अष्टादशोऽध्यायः । अथातो व्रणालेपनबन्धविधिमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discourse the Chapter which treats of the dressings and bandages of ulcers (Vranalepana-bandha-Vidhi-adhyaya). 1
आलेप आद्य उपक्रमः, एष सर्व्वशोफानां सामान्यः प्रधानतम्च, तञ्च प्रतिरोगं वक्ष्यामः । ततो बन्धः प्रधानं तेन शुद्धिर्व्रणरोपणमस्थिसन्धिस्थैर्य्यञ्च, तत्र प्रतिलोममालिम्पेन्नानुलोमम्; प्रतिलोमे हि सम्यगौषधमवतिष्ठते अनुप्रविशति च रोमकूपान् स्वेदवाहिभिः शिरामुखश्चवीर्य्यं प्राप्नोति ।। २ ।।
A medicinal plaster should be regarded as the general and most important remedy in all cases of (inflammatory) swelling. We shall presently discuss the nature of plasters to be used in each specific form of disease. A bandage plays a more important part (than a medicinal plaster) as regards its healing and curative efficacy, inasmuch as it materially contributes to the purification and healing of an ulcer and keeps the joints steady. A medicinal plaster should be applied from down upward or in a direction contrary to that of the local hair (Pratiloma). It should never be applied (so as to run down with the local hair), since a plaster, applied as directed above, would firmly stick to the surface of the affected part, and naturally percolate through the follicles of the hair and the external orifices of the vehicles of perspiration (Sudoriferous ducts), thus permeating the organism with its own native potency and virtue. 2
न च शुष्यमाणमुपेक्षेतान्यत्र पीडयितव्याच्छुष्को ह्यपार्थकोऽरुष्करश्च ॥३॥
A medicinal plaster should be removed or replaced by a fresh one as soon as it has become dry, except in cases where the purpose of its application would be found to be the drawing of pus to a definite head (Pidayitavya Vrana). A dried medicinal plaster will prove useless or abortive, and may act as a caustic or corrosive agent. 3
स त्रिविधःप्रलेपः प्रदेह आलेपश्च । तेषामन्तरं प्रलेपः शीतस्तनुरविशोषी विशोषी वा, प्रदेहस्तूष्णः शीतो वा बहलोऽबहुरविशोषी च, मध्यमोऽत्रालेपः ॥४॥
A medicinal plaster admits of being grouped under any of the three subheads of Pralepa, Pradeha and Alepana (according to its thickness or consistency) etc.
Medicinal plasters: A medicinal plaster of the Pralepa class is applied thin and cold, and is made to be endued with an absorbing (Visosi) or non-absorbing (Avisosi’) property according to the nature of the effect desired. On the other hand, a medicinal plaster of the Pradeha class is applied either thick or thin, warm or cold, and acts as a non-absorbent. A medicinal plaster of the Alepana class stands midway between a Pralepa and a Pradeha. 4
तत्र रक्तपित्तप्रसादकृदालेपः । प्रदेहो वातश्लेष्मप्रशमनः सन्थानः शोधनो रोपण: शोफवेदनापहश्च तस्योपयोगः क्षताक्षतेषु । यस्तु क्षतेषूपयुज्यते स भूयः कल्क इति संज्ञां लभते निरुद्धालेपनसंज्ञः । तेनास्रावसन्निरोधो मृदुता पूतिमांसापकर्षणमन्तर्निर्दोषता व्रणशुद्धिश्च भवति ॥५॥
Of these, a plaster of the Pralepana class is possessed of the efficacy of pacifying or restoring the deranged blood and Pitta to their normal condition. A plaster of the Pradeha class pacifies the deranged Vayu and Kapha and tends to bring about the union, purification, and healing (of an ulcer), causing the subsidence of pain and swelling.
1. As in the case of a Pidayitavya ulcer, described before, where the withdrawing or gathering of pus to a definite head is desired.Hence it should be used in all types of swelling whether ulcerated or otherwise.
