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

Treatment of IVledoja Vriddhi :— in

a case of the Medoja (fat-originated) type of the disease, the affected part should be (lightly) fomented, * and plasters composed of drugs (of the roots) of the Surasddi group or of the S' iro-vircchana group (Ch. XXXIX. Sutra Sthana) pasted with the urine of a cow should be applied to it in a lukewarm state. The inflamed and swollen scrotal tumour, (lightly) fomented as before, should be tightened round with a piece of cloth. Then having encouraged the patient, the surgeon should open the tumour with a Vriddhipatra (knife) carefully avoid- ing the two testes (lying within the scrotal sac) and the median line of the perineum (Sevani). Then having carefully removed all morbid products (Medas) from its inside, Saindhava and sulphate of iron should be applied to the incised part, ani the scrotum should be carefully bandaged (in the manner of a Gophand bandage). After the proper purification (disinfection) of the ulcer, its healing should be effected with the application of an oil

* The fomentation should be applied according to S'ivadas'a, with balls of cow-dung, etc., slightly heated. It should be noted in this connection that strong fomentations should not, in any case, be applied to the testes.

THE SUSHRUTA SAMHITA. [Chap. XIX.

cooked with Manahs'ild, Haritdla (yellow oxide of arsenic), rock-salt, and Bhalldtaka. y.

Treatment of IVIutraJa Vriddhi : —

In a case of an enlargement of the scrotun (hydro-
cele) due to the derangement of urine, it should be first
fomented and then a piece of cloth should be tightened
rount it. A puncture should then be made in the bottom
of the sac with a Vrihimukha instrument, on either side
of the raphe of the perineum (Sevani). A tube open
at both ends should be introduced (into the puncture)
and the accumulated (morbid) fluid should be let out.
The tube should then be taken off and the scrotum
should be tied up with a bandage of the Sthagika
pattern and the incidental ulcer should be purified and
healed up with appropriate medicinal applications. 8.

Treatment of Antra-Vriddhi : -A case

of Antra-Vriddhi (hernia when strangulated) extending
down to the scrotal sac (Kosha) should be given up as
irremediable ; but, in the case of its not being so
extended, it should be treated as a case of Vdtaja-
Vriddhi. If the colon be found to have descended down
to inguinal region (Vamkshana), it should be cauterized
with a heated crescent-mouthed rod (Arddha-Chandra
S'aldka) to prevent its descending down into the scrotal
sac. A case of hernia that, in spite of all these pre-
cautions, descends down into the scrotal sac (Kosha),
should be given up as irremediable. The first finger of
the hand opposite * the affected part {i.e., the affected
testes) should be incised at its middle and cauterized,

* Incision and cauterization should be performed in the thumb of the right hand, if the left testis is affected, and in case the affection is in the right testis, incision and cauterization should be made in the thunjb of the left hand.

Chap. XIX.] CHIKITSA STHANAM. 443

In cases of hernia (Antra-Vriddhi) of the Va(taja
and of the Kaphaja type the affected part should
be carefully cauterized in the above manner ; but in
these two cases, the Sn^yu (ligamenls) should be cut
off in addition (^before cauterization). In a case of
Antra-Vriddhi the veins (S'ird) of the temples at the
(upper) end of the ears on the opposite sides of the
affection should be carefully opened avoiding the
Sevani therein. 9-12.

Treatment of Upadams'a * :— in cases of

the curable type of Upadams'a, Sneha (oleaginous sub-
stances) should be first applied, and the affected part
should be fomented. Then the veins of the penis
should be opened, or leeches should be applied (to the
organ) for the elimination of the contaminated blood t
(according as the affections are more or less severe), 13.

General Treatments :— The system of the

patient should be cleansed with both emetics and
purgatives in the event of an excessive aggravation
of the Doshas inasmuch as the local pain and swelling
would subside simultaneously with the elimination of
the aggravated Doshas from the system. Medicinal
Vastis (enemas) should be injected (into the rectum) in
the way of a Niruha-Vasti for the elimination of the
aggravated Doshas, where the weakness of the patient
would prohibit the application of purgatives. 14,

Treatment of Vataja Upadams'a :— in

a case of the Vataja type of the disease, drugs such as,
Propaundarika, Yashti-inadhu, Varshdbhu, Kushtha,
Deva-ddru^ Sarald, Aguru and Rdsnd^ should be used
as a plaster (over the affected organ). Similarly

* See note, Chapter XII., Nidana Slhanam.

t Jejjata holds that leeches should be applied in a case of supejrficial Upadams'a.

