एकोनविंशोऽध्यायः । अथातो व्रणितोपासनीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १९ ॥ ॥१॥
Now we shall discuss the Chapter which treats of the management of nursing of patient with an ulcer etc. (Vranitopasaniya-adhyaya). i
व्रणितस्य प्रथममेवागारमन्विच्छत्, तच्चागारं प्रशस्तवास्त्वादिकं कार्य्यम् ॥२॥
First of all a suitable chamber should be sought and selected for a patient, suffering from an ulcer. It should be roomy and spacious and situated in a commendable site. 2
प्रशस्तवास्तुनि गृहे शुचावातपवर्ज्जिते ।
निवाते न च रोगाः स्युः शरीरागन्तुमानसाः । ॥३॥
Metrical Text:Diseases, whichare physical, mental or traumatic in their origin, can never attack a person who dwells in a clean and spacious chamber, protected from excessive heat, and strong gusts of wind. 3
तस्मिन् शयनमसम्बाधं स्वास्तीर्णं मनोज्ञं प्राक्शिरस्कं सशस्त्रं कुर्वीत ॥४॥
The bed should be spread clean, ample and comfortable, with the head of the beadstead turned towards the east, and provided with some kind of a weapon. 4
सुखचेष्टाप्रचार: स्यात् स्वास्तीर्णे शयने व्रणी। प्राच्यां दिशि स्थिता देवास्तत्पूजार्थं नतं शिरः । ॥ ५ ॥
तस्मिन् सुहृद्भिरनुकूलैः प्रियंवदैरुपास्यमानो यथेष्टमासीत
Metrical Texts: In a spacious and well-spread bed, an ulcerpatient can toss about and move his limbs with the greatest comfort. The reason for the head being turned towards the east is that the patient may easily make obeisance to the (demons and) celestial spirits, who inhabit that quarter of the sky. Thus the patient shall lie in comfortable posture, attended upon by his sweet-talking friends and relations.5-6
सुहृदो विक्षिपन्त्याशु कथाभिर्व्रणवेदनाः । आश्वासयन्तो बहुशस्त्वनुकूलाः प्रियंवदाः ।।७।।
दिवानिद्रावशगः स्यात् । च दिवास्वप्नाद् व्रणे कण्डूर्गात्राणां गौरवं तथा ।।८।।
श्वयथुर्वेदना राग: स्रावश्चैव भृशं भवेत् ।।९।।
Metrical Text: The friends and relations of a patient shall alleviate the pain of his ulcer with pleasant and interesting topics, and by solacing him with the prospect of a speedy recovery. An ulcerpatient should not sleep in the day time, as it tends to aggravate the pain, swelling and redness of the ulcer, increases its exudations, and gives rise to itching and heaviness of the limbs. 7-9
उत्थानसंवेशनपरिवर्त्तनचंक्रमणोच्चैर्भाषणादिषु चात्मचेष्टास्वप्रमत्तो व्रणं संरक्षेत् ॥१०॥
The patient must carefully protect the ulcer when moving any of his limbs, such as standing up, or sitting down, or turning on his sides, or while moving about, or speaking in a loud voice. 10
स्थानासनं चंक्रमणं दिवास्वप्नं तथैव च । व्रणितो न निषेवेत शक्तिमानपि मानवः ।।११ ।।
उत्थानाद्यासने स्थानं शय्या चातिनिषेविता । प्राप्नुयान्मारुतादङ्गे रुजस्तस्माद् विवर्ज्जयेत् ।। १२ ।।
Metrical Text: An ulcer-patient, even if he feels himself strong and capable, should avoid a standing or sitting posture, as well as locomotion, and day-sleep. These acts done to excess, or a long confinement to bed would aggravate the bodily Vayu, thus causing pain in the ulcer. 11-12
गम्यानाञ्च तथा स्त्रीणां सन्दर्शनसम्भाषणसंस्पर्शनानि दूरत एव परिहरेत् ॥१३॥
He should studiously avoid the company and touch of, and even conversation with, women with whom he can legitimately have intercourse. 13
स्त्रीदर्शनादिभिः शुक्रं कदाचिच्चलितं सवेत् ।
ग्राम्यधर्म्मकृतान् दोषान् सोऽसंसर्गेऽप्यवाप्नुयात् ।।१४।।
