The Sushruta Samhita — trans. Bhishagratna

An incision made by inserting the knife in one side is called the Gotirthaka (longitudinal). All exuding (bleeding) channels in the affected region should be cauterized with fire by the surgeon.

p. 340

A case of the ^ataponaka type occurring in a person of timid disposition or of delicate constitution, is extremely difficult to cure. Medicinal fomentations endowed with the virtue of arresting secretion and alleviating pain, should be quickly applied (to the seat of the disease). Fomentations with Kris'ard, or Pdyasa (porridge), made with the aforesaid Svedaniya (diaphoretic) drugs with a decoction of the drugs constituting the Vilvddi group, Vrikshddani and roots of the castor-plant mixed and boiled together with the flesh of the Ldva, Vishkira (a kind of bird) and that of animals living in swampy or marshy land or aquatic in their habits or Grdmya animals, and then kept in an oily pitcher and applied in the way of a Nddi-Sveda (fomentation through Nddi or pipe), should be at once applied to the seat of the ulcer. Sesamum, castor-seeds, linseed, iJ/<i5^^-pulse, barley, wheat, mustard-seeds, salts and the Amla-Varga (see Rasa-Vijndniya chapter) should be boiled in a saucer and the affected part or ulcer should be fomented therewith. After being fomented, the patient should drink (a potion consisting of) Kushtha, salts (the five officinal kinds of salts) Vachd^ Hingu and Ajamoda taken in equal parts and mixed with (an adequate quantity of) clarified butter, grape-wine (Mdrdvika), K^njika (Amla), Surci or Sauviraka.* Subsequent to that, the ulcer should be wetted with the Madhuka-oW and the rectum should be washed with medicated oils which would alleviate pain due to the action of the deranged and aggravated Vdyu. The preceding r^^edicinal remedies tend to bring about the outflow or evacuations of stool and urine through their natural channels or courses, and undoubtedly alleviate all acute and supervening distresses which specifically mark

* By the use of this potion the digestive power is increased.

Chap. Vlir.] CHIKITSA STHANAM. 34I

the progress of the disease. We have described the treatment of a case of fistula- in-ano of the Sataponaka (sieve) type ; now listen to me about the treatment of the Ushtragriva (camel's neck) type of the disease. 5.

Treatment of Ushtra-griva :— The ulcer

We have described the treatment of a case of fistula- in-ano of the Sataponaka (sieve) type ; now listen to me about the treatment of the Ushtragriva (camel's neck) type of the disease. 5.

Treatment of Ushtra-griva :— The ulcer

should first be searched with a probe or director and, after an operation, an alkali should be applied to it. To remove all sloughed off or sloughing flesh and membranes cauterization with fire is forbidden. [The fissures of pus (sinuses) and sloughed off flesh should be first drawn out]. A plaster of clarified butter and pasted sesamum should then be applied to it, and the ulcer duly bandaged. Clarified butter should be constantly applied over the bandage which should be removed on the third day. Cleansing or disinfecting (^S'odhana) measures should then be used by the surgeon, according to the Doshas involved in the ulcer, and the successive healing (Ropana) measures resorted after its being properly purified (S'odhana). 6

Treatment of ParisrsCvi :— In a case of the

ParisrAvi (exuding) type, where there is bleeding and secretion from the ulcer, the sinus and the cavities of pus should be first removed and then cauterized with an alkali or with fire by an intelligent surgeon. The region of the anus should then be kept wet by the sprinkling of lukewarm Anu-toila (described in the chapter on V^ta-vy^dhi). Warm plasters, or poultices, mixed with Yavakshdra and the urine (of a cow) should then be applied. Decoction of the emetic drugs as the seeds of Madana, etc.), should also be sprinkled slightly on the affected part. The ulcer when found to be softened and nearly free from pain and secretion (owing to the preceding measures) should be searched with a probe and the principal sinus should be cut open and again342. THE SUSHRUTA SAMHITA. [Chap. VIII. completely cauterized with fire or with an alkali. The incisions should be made in the shape or form of a Kharjura-patra (leaf of the date-palm), Ardha-chandra (half-moon), Chandra-chakra (moon's disc), Suchi-mukha (needle's mouth), or Avdmmukha (with downward mouth). After that the ulcer should be purified with mild cleansing or disinfecting remedies (as described above) 7.

After that the ulcer should be purified with mild cleansing or disinfecting remedies (as described above) 7.

In the case of an infant cauterization with fire or with an alkali, the use of strong purgatives and surgical operations are forbidden in the case of the disease (Bhagandara), whether outer-mouthed or inter-mouthed. Medicinal remedies calculated to be mild, though keen in their efficacy, should be used in such cases. A plug or a Varti in the shape of a wick and made of powdered Aragvadha, Haridrd and Kala, mixed with honey and clarified butter, should be inserted into the ulcer for purifying purposes. This medicinal compound speedily brings about the healing of a sinus, just as the wind will drive away a cloud. 8—9

Treatment of Agantuka Bhagandara :— The sinus in a fistula of traumatic origin should be carefully cut open by a surgeon (with a knife) and cauterized, according to the rules laid down, with a red-hot Jambvoshtha (instrument) or with a redhot director (SaUka). Vermifugal remedies should be applied to it, and measures laid down in connection with the extraction of a Salya from the body should be carefully resorted to. 10.

Treatment of Tridoshaja Bhagandara : — A case of Bhagandara, due to the concerted action of the three Doshas, should be treated without holding out any hope of recovery tot he patient's people, or should be given up as hopeless. The measures and remedies mentioned above should be adopted in

Chap. VIII.] CHIKITSA STHANAM. 343