द्वाविंशोऽध्यायः । अथातो व्रणास्रावविज्ञानीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discuss the Chapter, which treats of secretions from boils or ulcers of different types (Vranasrava-vijnaniyaadhyaya). 1
त्वङ्मांसशिरास्नाय्वस्थिसन्धिकोष्ठमर्म्माणीत्यष्टौ व्रणवस्तूनि, अत्र सर्व्वव्रणसन्निवेश: ॥२॥
A boil or an ulcer has its seat generally in one of the eight following components or principles of the body such as, the bone, the skin, the flesh, the veins, the ligaments, the joints, the viscera and the Marmas (vital parts of the body). A boil or an ulcer of any type may crop up or appear in any one of the above mentioned localities. 2
तत्राद्यैकवस्तुसन्निवेशी त्वग्भेदी व्रणः सूपचर:, शेषाः स्वयमवदीर्य्यमाणा दुरुपचाराः । तत्रायतश्चतुरस्रो वृत्तस्त्रिपुटक इति व्रणाकृतिसमासः । शेषास्तु विकृताकृतयो दुरुपक्रमा भवन्ति । सर्व्व एव व्रणा क्षिप्रं संरोहन्त्यात्मवतां सुभिषग्भिश्चोपक्रान्ताः, अनात्मवतामज्ञैश्चोपक्रान्ताः प्रदुष्यन्ति, प्रवृद्धत्वाच्च दोषाणाम् ॥३-४॥
A boil or an ulcer, which is confined only to the skin, readily yields to medical treatment, while the remaining types, as well as those, which spontaneously suppurate and burst, are hard to cure. A boil or an ulcer usually assumes a shape which is either diffused, rectangular, spheroidal or triangular; while those, which are irregular or indefinite in shape, (or have forms other than the preceding ones, should be looked upon as belonging to types which can be cured only with the utmost difficulty. Any Vrana (burst or incised abscess) in a patient, who observes a strict regimen, and who, from the outset, is placed under the medical treatment of an experienced physician (surgeon), will be speedily healed; while an ulcer, affecting a person of irregular habits and treated by a quack or an ignorant physician, will develop into one of a malignant type, which can be healed only with the greatest difficulty, on account of it becoming aggravated by the deranged bodily humours involved therein. 3-4
तत्रातिसंवृतोऽतिविवृतोऽतिकठिनोऽतिमृदुरुत्सन्नोऽवसन्नोऽतिशीतोऽत्युष्णः कृष्णरक्तपीतशुक्लादीनां वर्णानामन्यतमवर्णो भैरव: पूतिपूयमांससिरास्नायुप्रभृतिभिः पूर्ण: पूतिपूयास्राव्युन्मार्ग्युत्सङ्गघमनोज्ञदर्शनगन्धोऽत्यर्थं वेदनावान् दाहपाकरागकण्डूशोफपिडकोपद्रुतोऽत्यर्थं दुष्टशोणितास्रावी दीर्घकालानुबन्धी चेति दुष्टव्रणलिङ्गानि । तस्य दोषोच्छ्रायेण षत्वं विभज्य यथास्वं प्रतिकारे प्रयतेत ॥५॥
Symptoms of Dusta-Vranas: Malignant ulcers (Dusta Vranas) are known by the following indications: They are either too narrow or too widemouthed. They feel either extremely hard or soft to the touch and present either a raised elevated) or a depressed aspect. They are of either a black or red, yellow or white colour, and are characterised by extremes of temperature. Exhibiting strange and unusual features, they are checkered with networks of veins, ligaments, etc., and are filled with putrid and sloughing flesh and fetid pus. Indefinite and irregular in shape, they are found to exude a sort of dirty, fetid pus, which runs into fissures and cavities, following an oblique or upward course. They have a cadaverous look and smell and are characterised by extreme pain and burning sensation, attended with swelling, redness, itching and suppuration. Pustules crop up round these ulcers, which largely secrete vitiated blood, and linger unhealed for an inordinate length of time.
