Chapter I - The medical treatment of inflamed ulcers

Now we shall discourse on the medical treatment of the two kinds of inflamed ulcers (Dvivraniya Chikitsita). 1.

Ulcers may be grouped under two heads according as they are Idiopathic or Traumatic in their origin. The first group includes within its boundary all ulcers that are caused through the vitiated condition of the blood or the several deranged conditions of the Vayu, Pitta and Kapha, or are due to their concerted action (Sannipata), while the second group embraces those which are caused by the bites of men, beasts, birds, ferocious animals, reptiles or lizards, or by a fall, pressure and blow, or by fire, alkali, poison, or irritant drugs, or through injuries inflicted by pointed wood, skeletal bones^[1], horns, discus, arrows, axes, tridents, or Kuntas (a kind of shovel), or such other weapons. Although both these classes of ulcers possess many features in common, they have been grouped under two distinct heads on account of the diversity of their origin, the difference in remedial measures to be adopted in their treatment, and the variation in their strength and tenacity. Hence the chapter is called Dvivraniya. 2.

In all cases of traumatic ulcers, cooling measures should be at once resorted to, just after (the fall or blow or stroke), for the cooling of the expanding (radiating) heat of the incidenta ulcer, in the manner laid down in respect of (the pacification of enraged) Pitta, and a compound of honey and clarified butter should be applied on the wounded locality for the adhesion (Sandhana) of the lacerated parts, [and for the pacification, i.e, restoration to normal state, of the local blood and Vayu aggravated through an obstruction of their passage]. Hence arises the necessity of making the two-fold classification of ulcers. After that (a week) a traumatic ulcer should be treated as an idiopathic one (to all intents and purposes), inasmuch as it is found to be associated with deranged Vayu, Pitta or Kapha Hence at that stage the medical treatment of both the forms of ulcer is (practically) the same. 3.

In short, ulcers are further subdivided (particularly) into fifteen groups, according to the presence of the morbific diathesis (deranged Vayu, Pitta Kapha and blood therein), either severally or in combinations as described (before) in the Chapter on Vrana- Prashna (Sutra Sthana. Ch. XXI). Several authorities, by adding the simple uncomplicated ulcers (unassociated with any of the morbific principles of the deranged Vayu, Pitta, etc.) to the list, hold the number of types to be sixteen. (Practically they are innumerable, according to the combinations made of the deranged Vayu, etc. and the different Dhatus of the system). 4.

Symptoms of ulcer may be divided into two kinds viz., General and Specific. Pain is the general characteristic (of all forms of ulcer), while the symptoms, which are exhibited in each case according to the virtue of the deranged Vayu, Pitta, etc., involved therein, are called the Specific ones. A Vrana is so named from its etymology (the term being derived from the root Vrana—to break) and signifies a cracked or broken condition of the skin and flesh of the afflicted part) of the body. 5.

The Vataja-Ulcer:—

The ulcer assumes a brown or vermilion colour and exudes a thin, slimy and cold secretion, largely attended with tension, throbbing and a sort of pricking and piercing pain (in its inside), which seems as if being expanded and extended. This type of ulcer does not extend much and is characterised by a complete destruction of the tissue (flesh). The Pittaja ulcer is rapid in its growth. It assumes a bluish yellow colour, exudes a hot secretion resembling the washings of Kimshuka flowers, and is attended with burning, suppuration and redness, being surrounded with eruptions of small yellow-coloured pustules. The Kaphaja ulcer is found to be extended and raised around its margin and is accompanied by an irresistible itching sensation. It is thick and compact (in its depth), covered with a large number of vessels and membranous tissues (Shira-snayu-jala), grey in colour, slightly painful, hard and heavy, and exudes a thick, cold, white and slimy secretion. The Raktaja ulcer (resulting from a vitiated condition of the blood) looks like a lump of red coral. It is often found to be surrounded by black vesicles and pustules and to smell like a strong alkali. It becomes painful and produces a sensation, as if fumes were escaping out (of it). Bleeding (is present) and the specific symptoms of the Pittaja type are likewise found to supervene. 6—9.

