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

Forms of incision : — An experienced surgeon should know that the Ldngalaka, Ardha-Langalaka, Sarvatobhadraka and the Gotirthaka forms of incision should be the different shapes of incision, in a case of a many-mouthed S'ataponaka. An incision equal in its two sides is called the La(ugalaka (curvilineal), while the one with one arm longer than the other is named the Ardha-Laingalaka. An incision made in the region of the anus in the shape of a cross (crucial) and a little removed from the raphe of the perineum, is called the Sarvatobhadraka by men conversant with the shapes of surgical incisions. An incision made by inserting the knife in one side is called the Gotirthaka (longitudinal). All exuding (bleeding) channels in the affected region should be cauterized with fire by the surgeon.

340 THE SUSHRUTA SAMHITA. [Chap. VIII.

A case of the ^ataponaka type occurring in a person of timid disposition or of delicate constitution, is extremely difficult to cure. Medicinal fomentations en- dowed with the virtue of arresting secretion and alleviat- ing pain, should be quickly applied (to the seat of the disease). Fomentations with Kris'ard, or Pdyasa (por- ridge), made with the aforesaid Svedaniya (diaphoretic) drugs with a decoction of the drugs constituting the Vilvddi group, Vrikshddani and roots of the castor-plant mixed and boiled together with the flesh of the Ldva, Vishkira (a kind of bird) and that of animals living in swampy or marshy land or aquatic in their habits or Grdmya animals, and then kept in an oily pitcher and applied in the way of a Nddi-Sveda (fomentation through Nddi or pipe), should be at once applied to the seat of the ulcer. Sesamum, castor-seeds, linseed, iJ/<i5^^-pulse, barley, wheat, mustard-seeds, salts and the Amla-Varga (see Rasa-Vijndniya chapter) should be boiled in a saucer and the affected part or ulcer should be fomented therewith. After being fomented, the patient should drink (a potion consisting of) Kushtha, salts (the five officinal kinds of salts) Vachd^ Hingu and Ajamoda taken in equal parts and mixed with (an adequate quantity of) clarified butter, grape-wine (Mdrdvika), K^njika (Amla), Surci or Sauviraka.* Subsequent to that, the ulcer should be wetted with the Madhuka-oW and the rectum should be washed with medicated oils which would alleviate pain due to the action of the deranged and aggravated Vdyu. The preceding r^^edicinal remedies tend to bring about the outflow or evacuations of stool and urine through their natural channels or courses, and undoubtedly alleviate all acute and supervening distresses which specifically mark

* By the use of this potion the digestive power is increased.

Chap. Vlir.] CHIKITSA STHANAM. 34I

the progress of the disease. We have described the treat-
ment of a case of fistula- in-ano of the Sataponaka
(sieve) type ; now listen to me about the treatment of
the Ushtragriva (camel's neck) type of the disease. 5.

Treatment of Ushtra-griva :— The ulcer

should first be searched with a probe or director and, after an operation, an alkali should be applied to it. To remove all sloughed off or sloughing flesh and membranes cauterization with fire is forbidden. [The fissures of pus (sinuses) and sloughed off flesh should be first drawn out]. A plaster of clarified butter and pasted sesamum should then be applied to it, and the ulcer duly bandaged. Clarified butter should be constant- ly applied over the bandage which should be removed on the third day. Cleansing or disinfecting (^S'odhana) measures should then be used by the surgeon, accord- ing to the Doshas involved in the ulcer, and the successive healing (Ropana) measures resorted after its being properly purified (S'odhana). 6

Treatment of ParisrsCvi :— In a case of the

ParisrAvi (exuding) type, where there is bleeding and secretion from the ulcer, the sinus and the cavities of pus should be first removed and then cauterized with an alkali or with fire by an intelligent surgeon. The region of the anus should then be kept wet by the sprinkling of luke- warm Anu-toila (described in the chapter on V^ta-vy^dhi). Warm plasters, or poultices, mixed with Yavakshdra and the urine (of a cow) should then be applied. Decoction of the emetic drugs as the seeds of Madana, etc.), should also be sprinkled slightly on the affected part. The ulcer when found to be softened and nearly free from pain and secretion (owing to the preceding measures) should be searched with a probe and the principal sinus should be cut open and again

342. THE SUSHRUTA SAMHITA. [Chap. VIII.

completely cauterized with fire or with an alkali. The
incisions should be made in the shape or form of a
Kharjura-patra (leaf of the date-palm), Ardha-chandra
(half-moon), Chandra-chakra (moon's disc), Suchi-mukha
(needle's mouth), or Avdmmukha (with downward mouth).
After that the ulcer should be purified with mild cleans-
ing or disinfecting remedies (as described above) 7.