A medicinal plaster (Alepana) applied over an ulcer is called by the changed epithet of Kalka or Niruddha-Alepana (arrestive or astringent plaster). The function of such an Alepana consists in arresting a local haemorrhage, in softening the ulcer, in withdrawing sloughing or putrifying flesh from its cavity, in checking the formation of pus in its inside, and in correcting the morbid matter or deranged humours (that retard its union and healing ). 5
अविदग्धेषु शोफेषु यथास्वं दोषशमनं त्वक्प्रसादनमेवाग्रयं दाहप्रशमनं श्रेष्ठं हितमालेपनं भवेत् । दाहकण्डूरुजापहम् ॥६॥ मांसरक्तप्रसादनम् । तोदकण्डूविनाशनम् ।।७।।
मर्म्मदेशेषु ये रोगा गुह्येष्वपि तथा नृणाम् । संशोधनाय तेषां हि कुर्य्यादालेपनं भिषक् ॥ ८ ॥
षड्भागं पैत्तिके स्नेहं चतुर्भागन्तु वातिके। अष्टभागन्तु कफजे स्नेहमात्रां प्रदापयेत् ।। ९ ।।
Metrical Texts: A medicinal plaster of the Alepana class would prove beneficial in a swelling marked by the absence of suppuration, inasmuch as it subdues the characteristic symptoms of each of the deranged bodily humours viz. the burning sensation (peculiar to the deranged Pitta), itching (incidental to the deranged state of Kapha) and the aching pain (which marks the disorder of the bodily Vayu). Its action lies principally in cleansing the skin, the flesh and the blood of all morbiferous diatheses, in removing the burning sensation, and in alleviating the piercing pain and itching.
A physician (surgeon) should use an Alepana in ( ulcerous) diseases appearing about the anus, or about any other vital part (Marmas) or the body, with a view to bring about the purification of the (local deranged humours). In diseases caused by a deranged condition of the Vayu, Pitta of Kapha, medicinal plasters should be respectively mixed with a quantity of clarified butter, measuring a sixth, quarter, and a eighth part of their respective quantities. 6-9
तस्य प्रमाणमार्द्रमहिषचर्मोत्सेधमुपदिशन्ति । न च लेपं रात्रौ प्रयुञ्जीत, मा भूच्छेत्यपिहितोष्मणः तदनिर्गमाविकारप्रवृत्तिरिति ।।१०।।
It has been said that the thickness of an Alepana should not be made to exceed that of the newly-flayed skin of a buffalo. Under no condition, should a medicinal plaster be applied at night, inasmuch as such a measure would arrest the escape or radiation of heat from the swelling in virtue of its own inherent humidity, and thus bring on an aggravation. 10
प्रदेहसाध्ये व्याधौ तु हितमालेपनं दिवा। पित्तरक्ताभिघातोत्थे सविषे च विशेषतः ।।११।।
न च पर्युषितं लेपं कदाचिदवचारयेत् । उपर्युपरि लेपन्तु न कदाचित् प्रदापयेत् ।। १२ ।।
उष्माणं वेदनां दाहं घनत्वाज्जनयेत् स हि । न च तेनैव लेपेन प्रदेहं दापयेत् पुनः । शुष्कभावात् स निर्वीर्य्यो युक्तोऽपि स्यादपार्थकः ॥ १३ ॥ ।
Metrical Texts : In diseases, which are amenable to the application of medicinal plasters of the Pradeha type, as well as in swellings resulting from the vitiated condition of blood and the Pitta, or in those which are of extrinsic origin, or are due to the effect of a poison or blow, the plaster should be applied cold, by day. A plaster should not be applied without removing the previous one, nor over the one applied on the day before, as this would increase the local heat and aggravate the pain and the burning sensation on account of its greater or increased thickness. A medicinal plaster, previously used, should not be moistened and applied again; it should be held as absolutely ineffective owing to its virtue having been previously used or soaked in.’ 11-13
अत ऊर्द्धवं व्रणबन्धनद्रव्याण्युपदेक्ष्यामः । तद्यथा-क्षौमकार्पासाविकदुकूलकौशेयपत्रोर्णचीनपट्टचर्म्मान्तर्वल्कलालाबूशकललताविदलरज्जुतूलफलसन्तानिकालौहानीति, तेषां व्याधिं कालञ्चावेक्ष्योपयोगः, प्रकरणतश्चैषामादेशः ॥१४॥