The Vata-Pittaja Type:—

An ulcer due to the concerted action of the deranged Vayu and Pitta is marked by a pricking and burning pain and a red or vermilion colour. A sensation of fumes arising out of it (is also felt) and the ulcer exudes a secretion which partakes of the characteristic colours of both the deranged Vayu and Pitta. An itching and piercing pain is felt in the ulcer due to the combined action of the deranged Vayu and Kapha (Kapha-Vataja type), which becomes heavy and indurated, constantly discharging a cold, slimy secretion. An ulcer resulting from the deranged condition of the Pitta and Kapha (Kapha-Pittaja type) becomes heavy, hot and yellow. It is marked by a burning sensatian and exudes a pale, yellow-coloured secretion. An ulcer marked by the aggravated condition of the deranged Vayu and blood (Vata-Raktaja type) is dry and thin and is largely attended with a piercing pain and anesthesia. It exudes blood or a vermil-coloured secretion and is marked by the combined hues respectively peculiar to the deranged Vayu and blood. An ulcer due to the combined action of the deranged Pitta and blood (Kakta-Pittaja type) is marked by a colour which resembles the surface cream of clarified butter. It smells like the washing of fish, is soft, spreading (erysipelatous), and secretes a hot blackish matter. An ulcer due to the combined action of the deranged Kapha and blood (Kapha-Raktaja type) is red-coloured, heavy, slimy, glossy and indurated. It is usually marked by itching and exudes a yellowish bloody secretion. An ulcer due to the concerted action of the deranged Vayu, Pitta and blood (Vata-Pitta-Raktaja type) is marked by a sort of throbbing, pricking and burning pain. It discharges a flow of thin yellowish blood and produces a sensation, as if fumes were escaping (out of its cavity). An ulcer due to the concerted action of the deranged Vayu, Kapha and blood (Vata-Shleshma-Raktaja type) is usually attended with itching, throbbing and tingling sensations and thick, grey, blood-streaked discharge. An ulcer associated with the deranged Kapha, Pitta, and blood (Kapha-Pitta- Raktaja type) is largely attended with redness, itching, suppuration and burning sensation. It emits a thick, greyish, bloody secretion. An ulcer marked by the concerted action of the deranged Vayu, Pitta and Kapha (Sannipatika) is attended with diverse kinds of pain, secretion, colour, etc., peculiar to each of these types. An ulcer associated with the combined action of the deranged Vayu, Pitta, Kapha and blood (Vata-Pitta-Kapha-Raktaja type) is attended with a sensation, as if it were being burnt and lacerated. It is largely accompanied by throbbing, itching sensation, a sort of pricking and burning pain, with complete anaesthesia in the locality; redness, suppuration, various other kinds of colour, pain and secretion are its further characteristics. 10–20.

An ulcer (Vrana) which is of the same colour with the back of the tongue, soft, glossy, smooth, painless, wellshaped and marked by the absence of any kind of secretion whatsoever, is called a clean ulcer (Shuddha- Vrana). 21.

Therapeutics:—

The medical (and surgical) treatment of a Vrana (ulcer) admits of being divided into sixty^[2] different factors, such as,—

1. Apatarpana (fasting or low diet),
2. Alepa (plastering),
3. Parisheka (irrigating or spraying),
4. Abhyanga (anointing),
5. Sveda (fomentations, etc.),
6. Vimlapana (resolution by massage or rubbing),
7. Upanaha (poultice),
8. Pacana (inducing suppuration),
9. Visravana (evacuating or draining),
10. Sneha (internal use of medicated oils, ghrita, etc.),
11. Vamana (emetics),
12. Virecana (purgatives),
13. Chedana (excision),
14. Bhedana (opening—e.g., of an abscess),
15. Darana (bursting by medicinal applications),
16. Lekhana (scraping),
17. Aharana (extraction),
18. Eshana (probing),
19. Vyadhana (puncturing—opening a vein),
20. Vidravana (inducing discharge),
21. Sivana (suturing),
22. Sandhana (helping re-union or adhesion),
23. Pidana (pressing),
24. Shonitasthapana (arrest of bleeding),
25. Nirvapana (cooling application),
26. Utkarika (massive poultices),
27. Kashaya (washing with decoctions),
28. Varti (lint or plug),
29. Kalka (paste),
30. Ghrita (application of medicated clarified butter),
31. Taila (application of medicated oil),
32. Rasa-kriya (application of drug-extracts),
33. Avacurnana (dusting with medicinal powders),
34. Vrana-Dhupana (fumigation of an ulcer),
35. Utsadana (raising of the margins or bed of an ulcer),
36. Avasadana (destruction of exuberant granulation),
37. Mridu-Karma (softening),
38. Daruna-Karma (hardening of soft parts),
39. Kshara-Karma (application of caustics),
40. Agni-Karma (cauterization),
41. Krishna-Karma (blackening),
42. Pandu-Karma (making yellow-coloured cicatrices),
43. Pratisarana (rubbing with medicinal powders),
44. Roma-sanjanana (growing of hairs),
45. Lomapaharana (epilation),
46. Vasti-karma (application of enemas),
47. Uttara-Vasti-karma (urethral and vaginal injections),
48. Vandha (bandaging),
49. Patradana (application of certain leaves—vide Infra),
50. Krimighna (Vermifugal measures),
51. Vrimhana (application of restorative tonics),
52. Vishaghna (disinfectant or anti-poisonous applications),
53. Shiro-virecana (errhines),
54. Nasya (snuff),
55. Kavala-dharana (holding in the mouth of certain drug-masses for diseases of the oral cavity or gargling),
56. Dhuma (smoking or vapouring),
57. Madhu-sarpih (honey and clarified butter),
58. Yantra (mechanical contrivances, e g., pulleys, etc.),
59. Ahara (diet)
60. and Raksha-Vidhana (protection from the influence of malicious spirits). 22.

Of these, Kashaya, Varti, Kalka, Ghrita, Taila, Rasa- kriya and Avacurnana are the measures for the cleansing (Shodhana) of an ulcer and for helping its granulation (Ropana). The eight acts (from Chedana to Sivana) are surgical operations. We have already spoken of such acts as Shonitasthapana, Kshara-karma, Agni- karma, Yantra, Ahara, Raksha-vidhana and Vandha- Vidhana (in the Sutra-sthana). Later on, we shall discourse on Sneha, Sveda, Vamana, Virecana, Vasti, Uttara-vasti,Shiro-virecana, Nasya, Dhuma, and Kavala- dharana. Of the remaining measures we shall speak in the present chapter. 23.