Metrical Text: The sight of a woman etc. might lead to the secretion and emission of semen and give rise to all the distressing symptoms, which are consequent upon an act of actual coitus under the circumstance. 14
नवधान्यमाषतिलकलायकुलत्थनिष्पावहरितकशाकाम्ललवणकटुकगुडपिष्टविकृति वल्लूरशुष्कशाकाजाविकानूपौदकमांसवसाशीतोदककृ शरापायसदधिदुग्धतक्रप्रभृतीन् परिहरेत् ॥१५॥
Prohibited diet: A diet consisting of newly harvested Dhanya, Masa pulse, Sesamum, Kalaya, Kulattha, and Nispava should be avoided by an ulcer-patient. The pot-herbs known as Haritakasaka, acid, saline or pungent substances, treacle and its modifications, cakes, dried meat, dried pot-herbs, goat’s flesh, mutton, meat of animals which are amphibious in their habits or which live close to water, lard, cold water, Krsara (a composition prepared with sesamum, Masa pulse and rice), Payasa ( a sweetoned preparation of rice, milk and sugar boiled together), curd, milk and whey should be regarded as unwholesome. 15
तक्रान्तो नवधान्यादिर्योऽयं वर्गः विज्ञेयः दोषसञ्जननो ह्येष प्रकीर्त्तितः पूयवर्द्धनः ।।१६।।
मद्यपच मैरेयारिष्टासवसीधुसुराविकारान् परिहरेत् ।।१७।।
1. Different reading : Riding in a carriage or on horseback, and garrulousness.
मद्यमम्लं तथा रुक्षं तीक्ष्णमुष्णञ्च वीर्य्यतः । आशुकारि च तत् पीतं क्षिप्रं व्यापादयेद् व्रणम् ।। १८ ।।
Metrical Texts: Vegetables and articles which belong to the groups commencing from the one techinically known as the NavaDhanya-Varga, and ending with the one known as the Takra-Varga, should be understood as possessed of the property of increasing the pus in an ulcer and of aggravating the deranged bodily humours. If in the habit of taking wine, an ulcer-patient will do well to avoid the use of spirituous liquors, such as Maireya, Arista, Asava, Sidhu, Sura and its varieties.¹ An ulcer may develop into one of a malignant type through the use of a wine which is acid in its taste, or is sharp, dry and heat-making in its potency, or is followed by almost instantaneous intoxication. 16-18
वातातपरजोधूमावश्यायातिसेवनातिभोजनानिष्टभोजनश्रवणदर्शनेर्ष्यामर्षभयक्रोधशोकध्यानरात्रिजागरणविषमाशनशयनोपवासवाग्व्यायामस्थानचंक्रमणशीतवातविरुद्धाध्यशनाजीर्णमक्षिकाद्या बाधा: परिहरेत् ॥१९॥
An ulcer-patient should avoid all things that retard the progress of a rapid cure, such as wind, dust, smoke, exposure to heat and cold, over-eating, unpleasant sounds and sights, envy, humiliation, fear, anger, grief, scheming, keeping of late hours, sitting or lying in an uneven posture, fasting, garrulousness, physical exercise, leaping or a standing posture, locomotion, exposure to cold winds, ingestion of unwholesome, in-compatible or indigestible substances, and fleabites on the affected locality. 19
व्रणिनः संप्रतप्तस्य कारणैरेवमादिभिः । क्षीणशोणितमांसस्य भुक्तं सम्यङ् न जीर्य्यति ॥ २० ॥
अजीर्णात् पवनादीनां विभ्रमो बलवान् भवेत् । ततः शोफरुजास्रावदाहपाकानवाप्नुयात्।॥ २१ ॥
Metrical Texts: The food, partaken of by a weakened and emaciated ulcer-patient, is not fully digested owing to the above mentioned, and other multifarious causes. The undigested food violently
1. The species of wine which are made of the expressed juice of grapes and are antacids in their virtues, as well as those mentioned under the head of Haemoptysis, may be given to an ulcer-patient.
