥
Sat-palaka Ghrita : One pala weight of each of the following drugs, viz., pippali, Pippali-roots, Citraka, Sunthi, Yava-kshara and Saindhava should be cooked with one Prastha measure of clarified butter and the same quantity of milk¹. The medicated Ghrita thus prepared is called the Sat-palaka-Ghrita. It is highly efficacious in cases of an enlargement of the spleen, impaired digestion, Gulma, dropsy, Udavarta, anasarca (Svayathu), anaemia, cough, asthma, catarrh, Urdhva-Vata and Visama-Jvara. In cases of Udara attended with impaired digestion, the Hingvadi Curna should be prescribed. These measures should be as well employed in a case of an enlargement of the liver (Yakrt), but the speciality is that the vein (inside the elbow) of the right hand (instead of the left hand) should be opened in this case. 18
1. The practice, in this case, is to add twelve Seers (three prastha measures) of water to the Prastha measure of milk at the time of cooking.
मणिबन्धं सकृन्नाम्य वामाङ्गष्ठसमीरिताम् । दहेच्छिरां शरेणाशु प्लीह्रो वैद्यः प्रशान्तये ।। १९ ।।
Metrical Text: After slightly bending down the wrist (of the left hand), the vein in connection with the thumb of the left hand should be cauterized with a (burning) Sara for the purpose of giving relief in a case of enlarged spleen. 19
बद्धगुदे परित्राविणि च स्निग्धस्विन्नस्याभ्यक्तस्याधो नाभेर्वामतश्चतुरङ्गुलमपहाय रोमराज्या उदरं पाटयित्वा चतुरङ्गलप्रमाणान्यन्त्राणि निष्कृष्य निरीक्ष्य बद्धगुदस्यान्त्रप्रतिरोधकरमश्मानं बालं वाऽपोह्य मल-जातं वा ततो मधुसर्पिर्ध्यामभ्यज्यान्त्राणि यथास्थानं स्थापयित्वा वाह्यं व्रणमुदरस्य सीव्येत् । परिस्राविण्यप्येवमेव शल्यमुद्धृत्यान्त्रस्त्रावान् संशोध्य, तच्छिद्रमन्त्रं समाधाय कृष्णपिपीलिकाभिर्देशयेत् । दष्टे च तासां कायानपहरेन्न शिरांसि । ततः पूर्ववत् सीव्येत् । सन्थानञ्च यथोक्तं कारयेत्। यष्टीमधुकमिश्रया च कृष्णमृदाऽवलिप्य बन्धेनोपचरेत्, ततो निवातमागारं प्रवेश्याचारिकमुपदिशेद्, वासयेच्चैनं तैलद्रोण्यां सर्पिण्यां वा पयोवृत्तिमिति ॥ २०-२१ ॥
Treatment of Baddha-gudodara, etc. : In cases of the Baddhaguda (intestinal abstruction) and the Parisravi types of Udara, the patient should be first treated with emulsive measures and fomentations and then anointed with a sneha. Then an incision should be made on the left side of the abdomen below the umbilicus and four fingers to the left of the line of hair which stretches downward from the navel. The intestine to the length of four fingers should be gently drawn out; any stone, any dry hardened substance (Scybalum?), or any hair found stiffing to the intestine should be carefully examined and removed. Then the intestine should be moistened with honey and clarified butter. It should then be gently replaced in its original position and the mouth of the incision in the abdomen should be sewn up.