There are six kinds of swellings (Shophas), as described before, and the following eleven measures, commencing with Apatarpana and ending in Virecana, should be regarded as their cure. These are the proper remedies for a swelling and do not (cease to be efficacious in, nor) prove hostile to cases of swelling which are transformed into ulcers. The other measures should be deemed as remedial to ulcers but Apatarpana is the first, general and principal remedy in all types of swellings (Sophas). 24.

Memorable Verses:—

Apatarpana (fasting) should be prescribed in the case of a patient, full of enraged Doshas, as well as, in one having his organic principles (Dhatus) and refuse matters (Malas) of the system, deranged by them, for the purpose of bringing them to their normal condition, with a regard both to their nature and to the strength, age, etc., of the patient. Persons afflicted with diseases which result from the up-coursing of the deranged Vayu (Urdhva-vata) such as cough, asthma, etc., or with thirst, hunger, dryness of the mouth and fatigue, as well as old men, infants, weak persons, men of timid dispositions and pregnant womsn.should never fast. A swelling and an extremely painful ulcer should be respectively treated with a proper medicated plaster at the very outset. The pain in such a case will yield to the medicinal plaster as a blazing room or house is readily extinguished by means of steady watering. Such plasters not only give comfort to the patient (by removing the pain and leading to the absorption of the swelling), but heaves up the bed of the sore or the ulcer and contributes to its speedy purification and healing up (granulation). 25—28.

In the case of a swelling brought pn by the deranged Vayu, the affected part should be washed or sprinkled (Parisheka) with a warm lotion of clarified butter, oil, Dhanyamla and essence of meat or with a decoction of the drugs that tend to pacify the enraged Vayu and to relieve the pain. A swelling due to the action of the deranged Pitta or blood or to the effect of a blow or poison should be washed or sprinkle 1? with a lotion of milk, clarified butter, honey and sugar dissolved in water, the expressed juice of sugar-cane and a cold decoction of the drugs of the Madhura group (Kakolyadi-gana) and the Kshira-Vrikshas. A Kaphaja swelling on the body should be washed or sprinkled with a luke-warm lotion of oil, cow’s urine, alkaline solution, wine (Sura), Sukta and with a decoction of drugs that destroy the deranged Kapha. 29–31.

Metrical Text:—

As a fire is put out by jets of water, so the fire of the deranged morbific principles (Doshagni) of the body are speedily subdued and put down by the application of (medicinal lotions) washes. 32.

An anointing (Abhyanga), duly prescribed and used, with a full regard to the nature of the aggravated Doshas, leads to their pacification (restoration to the normal condition) and to softness (subsidence) of the swelling. 33.

Metrical Texts:—

An application of an anointment (Abhyanga) should precede the measures of fomentation, resolution, etc. while it should follow all evacuating measures, etc. A painful, extended and indurated swelling, as well as an ulcer of a similar nature, should be fomented, while an act of Vimlapana (resolution by gentle massage) should be done in respect of a fixed or unfluctuating swelling attended with little or no pain whatsoever. A wise physician should first annoint and foment the part and then gently and slowly press it with a bamboo-reed or with the back of his thumb or palm. A non-suppurated swelling or one that is partially suppurated should be treated with poultice (Upanaha\ which would lead to its resolution or suppuration, as the case might be. A swelling, not resolved or not subsiding even after the adoption of the measures beginning with Apatarpana and ending in Virecana (in the given list), should be caused to suppurate with the drugs enumerated in the chapter of Mishraka, such as curd, whey, wine (Sura), Shukta and Dhanyamla (a kind of fermented paddy gruel). They should be formed into a paste and the paste should be cooked into an efìficacious poultice-like composition (Utkarika), and mixed with salt and oil or clarified butter, it should be applied over the affected part (swelling) and bandaged with the leaves of an Eranda plant. The patient should be allowed to take a wholesome (i.e., which does not. produce Kapha) diet as soon as suppuration would set in (in the swelling), 34–39.

Blood-letting:—

Blood-letting should be resorted to in a case of newly formed swelling for its resolution and for alleviating the pain. Bleeding (Visravana) is recommended in the case of an ulcer which is indurated, marked by a considerable swelling and inflammation and is reddish black or red-coloured, extremely painful, gagged in its shape and considerably extended at its base (congested), specially in the case of a poisonous ulcer, for the subsidence of the pain and for warding off a process of suppuratiou therein, either by applying leeches or by opening (a vein in the locality) by means of an instrument. An ulcer-patient of a dry or parched temperament affected with distressing supervenients or ulcer-cachixia or who is weak should be made to drink an emulsive potion cooked with (a decoction of) appropriate drugs. A patient afflicted with an ulcer with an elevated margin and attended with swelling and specially marked by the presence of the deranged Kapha and by a flow of blackish red blood should be treated with emetics. Ulcer-experts recommend purgatives to a patient afflicted with an old or long-standing ulcer, attended with a deranged condition of the Vayu and Pitta. An excision should be made into an ulcer which refuses to suppurate and which is of a hard and indurated character attended with sloughing of the local nerves and ligaments (Snayu). An opening or excision (Bhedana) should be made into an ulcer (Vrana) in the inside of which pus has accumalated and makes it heave up and which not finding any outlet consequently eats into the underlying tissues and makes fissures and cavities. 40–46.

