Now we come to the second stanza. Commentators differ more in the exposition of this stanza than of the former. By the expression ''^rnr^^- ^WR[ is meant by some commentators "from the Gulpha to the Kama." Others, however, mean to take it as an adjective to *'?I^rWTf^" and explain it as meaning "from above the Khulaka whereof the Gulphas look like the Karnas." As regards the expression "^fm^"^t^'/', some are inclined to think that the excision should be made straight above the Ghona (i.e., the posterior part and especially the big vein there which looks like the nose (Ghond) of the ankle-joint).
Others, however, read it as "^t'HT^S^:" and explain it (^tWM^ + ^p^) as meaning "in a straight line with the Ghon^ (which may mean
434 THE SUSHRUTA SAMHITA. [Chap. XVIII.
The ashes (Masi) of the skins of a peacock, cow,
h'zard (Godhd) and snake and of tortoise shells
should be dusted (over an Apachi after lubricating it)
with the (expressed) oil of the Ingudi. Medicated oils to
be described under the treatment of Slipada (elephan-
tiasis) and Vairechanika fumes should also be applied in
a case of Apachi and the diet should consist of cooked
barley and Mudga pulse. 20-21.
Treatment of Vataja Arvuda :~ln a
case of Vsitaja Arvuda, a poultice composed of
Karkdruka, Ervdruka, cocoanut, Piydla and castor
seeds, boiled with milk, water and clarified butter,
and mixed with oil, should be applied lukewarm
(to the tumour). As an alternative, a poultice
made up of boiled meat or of Ves'a-vdra, should be
applied to it. Fomentation of the part in the manner
of aNaidi-sveda (application of medicated fumes through
a pipe; should be applied by an experienced physician
and the (vitiated) blood (of the locality) should be
repeatedly cuffed off with a horn. S'atdhvd or Trivrit *,
boiled with the decoction of the Vdyu-subduing
drugs and with milk and Kanjika, should be given to
the patient. 22-23.
Treatment of Pittaja Arvuda : —
Applications of mild fomentations and poultices (to the
either the nose or the big vein (Kandara) at the heel looking like the nose (Ghona) of the ankle-joint and below the Indra-vasti".
Dallana says that the part to be excisioned, according to the first stanza, is bBlow the Indra-vasti and that, according to the second, is above theflndra-vasti. We also think that the seat of the Indra-vasti should be carefully avoided and an excision should be made both above and below the Indra-vasti, according to the requirements in each case.
* There is a different reading "^cTT^ 1%§fi" '" place of "gjcTfJ^J f(j(§c['". In that case, roots of whitfe Trivrit should be boiled with the d^pocilon, etc" ■ '
Chap. XVIIL] CHIKITSA STHANAM. 435
affected part) and of purgatives are efficacious in
Pittaja Arvuda. The tumour should be well rubbed
with (the rough surface of) the leaves of the Udumbara,
S'dka^ or of the Goji and it should be plastered over
with the fine powders of Sarja-rasa, Priyangu, Pattanga
(red sandal wood), Rodhra, Anjana * and Yashti-
madhuy mixed with honey. As an alternative, a plaster
composed of Aragvadha, Goji, Soma and S'ydntd,
pasted together should be applied to it after the
secretion Visrdva. Clarified butter, cooked with
Klitaka (as a Kalka) and with the decoction of S'ydmd,
Girihvd, Anjanaki, Drdkshd and Saptalikd should be
prescribed for internal application in a case of Pittaja
Arvuda and of abdominal dropsy (Jathara) of the
Pittaja type. 24-26.
Treatment of Kaphaja Arvuda : — In
cases of the Kaphaja type of Arvuda blood should be
let out from the affected part after the system of the
patient has been cleansed (by emetics and purgatives).
Then a medicinal plaster composed of the drugs,-|* which
are efficacious in correcting the Doshas, confined to the
upper and lower parts of the organism, should be
applied hot to the tumour. Or a plaster composed of
Kdnsya-nila, S'uka^ Ldngaldkhya and Kdkddani roots,
and the dung of a Kapota and of Pdrdvata pasted
together with urine, or with alkaline water should be
applied to it. The Kalkas (pastes) of Nishpdva{^'\m\A)^
Pinydka (oil-cakes of sesamum) and Kulattha pulse,
pasted with curd-cream and an abundunt quantity of
flesh, should be used in plastering the affected part so
that worms and parasites may be produced in the ulcer
* Chakradatta reads **Arjuna" in place of "Anjana".
t These are the drugs included in the emetic and purgative groups
(see chap. XXXIX. Sutra Sthanam).
