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 other- wise, in conformityw ith the directions laid down before on that behalf. In diseases amenable to acts of punctur- ing (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 (San- dhana) of the edges should likewise be effected, as direct- ed 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 (Nir-
vapana — literally putting out) with suitable and proper
medicinal remedies. It should be allayed with com-
pounds 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 deep- seated and attended with a burning sensation and with suppuration, should be purified with the application of ^ medicated clarified butter, prepared with the purifying
252 THE SUSHRUTA SAMHITA. tChap. I.
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 fore-
going 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.
Deepf and foul-smelling ulcers covered with layers of deranged fat (phlegmonous ulcer) should be purified by the learned physician with the powders of the drugs with which the purifying plug or the lint has been enjoined to be plastered (Ajagandha, &c.). Decoctions of the drugs which are possessed of the virtue of setting in a process of granulation (Ropana) in an ulcer, sucn as Vata, &c., as stated before, should be used by a surgeon (Vaidya) after it had been found to have been thoroughly purified. Medicated plugs, composed of drugs possessing healing properties (such as, So7na,Amritd, As'vagandhd^ etc}) should be inserted in deep-seated ulcers, when cleansed and unattended with pain. 60-62.
* The total weight of the purifying drugs should be equal to that of the Karpasa-phala alone and they should be boiled together with four times their qnantity of clarified butter and with sixteen times of water.
t There is a difTerent reading of "Agambhira" in place of "Gabhira," but Gayi thinks the emendation undesirable.
Chap. I.] CHIKITSA STHANAM. 2^3
A Kalka or a levigated paste of sesamum and honey (mentioned in the Misraka Chapter) should be applied for the purpose of healing up an ulcer situated in a muscular part from which all putrid flesh has been removed or sloughed off and which exhibited a clear cavity. This paste (of sesamum) tends to allay the deranged Vayu through its sweet taste, oleaginous- ness and heat-making potency ; subdues the deranged Pitta through its astringent, sweet and bitter taste and proves beneficial even in the case of the deranged Kapha through its heat-producing potency and bitter and astringent taste. An application of the levigated paste of sesamum mixed with the drugs of purifying and healing properties tends to purify and heal up an ulcer. An application of the levigated paste of sesamum mixed with honey and Nimda-\es.ves leads to the purification of sores ; whereas an application of the same paste (?> , sesamum, honey and leaves of Nimbd), mixed with clarified butter tends to heal up the ulcer. Several authorities atribute the same virtue to a barley-paste.* Levigated pastes of barley and of sesamum (or a paste of barley mixed with sesamum) contribute to the resolution or subsidence of a non-suppurated swelling, fully suppur- ate one which is partially suppurated, lead to the spon- taneous bursting of a fully suppurated one, and purify as well as heal up one that has already burst out. 63-65.
An ulcer,whicb is due to the effects of poison, vitiated blood, or aggravated Pitta, and which is deep-seated oris of traumatic origin, should be healed up with a medicated clarified butter prepared with the drugs of healing virtues (Ropaniya— enumerated before) and milk. An ulcer marked by an aggravated condition of the deranged
Jejjada and Gayadasa interpret the term to mean '*barley-paste mixed with sesamum."
254 THE SUSHRUTA SAMHITA. [Chap. I.
Vayu and Kapha should be healed up with the applica-
tion of an oil, boiled and prepared with the proper
purifying drugs mentioned before. 66 6y.
Rasa-kriyat* with the two kinds of Haridrd should be resorted to for the purpose of healing up an ulcer, in which bandaging is forbidden (such as those due to the deranged Pitta or blood, or to blow, &c., or to the effects of poison), and an ulcer appearing on the moveable joints, which, though exhibiting all the features of a well-cleansed sore, has not been marked by any process of healthy granulationf. Healing medicinal powders should be used in the case of an ulcer which is con- fined to the skin, and is firm-fleshed and marked by the absence of any irregularity in its shape {i.e.^ not uneven in its margin). The mode of applying medicinal powders, as stated in the Sutra-sthana, should be adopted in the present instance. 68-69.
