अष्टाविंशोऽध्यायः अथातो विपरीताविपरीतव्रणविज्ञानीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः॥१॥
Now we shall discourse on the Chapter, which deals with the favourable or unfavourable prognosis of an ulcer. (ViparitaviparitaVrana-Vijnaniya-adhyaya). 1
फलाग्निजलवृष्टीनां पुष्पधूमाम्बुदा यथा । ख्यापयन्ति भविष्यत्त्वं तथा रिष्टानि पञ्चताम् ॥ २ ॥
तानि सौक्ष्म्यात् प्रमादाद् वा तथैवाशु व्यतिक्रमात् । गृह्यन्ते नोद्गतान्यज्ञैर्मुमूर्षोर्न त्वसम्भवात् ॥ ३ ॥
Metrical Text: Certain fatal or unfavourable symptoms (Aristas ) 1 unmistakably presage the death of an ulcer-patient, as a flower, smoke and cloud respectively herald a fruit, fire and rain. In most cases, the ignorant cannot interpret aright these fatal symptoms owing to their extremely subtile nature, or out of ignorance or stupidity, or because such symptoms are very ciosely followed by the death of the patient. 2-3
ध्रुवन्तु मरणं रिष्टे ब्राह्मणैस्तत् किलामलैः । रसायनतपोजप्यतत्परैर्वा निवार्य्यते । ॥ ४ ॥
The symptoms which are developed by the deranged bodily humours in the organism of a man at a time when they have passed beyond all medical cure, and when the body serves as a mere passive back-ground for those phenomena, awaiting its impending dissolution, are called Aristas.
These fatal indications serve as sure precursors of death in a patient, unless warded off by the blessings of holy Brahmanas, who are free from low desires or animal propensities, and are also accustomed to practise the Yoga and other religious penances; or death may be averted with the help of men who are initiated into the mystery of concocting life-giving elixirs ( Rasayana). 4
नक्षत्रपीडा बहुधा यथा कालाद् विपच्यते । तथैवारिष्टपाकञ्च ब्रुवते बहवो जनाः असिद्धिमाप्नुयाल्लोके प्रतिकुर्व्वन् गतायुषः ।
अतो रिष्टानि यत्नेन लक्षयेत् कुशलो भिषक् ॥६॥ गन्धवर्णरसादीनां विशेषाणां स्वभावतः वैकृतं यत् तदाचष्टे व्रणिनः पक्वलक्षणम्।।७।।
Many such indications do not prove instantly fatal but bring on death in course of time, just as diseases, supposed by some to be due to the influence of malignant planets, take time before they become patent out of their incubative stages. An attempt to cure a doomed patient is only repaid by failure and the ridicule of the world, and hence an intelligent physician should make it worth his while to carefully observe and study these fatal indications. A contrariety of the natural smell, colour, taste, ( sensation, sound, touch, etc.) of an ulcer indicates a near and fatal termination of the disease. 5-7
कटुस्तीक्ष्णश्च विस्रश्न गन्धस्तु पवनादिभिः । लोहगन्धिस्तु रक्तेन व्यामिश्रः सान्निपातिकः ।।८।।
लाजातसीतैलसमाः किञ्चिद्विस्राश्च गन्धतः । ज्ञेयाः प्रकृतिगन्धाः स्युरतोऽन्यद् गन्धवैकृतम् ॥ ९ ॥
An ulcer emits a pungent, sharp, or fishy smell under the respective influences of the deranged Vayu, Pitta and Kapha. An ulcer, deranged by the action of the vitiated blood, emits a smell like that of iron (Loha-gandhi), while one, originated through the concerted action of the deranged humours, emits a smell characterised by the distinctive features of each of them. On the other hand, an ulcer, due to the joint action (of the deranged Vayu and Pitta), emits a smell like that of fried paddy; one, due to the action of the deranged Vayu and Kapha, emits a smell like that of linseed oil; whereas one, brought about by the action of the deranged Pitta and Kapha, smells like sesamum oil. All those odours, marked by a somewhat fishy character, should be deemed the natural odours of ulcers, and any other smell should be held as a contrary or unnatural one. 8-9
मद्यागुर्व्वाज्यसुमनः पद्मचन्दनचम्पकैः । सगन्धा दिव्यगन्धाश्च मुमूर्षूणां व्रणाः स्मृताः ।।१०।।
