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

Thus ends the sixteenth Chapter of the Chikitsita Sthanam in the Sub'ruta Samhila which deals with the treatment of abscess.

* This medicated Ghrita (Chikitsita Sthdnam, Ch. IX) may be used both internally and externally with good results. Ed.

t Dallana reads "Tini" in place of "Nemi," both of which, however, mean "Tinib'a". Chakradatta does not include "Saindhava" in the list, but reads "Tinio'a-twacham" in place of "Nemi-Saindhavam". S'ivad^sa, however, adds another reading 'Tinis 'am Dhavam" on the authority of Chandrala.

CHAPTEE XVII.

Now we shall discourse on the medical treatment of
erysipelas, etc., (Visarpa), sinus, etc., (Nadl-
Vrana) and diseases of the mammary glands

(Stana-roga). i.

Of the types of erysipelas (Visarpa) the first three (viz., the Vdtaja, Pittaja and Kaphaja ones) are curable ; the two remaining types, viz., those caused by the con- certed action of the three Doshas (of the body) and those originating from wounds (Kshataja) should be considered as incurable. In cases of the curable types, medicated Ghritas, plasters (Upadehas) and affusions (Seka) prepared with the drugs (antidotal to the specific aggravated Dosha or Doshas (involved in the case) should be prescribed. 2.

Treatment of Vataja Visarpa :~ln

cases of the Vsitaja type of the disease, Mustd, S'atdhvd,
Sura-ddru, Kushtha, Vdrdhi, Kustumhuru (Dhanyaka)
Krishna-gandhd, and the drugs of a heat-making potency
(Ushna-gana)* should be used in preparing the medicinal
washings (Seka), plasters and Ghritas. The drugs res-
pectively included within the groups of the Vrihat-
Pancha-mula and the Svalpa-Pancha-mula, the Kantaka-
Pancha-mula and the Valli-Pancha-mula should be
(separately) used to prepare the medicinal plasters,
affusions, medicated Ghritas and as well as the neces-
sary oils. 3.

* Chakradatta reads "Arka", Vams'a and Artagala instead of the drugs of a heat-making potency. Dallana explains the drugs of a heat-making potency to be the drugs of the Bhadra-darvadi and the Pippalyddi groups.

Chap. XVII.] CHIKITSA STHANAM. 419-

Treatment of Pittaja Visarpa :— In

cases of Pittaja Visarpa^ a plaster consisting of Kaseruka, S'ringd-taka, Padma, Gundrd ^Guduchi), S'aivdla, Utpala diX\d clay pasted together and mixed, with clarified butter, should be wrapped* in a piece of linen, and applied cool to the affected part. A paste composed of Hrivera, Ldmajjaka (Us'ira-mula), Chandana^ Srotoja (Rasanjana\ Muktd, Mani and Gairika, pasted together with milk and mixed with clarified butter should be applied thin and cool to the affected part to alleviate the pain. Pittaja erysi- pelas readily yields to the application of a medicinal plaster composed of Prapaundarika, Yashti-niAdhu, Payasyd, f Manjishthd, Padmaka^ Chandana and Sugandhikd pasted together. Decoctions of the drugs of the Nyagrodhddi group should be used in washing (the affected part) ; or clarified butter should be cooked with the expressed juice of the above drugs and employed in the case. The part may be affused (Seka) with cold milk (or water), or with water mixed with honey or sugar, or with the expressed juice of the sugarcane. 4-5. Gauryadi Ghrita:— A Prastha measure of clarified butter should be cooked with the Kalka of Gauri, \ Yashti-madhu, Aravmda, Rodhra, Ambu, Rdjddanay Gairika, Rishahhaka^ Padmaka^ Sdrivdy KdkoH, Medd, Kumuda, Utpala, Chandana, Madhu- S'arkard, Drdkshd, Stkird, Prts'ni-parni, and S'atdhvd taken in equal parts (and weighing one seer § in all)

* In order to facilitate its removal.

t It means "Kshira-vid^ri". Jejjata explains it as "Arka-pushpi'*.