Measures which contribute to a spontaneous bursting by medicinal applications (Darana) of a swelling should be adopted in the case of an infant or an old or enfeebled patient, or of one incapable of bearing the pain (of a surgical operation), or of a person of a timid disposition, as well as in the case of a woman, and in the case of swellings which appear on the vulnerable parts (Marmas) of the body. Remedies which lead to the spontaneous bursting of a swelling should be applied by a wise physician to a well-suppurated swelling drawn up and with all its pus gathered to a head; or an alkaline substance should be applied on its surface and a bursting should be effected when the Doshas are found to be just aggravated by the incarcerated pus. 47.

An ulcer which is indurated, whose edges are thick and rounded, which has been repeatedly burst open, and the flesh of whose cavity is hard and elevated, should be scarified by a surgeon; or, in other words, an indurated ulcer should be deeply scarified, one with thick and rounded edges should be excessively scarified, while the one which has been repeatedly burst open should be entirely scraped off.^[3] An ulcer with a hard and elevated bed should be scraped evenly and longitudinally along the length of its cavity. In the absence of a scarifying instrument, the act should be performed with a piece of Kshauma (cloth made of the fibres of an Atasi plant), a linen (Plota) or a cotton pad (Pichu), or with such alkaline substances as nitrate of potash, Samudra-phena, rock-salt, or rough leaves of trees (e.g., those of Udumbara, etc.). 48.

The cavities or courses of a sinus, or of an ulcer which had any foreign matter lying imbedded in its inside, or which takes a crooked or round about direction, as well as of the one formed into cavities within its interior, should  be probed by gently introducing the tender fibres of bamboo sprouts (Karira), a (lock of) hair, a finger, or an indicator into its inside. The course of a sinus occurring about the anus or in the region of the eyes (Netra- Vartma) should be probed with the slender fibres of Chuccu, Upodika, or Karira, in the event of their mouths being narrow and attended with bleeding. The Shalya (incarcerated pus, etc.) should be extricated, whether the mouth of the sinus is constricted or otherwise, in conformity with the directions laid down before on that behalf. In diseases amenable to acts of puncturing (Vyadhana), the knife should be inserted into the seat of the disease to a proper depth and extent, to be determined by its situation in the body, and the Doshas (pus, etc.) should be let out, as stated before. Ulcers with a wide mouth, unattended with any symptoms of suppuration, and occurring in a fleshy part of the body, should be sutured up, and the adhesion (San- dhana) of the edges should likewise be effected, as directed before. A plaster composed of drugs (capable of drawing out and secreting the pus), as described before, should be applied around the mouth of an ulcer seated in any of the Marmas (vulnerable parts), or full of pus in its inside, with a narrow-mouthed aperture. The plaster should be removed when dry, and should not be applied on the orifice of the ulcer, as it would, in that case, interfere with the spontaneous secretion of pus (Dosha). 49-54.

An excessive hemorrhage incidental to such acts, as excessive hurting of the vein, etc., should be arrested with suitable styptic^[4] measures and remedies (Shonitasthapana).

An ulcer attended with fever, suppuration and burning sensation due to the excited state of the deranged Pitta and congestion of blood should be allayed (Nirvapana—literally putting out) with suitable and proper medicinal remedies. It should be allayed with compounds made up of the proper cooling drugs (of the Mishraka chapter), pasted with milk and lubricated with clarified butter. Cooling plasters (Lepa) should then be applied as well. 55–56.

An ulcer whose flesh is eaten away, which discharges a thin secretion, or is non-suppurating in its character, and is marked by roughness, hardness, shivering and the presence of an aching and piercing pain, should be fomented with a poultice-like efficacious preparation (Utkarika)cooked with the drugs of Vayu subduing properties, those included within the Amla-varga, and those which belong to the Kakolyadi group, and with the oily seeds (such as linseed, sesamum, mustard, castor, etc.). An indurated, painful, fetid, moist and slimy ulcer should be washed with a disinfectant or purifying lotion consisting of a decoction of the drugs mentioned before for the purpose. 57-58.

Plugs or lints plastered with a paste of the purifying drugs (enumerated before) should be inserted into an ulcer with any foreign matter (e.g., pus) lying embedded in it, or into one with a deep but narrow opening, or into one situated in a fleshy part of the body. An ulcer full of putrid flesh and marked by the action of the highly deranged Doshas (Vayu and Kapha) should be purified with a paste of the aforesaid available drugs making up the plug. An ulcer of a Pittaja origin, which is deep- seated and attended with a burning sensation and with suppuration, should be purified with the application of a medicated clarified butter, prepared with the purifying drugs with an admixture of Karpasa-phala^[5]. An intelligent Surgeon should purify an ulcer with raised flesh, and which is dry and is attended with scanty secretion with an application of medicated mustard oil. An indurated ulcer, refusing to be purified with the foregoing medicated oils, should be purified with a duly prepared decoction of the drugs enumerated before (Sutra, chap. 38,—the Salasaradi group) and prepared in the following manner of Rasa-kriya. A decoction of the said drugs duly prepared should be saturated with an after-throw of Hatitala, Manahshila, Kasisa and Saurashtra earth, and well compounded together; the preparation should also be mixed with the expressed juice of Matulunga and with honey. The medicine thus prepared should be applied to the ulcer on every third or fourth day. 59.