श्ववाजिमूषिकध्वाङ्गपूतिवल्लूरमत्कुणैः । सगन्धाः पङ्कगन्धाश्च भूमिगन्धाश्च गर्हिताः। ॥ ११ ॥
An ulcer emitting a sweet smell like that of wine, or fragrant aloe wood (Aguru), clarified-butter, Jati flower, Campaka,Candan, otus or any celestial flower (Divyagandha), should be regarded as the precursor of death. Similarly, a smell like the one which characterises a dog, horse, mole, crow or a bug, or like the one emitted by dry, putrid meat, or resembling the smell of earth or slime, should be likewise deemed unfavourable or fatal in an ulcer. 10-11
ध्यामकुङ्कुमकङ्गुष्ठसवर्णाः न दह्यन्ते न चूष्यन्ते भिषक् तान् पित्तकोपतः । परिवर्ज्जयेत् ।।१२।।
कण्डूमन्तः स्थिराः श्वेताः स्निग्धाः कफनिमित्ततः । दूयन्ते च विदह्यन्ते भिषक् तान् परिवर्ज्जयेत् ॥ १३ ॥
कृष्णाश्च ये तनुस्रावा वातजा मर्म्मतापिनः। स्वल्पामपि न कुर्व्वन्ति रुजं तान् परिवर्ज्जयेत् ॥ १४ ॥
A physician should give up a case where an ulcer, though it has assumed a blackish, saffron or Kankustha colour (a sort of mountain earth) through the action of the aggravated Pitta, is divested of the burning, sucking and drawing pain, which is peculiar to that morbiferous diathesis. Similarly, an ulcer, which, though brought about through the action of the deranged Kapha, has become cold, hard and whitish as natural in one of the Kaphaja type, should be given up as soon as it is marked by a burning pain. Likewise an ulcer, due to the action of the deranged Vayu, and characterised by a blackish hue and a thin secretion, and which is found to invade the vital principles of the body, should be abandoned by a physician, whenever found to be entirely devoid of pain. 12-14
क्ष्वेडन्ति घुघुरायन्ते ज्वलन्तीव च ये व्रणाः । त्वङ्मांसस्थाश्च पवनं सशब्दं विसृजन्ति ये ।। १५ ।।
ये च मर्म्मस्वसम्भूता भवन्त्यत्यर्थवेदनाः । दह्यन्ते चान्तरत्यर्थ बहि:शीताश्च ये व्रणाः ।।१६।।
दह्यन्ते बहिरत्यर्थं भवन्त्यन्तच शीतलाः । शक्तिध्वजरथाः कुन्तवाजिवारणगोवृषाः।।१७।।
येषु चाप्यवभासेरन् प्रासादाकृतयस्तथा । चूर्णावकीर्णा इव ये भान्ति वा न च चूर्णिताः ।।१८।।
An ulcer, which makes a gurgling or groaning sound, or one which is characterised by an extreme burning sensation, or is confined to the skin and the flesh, and is marked by the emission of wind with a loud report, is sure to have a fatal termination. Likewise, one which is characterised by extreme pain, though not otherwise seated about any of the vital parts of the body, or which is cold on the surface, though attended with an extremely burning sensation in its inside and vice versa, should be deemed the precursor of death. Similarly, an ulcer should be regarded as fatal, that is shaped like the barb of a spear, or a Kunta (a kind of barbed dart or spear), or like a banner, chariot, horse, or an elephant, or like a cow, an ox, a temple, or a palace. 1518
प्राणमांसक्षयश्वासकासारोचकपीडिताः प्रवृद्धपूयरुधिरा व्रणा येषाञ्च मर्म्मसु ।। १९ ।।
क्रियाभिः सम्यगारब्धा न सिध्यन्ति च ये व्रणाः । वर्ज्जयेत् तान् भिषक् प्राज्ञः संरक्षन्नात्मनो यशः ।।२०।।
A wise physician, with any regard to his own reputation, should abandon a patient laid up with an ulcer which appears to have been dusted over with a sort of pulverised crust, or who has been suffering from one accompanied by loss of flesh and strength, cough, difficult respiration and aversion to food. An ulcer, which occurring at any of the vital parts of the body secretes a copious quantity of pus and blood, and refuses to be healed even after a course of proper and persistent medical treatment, is sure to have a fatal termination. 19-20
इति सुश्रुतसंहितायां सूत्रस्थाने विपरीताविपरीतव्रणविज्ञानीयो नामाष्टाविंशोऽध्यायः ॥ २८ ॥
Thus ends the twenty-eighth Chapter of the Sutrasthana in the Susruta Samhita, which deals with the favourable and unfavourable prognosis of ulcers.