444 THE SUSHRUTA SAMHITA. tCbaP* XIX.

plasters composed of Nichula, castor-seeds, and pul-
verised wheat and barley grains pasted with Sneha
(clarified butter, oil, etc.) should be applied lukewarm to
the seat of the disease, which should also be affused
with a decoction of the above-mentioned drugs, viz,,
Prapaundarika, etc. 15.

Treatment of Pittaja Upadams'a :— in

a case of the Pittaja type of the disease, a plaster
composed of Gairika, Anjana, Yashti-madhu^ S'drivd,
Us'ira, Padmaka, (red) Chandana and Utpala mixed
with a Sneha (clarified butter),* or that composed of
Padma, Mrindla^ Sarjja^ Arjuna^ V etas a, and Yashti-
madhu mixed with clarified butter should be applied to
the affected organ which should be sprinkled with a
solution of milk, clarified butter, sugar, sugar-cane juice
and honey, or with a cold decoction of the drugs of
Vatay etc. 16.

Treatment of Kaphaja Upadams'a : -

In a case of the Kaphaja type of the disease, a plaster
composed of the barks of S^dla, As'va-karna, Aja-karna
and Dhava pasted with Surd and mixed with oil, should
be applied hot to the affected part. As an alternative,
the drugs such as, Haridrd^ Ativishd, Mustd^ Sarald,
Beva-ddru^ Patra, Pdthd, and Pattura should be used
for similar purposes and the affected organ should
be affused with a decoction of the drugs of the Su-
ras ddi an d y4 'ragvadhddi groups. 17.

The above remedial measures, viz., plasters, sprinkl-
ing (Parisheka), blood-letting and Sams'odhana (^V.,
application of purgatives, emetics, etc) as well as those

* According to S'ivad^sa the Sneha to be used In the plaster should be clarified butter washed a hundred times.

Chap. XIX.} CHIKITSA STHANAM. 445

described in the Sutra Sthdnam (and the first Chapter
of the Chikitsita Sthdnam), should be resorted to
in a case of (non suppurated) Upadams'a. The physi-
cian should try his best to arrest the setting in of
suppuration (in a case of Upadams'a) inasmuch as
suppuration in (and consequent putrefaction of) the (local)
veins, ligaments, skin and flesh would lead to the
destruction of the organ (Dhvaja). An incision should
be made as soon as suppuration would set in, and the
pus and other putrid matters being drawn out, the
incised part should be plastered with the paste of
sesamum mixed with honey and clarified butter.
The incidental ulcer should be washed with a decoction *
of the leaves of Karavira, of Jdti and A'ragvadha, or of
Vaijayanti and Arka. 18.

The use of a medicinal plaster composed of the fine
powders of Saurdshtra-mrittikd^ Gairikay Tuitha,
Pushpa-Kdsisa, Saindhava^ Rodhra^ Rasdfijana^ Ddru-
Haridrd, Haritdla, Manahs Ud, Harenukd and Eld^
mixed with honey is highly recommended in all cases
of Upadams'a. 19.

A decoction of the tender leaves of Jambu^ A'mra^ Sumanas, Nimba, S'vctd, and of Kdmboji f and the barks of S'allaki^ Vadara, Vilva, P aids' a, J mis' a and of the Kshiri trees, as well as Triphald should be used by the physician for constantly washing the ulcer. Oil cooked with the preceding decoction, with the Kalkas of Goji, Vidanga and Yashti-madhu, as well as with the different spices (Elad; group: should be used as the best remedy for the purpose of the healing up (Ropana) of

• According to Chakralatta the five kinds of leaves should be separately used in the preparations of the decoctions for washing, t "M^shaparni" according to Gayadasa.

44^ THE SUSHRUtA SAMHITA. [Chap. XIX.

ain Upadams'a-ulcer of whatsoever type. The use of a
pulverised compound composed of Svarjikd, Tuttha,
Kdsisa, S'aileya, Rasdnjana^ and Manahs'Ud taken in
equal parts arrests the extension of an ulcer and
Visarpa. Cises of Upadams'a and Visarpa readily yield
to the application of a pulverised compound of the
ashes of Gundrd, Haritdla and Manahs'Ud. An
(external) application of Bhrimgardja^ Jriphald and
Danti mixed with the powders of copper and iron,
destroys Upadams'a just as the thunder bolt of Indra
(complelely) destroys a tree. 20.

