The Sushruta Samhita — trans. Bhishagratna

40-46. Measures which contribute to a spontaneous bursting by medicinal applications (Da(rana) of a swelling should be adopted in the case of an infant or an old or enfeebled

Chap, i.] CHlklTSA StHANAM. 249

patient, or of one incapable of bearing the pain (of a surgical operation), or of a person of a timid disposition, as well as in the case of a woman, and in the case of swellings which appear on the vulnerable parts (Marmas) of the body. Remedies which lead to the spontaneous bursting of a swelling should be applied by a wise physician to a well-suppurated swelling drawn up and with all its pus gathered to a head ; or an alkaline substance should be applied on its surface and a bursting should be effected when the Doshas are found to be just aggravated by the incarcerated pus. 47.

An ulcer which is indurated, whose edges are thick and rounded, which has been repeatedly burst open, and the flesh of whose cavity is hard and elevated, should be scarified by a surgeon ; or, in other words, an indurated ulcer should be deeply scarified, one with thick and rounded edges should be excessively scarified, while the one which has been repeatedly burst open should be entirely scraped off. An ulcer with a hard and elevated bed should be scraped evenly and longitudinally along the length of its cavity. In the absence of a scarifying instrument, the act should be performed with a piece of Kshauma (cloth made of the fibres of an Atasi plant), a linen (Plota) or a cotton pad (Pichu), or with such alkaline substances as nitrate of potash, Samudra-phena, rock-salt, or rough leaves of trees (e. g., those of Udumbara, &c.). 48.

The cavities or courses of a sinus, or of an ulcer which had any foreign matter lying imbedded in its inside, or which takes a crooked or round about direction, as well as of the one formed into cavities within its interior, should

* This scraping off of the ulcer should be done by an instrument of Surgery and not by any rough leaf or the like, nien'ioned hereafter.

^2

p. 250

^2p. 250 be probed by gently introducing the tender fibres of bamboo sprouts (Karira), a (lock of) hair, a finger, or an indicator into its inside. The course of a sinus occurring about the anus or in the region of the eyes (Netra- Vartma) should be probed with the slender fibres of Chuchchu, Upodika, or Karira, in the event of their mouths being narrow and attended with bleeding. The Salya (incarcerated pus, etc.) should be extricated, whether the mouth of the sinus is constricted or otherwise, in conformityw ith the directions laid down before on that behalf. In diseases amenable to acts of puncturing (Vyadhana), the knife should be inserted into the seat of the disease to a proper depth and extent, to be determined by its situation in the body, and the Doshas (pus, etc.) should be let out, as stated before. Ulcers with a wide mouth, unattended with any symptoms of suppuration, and occurring in a fleshy part of the body, should be sutured up, and the adhesion (Sandhana) of the edges should likewise be effected, as directed before. A plaster composed of drugs (capable of drawing out and secreting the pus), as described before, should be applied around the mouth of an ulcer seated in any of the Marmas (vulnerable parts), or full of pus in its inside, with a narrow-mouthed aperture. The plaster should be removed when dry, and should not be applied on the orifice of the ulcer, as it would, in that case, interfere with the spontaneous secretion of pus (Dosha). 49-54-

An excessive haemorrhage incidental to such acts, as excessive hurting of the vein, etc., should be arrested with suitable styptic* measures and remedies (Sonitasthdpana).

* Styptic measures are of four kinds— Sandhana,Skandana, Pachana, and Dahana. See Sutra- Sthanam, Chap. XIV.

Chap. I.J CHIKITSA STHANAM. . 25 1

An ulcer attended with fever, suppuration and burning sensation due to the excited state of the deranged Pitta and congestion of blood should be allayed (Nirvapana — literally putting out) with suitable and proper medicinal remedies. It should be allayed with compounds made up of the proper cooling drugs (of the Mis'raka chapter), pasted with milk and lubricated with clarified butter. Cooling plasters (Lepa) should then be applied as well. 55-56.

It should be allayed with compounds made up of the proper cooling drugs (of the Mis'raka chapter), pasted with milk and lubricated with clarified butter. Cooling plasters (Lepa) should then be applied as well. 55-56.

An ulcer whose flesh is eaten away, which discharges a thin secretion, or is non-suppurating in its character, and is marked by roughness, hardness, shivering and the presence of an aching and piercing pain, should be fomented with a poultice-like efficacious preparation (UtkairikaL )cooked with the drugs of Vayu-subduing properties, those included within the Amla-varga, and those which belong to the Kdkolyddi group, and with the oily seeds (such as linseed, sesamum, mustard, castor, etc.). An indurated, painful, faetid, moist and slimy ulcer should be washed with a disinfectant or purifying lotion consisting of a decoction of the drugs mentioned before for the purpose. 57-58.

Plugs or lints plastered with a paste of the purifying drugs (enumerated before) should be inserted into an ulcer with any foreign matter (e.g., pus) lying embedded in it, or into one with a deep but narrow opening, or into one situated in a fleshy part of the body. An ulcer full of putrid flesh and marked by the action of the highly deranged Doshas (Vayu and Kapha) should be purified with a paste of the aforesaid available drugs making up the plug. An ulcer of a Pittaja origin, which is deepseated and attended with a burning sensation and with suppuration, should be purified with the application of ^ medicated clarified butter, prepared with the purifyingp. 252 drugs with an admixture of Kdrpasa-phala*. An intelligent Surgeon should purify an ulcer with raised flesh, and which is dry and is attended with scanty secretion with an application of medicated mustard oil. An indurated ulcer, refusing to be purified with the foregoing medicated oils, should be purified with a duly prepared decoction of the drugs enumerated before (Sutra, chap. 38,— the Salas^rddi group) and prepared in the following manner of Rasa-kriyat. A decoction of the said drugs duly prepared should be saturated with an after- throw of Haritdla, Manahs'ild, Kdsisa and Smirdshtra earth, and well compounded together ; the preparation should also be mixed with the expressed juice of Mdtulunga and with honey. The medicine thus prepared should be applied to the ulcer on every third or fourth day. 59.