blood and produces a sensation, as if fumes were escaping (out of its cavity). An ulcer due to the con- certed action of the deranged Vayu, Kapha and blood (Vaita-Sleshma-Raktaja type) is usually attended with itching, throbbing and tingling sensations and thick, grey, blood-streaked discharge. An ulcer associated with the deranged Kapha, Pitta, and blood (Kapha-Pitta- Raktaja type) is largely attended with redness, itching, suppuration and burning sensation. It emits a thick, greyish, bloody secretion. An ulcer marked by the concerted action of the deranged Vayu, Pitta and Kapha (Satanipaitika) is attended with diverse kinds of pain, secretion, colour, &c., peculiar to each of these types. An ulcer associated with the combined action of the deranged Vayu, Pitta, Kapha and blood (Va^ta-Pitta-Kapha-Raktaja type) is attended with a sensation, as if it were being burnt and lacerated. It is largely accompanied by throbbing, itchin^^ sensation, a sort of pricking and burning pain, with complete anaesthesia in the locality; redness, suppuration, various other kinds of colour, pain and secretion are its further characteristics. 10 — 20.
An ulcer (Vrana) which is of the same colour with the
back of the tongue, soft, glossy, smooth, painless, well-
shaped and marked by the absence of any kind of
secretion whatsoever, is called a clean ulcer (Suddha-
Vrana). 21.
Therapeutics :— The medical (and surgical)
treatment of a Vrana (ulcer) admits of being divided
into sixty * different factors, such as,— Apatarpana
(fasting or low diet), Alepa (plastering), Parisheka
(irrigating or spraying), Abhyanga (anointing), Sveda
* N.B. Authorities, however, differ in enumerating these factors, although every oiae of them sticks to the total number of sixty.
^44 THfe SUSHRUTA SAMhITA. fChap. t.
(fomentations, etc.), Vimldpana (resolution by mass- age or rubbing), Upanaha (poultice), Pdchana (inducing suppuration), Visrdvana (evacuating or draining), Sneha (internal use of medicated oils, ghrita, etc.), Vamana (emetics), Virechana (purgatives), Chhedana (excision), Bhedana (opening — e.g., of an abscess), Dirana (bursting by medicinal applications), Lekhana (scraping), Aharana (extraction^ Eshana (probing), Vyadhana (puncturing— opening a vein), Vidrdvana (inducing discharge), Sivana (suturing), Sandhana (helping re-union or adhesion), Pidana (pressing), Sonitasthdpana (arrest of bleeding), Nirvdpana (cooling application), Utkarikd (massive poultices), Kashaya (washing with decoctions), Varti (lint or plug), Kalka (paste), Ghrita (application of medicated clarified butter), Taila (application of medicated oil\ Rasa-kriya (application of drug-extracts), Avachurnana (dusting with medicinal powders), Vrana- Dhupana (fumigation of an ulcer), Utsddana (raising of the margins or bed of an ulcer), Avasddana (destruction of exuberant granulation), Mridu-Karma (softening), Daruna-Karma (hardening of soft parts), Kshdra-Karma (application of caustics), Agni-Karma (cauterization), Krishna-Karma (blackening), Pandu-Karma (making yellow-coloured cicatrices), Pratisarana (rubbing with medicinal powders), Roma-sanjanana (growing of hairs), Lomdpaharana (epilation), Vasti-karma (application of enemas), Uttara-Vasti-karma (urethral and vaginal injections\ Vandha (bandaging), Patradana (application of certain leaves — vide Infra), Krimighna (Vermifugal measures\ Vrimhana (application of restorative tonics), Vishaghna (disinfectant or anti-poisonous applications), Siro-virechana (errhines), Nasya (snuff), Kavala- dharana (holding in the mouth of certain drug-masses for diseases of the oral cavity or gargling), Dhuma (smoking
Chap. 1.] CHIKLITSA STHANAM. 245
or vapouring), Madhu-sarpih (honey and clarified butter),
Yantra (mechanical contrivances, e g., pulleys, &c.),
Ahara (diet) and Raksha-Vidhana (protection from
the influence of malicious spirits). 22.
Of these, Kashaya, Varti, Kalka, Ghrita, Taila, Rasa-
kriya and Avachurnana are the measures for the cleansing
(Sodhana) of an ulcer and for helping its granulation
(Ropana). The eight acts (from Chhedana to Sivana)
are surgical operations. We have already spoken of
such acts as Sonitasthapana, Kshara-karma, Agni-
karma, Yantra, Ahdra, Raksha-vidhana and Vandha-
Vidhana (in the Sutra-sth^na). Later on, we shall
discourse on Sneha, Sveda, Vamana, Virechana, Vasti,
Uttara-vasti, Siro-virechana, Nasya, Dhuma, and Kavala-
dharana. Of the remaining measures we shall speak
in the present chapter. 23.
There are six kinds of swellings (Sophas), as described before, and the following eleven measures., commencing with Apatarpana and ending in Virechana, should be regarded as their cure. These are the proper remedies for a swelling and do not (cease to be efficacious in, nor) prove hostile to cases of swelling which are transformed into ulcers. The other measures should be deemed as remedial to ulcers but Apatarpana is the first, general and principal remedy in all types of swellings (Sophas). 24.