Deep^[6] and foul-smelling ulcers covered with layers of deranged fat (phlegmonous ulcer) should be purified by the learned physician with the powders of the drugs with which the purifying plug or the lint has been enjoined to be plastered (Ajagandha, etc.). Decoctions of the drugs which are possessed of the virtue of setting in a process of granulation (Ropana) in an ulcer, such as Vata, etc., as stated before, should be used by a surgeon (Vaidya) after it had been found to have been thoroughly purified. Medicated plugs, composed of drugs possessing healing properties (such as, Soma, Amrita, Ashvagandha, etc.) should be inserted in deep-seated ulcers, when cleansed and unattended with pain. 60-62. 

A Kalka or a levigated paste of sesamum and honey (mentioned in the Mishraka Chapter) should be applied for the purpose of healing up an ulcer situated in a muscular part from which all putrid flesh has been removed or sloughed off and which exhibited a clear cavity. This paste (of sesamum) tends to allay the deranged Vayu through its sweet taste, oleaginousness and heat-making potency; subdues the deranged Pitta through its astringent, sweet and bitter taste and proves beneficial even in the case of the deranged Kapha through its heat-producing potency and bitter and astringent taste. An application of the levigated paste of sesamum mixed with the drugs of purifying and healing properties tends to purify and heal up an ulcer. An application of the levigated paste of sesamum mixed with honey and Nimba -leaves leads to the purification of sores; whereas an application of the same paste (i.e, sesamum, honey and leaves of Nimba), mixed with clarified butter tends to heal up the ulcer. Several authorities atribute the same virtue to a barley-paste.^[7] Levigated pastes of barley and of sesamum (or a paste of barley mixed with sesamum) contribute to the resolution or subsidence of a non-suppurated swelling, fully suppurate one which is partially suppurated, lead to the spontaneous bursting of a fully suppurated one, and purify as well as heal up one that has already burst out. 63-65.

An ulcer, which is due to the effects of poison, vitiated blood, or aggravated Pitta, and which is deep-seated or is of traumatic origin, should be healed up with a medicated clarified butter prepared with the drugs of healing virtues (Ropaniya—enumerated before) and milk. An ulcer marked by an aggravated condition of the deranged Vayu and Kapha should be healed up with the application of an oil, boiled and prepared with the proper purifying drugs mentioned before. 66–67.

Rasa-kriya^[8] with the two kinds of Haridra should be resorted to for the purpose of healing up an ulcer, in which bandaging is forbidden (such as those due to the deranged Pitta or blood, or to blow, etc., or to the effects of poison), and an ulcer appearing on the moveable joints, which, though exhibiting all the features of a well-cleansed sore, has not been marked by any process of healthy granulation^[9]. Healing medicinal powders should be used in the case of an ulcer which is confined to the skin, and is firm-fleshed and marked by the absence of any irregularity in its shape (i.e., not uneven in its margin). The mode of applying medicinal powders, as stated in the Sutra-sthana, should be adopted in the present instance. 68-69.

The healing and purifying measures described above should be deemed equally applicable to, and efficacious in cases of ulcers in general with regard to their Doshas (both idiopathic and traumatic). The success of these measures has been witnessed in thousands of cases and has been recorded in the Shastras (authorised works on medicine). Hence they should be used as incantations without any doubt as to their tested and infallible efficacy. An intelligent physician should employ the drugs, mentioned before, in any of the seven forms (either in the shape of a decoction, or a plug, or a paste, or through the medium of medicated oils and clarified butter, or in the shape of Rasa-kriya, or as powders), according to the requirements of each case. 70.

The drugs which constitute the two groups of Panca- mulas (major and minor), as well as those of the Vayu- subduing group, should be employed in the case of an ulcer due to the aggravated Vayu in any of the seven forms —decoction, etc. Similarly the drugs which are included within the groups of Nyagrodhadi or Kakolyadi should be used in any of those seven forms, in the case of an ulcer due to the aggravated Pitta (for the purification and healing thereof). Drugs which form the group of Aragvadhadi, as well as those which have been described as heat-making in their potency, should be used in any of those seven aforesaid forms, in the case of an ulcer due to the deranged Kapha. The drugs of two or three of those groups, should be combinedly used in any of those seven forms, in connection with an ulcer marked by the aggravated condition of any two or three of the deranged Doshas respectively. 71-74.

Fumigation:—

Vataja ulcers with severe pain and secretion should be fumigated with the fumes of Kshauma, barley, clarified butter and other proper fumigating substances [such as turpentine and resin (gum of Shala tree)]. 75.