These ulcers may be divided into six classes [according as, they are severally caused by the deranged bodily humours (Vayu, Pitta and Kapha), or are due to their concerted action (Sannipata), or to the effects of a blow ( traumatic) or to vitiated blood.], and should be medically treated according to the nature of their respective exciting factors. 5
अत ऊद्धर्वं सर्व्वस्रावान् वक्ष्यामः । तत्र घृष्टासु छिन्नासु वा त्वक्षु स्फोटेषु भिन्नेषु विदारितेषु वा सलिलप्रकाशो भवत्यास्रावः किंञ्चिद्विस्रः पीतावभासच। मांसगतः सर्पिः प्रकाश: सान्द्रः श्वेतः पिच्छिलश्च । सिरागतः सद्यश्छिन्नासु सिरासु रक्तातिप्रवृत्तिः, पक्वासु च तोयनाडीभिरिव तोयागमनं पूयस्य, आस्रावश्चात्र तनुर्विच्छिन्नः पिच्छिलोऽवलम्बी श्यावोऽवश्यायप्रतिमश्च । स्नायुगतः स्निग्धो घनः सिंघाणकप्रतिमः सरक्तश्च। अस्थिगतोऽस्थन्यभिहते स्फुटिते भिन्ने दोषावदारिते वा दोषभक्षितत्वादस्थि निःसारं शुक्तिधौतमिवाभाति । आस्रावश्चात्र मज्जमिश्रः सरुधिरः स्निग्धश्च । सन्धिगतः पीडचमानो न प्रवर्त्तते, आकुञ्चनप्रसारणोन्नमनविनमनप्रधावनोत्कटासनप्रवाहणैश्च स्रवति । आस्रावश्चात्र पिच्छिलोऽवलम्बी सफेनपूयरुधिरोन्मथितश्च । कोष्ठगतोऽसृङ्मूत्रपूरीषपूयोदकानि स्रवति । मर्म्मगतस्त्वगादिष्ववरुद्ध- त्वान्नोच्यते ॥६॥
Secretions from ulcers: Now we shall describe the characteristic secretions from all types of ulcers. Secretions from a contused or lacerated skin, as well as from an ulcer (confined only to it), whether spontaneously bursting or surgically opened, are thin and watery in their consistency. They are characterised by a raw (fleshy) smell and a yellowish colour. An ulcer, affecting the flesh exudes a slimy, thick and white secretion like clarified-butter. A copious quantity of blood flows out of a vein recently cut, while the incidental ulcer, in its suppurating stage, secretes a copious secretion, like water flowing out of a hydrant, which is moreover detached, thin, pendent (ropy), and slimy in its character and has a brown or frosty hue. An ulcer, confined only to a ligament, secretes a sort of cold and thick secretion, like expectorated mucous, though sometimes marked with streaks of blood.
A bone, injured fractured, or suddenly cracked by idiopathic causes (derangement of the bodily humours), loses its internal marrow and appears as if washed (loses its natural gloss). It assumes the colour of an oyster shell, whereas the secretions from an ulcer, which is seated in a bone, are cold and marked by streaks of blood and lumps of marrow. An ulcer, situated in any of the bone-joints, does not exude any secretion under pressure, but secretes a sort of slimy, pendent, frothy and blood-streaked pus, when the affected limb or part is flexed, expanded, raised or lowered, as in running (moving about), sitting or standing erect, or at defecation.