1. This portion of the text has been omitted by Cakrapani in his commentary entitled the Bhanumati.
Articles of bandaging: Now we shall enumerate the names of articles which are required in bandaging ulcers. They are as follows:
Ksauma (cloth woven with the fibres of Atasi plant), Avika (blankets made of sheeps’ wool), Dukula (loom-silk), Kauseya (silk), the Patrorna (a kind of cloth made of the fibres of Naga trees, which grow in the provinces of Paundra and Magadha), the Cinapatta (Chinese cloth), Antarvalkala (the inner bark or fibres of a tree), Carma (skin), the Alabu, Sakala (the skin of a gourd), the Lata-Vidala (half thrashed Syama creepers), string or cord, the cream of milk, Tula-phala (cotton seeds) and iron. These accessories should be used in consideration of the exigencies of each case and the time or the season of the year in which it occurs.¹ 14
तत्र कोशदामस्वस्तिकानुवेल्लितप्रतोलीमण्डलस्थगिकायमकखट्वाचीनविबन्धवितानगोफणाः पञ्चाङ्गी चेति चतुर्द्दश बन्धविशेषाः । तेषां नामभिरेवाकृतयः प्रायेण व्याख्याताः ॥१५॥
Bandages : The fourteen different forms of bandage are named as the Kosa (a sheath or scabbard), the Dama (a cord or chaplet), the Svastika (cross), the Anuvellita (a twist), the Pratoli (a winding street or road), the Mandala (ring), the Sthagika (a betel-box), the Yamaka (double or twin), the Khatva (a bedstead), the Cina (a streamer), the Vibandha (noose), the Vitana (canopy) the Gophana (cow-horn), the Pancangi (five limbed). their shapes can be easily inferred from the meanings of their names. 15
तत्र कोशमङ्गुष्ठाङ्गुलिपर्व्वसु विदध्यात्, दाम सम्बाधेऽङ्गे, सन्धि
1. In a swelling or ulcer caused by the deranged Vayu and Kapha, the bandage should consist of a piece of thick cloth; whereas in summer it should consists of thin linen. Similarly a bandage, tied round any deep or hollow part of the body. should consist of a piece of thick cloth. The contrary rule should be observed, when the seat of the bandage would be at any flexible part of the body.
Similarly in the case of a snake-bite, a ligature should be firmly tied above the punctured wound with a string or twisted cord of cotton, while a fractured bone should be set right by twisting bunches of half-thrashed shyama creeper (Latavidala) round the seat of fracture. A local haemorrhage should be arrested by binding the part with milk-cream, while the affected part in a case of Ardita (facial paralysis) as well as a broken tooth should be bound with strings of iron, gold or silver. Warts, etc. should be bandaged with Ela (cardamom skins), while dried gourd-skins should be used in bandaging ulcers on the head (scalp).