In the case of an infant cauterization with fire or with an alkali, the use of strong purgatives and surgical operations are forbidden in the case of the disease (Bhagandara), whether outer-mouthed or inter-mouthed. Medicinal remedies calculated to be mild, though keen in their efficacy, should be used in such cases. A plug or a Varti in the shape of a wick and made of powdered Aragvadha, Haridrd and Kala, mixed with honey and clarified butter, should be inserted into the ulcer for purifying purposes. This medicinal compound speedily brings about the healing of a sinus, just as the wind will drive away a cloud. 8—9

Treatment of Agantuka Bhagan-
dara :— The sinus in a fistula of traumatic origin
should be carefully cut open by a surgeon (with a knife)
and cauterized, according to the rules laid down, with
a red-hot Jambvoshtha (instrument) or with a red-
hot director (SaUka). Vermifugal remedies should be
applied to it, and measures laid down in connec-
tion with the extraction of a Salya from the body
should be carefully resorted to. 10.

Treatment of Tridoshaja Bhagan-
dara : — A case of Bhagandara, due to the concerted
action of the three Doshas, should be treated without
holding out any hope of recovery tot he patient's people,
or should be given up as hopeless. The measures and
remedies mentioned above should be adopted in

Chap. VIII.] CHIKITSA STHANAM. 343

succession in all types of Bhagandara. In the
event of there being any pain in it, owing to the
insertion of a knife or to any other surgical operation,
luke-warm Anu-taila should be applied. As an alternative,
the drugs possessed of the virtue of subduing the de-
ranged Vdyu (Bhadra-ddrvddi and Erandadi groups)
should be boiled in a pot covered by a lid having a
hole or aperture on its top ; then the patient with his
rectum anointed with oil, etc., should be made to sit in
such a way over the said covered pot that the seat of
the disease may be fomented with the warm fumes
escaping through that aperture ; or Nddi-sveda should
be applied to the affected region through a pipe in a
recumbent posture to alleviate the pain. As an
alternative, a hot bath should be prescribed for the
alleviation of the pain. Sailvana Upanaiha (described in
connection with the treatment of Vata-vyadhi and that
with the skins of the Kadali Mriga, Lopaka and Priyaka,
should be applied to the affected locality to subdue
the pain. A potion of the drugs or substances such
as, Trikatu, Vachd^ Hingu, salt (five kinds of salt) and
Dipyaka, should be administered with wine, Kdnjika,
Sauviraka and Kulattha-Soup, etc. 11-12.

Jyotishmati^ Ldngalaki, S'ydmd^ Danti, Trivrit, Tila^ Kushtha, S'atdhvd,Golomi, Tilvaka^ Giri-karnikd^Kdsisa and the two kinds of Kdnchana-kshiri, compose the group which is possessed of the virtue of purifying (afistular sore). (The decoction of these substances should be applied for the purification of the ulcer). The sore of a fistula may be filled (healed^ up by the application of (a compound of) Trivrit, Tila, Ndgadanti, Manjishthd and rock-salt pasted together with milk and honey. A plaster (Kalka) consisting of Rasdnjana, turmeric, Ddru-kartdrd, Manjishthd^ Nimha leaves, Trivrit ^ Tejovati and Danti

344 THE SUSHRUTA SAMHITA. [Chap. VIII.

proves curative in a case of sinus. The drugs known as
Kuskthuy Trivrit^ Tila^ Danti, Pippaliy Saindhava^
honey, turmeric, Triphala and sulphate of copper
(Tuttha) are efficacious in purifying an ulcer. 13-16.

Oil* cooked (slowly) with Pippali, Yashti-madhu^ Lodhra^ Kushtha, Eld^Harenu, Samangd (Bardha-krdnti), Dhdtaki flower, Sdrivd^ the two kinds of Haridrd, Priyangu^ Sarja-rasa^ Padmaka, P adrnd-kes^ ara^ Sudhd, Vachd.Ldngalikd, wax, and Saindhava should be regarded as a potent remedy in healing up the ulcer and curing fistula-in-ano. This remedy proves beneficial in cases of scrofula (Ganda-mald), Meha, ulcers and in the Mandala type of cutaneous affections as well. The drugs which constitute the Nyagrodhddi group are efficacious in dis- infecting (Sodhana) and healing up an ulcer. A medi- cated oil or Ghrita prepared with the preceding drugs proves curative in a case of fistula in-ano. Similarly a medicated oil duly cooked and prepared with the roots of Trivrit, Dantiy Haridrd, and Arka, as well as with Vidanga, Triphala^ milk of both Snuhi and Arka, honey and wax should be applied, as it is specifically efficacious in a case of Bhagandara. 17-19.