436 THE SUaHRUTA SAMHITA. [Chap. XVIIL
and flies attracted to it (and so consume the ulcer). A
small portion of the ulcer, left unconsumed (un-eaten)
by worms and parasites, etc., should be scarified and
the ulcer should then be cauterised with fire. 27-28.
A comparatively superficial tumour (Arvuda; should be covered with thin leaves of zinc, copper, lead, or of iron, and cauterization with fire or with an alkali as well as surgical operations should be carefully and repeatedly resorted to, so as not to hurt, nor in any way injure the body. The incidental ulcer should be washed with the decoction of the leaves of the Asphota, fdti, and Karavira for the purpose of purification. A medicated oil, cooked with Bhdrgi, Vidanga, Pdthd,^,x\d Triphald should then be used as a healing remedy. An experienced physician should treat a tumour, sponta- neously suppurating, in the manner of a suppurated ulcer. 29-31.
Treatment of Medoja Arvuda :— A
Medoja Arvuda (fat origined tumour) should be first
fomented and then incised. The blood in its inside
having been cleansed it should be quickly sutured and
then plastered over with a compound composed of
Haridrd, Griha-dhuma (soot of a room), Rodhra,
Pattanga, Manahs'Ud and Haritdla pounded together
and mixed with a proper quantity of honey After its
purification, thus produced, it should be treated with
the application of Karanja-Taila (prescribed before in
•cases of Vidradhi). Even the least particle of Doshas
(pus, etc.) in a tumour, left unremoved, would lead
to a fresh growth of the excrescence and bring on death
just like the least particle of an unextinguished fire.
Hence it should be destroyed in its entirety. 32-33.
Treatment of Vataja Gala-ganda : —
A case of the Vaitaja type of Gala-ganda (goitre) should
Chap, XVIIL] CHIKITSA STHANAM. 437
be treated with fomentations of the vapours of the
decoctions of tender leaves of the Vayu-subduing drugs
prepared by boiling them with Kanjika, various kinds
of urine and milk as well as with minced meat and oil,
and should be applied in the manner of a Nadisveda.
After this fomentation, the contents should be carefully
drained ^from inside the goitre). Then after having duly
purified (the incidental ulcer), it should be plastered with
a medicinal compound composed of (the seeds ofj the
S'ana^ Atasi, Mulaka, S'igru and sesamum and Kmva
and the piths of the Piydla^ or with that composed of
Kdld, Amritd, S'igru, Pufzamavd, Arka, Gaja-pippali,
Kara/idta {Ma.da.na.) a.nd Kus/it/ia, or with that com-
posed of Ekazs/nkd, Vrikshaka and Tilvaka. All of
them should be pasted with Sura and Kanjika and ap-
plied hot to the affected part. The internal u^e of a
medicated oil, cooked* with Ainritd, Nimba, Hamsdhvd,
Vrikshaka, Pippali, Vald, Ati-vald, and Deva-ddru,
always proves efficacious in a case of goitre. 34-36.
Treatment of Kaphaja Cala-ganda :
— A case of the Kaphaja type of goitre should be treated
with applications of fomentation and poultice and
should be duly drained (Visrava). Then a medicinal
plaster composed of Aja-gandhd, Ati-vishd, Vis'afyd,
Vishdnikd, Kushtha, S'ukdhvayd, Gunjd (taken in
equal parts) and pasted with the alkaline water
prepared from the ashes of the Palds'a wood should
be applied hot to the affected part. A medicated oil
cooked with the drugs of the Pippalyddi group and
mixed with the five officinal kinds of salt should
* Some say that the oil should be prepared with the decoction as well as with Kalka of the said drugs. Others, however, hold that water should be used in the preparation of the oil and the said drugs should be used only as a Kalka.
438 THE SUSHRUtA SAMHiTA. CChap. XVIII.
be taken by the patient. Emetics, errhines and
inhalations of Vairechanika-dhuma are beneficial in such
cases. In the Va'taja and the Kaphaja types of goitre
(Gala-ganda), the skilful physician should employ
suppurating measures in partially suppurated cases.
The patient*s diet should consist of rice, barley and
Mudga soup and should be taken with honey, Trikatu,
cow's urine, fresh ginger, Patola and Nimba. 37-39.
Treatment of Medoja Gala-ganda :—
In a case of a Medoja goitre (due to the deranged fat\ the patient should be first made to use oleaginous substances (internally and externally) and venesection should then be resorted to, as advised before (Sarira-Sthdna. Ch VIII). A hot plaster composed of S'ydmd (Trivrit), Sudhd, Manduray Danti and Rasdnjana pasted together should be applied to the seat of the disease. Powders of the essential parts (Sara) of a S'dla tree mixed with cow's urine may be given every morning with advantage.