X Some explain it as "Haridra", while others explain it as "Gorochand".

§ Dallana, however, says that these drugs will weigh four Pains i. e., half a seer in all.

'420 THE SUSHRUtA SAMHITA. [Chap. XVII.

and with the decoctions, weighing four times that of the
Ghrita, of the drugs of the Nyagrodhddi, Sthirddi (minor
Pancha-mula) and Vilvddi (major Pancha-mula)
groups together with the same weight (sixteen seers) of
milk. The washing (of the affected part) with this me-
dicated Ghrita proves curative in Pittaja erysipelas and
sinus. Visphota (boils\ head diseases, malignant sores
and inflammatory affections of the mouth, yield to
the internal use of this Ghrita. It is called the
Giuryyaidi Ghrita and is highly efficacious in
the derangements to which children are liable, (com-
monly) attributed to the malignant influences of evil
stars, as well as in cases of emaciated ones. 6.

Treatment of Kaphaja Visarpa :—

Cases of the Kaphaja type of Visarpa readily yield to a
proper application of a medicinal plaster (Pradeha)
composed of Aja-gandkd, As'va-gandhd, Sarald^
Kdld, Ekaishikd^ and Aja-s'ringiX pasted with
the urine of a cow. Drugs, such as Kdldnusdryd, Aguru^
Chocha (cardamom), Gunjd, Rdsnd, Vachd^ S'ita-s'iva,
Indra-parni^ Pdlindi, Munjdta and Mahi-Kadamba
^applied similarly) are also efficacious in the present
type. Drugs of the Varunddi group may be used in any
form (such as plasters, washes, etc*\ for erysipelas.
Blood-letting (by means of leeches) and Samsodhana
(purifying) measures are the principal remedies in all
cases of this disease (Visarpa^. Suppurated erysipelas
should be first purified and then treated with the reme-
dies described in the treatment of Vrana (ulcer), 7-8.

* «'SaraU" here means '«Trivrit''. Chakradatta reads *'^[TW" which also means *'Trivrii",

t 'Ekaishika," according to Uallana, would mean S'atdvari but S'ivadasa explains it as Pdlha.

X Gayadasa explains it as Karkata-S'ringi.

Chap. XVit] CHIKITSA STHANAM. 42 1

Treatment of Nadi-vrana :— A Case of

Naidi-Vrana (sinus) due to the concerted action of the
three Doshas (Sannipatajaj baffles all cure, while the
four remaining types are amenable to careful medical
treatment. Poultices (Upandhiy* should be applied at
the outset in the Vaitaja Nadi-Vrana and then
the course of the pus-channels should be (ascer-
tained and) fully opened (with a knife) and bandaged
with a paste of sesamum, Apd^ndr^-a-SQeds and
Saindhava salt. A decoction of (the drugs of) the
Vrihat-Pancha-mula group should be constantly
used in washing the ulcer. Oil f duly cooked with
the following drugs, viz , Hinisrd, Haridrdy Katuka^
Vald, Gojihvikd and Viha-roots should be used for the
purification, filling up and healing of the sores of
the sinus. 9-1 r.

Treatment of Pittaja Nadi :— In a case

of Pittaji sinus, an intelligent surgeon should
employ a porridge (Utkarikaj mixed with milk and
clarified butter as a poultice, Then having opened
the sinus with a knife, a plaster composed of Tzla,
Ndga-danti and Yashti-madhu should be applied to
heal it. A decoction of Soma, Nimba and Haridrd
should be used by a skillful surgeon in washing the
ulcer daily. A medicated Ghrita cooked with S'ydmd^
Trivrit, Triphald, Haridrd^ Ddru-Haridrd^ Rodhra
and Kiitaja and with milk should be used to lubricate
(Tarpana) the sinus. This Ghrita will even heal a sinus
affecting the Koshtha. 12-13.

