The Sushruta Samhita — trans. Bhishagratna

Guggulu should be taken every morning with a decoction of Triphald^ Ddrvi and

p. 315

Patola or with that of Kus,'a roots* ; it may also be taken with an adequate quantity of cow's urine, or with alkalinef or tepid water. The patient should take boiled rice with soup, milk, or extract of meat after the Guggulu has been digested. Diseases such as internal tumour (Gulma), urinary complaints (Meha), Uddvarta, ascites, fistula-in-ano, worms in the intestines, itches, an aversion to food, leucoderma (Svitra), tumour and glands (Arvuda>, sinus, Adhya-Vdta, swelling (oedema), cutaneous affections (Kushtha) and malignant sores and ulcers readily yield to it, if used for a month (with the observance of the regimen of diet and conduct laid down previously). It also destroys the deranged Vdyu incarcerated in the Koshtha, bones and joints, just as a thunderbolt will destroy trees. 44.

Thus ends the fifth Chapter of the Chikilsita Sthanam in the Sus'ruta*
Samhita which deals with the medical treatment of Mahd-Vafa-Vyddhi.

* Some explain that a third decoction should be that of Triphala, Ddrvi, Patola and Kus'a grass taken together.— Dallana.

The decoctions may be prepared separately with Triphala, Darvi,
Patola and Kus'a.— ^aT.

t Some read '^Kshira" (milk) in the place of ''Kshara" (alkali).

CHAPTER VL

Now we shall discourse on the medical treatment of
Haemorrhoids (A rsas). i.

The remedial measures in haemorrhoids may be grouped under four subheads ; namely, the employment of (active) medicinal remedies, the application of an alkali (into the seat of the disease), actual cauterization (of the polypii) and surgical operation. A case of recent origin involving the action of theDoshas to a slight degree and uncomplicated with any grave or dangerous symptom and complication may prove amenable to medicine alone. Deep-seated polypii. which are soft to the touch and markedly elevated and extended (external — D R.), should be treated with alkaline applications, while those which are rough, firm, thick and hard should be cauterized with fire. Polypii which are raised, exuding and slender at the roots should be surgically treated. Hcemorrhoids which are held amenable to medicine and are not visible (to the naked eye) should be treated with the help of medicines alone. Now, listen to the procedure to be adopted in the treatment of Ars'as which would require alkaline applications, a cauterization, or a surgical operation. 2.

Application of Kshara:— The body of

Now, listen to the procedure to be adopted in the treatment of Ars'as which would require alkaline applications, a cauterization, or a surgical operation. 2.

Application of Kshara:— The body of

the patient suffering from haemorrhoids, in the event of possessing sufficient strength, should be anointed and duly fomented. He should be made to eat warm but demulcent food (Anna) in a fluid state (of a gruel-like consistency) to alleviate the excessive pain incidental to the action of the deranged Vdyu. In a season neither too hot nor too cold, and when thep. 317 sky is cloudless, he should be placed in a raised up position in a clean and well-equipped place on a plain slab or on a clean bed with his head resting on the lap of an attendant and the anal region exposed to the sun. In this position the waist should be made to elevate a little and to rest on a cushion of cloths or blankets. The neck and the thighs of the patient should be drawn out, and then secured with trappings and held fast by the attendants so as not to allow him to move. Then a straight and slender-mouthed instrument (somewhat like the modern rectal speculum^ lubricated with clarified butter, should be gently inserted into the rectum and the patient should be asked to strain down gently at the time. After seeing the polypus (through the speculum), it should be scraped with an indicator and cleansed with a piece of cotton or linen after which an alkali should be applied to it. The exterior orifice of the instrument should be closed with the palm of the hand after this application and kept in that manner for a period that would be required to utter a hundred words.

Then after having cleansed the polypus, a fresh application should be made according to the strength of the alkali and the intensity of the aggravated Doshas involved in the case. Further application of the alkali should be stopped and the polypus washed with fermented rice-gruel (Dhdnyamla), curd-cream, Sukta, or the juice of acid fruits, in the event of its having been found to have become a little flabby, bent down, and to have assumed the colour of a ripe Jambu fruit. After that it should be cooled with clarified butter mixed with Yashti-Madhu, the trappings should be removed and the patient should be raised up and placed in a sitting posture in warm water and refreshed with

3l8 THE SUSHRUTA SAMHITA. [Chap. VI.

After that it should be cooled with clarified butter mixed with Yashti-Madhu, the trappings should be removed and the patient should be raised up and placed in a sitting posture in warm water and refreshed with

3l8 THE SUSHRUTA SAMHITA. [Chap. VI.

sprays of cold water, or, according to some authorities, with warm water. Then the patient should be made to lie in a spacious chamber, not exposed to the blasts of cold winds (specially), and advised as regards his diet and regiinen Each of the remaining polypii, if any, should be cauterized with the alkaline application at an interval of seven days. In case of a number of polypii, those on the right side should be first cauterized and then those on the left, and after that those on the posterior side ; and lastly those that would be found to be in front. 3.

Polypii, having their origin in the deranged Vs^yu and Kapha, should be cauterized with fire or alkali ; while those, which are the outcome of the deranged Pitta and vitiated blood should be treated with a mild alkali alone. A perfect and satisfactory cauterization (Samyag^- dagdha) of a polypus should be understood from such symptoms as, restoration of the bodily Vdyu to its normal condition, relish for food, keenness of the appetite, lightness of the body and improvement in strength, complexion and pleasure. An over-cauterized (Atidagdha) polypus gives rise to such symptoms as, cracking of the region of the anus, a burning sensation (in the affected locality), fainting, fever, thirst, and pn fuse haemorrhage (from the rectum), and consequent complications ; while an insufficiently cauterized (Hinadagdha) polypus is known by its tawny brown colour, smallness of the incidental ulcer, itching, derangement of the bodily Vdyu^ discomforts of the cognitive organs and a non-cure of the disease. 4.

A large polypus, appearing in a strong person, should be clipped off (with a knife) and cauterized with fire. As regards an external polypus full of extremely aggravated Doshas (Vdyu, Pitta, Kapha and blood) no

p. 319