कूर्च्चकभ्रूस्तनान्तरतलकर्णेषु प्रतोलीम्, वृत्तेऽङ्गे मण्डलम् स्वस्तिकम्, अनुवेल्लितं शाखासु, ग्रीवामेढ्योः अङ्गुष्ठाङ्गुलिमेद्राग्रेषु स्थगिकाम्, ? ” यमलव्रणयोर्यमकम्, हनुशङ्ख गण्डेषु खट्वाम्, अपाङ्गयोश्चीनम्, पृष्ठोदरोरःसु विबन्धम् मूर्द्धनि वितानम्, चिबुकनासौष्ठांसबस्तिषु गोफणाम्, जत्रुण ऊद्धवं पञ्चाङ्गीमिति । यो वा यस्मिन् शरीरप्रदेशे सुनिविष्टो भवति तं तस्मिन् विदध्यात्। यन्त्रेणमूर्ध्वमधस्तिर्य्यक् च ॥१६॥
Applications : Out of these, the Kosa or the sheath-shaped bandage should be tied round the thumb and the phalanges of the fingers; the Dama or chaplet-shaped bandage, round the narrow or unbent parts of the body; the Svastika or cross shaped, round the joints, round the articulations or the Marmas known as the Kurcakas (Navicular ligaments) round the eye-brows, round the ears and round the region of the breast. Similarly, the bandage, known as the Anuvellita, should be used when the seat of the affection would be found to be situated at the extremities (hands and legs). A bandage of the Protoli class should be tied round the neck or the penis; the Mandalam (ring-shaped), round the circular parts of the body; the Sthagika (betel-box), round the glans-penis and the tips of the fingers; the Yamaka, round the confluent or contiguous ulcers; the Khatva (bedstead-shaped), over and around the cheeks, cheek-bones, and the parts between the ears and the eye-brows; Cina bandage should be applied over both the outer canthus regions; Vibandha bandage should be applied on the back, abdomen and chest; the Vitana over the skull, the Gophana (horn-shaped), round the region of the chin; and the Pancangi, round the part lying above the clavicles.
In short, a bandage of any particular shape should be tied round the part of the body to which it would be found to be most suited. Now we shall deal with the Yantranas (fastenings of bandages) which admit of being divided into three different classes according as they are fastened above, below, or obliquely round an ulcer. 16
तत्र घनां कवलिकां दत्त्वा वामहस्तपरिक्षेपमृजुमनाविद्धमसंङ्कुचितं मृदुपट्टं निवेश्य बघ्नीयात् । न च व्रणस्योपरि कुर्य्याद् ग्रन्थिमाबाधकरञ्च । । १७ ।॥
Kavalika (Tow) : Any soft stuffing or tow (such as the leaves or the bark of trees of medicinal virtues) between the medicine applied over an ulcer and the bandaging linen is callled the Kavalika (medicated tow). The tow or the Kavalika should be placed thickly (on the seat of affection); and then the physician (surgeon) having pressed it with his left hand should’ place piece of straight, soft, untwisted, and unfolded or unshrivelled linen over it, and then firmly tie up the bandage in a manner so as not to leave any knot over the seat of the ulcer, or to cause any discomfort to the patient. 17
न च विकेशिकौषधेऽतिस्निग्धेऽतिरुक्षे विषमे वा कुर्वीत | यस्मादतिस्नेहात् क्लेदो, रौक्ष्याच्छेदो, दुर्न्यासाद्व्रणवर्त्मावघर्षणमिति ॥१८॥
Introduction of lint: A Vikesika (lint) saturated with honey, clarified butter, and a medicinal paste should be inserted into the ulcer. Care should be taken not to introduce the lint extremely dry, or oily (oversoaked in a lubricating or oily medicinal preparation), in as much as an over-lubricated lint would give rise to an excessive formation of slimy mucus in the ulcer, whereas, its parched substitute would bring about the friction and the consequent breaking of the edges of the ulcer, like one mis-placed or wrongly inserted. 18
A bandage should be tied in any of the three ways of Gadha, Sama and Sithila fastenings according to the shape and seat of the ulcer: 19
पीडयन्नरुजो गाढः, सोच्छ्वासः शिथिलः स्मृतः ।
नैव गाढो न शिथिलः समो बन्धः प्रकीर्त्तितः ॥ २० ॥
A bandage, tightly tied round an ulcerated or affected part of the body without causing any pain or discomfort to the patient, is called Gadha-bandha, while the one which is loosely bound is called Shithila, the one neither too tight nor too loose being called a Samabandha. 20
Carefully examining whether the applied remedy had been uniformly distributed over the diseased surface and whether the contemplated pattern of bandage would be actually suited to the case.
