An English Translation of the Sushruta Samhita, Vol. II — trans. Kaviraj Kunja Lal Bhishagratna (1911)

In all cases of traumatic ulcers, cooling measures should be at once resorted to, just after (the fall or blow or stroke), for the cooling of the expanding (radiating) heat of the incidenta' ulcer, in the manner laid down in respect of (the pacification of enraged) Pitta, and a compound of honey and clarified butter should be applied on the wounded locality for the adhesion (Sandhdna) of the lacerated parts, [and for the pacification, i e, restoration to normal state, of the local blood and Vdyu aggravated through an obstruction of their passage]. Hence arises the necessity of making the tw^o-fold classification of ulcers. After that (a week) a traumatic ulcer should be treated as an idiopathic one (to all intents and purposes\ inasmuch as it is found to be associated with deranged Vayu, Pitta or Kapha Hence at that stage the medical treatment of both the forms of ulcer is (practically) the same. 3.

In short, ulcers are further subdivided (particularly) into fifteen groups, according to the presence of the morbific diathesis (deranged Vayu, Pitta Kapha and blood therein), either severally or in combinations as described (before) in the Chapter on VranaPras'na (Sutra Sthanam. Ch. XXI). Several authorities, by adding the simple uncomplicated ulcers (unassociated with any of the morbific principles of the deranged Vayu, Pitta, &c.) to the list, hold the number of types to be sixteen. (Practically they are innumerable, according to the combinations made of the deranged Vayu, etc. and the different Dh£itus of the system). 4.

Symptoms of ulcer may be divided into two kinds viz., General and Specific. Pain is the general characteristic

Chap. I.] CHIKITSA STHANAM.

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(of all forms of ulcer), while the .symptoms, which are exhibited in each case according to the virtue of the deranged Vayu, Pitta, etc, involved therein, are called the Specific ones. A Vrana is so named from its etymology (the term being derived from the root Vrana — to break) and signifies a cracked or broken condition ^of the skin and flesh of the afflicted part) of the body. 5.

The Vataja- Ulcer :— The ulcer assumes a brown or vermilion colour and exudes a thin, slimy and cold secretion, largely attended with tension, throbbing and a sort of pricking and piercing pain (in its inside), which seems as if being expanded and extended. This type of ulcer does not extend much and is characterised by a complete destruction of the tissue (flesh). The Pittaja ulcer is rapid in its growth. It assumes a bluish yellow colour, exudes a hot secretion resembling the washings of Kims'uka flowers, and is attended with burning, suppuration and redness, being surrounded with eruptions of small yellow-coloured pustules. The Kaphaja ulcer is found to be extended and raised around its margin and is accompanied by an irresistible itching sensation. It is thick and compact (in its depth), covered with a large number of vessels and membranous tissues (Sira-snd.yu-jala), grey in colour, slightly painful, hard and heavy, and exudes a thick, cold, white and slimy secretion. The Raktaja ulcer (resulting from a vitiated condition of the blood) looks like a lump of red coral. It is often found to be surrounded by black vesicles and pustules and to smell like a strong alkali. It becomes painful and produces a sensation, as if fumes were escaping out (of it). Bleeding (is present) and the specific symptoms of the Pittaja type are likewise found to supervene. 6 — 9.

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The Vata-Pittaja Type :— An ulcer due to the concerted action of the deranged Vayu and Pitta is marked by a pricking and burning pain and a red or vermilion colour. A sensation of fumes arising out of it (is also felt) and the ulcer exudes a secretion which partakes of the characteristic colours of both the deranged Vayu and Pitta. An itching and piercing pain is felt in the ulcer due to the combined action of the deranged Vayu and Kapha (Kapha-Vataja type), which becomes heavy and indurated, constantly discharging a cold, slimy secretion. An ulcer resulting from the deranged condition of the Pitta and Kapha (Kapha-Pittaja type) becomes heavy, hot and yellow. It is marked by a burning sensatian and exudes a pale, yellow-coloured secretion. An ulcer marked by the aggravated condition of the deranged Vayu and blood (Vata-Raktaja type) is dry and thin and is largely attended with a piercing pain and anaesthesia. It exudes blood or a vermil-coloured secretion and is marked by the combined hues respectively peculiar to the deranged Vayu and blood. An ulcer due to the combined action of the deranged Pitta and blood (Kakta-Pittaja type) is marked by a colour which resembles the surface cream of clarified butter. It smells like the washing of fish, is soft, spreading (erysipelatous), and secretes a hot blackish matter. An ulcer due to the combined action of the deranged Kapha and blood (Kapha-Raktaja type) is red-coloured, heavy, slimy, glossy and indurated. It is usually marked by itching and exudes a yellowish bloody secretion. An ulcer due to the concerted action of the deranged Vciyu, Pitta and blood (Vata-Pitta-Raktaja type) i'^ maikcd by a .sort of throbbing, pricking and burning pain. It discharges a flow of thin yellowish