* Poulticing with the drugs which induce suppuration is not approv- ed of by Gayaddsa.

t Four seers of oil, the (Kalka) drugs combindely weighing one seer and sixteen seers of water are to be taken in its preparation. — Dallana.

422 tME ^USHRUTA SAMHITA. [Chap. XVIt

Treatment of Kaphaja Nstdi:— in a case

of the Kaphaja type of the Nadi, the sinus should be duly poulticed i^Upanaha) with Kulattha, white mustard seeds, S'aktu and Kinva. When softened by its application, the direction of the sinus (with the help of a director) should be first ascertained ; and an expert surgeon should then open it fully with a knife and plaster it with a com- pound composed of Nimba, sesamum, Saindhava salt and Saurdshtra-mrittikd. A decoction (Sva-rasa-lit.— express- ed juice") of the Karanja, Nimba, Jdti, Aksha and Pilu should be used in washing the incidental ulcer. Oil duly cooked with Suvarchikd, Saindhava, Chitraka, Nikum- bha^ Tdli^ Nala, Rupikd and Apdmdrg-a-scQds and with cow's urine should be used for healing purposes. 14.

Treatment of ^alyaja Nadi :— in a case

of Salyaja Ns^di (incidental to any foreign matter into
the body), the Salya should be first extracted by an
incision into the sinus. Then having fully cleansed the
channel, the ulcer should be purified with a plaster of
sesamum profusely saturated with honey and clarified
butter. It should hz then healed up. Oil cooked with
the decoction of the tender fruits of the Kumb/izka,
K/iarj'ura, Kapitthay Vilva and the Vanaspatis (Vata,
etc."*, and with the Kalkas of Mustd^ Sarald^ Priyangu.
Sugandhikd, Mocharasa, f Ahi-pushpa (Ndgesvara),
Rodhra and Dhdtaki flowers leads to a speedy healing
up (granulation) of ulcers (Vrana) and traumatic
sinuses. 15.

* Dallana's reading evidently is "Tali-lala" and he explains it as the roots of "Bhumyamalaki". Chakradalta also prescribes this oil but he takes "Nilika" instead of "Tali". S'ivadasa, again, in his commentary quotes from Sus'rula but reads "Nili-Nala* in place of "Tala-Nala."

t "Mocha-rasa" is explained by Dallana lo be "S'obhdnjana," but it generally means '*S'almaIi-veshta/'and S'ivadasa ejcplains it as such. — Ed.

Chap. XVII.] CHIKITSA STHANAM. 423

Treatment with Kshara-Sutra :— An

erudite surgeon should open a sinus, occurring in any of the Marmas, or in a weak, timid, or emaciated person with an alkalined string (KshaVa-Sutra\ and not with a surgical knife. The course of the sinus should be first ascertained with a director ; and a needle, threaded with a string of alkalined thread should be passed from one end of the sinus and quickly drawn out through the other. Then the two ends of the thread should be firmly fasten- ed together. An intelligent surgeon should likewise pass another alkalined thread in the event of the alkali of the first thread being comparatively weak. This should be repeated till the sinus completely bursts out. The surgeon should know that the same procedure may be as well adopted in cases of fistula-in-ano. Similarly in cases of tumours (Arvuda), etc. they should be lifted up (with the hand) and tied round at their base with an alkalined thread, or it should be punctured around with a kind of needle with their mouth resembling a barley corn and then tied again at their base with an alkalined thread. After their bursting (and falling offj, they should be treated as common ulcers (Vrana\ 16.