An ulcer, seated in the abdominal cavity (Kostha), exudes a secretion, which is mixed with urine, fecal matter, pus or blood, and a thin or watery (serous) fluid. The secretions from an ulcer, affecting any vital part of the body, need not be separately described, as such a part naturally involves the organic principles of skin, flesh, etc.; and hence an ulcer, invading it, must necessarily exude a secretion, which is peculiar to any of the aforesaid bodily principles (skin, flesh, etc.) that has become affected. 6
तत्र त्वगादिगतानामास्रावाणां यथाक्रमं पारुष्यश्यावावश्यायदघिमस्तुक्षारोदकमांसधावनपुलाकोदकसन्निभत्वानि मारुताद् भवन्ति । पित्ताद्गोमेदकगोमूत्रभस्मशङ्खकषायोदकमाध्वीकतैलसन्निभत्वानि । पित्तवद्रक्तादतिवित्वञ्च | कफान्नवनीतकासीसमञ्जपिष्टतिलनारिकेलोदकवराहवसासन्निभत्वानि । सन्निपातात् तिलनारिकेलोदकैर्व्वारुकरसकाञ्जिकप्रसादारुकोदकप्रियङ्गफलयकृन्मुद्गयूषसवर्णत्वानीति ॥७॥
The deranged Vayu makes the secretions from an ulcer, seated in any of the seven abovesaid principles such as, the skin, flesh, veins, ligaments, bones, joints and the abdomen, respectively coarse, and rough to the touch, brown, grey, frosty, or white like the cream of curd, and coloured like the washings of an alkali, like that of meat or paddy husks. Similarly, the action of the deranged Pitta should be inferred from the secretions assuming the colours of a Gomedha (a species of bluish yellow agate), or that of the urine of a cow, or that of water saturated with the burnt ashes of conch-shells or that of Kasaya water or that of the wine known as the Madhvika or that of oil, according as the skin, flesh, etc. are respectively affected. The action of the deranged blood, in changing the nature of the secretions of ulcers in the seven above said locations, is identical with that of the deranged Pitta with the exception, that the secretions are characterised by an extremely fishy smell.
In an epidermic (confined only to the epidermis of a part) or superficial ulcer the action of the deranged Kapha manifests itself by imparting a butter-like or a Kasisa (sulphate of iron) colour to the secretions. They have lard-like hue or a colour like that of rice paste, or that of water tinged with sesamum, or a colour like that of the internal juice or water of a coconut, or a colour like that of hog’s lard, according as the flesh, a vein, a ligament, a bone or a joint is attacked. On the other hand, through the combined action of all the three deranged humours of the body (Sannipata), those secretions become coloured like the water tinged with the soakings of sesamum seeds, or the internal sap or water of a cocoanut, or the juice of the Ervaruka or the transparent surface layer of rice gruel, or the washings of the Aruka fruit, or the water tinged with the fruits of the Priyangu, or like the liver or the Mudga pulse. 7
श्लोकौ चात्र भवतः पक्वाशयादसाध्यस्तु पुलाकोदकसन्निभः । क्षारोदकनिभ: स्रावो वर्थ्यो रक्ताशयात् प्रवन् । ८ ।। आमाशयात् कलायाम्भोनिभश्च त्रिकसन्धिजः । स्रावानेतान् परीक्ष्यादौ ततः कर्म्माचरेद् भिषक् ।।९।।
Authoritative verses on the subject: An ulcer, situated in the cavity of the abdomen and secreting an exudation resembling paddy husks in colour, as well as one located in the viscera of blood (spleen or liver-Raktasayam) and exuding a secretion like alkaline water, should be deemed incurable. Similarly, an ulcer having its seat in the cavity of the stomach ( Amasaya), or in the region of the Trika, (articulation of the clavicle with the intraclavicular notch) and exuding a thin, watery secretion, coloured like the washings of Kalaya pulse, should be regarded as belonging to the same type (incurable). A physician should only take in hand the treatment of an ulcer-patient after having examined the abovesaid nature of the discharges. 8-9
अत ऊद्धर्व सर्व्वव्रणवेदना वक्ष्यामः | तोदनभेदनताडनच्छेदनायामनमन्थनविक्षेपणचुमुचुमायननिर्द्दहनावभञ्जनस्फोटनविदारणोत्पाटनकम्पनविविधशूलविश्लेषणविकिरणपूरणस्तम्भनस्वप्नाकुञ्चनाङ्कुशिकाः सम्भवन्ति, अनिमित्तविविधवेदनाप्रादुर्भावो वा मुहुर्मुहुर्यत्रागच्छन्ति वेदनाविशेषास्तं वातिकमिति विद्यात् । ओषचोषपरिदाहधूमायनानि यंत्र गात्रमङ्गारावकीर्णमिव पच्यते यत्र चोष्माभिवृद्धिः क्षते क्षारावसिक्तवच्च वेदनाविशेषास्तं पैत्तिकमिति विद्यात्। पित्तवद्रक्तसमुत्थं जानीयात् । कण्डूर्गुरुत्वं सुप्तत्वमुपदेहोऽल्पवेदनत्वं स्तम्भः शल्यञ्च यत्र तं श्लैष्मिकमिति विद्यात् । यत्र सर्व्वासां वेदनानां समुत्पत्तिस्तं सान्निपातिकमिति विद्यात् ॥१०॥
Pain and its character: Now we shall describe all the different kinds of pain, which are experienced in the several types of Vrana (ulcers) described before.
