An English Translation of the Sushruta Samhita (Bhishagratna ed.)

Chap. VI.] CHIKITSA STHANAM. 317

sky is cloudless, he should be placed in a raised up position in a clean and well-equipped place on a plain slab or on a clean bed with his head resting on the lap of an attendant and the anal region exposed to the sun. In this position the waist should be made to elevate a little and to rest on a cushion of cloths or blankets. The neck and the thighs of the patient should be drawn out, and then secured with trappings and held fast by the attendants so as not to allow him to move. Then a straight and slender-mouthed instrument (somewhat like the modern rectal speculum^ lubricated with clarified butter, should be gently inserted into the rectum and the patient should be asked to strain down gently at the time. After seeing the polypus (through the speculum), it should be scraped with an indicator and cleansed with a piece of cotton or linen after which an alkali should be applied to it. The exterior orifice of the instrument should be closed with the palm of the hand after this application and kept in that manner for a period that would be required to utter a hundred words.

Then after having cleansed the polypus, a fresh
application should be made according to the strength
of the alkali and the intensity of the aggravated Doshas
involved in the case. Further application of the alkali
should be stopped and the polypus washed with
fermented rice-gruel (Dhdnyamla), curd-cream, Sukta,
or the juice of acid fruits, in the event of its having
been found to have become a little flabby, bent down,
and to have assumed the colour of a ripe Jambu fruit.
After that it should be cooled with clarified butter
mixed with Yashti-Madhu, the trappings should be
removed and the patient should be raised up and placed
in a sitting posture in warm water and refreshed with

3l8 THE SUSHRUTA SAMHITA. [Chap. VI.

sprays of cold water, or, according to some authorities, with warm water. Then the patient should be made to lie in a spacious chamber, not exposed to the blasts of cold winds (specially), and advised as regards his diet and regiinen Each of the remaining polypii, if any, should be cauterized with the alkaline application at an interval of seven days. In case of a number of polypii, those on the right side should be first cauterized and then those on the left, and after that those on the posterior side ; and lastly those that would be found to be in front. 3.

Polypii, having their origin in the deranged Vs^yu and Kapha, should be cauterized with fire or alkali ; while those, which are the outcome of the deranged Pitta and vitiated blood should be treated with a mild alkali alone. A perfect and satisfactory cauterization (Samyag^- dagdha) of a polypus should be understood from such symptoms as, restoration of the bodily Vdyu to its normal condition, relish for food, keenness of the appe- tite, lightness of the body and improvement in strength, complexion and pleasure. An over-cauterized (Ati- dagdha) polypus gives rise to such symptoms as, cracking of the region of the anus, a burning sensation (in the affected locality), fainting, fever, thirst, and pn fuse haemorrhage (from the rectum), and consequent complications ; while an insufficiently cauterized (Hina- dagdha) polypus is known by its tawny brown colour, smallness of the incidental ulcer, itching, derangement of the bodily Vdyu^ discomforts of the cognitive organs and a non-cure of the disease. 4.

A large polypus, appearing in a strong person, should
be clipped off (with a knife) and cauterized with fire.
As regards an external polypus full of extremely
aggravated Doshas (Vdyu, Pitta, Kapha and blood) no

Chap. VI.l CHIKITSA STHANAM. 319

Yantra should be used, but the treatment should consist
of fomentation, anointing, poulticing, immersion,
plastering, evacuating measures (Visrava), cauterization
with fire and alkali and a surgical operation.
Measures laid down under the head of Rakta-pitta
should bs resorted to in cases of haemorrhage
(from the seat of affection). Remedies mentioned
in connection with dysentery (Atisdra) should be em-
ployed in cases of a looseness of the bowels ; whereas
in cases of constipation of the bowels oily purgatives
should be administered, or the remedies for UdAvartta
should be adopted. These rules shall hold good in the
cases of treating (cauterization, etc) a polypus occurring
in any part of the body whatsoever. 5.

A polypus should be caught hold of and an alkali
should be applied thereto with a Darvi, or a brush
(Kurcha), or an indicator (Salaka). In a case of a
prolapsus of the anus, cauterization should be made
without the help of any Yantra (speculum).