वदनकर्णीष्ठमेढ्रमुष्कपृष्ठपार्श्वोदरोर:सु समः, अक्ष्णोः सन्धिषु च शिथिल इति ।। २१ ।।
A tight bandage (Gadha-bandha) should be tied round the buttocks, round the sides, round the arm-pits, round the inguinal regions, round the breast or round the head. A bandage of the Sama pattern should be fastened round the ears, round the extremities (hands and legs), round the face, round the throat, round the lips, round the penis, round the scrotum, round the back, round the belly and the chest. A loose bandaging (Sithila-bandha) should be the rule in the region of the eyes and locations of important joints or unions. 21
तत्र पैत्तिकं गाढस्थाने समं बध्नीयात्, समस्थाने शिथिलं, शिथिलस्थाने नैव, एवं शोणितदुष्टश्च । श्लैष्मिकं शिथिलस्थाने समं, समस्थाने गाढं, गाढस्थाने गाढतरमेवं वातदुष्टञ्च ॥ २२ ॥
An ulcer, brought about or characterised by the symptoms of the deranged Pitta and occurring at a place where a tight bandaging is indicated, should be fastened with one of the Sama-bandha class, and with a Sithila bandage where one of the Sama type would be indicated; whereas it should not be bandaged at all in the even of a loose bandage Sithila-bandha) being indicated. The same rule should be observed in the case of an ulcer caused through a diseased or contaminated state of the blood. Similarly, in the case off an ulcer produced through a deranged condition of the Kapha, a loose bandaging, otherwise enjoined to be adopted, should be substituted for one of the same pattern. A tight bandage should give place to a lighter one under the same circumstances, and such a procedure should be deemed as holding good even in the case of an ulcer caused by the action of the deranged Vayu. 22
तत्र पैत्तिकं शरदि ग्रीष्मे द्विरहो बध्नीयात् रक्तोपद्रुतमप्येवं, श्लैष्मिकं हेमन्तवसन्तयोस्त्र्यहात्, वातोपद्रुतमप्येवम् । एवमभ्यूह्य बन्धविपर्य्ययञ्च कुर्यात ॥२३॥
In summer and autumn, the bandage of an ulcer, due to the vitiated blood or Pitta, should be changed twice a day; while the one tied round an ulcer of the deranged Vayu or Kapha, should be changed on each third day in spring and Hemanta. Similarly, an ulcer, marked by the action of the deranged Vayu, should be bandaged twice a day. “Thou shalt exercise thy own discretion, and vary or adopt the preceding rules of bandaging according to the exigencies of each case.” 23
तत्र, समशिथिलस्थानेषु गाढं बद्धे विकेशिकौषधनैरर्थक्यं शोफवेदनाप्रादुर्भावश्च, गाढसमस्थानेषु शिथिलं बद्धे विकेशिकौषधपतनं पट्टसञ्चाराद् व्रणवर्त्मावघर्षणमिति, गाढशिथिलस्थानेषु समं बद्धे च गुणाभाव इति । अविपरीतबन्धे वेदनोपशान्तिरसृकप्रसादो मार्द्दवञ्च ॥२४॥
A medicated lint fails to have any efficacy but rather tends to augment the local pain and swelling where a bandage, enjoined to be loosely bound, or bound up with moderate and uniform steadiness (Sama-bandha), is replaced by a tight or deep fastened one (Gadhabandha). A loose bandage, injudiciously used in a case where a tight or a moderately firm bandage should have been used, would cause the medicine to fall off from the lint and give rise to the consequent friction and laceration of the edges of the ulcer. Similarly, a moderately firm and steady bandage (Sama-bandha) fastened in a case where a light or loose bandage should have been used, would fail to produce any effect. A proper bandage would lead to the subsidence of pain, and the softening of the edges of the ulcer, thus bringing about a purification of the local blood. 24