Vataja pain: Pains of pricking, piercing, thrashing, cutting, expanding, gnawing, churning, shooting, tingling, burning, breaking, bursting, pinching, uprooting, uplifting, quivering, aching of different types, shifting, stuffing, benumbing, indurating, contacting, and pains, of a spasmodic character are usually felt in ulcers. A pain, which comes on or vanishes without any apparent cause, or is varied and shifting in its character, should be ascribed to the effects of the deranged Vayu.
Pittaja pain A sensation of burning is felt in the ulcer accompanied by a sort of sucking pain. A feeling of inhaling heat or vapour, and a burning sensation running through the whole body, should be looked upon as the resultant of the deranged Pitta. At the same time the body seems as if it had been strewn over with bits of glowing charcoal. The heat or (the temperature of the affected locality) shows a steady rise, and a pain like the one incidental to the application of alkaline water (caustic solution is experienced in the ulcer).
Raktaja pain: The pain and other specific features of an ulcer due to the vitiated condition of the blood are identical with those developed by one of the Pittaja type.
Kaphaja pain: An ulcer, characteriesed by numbness, heaviness, coldness, itching and a slight pain in the affected part, and which seems as if it has been plastered over with a paste, and which proves insensible to touch, should be ascribed to the action of the deranged Kapha.
Sannipatika pain: The symptoms, described under the head of each of the preceding humoural types of ulcer, simultaneously exhibit themselves in the one brought about by the concerted action of all the deranged humours (Sannipatika). 10
अत ऊर्ध्वं व्रणवर्णान् वक्ष्यामः । भस्मकपोतास्थिवर्णः परुषोऽरुणः कृष्ण इति मारुतजस्य | नीलः पीतो हरितः श्यावः कृष्णोः रक्तः कपिलः पिङ्गल इति रक्तपित्तसमुत्थयोः । श्वेतः स्निग्धः पाण्डुरिति श्लेष्मजस्य । सर्व्ववर्णोपेतः सान्निपातिक इति ॥११॥
Colours of Vranas: Now we shall describe the colours assumed by the several types of ulcers. An ulcer, due to the action of the deranged Vayu, is rough and black, red, or ash-coloured, or is of the colour of a bone, or a pigeon. An ulcer, caused by the action of the deranged blood or Pitta, is coloured either blue, yellow, greenishbrown, black, reddish-tawny or flame-coloured. An ulcer due to the action of the deranged Kapha is white, grey and glossy. An ulcer, due to the combined action of the three deranged bodily humours, may assume any colour peculiar to them. 11
भवति चात्र न केवलं व्रणेषूक्तो वेदनावर्णसंग्रहः । सर्व्वशोफविकारेषु व्रणवल्लक्षयेद् भिषक् ॥ १२ ॥
Authoritative verses on the subject: Not only in the cases of Vrana, but in all (inflammatory) swellings of whatsoever type, the physician should carefully observe the nature of the local pain, and the colour of the epidermis. 12
Thus ends the twenty-second Chapter of the Sutrasthana in the Susruta Samhita which treats of secretion from different types of ulcers.