Diet : — In all types of haemorrhoids, the diet should consist of wheat barley, Shashtika rice or S'dli rice, (boiled) and mixed with clarified butter, to be taken with milk, Nimba-soup, or Patola-soup. The patient should be advised to take (his meal) with Vdstuka, Tanduliyaka^ Jivanti, Upodikd, As'va-vald, tender Mulaka, Pdlanka, As ana, Chilli, Chuchchu, Kaldya, Valliy or any other S'dkas (pot-herbs;, according to the nature of rhe Doshas involved in the case Any other oleaginous, diuretic, laxative and appetising (Dipana) diet possessing the virtue of curing piles should also be prescribed. 6.

After the cauterization of the polypus, as well as in
a case where no cauterization would be necessary, the
body of the patient should be anointed with clarified

320 THE SUSHRUTA SAMHITA. [Chap. VI.

butter and oil, etc., and measures both general and specific (mentioned below and in accordance with the Dosha or Doshas involved) should be employed for the purpose of improving the digestive powers and to alleviate any aggravation of the Vaiyu. He should be made to drink a potion consisting of clarified butter cooked with the Vdyu-subduing and appetising (Dipana) drugs* (Kalka and Kvatha) mixed with the powders of Hingu, etc., (described in the treatment of Maha-Vdta- vyAdhl, chapter. V). In a case of Pittaji-Ars'as, clarified butter prepared by cooking it with the drugs of the Pippallyddi and Bhadra-ddrvddi\ groups, should again be cooked with the decoction of Prithakparnyadi group and the Kalka of the Dipaniya (Pippallyddi) group, and given as a potion to the patient. In a case of haemorr- hoid due to the action of the deranged blood \ (Rakt^rsas), the clarified butter should be cooked with a decoction of Manjishthd, Murungi, (D. R. Surangi), &c., while in a case of one due to the action of the deranged Kapha, the clarified butter should be cooked with a decoction of the drugs constituting the Suras ddi group. The supervening distresses should be alleviated by the remedial measures peculiar to each of them . 7 .

Cauterization with fire or with an alkali or any surgical

* Such as the decoction of the drugs of the Bhadra-datvddi (Vayu- subduing) and Pippalyadi (Dipaniya) group?. This Ghrita should be prescribed in a VsCtaja Arsas.

t The epithet "Bhadra-darvadi-pippallyddi" in the phrase "Bhadra- darvadi-pippallyadi-sarpih" seems to be included into the body of the text through an accident. In our opinion, it is only an annotation of the phrase **Dipaniya-Vdta-hara-siddha" occurring in the last sentence. — Ei.

X The Kalkas of the Pippallyadi group should also be taken in the preparation of the two kinds of medicated clarified butter to be used in Raktars'as, and Pittiis'as. ^Z)a//a»»a,

Chap. VI. J CHIKITSA STHANAM. 32 1

operation in the present disease should be effected by introducing the Yantra (speculum) into the rectum (with the utmost care, inasmuch as an error happening in any of these cases may bring on impotency, swelling (Sopha), a burning sensation, epilepsy, rumbling in the intestines, retention of stool and urine, dysenteiy, diarrhoea, or may ultimately end in death. 8.

Rectal Speculum :--Now we shall describe the dimensions of the Yantras (and the materials of which they are made of). The instrument may be made of iron, ivory, horn or wood. It should be made to resemble the teat of a cow. In the case of a male patient, it should be four fingers in length and five fingers in circumference ; whereas in the case of a female patient, the length should be commensurate with that of the palm of the hand (of the same length as before — D. R.) and six fingers in circumference. The instrument should be provided with two separate apertures in its inside, one for seeing the interior of the rectum and the other for applying an alkali, or actual cautery (Agni) to the polypus, since it is impossible to apply fire and alkali through the same aperture. The circumference of the aperture in the upper three fingers of the instru- ment should be like that of a thumb. There should be a bulb-like protrusion of the same width, at the bottom, and above it a space of half a finger's width. Thus we have briefly described the shape of the instrument. 9-10.

