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

426 THE SUSHRUTA SAMHITA. [Chap. XVlt.

non-suppurated, suppurating^, or suppurated— the

milk should be pressed out from the breast of the Dhatri* 27-29.

Thus ends the Seventeenth Chapter of the Chikitsita Sthanam in the Sus'ruta Samhita which deals with the treatment of erysipelas, sinus and the diseases of the mammary glands.

* The milk should be pressed out of the Dhatri's breasts in the non-suppurated stage, to alleviate the burning sensation therein, in the suppurating stage for the avoidance of further suppuration, and in the suppurated stage for the prevention of sores, sinus, etc.

CHAPTER XVIII.

Now we shall discourse on the medical treatment
of Glandular Swellings, etc. (Gratlthl), Scurvy
(Apachi), Tumour, etc. (Arvuda) and Goitre

(Gala-g^anda). i

General treatment of Granthi :— In

the non-suppurated or acute (inflammatory) stage of
Granthi, an experienced physician should prescribe
the measures # laid down in connection with (in-
flammatory) swellings (Sopha) in general. As bodily
strength arrests the progress of the disease, the
strength of the patient should hence be always carefully
guarded against suffering any diminution in that respect.
The patient should be made to drink oil, or clarified
butter, or both ; or he should be made to drink lard,
oil and clarified butter, mixed together.f Apehivdtd
(Prasarani) and Das'a-mula cooked with the four kinds
of lardacious or emollient substances (oil, clarified

* Beginning with Apatarpana up to the purgative measures.

t Oil, clarified butter and lard mixed together is technically called the "Trivrita."— Dallana.

In the case of a Vataja Granthi, a potion of oil cooked with the decoction and paste (Kalka) of the Vayu-subduing drugs should be prescribed for the patient ; in the case of a Pittaja Granthi, clarified butter cooked with the decoction and Kalka of the Pitta-subduing drugs should be administered in the same manner ; while in the case of a Kaphaja Granthi, oil cooked with the decoction and Kalki of the Kapha-subduing drugs should be taken by the patient. But in a case of Granthi due to the concerted action of the two, or three of the Doshas, any compound medicated oil, prepared by cooking any two, three, or four of the oily substances, viz.^ oil, clarified butter, lard and marrow, with the decoction and Kalka of those drugs which are antidotes to the said Doshas, should be prescribed for the patient as drinks,

428 THE SUSHRUTA SAMHITA. [Chap. XVIII.

butter, lard and marrow), or with any two of them should be prescribed. 2-3.

Treatment of Vsitaja Cranthi :~A

medicinal plaster composed of Himsrd, Rohiniy Amritd,
Bhdrgi^ S'yondka, Viha, Aguru, Krishna-gandhd, Goji
and Tdla-patri (Tdla-parni — D. R ) pasted together,
should be applied ito the inflamed gland) in the
Vaitaja type of Granthi. Different kinds of fomen-
tation (Sveda), poulticing (Upanahaj and medicinal
plasters (Lepa), possessed of the efficacy of subdu-
ing the deranged Vdyu, should be likewise resorted to. A
suppurated swelling should be opened and the pus drained.
Then the incised wound should be washed with a
decoction of Vilva^ Arka and Narendra (Aragvadha)
and purified (disinfected) with a plaster consisting of
sesamum and the leaves of the Panchndgula (castor oil
plants), together with Saindhava salt. After the
purification, it should be healed up by applying a
medicated oil, mixed with the powders of Rdsnd and
Sarald ; or by a medicated oil prepared by cooking it
with Vidanga, Yashti-madhu and Amritd and cow's
milk. 4.

Treatment of Pittaja Granthi:— In a

case of the Pittaja type of the disease, leeches should
be applied to the affected part, which should be further
affused with milk and water. The patient should be
niade to drink a cold decoction of the drugs of the
Kdkolyddi group with the addition of sugar ; or he
should take the powders of Haritaki through the
medium of grape-juice, or of the expressed juice of sugar-
cane. Hot plasters, prepared by pasting together the
bark of the Madhuka (flower) tree, and of the Jambu

* Some read *'1%'^T^^^Tl%^ia:" and explain that the\decocUons of the Vilvadi and the Arkadi groups are to be taken for the purpose.