Treatment of Tridoshaja and Rak-

taja UpadamS'a:— The medical treatment of the two kinds of Upadams'a due to the concerted action of the three Doshas as well as that due to the vitiated blood (Raktaja) should be taken in hand without holding out any definite hope of recovery. The above-mentioned medicines specific to the different Doshas should be combinedly applied in these cases in consideration of the nature and intensity of the Doshas specifically involv- ed in them. Now hear me discourse on the special treatment of Tridoshaja Upadams'a. It should be the same as in the case of a malignant ulcer (Dushta-Vrana). The putrid portion of the male organ should be cut off and the remaining portion should be fully cauterized (in the incised part) with a Jambvoshtha instrument, made red-hot in fire. Honey, and clarified butter should then be applied to the cauterized part, and medicinal plasters and oils possessed of healing properties should be applied to the incidental ulcer when it would be cleansed (disinfected). 21-22.

Treatment of ^lipada:— In a case of

Elephantiasis (Slipada) due to the action of the deranged and aggravated Va(yu, the vein (Sird) at a distance

Chap. XIX.] CHIKITSA STHANAM. 447

of four fingers above the instep (Gulpha) should be
opened after an application of Sneha and Sveda *
to the patient. Vastis should be employed when
the patient has been (soothed and) restored to his
former condition (with appropriate and nutritious diet,
etc.V He should be made to take continuously for a
month, a potion consisting of castor-oil mixed with
(an adequate quantity of cow's) urine The patient
should take rice as his diet with milk duly cooked with
S'unthi. The use of the Traivrita Ghrita as well as
cauterization of the affected part with fire is also recom-
mended in such a case. 23.

Treatment Of Pittaja ^Iipada:-ln a

case of Pittaja type of Elephantiasis, the vein ^^ird)
below the instep (Gulpha) should be opened. Medicinal
remedies mentioned in connection with the treatmeiit
of the Pittaja type of tumours (Arvuda) and of Erysi-
pelas (Visarpa) as well as other Pitta-subduing remedies
and measures should be employed-f-. 24.

Treatment of Kaphaja ^Iipacla:-ln

a case of the Kaphaja type of elephantiasis the principal
vein (Sird) of the first toe should be opened by an
experienced surgeon and the patient should be made
to take at intervals the decoction (of the Kapha-sub-
duing drugs) with honey. As an alternative, the patient
should be advised to take the powders (Kalka) of Abhayd
mixed with any officinal kind of urine. The affected
locality should be constantly plastered with the paste

* Chakradalta reads "^l^^iT*n^n'' in place of "^^^^i:^,:^^ g" meaning thereby that such Sveda and Upanaha should be applied before the incision of the vein. Gayadasa also supports this reading as is evident from Dallana's commentary. — Ed.

t The panicle ««=^" in the text shows that Kapha-subduing remedies and measures should also be used in all these cases.

448 THE SUSHRUTA SAMHITA. CChap. XIX.

of Katukuy Amritd, S'unthiy Vidanga, Deva-ddru and Chitraka, or with Chitraka and Deva-ddru, An oil cooked with Vidanga, Markka, Arka, S'unthi, Chitraka, Deva-ddru^ Elakd and all the five officinal kinds of salt should be given him as a potion. Cooked barley is specially recommended as diet in the present case. 25. As an alternative, the patient should be made to drink a potion of mustard oil* or of the expressed juice of the leaves of /^//^/-A^^ra/^y^^ according to his capacity for the cure of Slipada. In the same wayf the juice of Putranjivaka should be prescribed by a physician after a due consideration as to the strength of the patient and of the time. The same juice {i.e., of Putran- jivaka) should be taken along with the juice of the bulbs of Kechuka with Pakima (vit) salt. 26.

The Alkaline Remedies :— An alkali

should be prepared from the ashes of Kdkddani, Kdka-
janghd, Vrihati, Kantakdrikd, Kadamba-pushpa, Mandd-
ri, Lamhd Sukanasd in the usual way by filtering them
(twenty one times) after dissolving them in cow's urine.
\ The expressed juice of Kdkodumharikd, Sukanasd and
the decoction of Madana fruit should be mixed with
the above alkaline preparation fand duly cooked in the
manner of Kshira-pdka). Diseases, such as Slipada