अबध्यमानो दंशमशकतृणकाष्ठोपलपांशुशीतवातातपप्रभृतिभिर्विशेषैरभिहन्यते व्रणः, विविधवेदनोपद्रुतश्च दुष्टतामुपैत्यालेपनादीनि चास्य विशोषमुपयान्ति ॥ २५ ॥
Evils of non-bandaging: An ulcer, left uncovered and untied with a suitable bandage, is soon assailed by gnats and flies. It is moistened by sweat and cold wind, etc. and stands in danger of being irritated by deposits of many foreign matters such as, the particles of bone, dust, weeds, etc. Moreover, a constant exposure to heat or cold brings on varied pains, the ulcer develops into one of a malignant type, and the applied medicinal plasters are dried, encrusted and speedily fall off. 25
चूर्णितं मथितं भग्नं विश्लिष्टमतिपातितम् । अस्थिस्नायुशिराच्छिन्नमाशु बन्धेन रोहति ॥ २६ ॥
सुखमेवं व्रणी शेते सुखं गच्छति तिष्ठति । सुखं शय्यासनस्थस्य क्षिप्रं संरोहति व्रणः ।। २७ ।।
Metrical Texts : A smashed, lacerated, fractured, dislocated, displaced bone, or a vein or a ligament similarly jeopardised, may be soon healed or set right with the help of a surgical bandage. The patient is enabled by such a means to lie down, or stand up or move about with ease. And an increased facility of rest or movement leads to speedy healing. 26-27
अबन्ध्याः पित्तरक्ताभिघातविषनिमित्ताः, यदा चोफदाहपाकरागतोदवेदनाभिभूताः क्षाराग्निदग्धाः पाकात् प्रकुथिताः प्रशीर्णमांसाश्च भवन्ति ॥२८॥
Cases where bandaging is prohibited: Ulcers should not be bandaged at all that are due to the deranged condition of blood or Pitta, or to the effects of a blow or of any imbibed poison, and characterised by a sucking, burning pain, redness, or suppuration, as well as those which are incidental to burns, or to the applications of actual or potential cauteries marked by a sloughing or phagedenic character. 28
कुष्ठिनामग्निदग्धानां कणिकाश्चोन्दुरुविषे पिडकामधुमेहिनाम्। विषजुष्टव्रणाश्च ये। मांसपाके न बध्यन्ते गुदपाके च दारुणे ।। २९ ।।
स्वबुद्धया विभजेच्चापि कृत्याकृत्यांच बुद्धिमान् । देशं दोषञ्च विज्ञाय व्रणञ्च व्रणकोविदः । ऋतं परिसंख्याय ततो बन्धान् निवेशयेत् ।। ३० ।।
Metrical Texts: An ulcer due to a scald in a leper or a carbuncle in a diabetic patient (Pidaka) as well as a fleshy condylomata due to a bite from a venomous rat, or any other poisonous ulcer should not be bandaged at all. The same rule should be observed in the case of a dreadful suppuration about the anus, or in that of a sloughing ulcer. An intelligent physician, familiar with the specific features of ulcers, should observe the shape of the one under treatment, and prognosticate the result from its seat or locality and the nature of the deranged bodily humours involved in the case. The season of the year in which an ulcer is first seen to appear also determines the nature of the
ऊर्ध्वं तिर्य्यगधस्ताच्च यन्त्रणा त्रिविधा स्मृता । यथा च बध्यते बन्धस्तथा वक्ष्याम्यशेषतः ।। ३१ ।। घनां कवलिकां दत्त्वा मृदु चैवापि पट्टकम् | विकेशिकामौषधञ्च नातिस्निग्धं समाचरेत् ॥ ३२ ॥ प्रक्लेदयत्यतिस्निग्धा तथा रुक्षा क्षिणोति च। युक्तस्नेहा रोपयति दुर्न्यस्ता वर्त्म घर्षति ।। ३३ ।। विषमञ्च व्रणं कुर्य्यात् स्तम्भयेत् स्रावयेत् तथा । यथाव्रणं विदित्वा तु योगं वैद्यः प्रयोजयेत् ॥ ३४ ॥ पित्तजं रक्तजं वापि सकृदेव परिक्षिपेत् । असकृत् कफजे वापि वातजे च विचक्षणः ।।३५ ।। तलेन प्रतिपीड्याथ स्रावयेदनुलोमतः । सर्व्वाश्च बन्धान् गूढांन्तान् सन्धींश्च विनिवेशयेत् ॥३६ ।।