Chap. XVIII. ] CHIKITSA STHANAM. 429

tree, Arjuna tree, and Vetasa creeper. As an alter-
native, hot plasters compounded of the roots of the
Trina-s'unya (Ketaki), or Muchukunda mixed with
sugar, should be constantly applied to the affected part.
The Granthi should be opened when fully suppurated,
and the pus let out ; after which it should be washed
with a decoction of the bark of the Vanaspati^ The
incidental ulcer should then be purified with a plaster
composed of sesamum and Yashtimadhu ; and lastly it
should be healed up with clarified butter cooked with
the drugs of the Madhii7'a (Kdkolyadi group. 5-6.

Treatment of Kaphaja Granthi :— In a

case of the Khaphaja type of the disease, the Doshas
should be first eliminated from the system with the
regular and successive measures. f The affected part
(Granthi) should then be fomented and firmly pressed
(Vimlapana) and rubbed with either the thumb, or a
piece of iron rod, or stone, or with a bamboo rod in order
to bring about its resolution. A plaster composed of the
roots of the Vikamkata, J Aragvadha, Kdkananti (Gunja),
Kdkddani (Vayasa-tinduka), and Tdpasa-Vriksha
(Ingudi) and with Pinda-phala (Tiktdldvu), Arka, §
Bhdrgi, Karanja, Kdld and Madana^ pasted together,
should be applied to it by an erudite physician. A
glandular swelling v Kaphaja Granthi) on any part of the
body other than a vital and vulnerable one (Marma) and

* The Vanaspati class consists of Vata, Plaksha, As'vatlha and Udumbara frees.

t These are ihe applications of Sn^ha, fomentation, emetics, pur- gatives, Asihapana, S'iro-virechana and blood- letting.

X Dallana explains "Vikamkata" as "Kanta-karika," but it means Sruva (called Vainch in Bengal) and S'ivadasa also explains it as such,— i^r/.

^ Chakradatia does not read "Arka" in the list.

430 THE SUSHRUTA SAMHITA. [Chap. XVIII.

not (otherwise) resolved and absorbed should be cut open
even in its non-suppurated stage and the glands
removed. The expert surgeon should then cauterize the
incidental wound after the cessation of the bleeding and
treat it in the manner * of the Sadyo-Vrana treatment.
These remedies should be employed by the experienced
physician, where the swelling would be found to have
assumed a large, stiff, elevated and fleshy aspect
(bulging from the deeper tissues of the flesh). A
Kaphaja Granthi should be opened with an incision as
soon as it becomes fully suppurated and should then be
washed with a decoction of appropriate medicinal
drugs. The incidental ulcer should be purified (disin-
fected) with a purifying remedy prepared with a
profuse quantity of Yava-kskara, honey and clarified
butter ; and finally it should be healed up by the
application of an oil, cooked with Vidanga, Pdthd and
RoJiini. 7-9.

Treatment Of Medoja Granthi : -In a

case of Medoja Granthi (originated from the vitiated condition of the bodily fat) a plaster of pasted sesamum, placed inside the folds of a piece of linen, should be applied to the seat of the affected part and fomen- tations with hot iron- rods should be frequently applied, inasmuch as application of heat (lit. — fire) is efficacious in such cases. As an alternative, the affected part should be fomented with a ladle, pasted with heated shellac (Ldksha). The Granthi (in its non-suppurated stage) should be opened by an incision and the fat removed ; the incidental ulcer should then be (actually) cauterized. On the other hand, the Granthi, when fully suppurated, should be incised and washed with the urine (of a cow). Then a paste, composed of * Applications of honey, clarified butter, etc.

Chap. XVIlI.] CHIKITSA STHANAM. 431

sesamum, Suvarchikd, Haritdla and rock-salt, pounded
together and mixed with honey, clarified butter and an
abundant quantity of Yava-kshara, should be applied
to the incidental wound for purifying purposes. Oil,
cooked with the two kinds of Karanja, Gunjd^ the
green scrapings of bamboo, Ingudi and the urine * of a
cow, should be used to heal the ulcer. lo-ii.

Treatment of Apachi :— Clarified butter
cooked with the fruit of Jimictaka and Kosha-vati,
and with (the roots of) Danii, Dravanti and Trivrit^
is a very powerful and efficacious remedy.-|* Adminis-
tered internally as well as externally, it leads to the
cure of the advanced cases of Apachi. 12.