The different kinds of Plug-Stick (Varti) described
in the Dvi-Vraniya Chapter (Chikitsita—chap.-i.) may
be similarly used with advantage in all cases of sinus.
The use of a plug made of the following drugs, viz.,
the bark and fruit of the Ghonta, (the five officinal kinds
of) salt,* LdksM, Puga and the leaves of the Alavand \

* According to Chakradatta's reading and S'ivadas's commentary there- on, only the Saindhava (instead of the five officinal kinds of sail) should be taken. We, however, follow Dallana's inttrpretation with good results. -j^^.

t *'Alavana" has been explained by Dallana as "Kaka-mardanika" and by S'ivadasa as "Jyotishmati". S'ivadasa is, however, followed in practice in this case,

424 THE SUSHRUTA SAMHITA. CChap. XVII.

pasted together with the milky juice of the Snuhi and
Arka leads to the speedy healing up of a sinus. The
powdered* stones of Vibhitaka^ mangoe fruits, Vata-
sprouts, Harenu, S'amkhini-setd, V drdhi-kanda mixed
with oil can also be used in a case of sinus. 17-19.

The seeds of the Dhustura^ Madana and Kodrava,
Kos'dtaki, S'uka-nasd, Mriga-bhojani and the seeds and
flowers of the ^f//>^^/<3; should be pounded together and
applied to a sinus (Nddi) after having washed it with a
decoction of Ldkshd. Cases of sinus speedily yield
to the curative efficacy of the application of these
powders mixed with oil. The use of the oil cooked
with cow's urine and with the preceding drugs (as
Kalkas) brings about the healing up of a sinus in seven
nights. 20-21.

The application of the oil cooked with the roots of
the Pinditaka treated with the expressed juice of the
Vardha-kanda in the manner of a BhAvand saturation
and with the bulbs of Suvahd brings about a speedy and
effective remedy for a sinus. The same effect is pro-
duced by an application of the oil cooked with the
bulbs of the the Vajra-kanda. 22.

Bhallatakadya Taila:— The use of the

oil cooked with the paste (Kalka) of Bhalldtaka,
Arka, Marichdi Saindhava salt, Vidanga, Haridrd,
Ddru-Haridrd and Chitraka and with the expressed
juice of the Bhringa-rdja readily cures cases of sinus,
Apachi and ulcer due to Vdyu and Kapha. 23.

Treatment of Stana-roga : - In cases of

a derangement of the milk (of the breast) a draught of clarified butter should be quickly given to the Dhatri

* According to some different reading "burnt ashes" (instead of pow- ders) of the drugs should be taken. In our humble opinion the reading in the text seems to be the correct one,

Chap. XVIL] CHIKITSA STHANaM. 425

(mother ov wet-nurse) by the physician ; and in the
evening a draught composed of the decoction of Nimba,
mixed with honey and Mdgadhikd, should be given
to her for emetic purposes. Next day she should
take a meal (of boiled rice) with the soup (Yusha)
of Mudga pulse. The use of emetics should be
continued for three, four, or six days ; or she
should be made to drink a potion of clarified butter
(cooked) with Triphald, A decoction of Bhdrgi,
Ativishd, Vachd, Sura-ddru, Pdthd, the drugs of the
Mustddi Gana, Murvd and Katu-rohini, or that of the
drugs of the Ai^agvadhddi group mixed with honey,
should be given to the Dhdtri ^wet-nurse) for the purifi-
cation of her breast-milk. 26.

The above are the general remedial measures which
are to be adopted in the affections of breast-milk. Any
other defect in the breast-milk should be corrected
specially with an eye to the nature of the Dosha
involved in the case. In cases of inflammatory
swellings of the breasts, the physician should remedy
them by means of any one of the various measures laid
down under the head of Vidradhi with a due considera-
tion to the requirements of each particular case. Medici-
nal remedies should only be internally employed and no
poultices should be applied for the speedy suppuration
of the swelling of the breast, even if found to have al-
ready commenced to suppurate ; since the breasts are of
an extremely soft and fleshy growth, any tight banda-
ging about those parts may be followed by local slough-
ing or even bursting. In a case where suppuration had
already taken place, an operation should be made
in the affected part, avoiding the milk-carrying veins
as well as the nipple with its black surroundings.
In all the cases of Stana-V id rad hi— whether