The healing and purifying measures described above
should be deemed equally applicable to, and efficacious
in cases of ulcers in general with regard to their
Doshas (both idiopathic and traumatic). The success
of these measures has been witnessed in thousands of
cases and has been recorded in the Sastras (authorised
works on medicine). Hence they should be used as
incantations without any doubt as to their tested and
infallible efficacy. An intelligent physician should
employ the drugs, mentioned before, in any of the
seven forms (either in the shape of a decoction, or a
* The decoction of IriphalA and the drugs of the Nyagrodhadi group should be duly prepared, filtered and then condensed to the consistency of tteacle. Powders of Haridrd and Daru-haridra should be then thrown into it. In the end, the whole preparation should be well-stirred, mixed with honey and applied. This is what is called Rasa-kriya.
t Several editions read "though cleansed yet ungranulating ulcere."
Chap, t] CHlklTSA STHANAM. 2^5
plug, or a paste, or through the medium of medicated oils and clarified butter, or in the shape of Rasa-kriya, or as powders), according to the requirements of each case. 70.
The drugs which constitute the two groups ofPancha-
mulas (major and minor), as well as those of the Vayu-
subduing group, should be employed in the case of an ulcer
due to the aggravated Vatyu in any of the seven forms
— decoction, etc. Similarly the drugs which are included
within the groups of Nyagrodhadi or Kakolyadi should
be used in any of those seven forms, in the case of an
ulcer due to the aggravated Pitta (for the purification
and healing thereof). Drugs which form the group of
Aragvadhadi, as well as those which have been des-
cribed as heat-making in their potency, should be used
in any of those seven aforesaid forms, in the case of
an ulcer due to the deranged Kapha. The drugs of two
or three of those groups, should be combinedly used
in any of those seven forms, in connection with an
ulcer marked by the aggravated condition of any two
or three of the deranged Doshas respectively. 71-74.
Fumig'ation : — Vataja ulcers with severe pain
and secretion should be fumigated with the fumes of
Ks/iauma, barley, clarified butter and other proper fumi-
gating substances [such as turpentine and resin (gum of
Sdlatree)]. 75.
Utsadana-Kriya (Elevation) :— Medicated plasters (consisting of Apdmdrga, As'va^andhd, etc.) and medicated clarified butter (prepared with the same drugs should be used in ulcers (due to the aggravated Vayu and marked by the absence of any secretion, and affecting a considerably smaller area or depth of flesh, as well as in those (due to the deranged and aggravated Pitta and) seated deep into the flesh, for the purpose of raising up (filling up) the beds or cavities thereof. Meat of carni-
256 THE SUSHRUTA SAMHITA. tChap. t.
vorous animals should be taken in the proper manner by
the patient, inasmuch as meat properly partaken of in
a calm and joyful frame of mind adds to the bodily flesh
of its partaker. J6.
Ava.Sada.na (destruction of super-growths) : —
Proper drugs or articles (such as sulphate of copper,
etc.) powdered and pasted with honey should be applied
for destroying the soft marginal growths of an ulcer
found to be more elevated than the surrounding surface
of the affected locality. 77.
IVI rid U- Karma (softening) :— In respect of
indurated and fleshless (not seated in a part of the body
where flesh abounds) ulcers marked by a deranged
condition of Vayu, softening measures (with the
help of repeated applications of lotions and plasters
composed of sweet and demulcent substances mixed
with salt in a tepid or luke-warm state) and blood-
letting* should be resorted to. Sprinkling (Seka) and
application of clarified butter or oil prepared with the
Vayu-subduing drugs should also be resorted to. yZ.
D^runa-karma:— The employment of harde-
ning measures (Daruna-karma) is efficacious in con-
nection with soft ulcers and in the following man-
ner. Barks of Dhava, Priyangu, As' oka, Rohini^
Triphala, Dhdtaki flowers, Lodhra and Sarjarasa^ taken
in equal parts and pounded into fine powders, should be
strewn over the ulcer, i.e., the ulcer should be dusted
with the same. 79.
Kshara- Karma (Potential cauterization) : — The measure of applying alkali should be adopted for the
* Blood-letting should be resorted to in the event of any vitiated blood being found to have been involved in the case ; but in the event of a similar participation of any deranged Kapha, oils and lotions composed of the Va'yu-destroying drugs should be made use of.