disturbs and aggravates the bodily humours, which move about in the body and give rise to swelling, secretion, burning pain and suppuration in the ulcer. 20-21
सदा नीचनखरोम्णा शुचिना शुक्लवाससा शान्तिमङ्गलदेवताब्राह्मणगुरुपरेण भवितव्यम् । तत् कस्य हेतोः ? हिंसाविहाराणि हि महावीर्य्याणि रक्षांसि पशुपतिकुबेरकुमारानुचराणि मांसशोणितप्रियत्वात् क्षतजनिमित्तं व्रणिनमुपसर्पन्ति, सत्कारार्थं जिघांसूनि वा कदाचित् ॥ २२ ॥
An ulcer-patient should always be clad in clean and white garments, have his hair and nails closely clipped and pared off, and live in humble devotion to the Brahmanas, to the gods and the preceptors. Th rites of benediction and divine peace should be done into him, wherefore? Because the monsters and demons of mighty prowess, who are the attendants of the gods Pasupati, Kubera and Kumara, roam about in quest of prey, and visit the bedside of an ulcerpatient out of their fondness for flesh and blood, being attracted thereto by the smell of the secreted and morbid matter in the ulcer. These evil spirits come to take away the life of a patient in a case which is doomed to terminate fatally, while in a successful case their advent is due to the desire of extorting sacrificial oblations from him. 22
भवति चात्र
तेषां सत्कारकामानां धूपबल्युपहारांश्च
प्रयतेतान्तरात्मना भक्ष्यांश्चैवोपहारयेत् ॥ २३ ॥
Authoritative verse on the subject: These honour-seeking evil spirits should be worshipped and propitiated with the whole heart; and offerings of burning incense sticks, edibles and sacrifices, etc. should be made to them with the greatest humility. 23
ते तु सन्तर्पिता आत्मवन्तं न हिंस्युः । तस्मात् सततमतन्द्रितो जनपरिवृतो नित्यं दीपोदकशस्त्रस्त्रग्दामपुष्पलाजाद्यलङ्कृते वेश्मनि सम्पन्मङ्गलमनोऽनुकूला: कथा: श्रृण्वन्नासीत ॥२४॥
The evil spirits, worshipped and propitiated as above, spare the life of a self-controlled patient (out of compassion). Hence he shall be kept in a chamber furnished with flowers, garlands, weapons, fried paddy, and lamps kept continuously burning. His friends and relations should regale him with fond and loving topics to drive away the feeling of sleepiness with the prospect of a speedy cure. 24
सम्पदाद्यनुकूलाभिः कथाभिः प्रीतमानसः ।
आशावान् व्याधिमोक्षाय क्षिप्रं सुखमवाप्नुयात् ॥ २५ ॥
Metrical Texts: A patient, constantly cheered with the suggested prospects of a speedy recovery, and beguiled with pleasant and congenial discourses, soon gets rid of his complaint. 25
ऋग्यजुः सामाथर्व्ववेदाभिहितैरपरैश्चाशीर्व्विधानैरुपाध्याया भिषज श्वसन्ध्ययोः रक्षां कुर्युः ॥ २६ ॥
Morning and evening, the physicians and the Brahmanas should perform the rites of benediction, over him, as laid down in the Rg, Yajur, Sama and the Atharva Vedas. 26
सर्षपारिष्टपत्राभ्यां सर्पिषा लवणेन च।
द्विरह्नः कारयेद् धूपं दशरात्रमतन्द्रितः ।। २७ ।।
Metrical Texts: For ten consecutive days, the room of the patient should be diligently fumigated, morning and evening, with the fumes of mustard, Arista-leaves, clarified-butter and salt made into a kind of incense stick. 27