Utsadana-Kriya (Elevation):—

Medicated plasters (consisting of Apamarga, Ashvagandha, etc.) and medicated clarified butter (prepared with the same drugs should be used in ulcers (due to the aggravated Vayu and marked by the absence of any secretion, and affecting a considerably smaller area or depth of flesh, as well as in those (due to the deranged and aggravated Pitta and) seated deep into the flesh, for the purpose of raising up (filling up) the beds or cavities thereof. Meat of carnivorous animals should be taken in the proper manner by the patient, inasmuch as meat properly partaken of in a calm and joyful frame of mind adds to the bodily flesh of its partaker. 76.

Avasadana (destruction of super-growths):—

Proper drugs or articles (such as sulphate of copper, etc.) powdered and pasted with honey should be applied for destroying the soft marginal growths of an ulcer found to be more elevated than the surrounding surface of the affected locality. 77.

Mridu-Karma (softening):—

In respect of indurated and fleshless (not seated in a part of the body where flesh abounds) ulcers marked by a deranged condition of Vayu, softening measures (with the help of repeated applications of lotions and plasters composed of sweet and demulcent substances mixed with salt in a tepid or luke-warm state) and bloodletting^[10] should be resorted to. Sprinkling (Seka) and application of clarified butter or oil prepared with the Vayu-subduing drugs should also be resorted to. 78.

Daruna-karma:—

The employment of hardening measures (Daruna-karma) is efficacious in connection with soft ulcers and in the following manner. Barks of Dhava, Priyangu, Ashoka, Rohini, Triphala, Dhataki flowers, Lodhra and Sarjarasa, taken in equal parts and pounded into fine powders, should be strewn over the ulcer, i.e., the ulcer should be dusted with the same. 79.

Kshara-Karma (Potential cauterization):—

The measure of applying alkali should be adopted for the purification of the sore of a long-standing ulcer which is of an indurated character with its margin raised higher (than the surrounding skin), and is marked by itching and a stubborn resistance to all purifying medicines. 80.

Agni-Karma (actual cauterization):—

An ulcer incidental to an act of lithotomic operation allowing the urine to dribble out through its fissure, or one marked by excessive bleeding, or in which the connecting ends have been completely severed, should be actually cauterised with fire. 81.

Krishna-Karma:—

The blackening of a white cicatrix, which is the result of a bad or defective granulation, should be made (after the complete healing up of the ulcer) in the following manner. Several Bhalla - taka seeds should be first soaked in the urine of a cow (and then dried in the sun, this process should be repeated for seven days consecutively), after which they should be kept (a week) immersed in a pitcher full of milk. After that the seeds should be cut into two and placed in an iron pitcher. Another pitcher should be buried in the ground with a thin and perforated lid placed over its mouth, and the pitcher containing the seeds should be placed upon it with its mouth downward (so that the mouths of the two pitchers might meet), and then the meeting place should be firmly joined (with clay). This being done a cow-dung fire should be lit around the upper pitcher. The oily matter (melted by the heat) and dribbling down from the Bhallataka seeds into the underground pitcher should be slowly and carefully collected. The hoofs of village animals (such as horses, etc.) and those which live in swamps (anupas —such as buffaloes, etc.) should be burnt and pounded together into extremely fine powder. The oil (of the Bhallataka seeds collected as above) should then be mixed with this powder, and applied to the white cicatrix. Similarly, the oily essence of the piths of some kinds of wood, as well as of some kinds of fruit (Phala-sneha) prepared in the manner of the Bhallataka oil (and mixed with the powdered ashes of hoofs) should be used for the blackening of a cicatrix. 82-83.

Pandu-karana:—

The natural and healthy colour (Pandu) of the surrounding skin should be imparted to a cicatrix which has assumed a black colour owing to the defective or faulty healing up of the sore in the following manner. The fruit of the Rohini^[11] should be immersed in goat’s milk for seven nights and, afterwards finely pasted with the same milk, should be applied to the skin. This measure is called Pandu-karana (imparting a yellow or natural skin-colour to the cicatrix). To attain the same result, the powder of a new earthen pot, Vetasa roots, Shala roots, Sulphate of iron, and Madhuka (Yashti-madhu) pasted together with honey may be used. As an alternative, the hollow rind of the Kapittha fruit, from which the pulp has been removed, should be filled with the urine of a goat together with Kasisa (Sulphate of iron), Rocana, Tuttha (Sulphate of copper). Haritala, Manahshila, scrapings of raw bamboo skin, Prapunnada (seeds of Chakunde), and Rasanjana and buried a month beneath the roots of an Arjuna tree after which it should be taken out and applied to the black cicatrix. The shell of a hen’s egg, Kataka, Madhuka, (Yashti-madhu), sea-oysters and crystals^[12] (pearls according to Jejjata and Brahmadeva) taken in equal parts should be pounded and pasted with the urine of a cow and made into boluses which should be rubbed over the cicatrix^[13] 84-87.

Roma-sanjanana (hair-producers):—

The burnt ashes of ivory and pure Rasanjana (black antimony; pounded (and pasted with goat’s milk) should be applied to the spot where the appearance of hair (Lomotpatti) is desired. An application of this plaster would lead to the appearance of hair even on the palms of the hands. Another alternative is a pulverised compound consisting of the burnt ashes of the bones, nails, hair, skin, hoofs and horns of any quadruped, over a part of the body, previously anointed (rubbed) with oil, which would lead to the appearance of hair in that region. And lastly, a plaster composed of Sulphate of iron, and tender Karanja leaves pasted with the expressed juice of Kapittha, would be attended with the same result. 88–90.