Memorable Verses --—Apatarpana (fasting)
should be prescribed in the case of a patient, full of
enraged Doshas, as well as, in one having his organic
principles (Dhatus) and refuse matters (Malas) of the
system, deranged by them, for the purpose of bringing
them to their normal condition, with a regard both
to their nature and to the strength, age, &c., of the
patient. Persons afflicted with diseases which result
246 THE SUSHRUTA'SAMMITA. tChap. t.
from the up-coursing of the'deranged Vayu(Urdhva-vata)
such as cough, asthma, &c., or with thirst, hunger,
dryness of the mouth and fatigue, as well as old men,
infants, weak persons, men of timid dispositions and
pregnant vvom^n should' never fast. A swelling and an
extremely painful ulcer should be respectively treated
with a proper medicated plaster at the very outset. The
pain in such a case will yield to the medicinal plaster
as a blazing room or house is readily extinguished by
means of steady watering. Such plasters not only give
comfort to the patient (by removing the pain and leading
to the absorption of the swelling), but heaves up the bed
of the sore or the ulcer and contributes to its speedy
purification and healing up (granulation). 25—28.
In the case of a swelling brought on by the deranged
Vayu, the affected part should be washed or sprinkled
(Parisheka) with a warm lotion of clarified butter, oil,
Dhanyamla and essence of meat or with a decoction
of the drugs that tend to pacify the enraged Vayu
and to relieve the pain. A swelling due to the action of
the deranged Pitta or blood or to the effect of
a blow or poison should be washed or sprinkle 1
with a lotion of milk, clarified butter, honey and sugar
dissolved in water, the expressed juice of sugar-cane
and a cold decoction of the drugs of the Madhura group
(Kakol>'*adi-gana) and the Kshira-Vriksfias. A Kaphaja
swelling on the body should be washed or sprinkled
with a luke-warm lotion of oil, cow's urine, alkaline
solution, wine >^Sura), Sukta and with a decoction of
drugs that destroy the deranged Kapha. 29—31.
IVIetrical Text : —As a fire is put out by jets of
water, so the fire of the deranged morbific principles
(Doshagnl) of the body are spe idily subdued and put down
by the application of (medicinal lotions) washes. 32.
Chap. I.] CHIKITSA STHANAM. 247
An anointing (Abhyanga), duly prescribed and used,
with a full regard to the nature of the aggravated
Doshas, leads to their pacification (restoration to the
normal condition) and to softness (subsidence) of the
swelling. 33.
lYICtrical Texts: — An application of an anoint- ment (Abhyanga) should precede the measures of fomen- tation, resolution, &c , while it should follow all evacuating measures, &c. A painful, extended and indurated swell- ing, as well as an ulcer of a similar nature, should be fomented, while an act of Vimlapana (resolution by gentle massage) should be done in respect of a fixed or unfluctuating swelling attended with little or no pain whatsoever. A wise physician should first annoint and foment the part and then gently and slowly press it with a bamboo-reed or with the back of his thumb or palm. A non-suppurated swelling or one that is partially suppurated should be treated with poultice (Upandha\ which would lead to its resolution or suppu- ration, as the case might be. A swelling, not resolved or not subsiding even after the adoption of the measures beginning with Apatarpana and ending in Virechana (in the given . list), should be caused to suppurate with the drugs enumerated in the ^chapter of Mis'raka, such as curd, whey, wine (Sura), Sukta and Dhany^mla (a kind of fermented paddy gruel). They should be formed into a paste and the paste should be cooked into an efficacious poultice-like composition:(Utk^rikd), and mixed with salt and oil or clarified butter, it should be applied over the affected part (swelling) and bandaged with the leaves of an Eranda plant. The patient should be allowed to take a wholesome (?^., which does not. produce Kapha) diet as soon as suppuration would set in (in the swelling), 34-39.
248 THE SUSHRUTA SAMIilTA . [Chap. I.
Blood-letting' :— Blood-letting should be re- sorted to in a case of newly formed swelling for its resolution and for alleviating the pain. Bleeding (Visratvana) is recommended in the case of an ulcer which is indurated, marked by a considerable swelling and inflammation and is reddish black or red-coloured, extremely painful, gagged in its shape and considerably extended at its base (congested), specially in the case of a poisonous ulcer, for the subsidence of the pain and for warding off a process of suppuratiou therein, either by applying leeches or by opening (a vein in the locality) by means of an instrument. An ulcer-patient of a dry or parched temperament affected with dis- tressing supervenients or ulcer-cachixia or who is weak should be made to drink an emulsive potion cooked with (a decoction of) appropriate drugs. A patient afflicted with an ulcer with an elevated margin and attended with swelling and specially marked by the presence of the deranged Kapha and by a flow of blackish red blood should be treated with emetics. Ulcer-experts recommend purgatives to a patient afflicted with an old or long-standing ulcer, attended with a deranged condition of the Vayu and Pitta. An excision should be made into an ulcer which refuses to suppurate and which is of a hard and indurated character attended with sloughing of the local nerves and ligaments (Snayu). An opening^ or excision (Bhedana) should be made into an ulcer (Vrana) in the inside of which pus has accumalated and makes it heave up and which not finding any outlet consequently eats into the underlying tissues and makes fissures and cavities. 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.