Treatment of Parisravi-Udara : In cases of the Parisravi type of Udara the obstructing matter should be similarly removed (from the intestines), as in the preceding case, and the secreting intestine should be purified. The (two ends of the severed intestines should be firmly pressed and adhered together and large black ants should be applied to these spots to grip them fastly with their claws. Then the bodies of the ants having their heads firmly adhering to the spots, as directed, should be severed and the intestines should be gently reintroduced into their original position (with the severed heads of the ants adhering to the ends of the incision) and sutured up, as in the preceding case. A union or adhesion of the incidental wound should then be duly effected. The same should now be plastered with black earth mixed with Yastimadhu and duly bandaged. The surgeon should cause the patient to be removed to a chamber protected from the wind and give him the necessary instructions. The patient should be made to sit in a tub full of oil or clarified butter and his diet should consist only of milk. 20-21
उदकोदरिणस्तु वातहरतैलाभ्यक्तस्योष्णोदकस्विन्नस्य स्थितस्याप्तैः सुपरिगृहीतस्या कक्षात् परिवेष्टितस्याधो नाभेर्वामतश्चतुरङ्गुलमपहाय रोमराज्या व्रीहिमुखेनाङ्गष्ठोदरप्रमाणमवगाढं विध्येत् । तत्र त्रप्वादीनामन्यतमस्य नाडीं द्विद्वारां पक्षनाडीं वा संयोज्य दोषोदकमवसिञ्चेत् । ततो नाडीमपहृत्य तैललवणेनाभ्यज्य व्रणं बन्धेनोपचरेत् । न चैकस्मिन्नेव दिवसे सर्वं दोषोदकमपहरेत्; सहसा ह्यपहृते तृष्णाज्वराङ्गमर्दातिसारश्वासकासपाददाहा उत्पद्येरन्नापूर्य्यते वा भृशतरमुदरमसञ्जातप्राणस्य, तस्मात् तृतीयचतुर्थपञ्चमषष्ठाष्टमदशमद्वादशषोडशरात्राणामन्यतममन्तरीकृत्य दोषोदकमल्पाल्पमवसिञ्चेत् । निःसृते च दोषे गाढतरमाविककौशेयचर्मणामन्यतमेन परिवेष्टयेदुदरम् । तथा नाध्मापयति वायुः षण्मासांश्च पयसा भोजयेज्जाङ्गलरसेन वा । ततस्त्रीन् मासानर्धोदकेन पयसा फलाम्लेन जाङ्गलरसेन वा अवशिष्टं मासत्रयमन्नं लघु हितं वा सेवेत । एवं संवत्सरेणागदो भवति ॥ २२ ॥ L
Treatment of Udakodara : A patient afflicted with Jalodara (ascites) should be first anointed with medicated oils, possessed of Vayu-subduing virtues, and fomented with hot water. Then his friends and relatives should be asked to hold him firmly by his arm-pits, when the surgeon would make a puncture with a surgical instrument, known as the Vrihi-mukha, on the left side of the abdomen below the umbilicus, to the breadth of the thumb in depth and at a distance of four fingers to the left of the dividing line of hairs in the abdomen. Simultaneously with that, a metal tube or a bird’s quill, open at both ends, should be introduced through the passage of the puncture to allow the morbific fluids (Dosodoka), accumulated in the abdomen, to ooze out. And then having removed the tube or the quill, the puncture should be lubricated with oil and Saindhava salt and bandaged in the manner described in connection with the bandaging of ulcers.
The entire quantity of the morbific fluid should not be allowed to ooze out in a single day, in as much as thirst, fever, aching of the limbs, diarrohea, dyspnoea and a burning of the feet (Pada-daha) might supervene in consequence, or as it might lead to a fresh accumulation of matter in the abdomen, in the event of the patient being of a weak constitution. Hence it should be gradually tapped at intervals of three, four, five, six, eight, ten, twelve, or of even sixteen days. After the complete outflow of the fluid, the abdomen should be firmly tied with a piece of flannel, silk-cloth or leather, in as much as this would prevent its flatulent distension.
Diet For six months the patient should take his food only with milk or with the soup (Rasa) of Jangala animals.
The diet for the next three months should consist of (meals taken with) milk diluted (and boiled) with an equal quantity of water or with the soup of flesh of animals of the Jangala group seasoned with the juice of acid fruits. During the next three months diet should consist of light and wholesome meals. This rule observed for a year brings about a cure. 22
भवति चात्र ।
आस्थापने चैव विरेचने च पाने तथाऽऽहारविधिक्रियासु । सर्वोदरिभ्यः कुशलैः प्रयोज्यं क्षीरं शृतं जाङ्गलजो रसो वा ।। २३ ।।
1. The use of water is forbidden during these nine months.
During the first six months, drinking, washing, etc., should be done with milk or the soup of Jangala animals. After this period, the said purposes should be served with half-diluted milk or meat-soup seasoned with the juice of acid fruits. Water may be used during the period of the next three months. –Dalhana. Vagbhata following Charaka says:
The patient should live only on milk for six months. After this period, he should live on porridge (Peya) boiled with milk; and for the next three months he should live on boiled Syama-rice with milk, or with the soup of meat seasoned with the juice or acid fruits and mixed with clarified butter and a small quantity of salt. The water of tender and green coconuts is used in cases of Udara in place of pure drinking water with benefit.
Memorable Verse: Skilled physicians should prescribe boiled milk and the soup of the flesh of animals of the Jangala group as food and drink in all cases of Udara and use these as Asthapana measures and as purgatives as well. 23
इति सुश्रुत संहितायां चिकित्सितस्थाने उदरचिकित्सितं नाम चतुर्दशोऽध्यायः
Thus ends the fourteenth Chapter in Chikitsa Sthana of the Susruta Samhita which deals with the treatment of Udara.