Syandana Taila :— Oil slowly cooked and

prepared (in the manner aforesaid) with Chitraka, Arka
Trivrit, Pdthd, Malapu (Kakodumbara), Karavira,
Sudhd (Snuhi), Vachd, Ldngalaki, Saptaparna^ Suvar-
chikd and fyotishmati, is called the Syandana-Taila and
should be constantly applied in a case of Bhagandara.
It is efficacious in purifying, healing and imparting a
natural skin-colour to the cicatrix. A learned and
experienced physician should adopt the remedial
measures for this disease according to the procedure laid

* Four seers of oil, one seer of the drugs and sixteen seers of water should be taken at the time of preparation.

Chap. VIIL] CHIKITSA STHANAM. 345

down under the treatment of Dvi-Vrana, when there is any ulcer (vrana) in existence. 20,

The bulb-like protrusion above the hole of the instru- ment (speculum), mentioned in connection with the treatment of Ars'as, should be removed and the instru- ment, now in the shape of a half-moon, should be used by an experienced surgeon in the treatment of a case of fistula-in-ano. The patient should refrain from sexual intercourse, physical exercise, riding, anger, and the use of heavy and indigestible articles of food for a full period of one year even after the healing up of the ulcer in a Bhagandara. 21 — 22.

Thus ends the eighth Chapter of the Chikitsita Sthanam of the Sub'ruta-Samhita which deals with the treatment of Bhagandara.

Now we shall discourse on the medical treatment of cutaneous affections in general (Kushtha). i.

A cutaneous disease (Twag-dosha) originates through injudicious conduct of life such as^ partaking of large quantities of unwholesome food, or taking it before the previously eaten one is digested {i. e , eating too often), indulgence in incompatible articles of fare, voluntary- suppression of the natural urgings of the body, and improper application of medicated oil, clarified butter, or other lardacious articles. It is attributed even to the dynamics of sinful acts done by a man in this or in some prior existence. 2.

Conduct of diet and regimen :— A

person afflicted with any kind of skin disease should
refrain from taking meat, lard, milk, curd, oil, Kulattha
pulse, Mdsha pulse, Nishpdva, preparations and modifica-
tions of sugarcane juice, acid substances, incompatible
food, meals taken before the complete digestion of the
preceding one, unwholesome and indigestible food, or
food causing a burning sensation and some kind of
internal secretion, day-sleep and sexual intercourse, 3.

Regulation of diet and conduct: —

The old and matured grain of S'dli, Shashtika, barley,
wheat, Koradusha^ S'ydmdka, Udddlaka, etc., boiled and
taken along with the soup(Supa) or a decoction* (Yusha)

* An unsalted decoction of any substance not seasoned with any spices whatever is called Yusha, while the one salted and seasoned with spices is called Supa- In preparing the soup of any pulse, all husks should be carefully thrashed out and the grain should be slightly fried before boiling*

Chap. IX.] CHIKITSA STHANAM. 347

of either Mudga pulse or Adhaki pulse mixed with Nimba leaves and Arushkara are wholesome in a case of Kushtha. Preparations of any of the aforesaid grains may be taken with Manduka-parni^ Avalguja, Atarushaka and Rupikd flowers cooked in mustard oil or clarified butter, or with the soup prepared of the articles of the Tikta-varga (bitter group, mentioned in the Sutra- sthdnam). The cooked flesh of Jdngala animals, devoid of all fatty matter, should be given to a patient, habituated to the use of meat diet. The medicated oil, known as the Vajraka-Taila should be used for anoint- ing the body. A decoction of the drugs of the Arag- vadhddi group should be used for rubbing (Utsadana) purposes. Decoctions of Khadira should be employed in drinks, baths, washes, etc. The preceding rules are intended to regulate the diet and regimen of one suffer- ing from Kushtha (cutaneous affections). 4.

Preliminary Treatment :— in the premo-

nitary stages of the disease the system should be
cleansed by the application of both emetics and pur-
gatives. When the disease is found to invade the
Tvak* only, a plaster prepared of the purifying drugs
should be applied to the affected parts ; blood-letting
and the use of medicinal decoctions and purifying and
disinfecting plasters are the remedies to be employed
when the desease would appear to infect the blood.
The same remedies and Arishta, Mantha, Pras'a, etc ,
should be employed when the disease would be found
to have invaded the principle of the Matmsa (muscles).
Palliation and temporary respite are the only cure that
can be offered in a case of the sin-begotten typef of the