Bandages may be tied up either from above, below, or from the sides of a diseased locality. Now I shall fully describe the process of bandaging an ulcer.¹ First the Kavalika or tow should be thickly laid over the seat of the ulcer and after that a piece of soft and unshrivelled linen should be placed upon it, and the bandage should be loosely or tightly tied up according to the direction laid down before.²
The lint and the (inserted) medicine should not be over-lubricated and must not be inordinately oily in asmuch as such a lint or medicine I would give rise to the formation of excessive and abnormal slimy mucous in the ulcer. On the other hand, and extremely dry lint would set up friction and laceration of the edges of the ulcer, like the one wrongly or improperly inserted into its cavity, causing numbness, excessive exudation and unevenness of its surface. A lint, properly saturated with a medicinal plaster and rightly inserted into the cavity of an ulcer, leads to its speedy healing. All secreting measures in connection with an ulcer should be continued or stopped according to
1. Different reading: Pricking, burning pain.
2. Several authorities such as Gayadasa, Brahinadeva, etc. hold this portion of the text to be an interpolation. Both Dallana and Cakrapani have included it within their commentaries with nearly the same remark.
its condition, whereby the nature and shape of the bandage should be determined as well. An ulcer, due either to the deranged condition of blood or the Pitta, should be dressed and bandaged once a day which may be extended to a number of times in the case of an ulcer brought about by the deranged Kapha and Vayu. The pus or the local morbid matter should be secreted by pressing the base or the bottom of an ulcer and by gently moving the hand along it in a contrary direction (down, upward); and all bandages ( around joints and Gudhsandhis) should be duly tied up. 31-36
ओष्ठस्याप्येष सन्धाने यथोद्दिष्टो विधिः स्मृतः । वुद्धयोत्प्रेक्ष्याभियुक्तेन तथा चास्थिषु जानता ।।३७।।
The rules laid down under the head of adhesioning the parts of a bufurcated ear-lobe would hold good in a case of severed lips as well. The measures amply discussed in the present Chapter should be extended by means of inference, analogy and judgment to apply mutatis mutandis to the bandaging of a fractured or dislocated bone. 37
उत्तिष्ठतो निषण्णस्य शयनञ्चापि गच्छतः । गच्छतो विविधैर्यानैर्नास्य दुष्यति स व्रणः ॥ ३८ ॥
ये च स्युर्माससंस्था वै त्वग्गताश्च तथा व्रणाः । सन्ध्यस्थिकोष्ठप्राप्ताश्च शिरास्नायुगतास्तथा ॥३९ ।।
तथा वगाढगम्भीराः सर्व्वतो विषमस्थिताः । नैते साधयितुं शक्या ऋते बन्धाद् भवन्ति हि ॥ ४० ॥
An ulcer, properly bandaged, has a greater chance of not being affected by lying down, sitting up, or any other movement of the patient, nor by the joltings of a conveyance he may ride or be carried in. An ulcer affecting a vein or a ligament or the skin (superficial) or the flesh or the bones cannot be healed without bandaging it. An ulcer situated in any of the internal chambers (cavities) of the body, or occurring at any junction of the limbs or organs, etc. or having its seat in a bone and whether of a deep, superficial, malignant or corrosive character, cannot be brought to a successful termination without the help of a bandage. 38-40
इति सुश्रुतसंहितायां सूत्रस्थाने व्रणालेपनबन्धविधिर्नामाष्टादशोऽध्यायः ॥१८॥
Thus ends the eighteenth Chapter of the Sutrasthana in the Susruta Samhita which treats of the dressing and bandaging of ulcers.