A strong emetic composed of Nirgundi, Jdti (flower)
.and Varihistha (Vala) together "^ith. Jitmitaka, profusely
mixed with honey and Saindhava, should be given
warm to the patient. It is a very powerful emetic,
and leads to the recovery of even a malignant form
of Apachi. An oil, cooked with the pastes (Kalka) of
Kaitaryya,\ Vimdiand Karavira^ may be profitably used
as an errhine (Siro-virechana). Oil cooked with the
expressed juice of S'akhotaka may also be used profit-
ably as an errhine. § Avapida errhines (used in drops

* Cow's urine measuring four times the oil should be taken in the preparation of this medicated oil.

t In preparing this medicated Ghrita, the quantity of clarified butter should be taken four times as much as the combined weight of the Kalka (paste). These should be boiled with water, taken four times as much as the quantity of clarified butter. Some authorities, however, are of opinion that both the paste (Kalka) and the decoction of the drugs are to be taken in its preparation,

X Some read *Nirgundi' after it.

§ This medicated oil should be cooked without any Kalka. But some are of opinion that both the decoction and the Kalka of S'akhotaka should be used.

43^ THE SUSHRUTA SAMHITA. [Chap. X III.

into the nostrils) should be applied with Madkuka-sdra, S'ig'ru-sQeds and Apdmdr^a-seedsJ^ 13-15.

A glandular swelling (Granthi), occurring in any
part of the body other than a Marma, should be opened
in its non-suppurated stage and cauterized with
fire ; f or it should be rubbed with an alkali I after
scarificaticn as already advised. 16.

A length of twelve fingers should be measured
(Mitvd) from and above the Parshni, i.e., the posterior
side of the ankle (and the space of Indra-vasti above
this part should be ascertained). The Indra-vasti
(occupying a space of half a finger, or, according to
others, two fingers) having been carefully avoided, an
excision (on the opposite side of the affection) should
be made and the spawn-like glands having been
removed (therefrom), the excisioned part should be
cauterised with fire.

Others say that the excision should be made straight
above the ankle (Ghona) after carefully avoiding the
space of Indra-vasti, measuring two fingers (and to
make sure an additional space of half a finger should
be left out), which would be found out by taking one-
eighth part (of the Jangha, 2>,, the leg— excluding the
, foot and measuring twenty fingers) from the Khulaka
(ankle-joint) of which the (two) Gulphas (ankles) look
like the (two) ears. § 17-18.

* Madhuka-sara mixed wiih tepid water and the expressed juice of S'igru-seeds and of Apamarga-seeds should be used.

t In cases of the preponderance of Vayu and of Kapha.

X In cases of the preponderance of Pitta.

§ There is a good deal of difference as to the reading and explanation of this passage amongst the different commentators. The different explana- tions arise from the different interpretations put upon the word *'j}t%" in the Text, "qif^' 5if?T %K^ '^Tl^^TfT, etc." The words ''^]H 5rf?T"

Chap. XVIII.] CHIKITSA STHANAM. 433

As an alternative, the region of the wrist (Mani-
bandha) should be branded by a physician with three
mark lines, one finger apart, for a radical cure of
Apachi. 19.

may mean either of the following, (i) On the opposite side of the Parshni, Vagbhata subscribes to this view. (2) On the opposite {i.e.y the other) Parshni, that is to say, if the affection be on the right side of the body the operation should be made on the Parshni of the left leg and so on. Vriddha Vagbhata subscribes to this interpretation in the clearest language. (3) In the region of the Parshni, «.e,, on the dorsal side of the leg.

The different commentators, again, do not agree as to the seat and extent of the excision. Some say that the operation should be made above the Indra-vasti and the extent should be two fingers in length. Vagbhata seems to subscribe to this view. Others hold that the operation should be made below the Indra-vasti and the extent should be two fingers' length : Dallana is of this opinion. A third class of commentators assert that the whole extent of the length from above the Parshni up to the Indra vasli should be opened.

As to the extent of the Indra-vasti, again, there is a difference. According to Dallana it occupies a space of two fingers. But Jejjata holds that it occupies a space of half a finger only. The Indra-vasti (Marma) is situated twelve fingers above [i.e., in the thirteenth finger of) the Parshni. The reading in the printed editions of the text is "fifc^T", whereas Vrinda and Chakradatta read *'t%c^". Dallana's reading also evidently is "1%^". "fvTc^" would be quite redundant and as "f»f^" gives a better meaning, we accept this reading.