As an alternative, the Goitre (Gala ganda) should
be opened, its fatty contents fully removed and the
wound then sutured. Or it should be cauterised with
the application of heated animal marrow, clarified
butter, lard, or honey ; after which it should be lubri-
cated with clarified butter and honey (mixed together),
and a pulverised compound of Kdsisa, Tuttha, and
Gorochandy should be applied to it ; or after lubricating
it with oil, it should be dusted with the ashes of cow-
dung and of S'dla-sdra. Daily washings with the decoc-
tion of Triphald, hard bandaging and a diet of barley,
prove efficacious (in cases of goitre). 40.
Thus ends the Eighteenth Chapter of the Chikitsita Sthdnam in the Sus'ruta Samhitd, which deals with the medical treatment of Glands, Scrofula, Tumour and Goitre.
CHAPTER XIX.
Now we shall discourse on the medical treatment of
hernia, hydrocele, scrotal tumour, etc. (Vriddhi),
diseases of the genital organ (UpadamS'a) and
elephantiasis (Slipada). i.
In the six types of Vriddhi other than the one known as the Antra- Vriddhi (Hernia), riding on horse back, etc., excessive physical labour, fastings, sitting in an unnatural position, constant walking, voluntary restraint of any natural urging (for stool and urine, etc.), sexual intercourse and eating of food difficult of digestion should be avoided. 2.
Treatment of Vataja Vriddhi :— In
the VaLtaja type of Vriddhi, the patient should be first soothed (Snigdha) with the application of Traivrita Ghrita (vide, Chap. V. Chikitsita Sthana). He should then be duly fomented and subjected to a proper course of purgatives. As an alternative, he should be made to drink the expressed oil of the Kos'dmra^ Tilvaka, or Eranda {cdiStor) oil (as a purgative) with milk for a month. A decoction of the Vayu subduing drugs mixed with the powders of the same drugs should then be employed by an experienced physician at a proper time * in the manner of a Niruha Vasti. The patient should then be made to take a meal (of boiled rice'; along with meat soup ; and oil cooked with Yashti 7nadhti should be applied (in the manner of an Anuvasana measure).
* After a period of one week from the time of the application of purgatives and in case the patient is strong enough to undergo the Niruha. Vast! measure,
440 THE SUSHRUTA SAMHITA. [Chap. XIX.
Applications of Sneha (oil, etc.), poultices (Upandha),
and plasters (Pradeha) of the Vdyu-subduing drugs should
be applied to the affected part. If the tumour (Vriddhi)
begins to suppurate, it should be made to do so
fully. It should be then opened with an incision
avoiding the median line (Sevani) of the perineum
and the proper purifying (i.e., antiseptic and healing)
measures should be resorted to in the usual way
laid down (in the treatment of Dvi-vrana*). 3.
Treatment of Pittaja Vriddhi :-^A
case of the non-suppurated stage of Pittaja Vriddhi
may be beneficially treated with the remedies laid
down in connection with a case of the same type of
glandular swelling (Pittaja Granthi). In the case of
it being suppurated, the surgeon should open it with
a knife and purify it with the application of honey
and clarified butter. The incidental ulcer should then be
healed up with oils and pastes of healing virtues. 4.
Treatment Of Raktaja Vriddhi :-ln a
case of Raktaja Vriddhi (originated through the vitia-
ted condition of the blood), the (vitiated) blood should
be drawn out by the application of leeches. As an
alternative, purgatives should be administered through
the medium of honey and sugar. Remedial measures
described in connection with the Pittaja type of the
disease should be employed both in the suppurated
and the non-suppurated stages (of this type). 5.
Treatment of Kaphaja Vriddhi :— In
a case of the Kaphaja type of the disease, poultices with the heat-making f drugs (i.e , Vachadi, Pipp^lyadi
* According to Gayadasa, the measures to be adopted should be those laid down in the Mis'raka chapter (Chap. XXV).
t Some say that the heat-producing drugs are those comprised in the Aja-gandhddi group mentioned in the Mis'^raka chapter, Sutra Sth^nam.
Chap. XIX.] CHIKITSA STHANAM. 441
and Mushkakddl groups, etc.) pasted with cow's uHne
should be applied. The patient should be made to
drink a potion consisting of the decoction of Ddru-
Haridrd mixed with the urine of a cow, and all the
remedial measures with the exclusion of VimUpana
(resolution by pressure) laid down under the treatment
of the Kaphaja Granthi should be employed. The
tumour should be opened (with a knife) when suppurated
and the oil cooked with fdti, Arushkara^ Ainkota and
Sapta-parna should be used for the purification
(disinfection) of the incidental ulcer. 6.