छत्रातिच्छत्रे लाङ्गूलीं जटिलां ब्रह्मचारिणीं लक्ष्मीं गुहामतिगुहां वचामतिविषां शतवीर्या सहस्रवीर्य्यां सिद्धार्थकांश्च शिरसा धारयेत् ॥२८॥
Drugs such as Chatra, Atichhatra, Languli, Jatila, Bramhacharini, Laksmi, Guha, Atiguha, Vaca, Ativisa sata-virya, Sahasra-virya and white mustard seeds should be placed on the head of the patient. 28
व्यज्येत बालव्यजनैर्व्रणं न च विघट्टयेत् । न तुदेन्न च कण्डूयेच्छयानः परिपालयेत् ||२९ ।।
अनेन विधिना युक्तमादावेव निशाचराः । वनं केशरिणाऽक्रान्तं वर्जयन्ति मृगा इव | ॥ ३० ॥
Metrical Texts: The patient should be fanned with blowing chowries so that the ulcer may not be in any way thrashed or lacerated during the fanning. The ulcer should not be scratched or pressed. The
patient should be carefully watched, while asleep. Demons, that get abroad in the night, fly from the presence ofanulcer-patient protected as above,asherds of deery fly from the forest wherelionsarefound. 29-30
जीर्णशाल्योदनं स्निग्धमल्पमुष्णं द्रवोत्तरम् । भुञ्जानो जाङ्गलैर्मासैः शीघ्रं व्रणमपोहति ॥ ३१ ॥
तण्डुलीयकजीवन्तीसुनिषण्णकवास्तुकैः । बालमूलकवार्त्ताकपटोलैः कारवेल्लकैः।।३२ ।।
सदाडिमैः सामलकैर्घृतभृष्टैः ससैन्धवैः । अन्यैरेवंगुणैर्वापि मुद्गादीनां रसेन वा । सक्तून् विलेपीं कुल्माषं जलञ्चापि श्रृतं पिबेत् ॥ ३३ ॥
व्रणं श्वयथुरायासात् स च रागश्च जागरात् । तौ च रुक् च दिवास्वप्नात् ताश्च मृत्युश्च मैथुनात् ॥ ३४ ॥
Regimen of diet and conduct: An ulcer-patient living on a diet consisting of old and boiled Sali rice, not extremely liquefied, and treated with clarified-butter, and taken with the cooked meat of animals of the Jangala species, soon gets rid of his disease. A diet consisting of boiled rice, the pot-herbs known as the Tanduliyaka, Jivanti, Sunisannaka, Vastuka, immature Mulaka, Vartaku, Patola and Karvellaka, fried with Saindhava (rock-salf) and clarified-butter, and seasoned with the expressed Juice of Dadima and Amalaka, or of Mudga soup treated as above, should be prescribed for the patient. Barley powder, Vilepi, Kulmasa and boiled water, should be likewise given to the patient for food and drink. Fatigue or physical exercise causes the ulcer to swell, while the keeping of late hours increases the local redness. A sleep during the day under the circumstance would give rise to pain in the affected part, while a coitus may bring on the death of the patient. 31-34
दिवा न न निद्रावशगो निवातगृहगोचरः । व्रणी वैद्यवशे तिष्ठन् शीघ्रं व्रणमपोहति ।। ३५ ।।
एवंवृत्तसमाचारो व्रणी सम्पद्यते सुखी । आयुश्च दीर्घमाप्नोति धन्वन्तरिवचो यथा ॥३६॥
An ulcer-patient, not given to sleep in the day, and living in a room protected from gusts of wind, and strictly following the instructions of his physician, (surgeon) is healed in the course of a very short time and will enjoy a long life through the observance of the abovesaid regimen of diet and conduct. This is the dictum of Dhanvantari. 35-36
इति सुश्रुतसंहितायां सूत्रस्थाने व्रणितोपासनीयो नामैकोनविंशोऽध्यायः ॥१९॥
Thus ends the nineteenth Chapter of the Sutrasthana in the Susruta Samhita which treats of the nursing or management of an ulcer-patient.