Hair-depilators:—

The hair of an ulcerated part of the body found to interfere with the satisfactory healing up of the ulcer, should be shaved with a razor or clipped with scissors, or rooted out with the help of forceps. As an alternative, an application of a plaster consisting of two parts of pulverised (burnt ashes of) conch-shell and one part of Haritala (yellow orpiment or yellow oxide of arsenic) pasted with Sukta (an acid gruel) over the desired spot, would be attended with the same result. A compound made of the oil of Bhallataka mixed with the milky exudation of Snuhi, should be used by an intelligent physician as a depilatory measure. As an alternative, the burnt ashes of the stems of plantain leaves and Dirghavrinta (Shyonaka) mixed with rock-salt, Haritala and the seeds of Shami, pasted with cold water, should be deemed a good hair-depilatory^[14] A plaster composed of the ashes of the tail of a domestic lizard, plantain, Haritala (oxide of arsenic), and the seeds of Ingudi burnt together and pasted with oil and water, and baked in the sun may also be used for the eradicating of hair in the affected locality. 94-95.

Vasti-Karma:—

A medicated Vasti (enema) should be applied to the rectum in the case of an ulcer marked by an aggravated condition of the deranged Vayu which is extremely dry and is attended with an excruciating pain occurring specially in the lower region of the body. A measure of Uttara-vasti (Vaginal or Urethral syringe) should be adopted in the cases of strictures and other disorders connected with urine, semen and menstruation, as well as in cases of gravel^[15] in case these are due to an ulcer. An ulcer is purified, softened and healed up by bandaging leaving no room for the apprehension of a relapse. Hence bandaging is recommended. 96-98.

Patradana (application of leaves on an ulcer):—

Leaves possessed of proper medicinal virtues taking into consideration the particular Dosha and season of the year should be tied (over the medicinal plaster applied) over an ulcer of non-shifting or non-changing character and not affecting a large depth of flesh and which refuses to be healed up owing to its extreme dryness. An ulcer of the deranged Vayu should be tied over with the leaves of the Eranda, Bhurja, Putika, or Haridra plants as well as with those of the Upodika and Gambhari. An ulcer marked by an aggravated condition of the deranged Pitta, or incidental to a vitiated condition of the blood, should be tied in the aforesaid manner with the leaves of the Kashmari, the Kshira trees (milk- exuding trees), and aquatic plants. An ulcer due to the deranged and aggravated Kapha, should be tied over with the leaves of the Patha, Murva, Guduci, Kakamachi, Haridra or of the Shukanasa. Only those leaves which are not rough, nor putrid, nor old and decomposed, nor worm-eaten and which are soft and tender should, be used for purposes of Patradana.^[16] The rationale of such a procedure (Patra-vandha) is that the leaves tied by an intelligent physician in the manner above indicated serve to generate heat or cold and retain the liniment or medicated oil in their seat of application. 99-102.

Vermifugal:—

The germination of worms due to flies in an ulcer is attended with various kinds of extreme pain, swelling and bleeding in case the worms eat up the flesh. A decoction of the drugs of the Surasadi gana proves efficacious as a wash and healing medicine in such a case. The ulcer should be plastered with such drugs as the bark of Saptaparna, Karanja, Arka, Nimba, and Rajadana pasted with the urine of a cow, or washed with an alkaline wash (for expelling the vermin from it). As an alternative, the worms should be brought out of the ulcer by placing a small piece of raw flesh on the ulcer. These vermin may be divided into twenty groups or classes, which will be fully dealt with later on. (Uttara-Tantra–ch. 54). 103.

Vrinhana (use of restorative and constructive tonics):—

All kinds of tone-giving and constructive measures should be adopted in the case of a patient weak and emaciated with the troubles of a long-standing sore, taking full precaution not to tax his digestive powers. Anti-toxic (Vishaghna) medicines and measures and symptoms of poisonings will be described under their respective heads in the Kalpa-Sthana. 104-105.

Shiro-virecana and Nasya:—

Shiro-virecana measures (errhines) should be resorted to by skilful physicians in respect of ulcers situated in the clavicle regions and marked by itching and swelling. The use of medicated (fatty) snuff (Nasya) is recommended in cases where the ulcers would be found to be seated in the regions above the clavicles and marked by an aggravated condition of the deranged Vayu, pain, and absence of the oily matter. 106-107.

Kavala-dharana:—

Medicated gargles (consisting of decoctions of drugs) of purifying or healing virtues either hot or cold^[17] (according to requirements) should be used in the case of an ulcer in the mouth, for the purpose of alleviating the Doshas therein, for allaying the local pain and burning, and for removing the impurities of the teeth and the tongue. 108.