Alepa (plasters) :— Now we shall describe the
plasters to be applied to the haemorrhoids (to cause
their spontaneous dropping off). The first consists of
pulverised turmeric mixed with the milky exudation of
the Snuhi tree. The second contains of the cock-
evacuations and pulverised Gunjd, turmeric SLnd-Ptppa/t

322 THE SUSHRUTA SAMHITA. [Chap. Vl.

pasted with the urine and bile of a cow. The third
is compounded of Danti^ Chitraka, Suvarchikd and
Ldngali pounded together and made into a paste with
cow's bile. The fourth consists of Pippali^ rock-salt,
S'irisha-SQQds and Kushtha pasted with the milky juice
of an Arka^ or Snuhi plant. An oil cooked in combina-
tion with Kdsisa (sulphate of iron), Haritdla (yellow
orpiment), rock-salt, As'vamdraka, Vidanga, Putika,
Kritavedhana, Jamhu, Arka, Uttatndrani, Danti^
Chitraka, Alarka and Snuhi-m\\V, and used as an
unguent, leads to the falling off of the polypus, ii.

Internal piles :— Now we shall describe the
remedial measures which bring about the falling off of
the invisible (internal) haemorrhoids. The patient should
take Haritakl with treacle every morning ; or a hundred
Haritakis should be boiled in a Drona measure of cow's
urine and the patient, observing a strict continence,
should take with honey every morning as many of them
as suit his constitution ; or he should be made to
take every day a paste made of the roots of Apdmdrga
with the washings of rice and with honey. S'atdvari
pasted with an adequate quantity of milk or ;a Karsha
measure of) the powders of Chitraka mixed with a copious
quantity of good Sidhu wine, or a gruel (Mantha)
(neither extremely thick nor thin), or powdered barley
or wheat mixed with Takra and Bhalldtaka powder,
should be administered without any salt. A quantity of
Takra should be kept in an earthen pitcher, plastered
inside with a paste of Chitraka roots, and given to
the patient in food and drinks whether fermented or
not, A Takra should also be separately prepared as in
the preceding manner with Bhdrgi^ Asphotd, barley,
Amalaka and Guduchi and administered similarly ;. this
is called the Takra-kalpa (butter-milk compound). 12.

Chap. VI.3 CHIKITSA STHANAM. 323

A medicated Takra should also be prepared with Pippali^ Pippali-mula, Chavya^ ChiU'aka^ Vidanga, S'unthi and Haritaki^ in the manner described above, (and given to the patient), who should abstain from taking any solid food, but live only on (this) Takra for a period of one full month ; or he should be given milk boiled with a decoction of S'ringavera, Punarnavd and Chitraka, or a condensed decoction (Phdnita) of the bark of Kutaja roots mixed with an after-throw of the powdered drugs of the Pippalyddi group and honey. The patient should be made to partake of the medicinal compound known as the Hingvadi-churua,* described in the chapter on Maha-Vdta-vyddhi, and be made to live either on milk, or on Takra. As an alternative, he should take Kulmdsha boiled in Kshdrodaka (alkaline water) prepared from Chitraka-voois and made saline with a liberal after-throw of Yava-kshdra ; or he should take milk boiled with the Kshdrodaka (alkaline water) prepared from Chitraka-roots, or Kulmasha boiled with the alkaline water prepared from the ashes of burnt P aids a ; or he should drink frequent potions of clarified butter mixed with the alkali made of the ashes of either Patola, Apdmdrga, Vrihati, or Paldsd wood ; or drink Takra mixed with the Kalka of the roots of Kutaja and of Vanddka ; or take the alkaline water of Putika mixed with a Kalka of Chitraka, Putika and Ndgara ; or use the clarified butter boiled in an alkaline solution-f- with the powdered drugs of the Pippalyddi group,

* In a preponderance of Vayu and Kapha, Takra should be taken as diet ; whereas milk should be taken in a case of the preponderance of vitiated blood.

t During the period when the above mentioned alkaline preparations are used, the diet of the patient should consist of clarified butter, milk and meat-soup for fear of the loss of the Ojo-Dhatu,

324 THE SUSHRUTA SAMHITA. [Chap. VI.

added to it by way of an after-throw ; or he should take
every morning one or two Palas of black sesamum
(according as required), with cold water. These
measures prove remedial in cases of haemorrhoids and
tend to improve the digestion. 13.