Dhuma-pana:—

Inhaling of smoke or vapours (of medicated drugs) should be prescribed in cases of ulcers of the deranged Vayu and Kapha attended with swelling, secretion and pain and situated in the region above the clavicles. Application of honey and clarified butter, separately or mixed together should be prescribed in cases of extended or elongated ulcers which are traumatic or incidental in their character (Sadyo-Vrana) for allaying the heat of the ulcer and for bringing about its adhesion. Surgical instruments should be used in connection with an ulcer which is deep-seated but provided with a narrow orifice and which is due to the penetration of a Salya (shaft) and which could not be removed with the hand alone. 109-111.

The diet of an ulcer-patient should in all cases be made to consist of food which is light in quantity as well as in quality, demulcent, heat-making (in potency) and possessed of appetising properties^[18] Protective rites should be performed for the safety of an ulcer-patient from the influences of malignant stars and spirits with the major and the minor duties (Yama and Niyama) enjoined to be practised on his behalf. 112-113.

The causes of ulcers are six^[19]; their seats in the body number eight^[20] in all; the features which characterise them are five^[21]. The medicinal measures and remedies in respect of ulcers are sixty^[22] in number. And these ulcers are curable with the help or co-operation of the four necessary factors (the physician, the medicines, the nurse and the patient). 114.

The comparatively smaller number of drugs which I have mentioned (under the heads of Ropana, Shodhana, etc., in the present chapter) from fear of prolixity, may be increased in combination with other drugs or substances of similar virtue, (digestionary transformation and potency, etc.) without any apprehension of doing any mischief thereby. Recipes consisting of rare or a large number of drugs or ingredients, should be made up with as many of them as would be available in the absence of all of them, as mentioned in the present work. A drug belonging to any particular Gana or group if separately described as non- efficacious to any specific disease, should be omitted whereas a drug not belonging to a group may be added to it if it is elsewhere laid down as positively beneficial thereto. 115-117.

Upadrava:—

The distressing supervening symptoms which are found to attend a case of ulcer, are quite different from those of an ulcer-patient. Those which confine themselves solely to the ulcer are five in all—smell, colour, etc., and those which are exclusively manifest in the patient are fever, diarrhea, hiccup, vomiting, fainting fits, aversion to food, cough, difficult breathing, indigestion and thirst. The medical treatment of ulcers though described in detail in the present chapter, will be further dealt with in the next chapter on Sadyo-Vrana. 118–120.

 

Thus ends the first Chapter of the Chikitsita-Sthana in the Sushruta Samhita which deals with the treatment of the two kinds of ulcer.

Footnotes and references:

[1]:

Fragments of broken pottery.—Dallana.

[2]:

N.B. Authorities, however, differ in enumerating these factors, although every one of them sticks to the total number of sixty.

[3]:

This scraping off of the ulcer should be done by an instrument of Surgery and not by any rough leaf or the like, mentioned hereafter.

[4]:

Styptic measures are of four kinds—Sandhana,Skandana, Pacana, and Dahana, See Sutra-Sthana, Chap. XIV.

[5]:

The total weight of the purifying drugs should be equal to that of the Karpasa-phala alone and they should be boiled together with four times their quantity of clarified butter and with sixteen times of water.

[6]:

There is a different reading of “Agambhira” in place of “Gabhira,” but Gayi thinks the emendation undesirable.

[7]:

Jejjada and Gayadasa interpret the term to mean “barley-paste mixed with sesamum.”

[8]:

The decoction of Triphala and the drugs of the Nyagrodhadi group should be duly prepared, filtered and then condensed to the consistency of treacle. Powders of Haridra and Daru-haridra should be then thrown into it. In the end, the whole preparation should be well-stirred, mixed with honey and applied. This is what is called Rasa-kriya.

[9]:

Several editions read “though cleansed yet ungranulating ulcers.”

[10]:

Blood-letting should be resorted to in the event of any vitiated blood being found to have been involved in the case; but in the event of a similar participation of any deranged Kapha, oils and lotions composed of the Vayu-destroying drugs should be made use of.

[11]:

Rohini, according to some commentators, means a kind of Haritaki; according to others, it means Katu-tumbi.

[12]:

Burnt ashes of sea-oysters, and pearls etc., should be used.

[13]:

This also is a remedy for giving a natural colour to the skin.

[14]:

According to some this may be used internally for the purpose.

[15]:

D. R. Some read “Tathanile” in place of “Ashmari-vrane.” . “Taihanile” means and in cases of (aggravated) Vayu.

[16]:

The leaf which does not poison the Sneha and the essence of the medicinal drugs placed in a folded piece of linen (and applied over an ulcer is the proper leaf and) should be used for tying over the paste.

[17]:

Hot gargles are recommended in cases of ulcers of the deranged Vayu and Kapha while cold ones in cases of ulcers of the aggravated Pitta and blood.

[18]:

See Chap. XIX.—Sutra-Sthana.

[19]:

The six causes of an ulcer are Vayu, Pitta, Kapha, Sannipata, Shonita aud Agantu.

[20]:

The eight seats of an ulcer are Tvak, Mansa, Shira, Snayu, Sandhi, Asthi, Koshtha and Marma.

[21]:

The five symptoms of an ulcer are due to Vata, Pitta, Kapha, Sannipata and agantu. The symptoms due to Shonita being identical with those due to Pitta, are not separately counted.

[22]:

The sixty medicinal measures and remedies are those described before in the present chapter.