Chapter XII - The medical treatment of abscesses sequeling Prameha

Now we shall discourse on the medical treatment of the abscesses or eruptions which mark the sequel of a case of Prameha (Prameha-Pidaka). 1.

The nine kinds of abscesses (Pidakas), such as Saravika, etc., have been described before. Of such abscesses those, appearing in a strong person but small in size, affecting (only) the Tvak (skin) and the flesh, soft to the touch, slightly painful, easily suppurative and after a time bursting, are curable. 2.

Patients suffering from Prameha and afflicted with the above kinds of abscesses (Pidakas) should be treated (in the following manner). Measures, such as fastings (Apatarpana), etc., decoctions^[1] (of Vata, etc.) and the urine of a she-goat, should be employed in the incubative stage of the disease. The urine, perspiration and the Shleshma (sputum, etc.), soon acquire a sweetish taste, if the aforesaid preliminary measures are not resorted to and if the patient goes on using sweet articles of food in utter disregard of the instructions, thus developing fully the specific indications of Prameha. In this stage the system of the patient should be cleansed (Samshodhana) with both emetics and purgatives. If the disease is not checked (even at this stage) with the aforesaid measures (emetics and purgatives), the aggravated Doshas of the body go on increasing in intensity and tend to affect or vitiate the flesh and the blood and produce an inflamatory swelling of the body, or bring on other supervening distresses in their train, venesection as well as the aforesaid remedies and measures should be resorted to in such cases. 3.

The swelling increases in size attended with excessive pain and burning sensation, if the aforesaid remedies be not employed at this stage of the disease. Surgical operations and other remedial measures, described in connection with abscesses or inflammatory swellings (Vrana) in general, should be resorted to in such cases. If these be not done (at this stage), the pus eats into the deeper tissues of the locality, creates large cavities in its inside, and is accumulated there and the abscess (Vrana) becomes incurable.^[2] Hence a case of Prameha should be remedied at its very outset. 4-6.

Dhanvantara Ghrita:—

Ten Pala weight of each of these drugs, viz,, Bhallataka, Vilva, Ambu, roots of Pippali, Udakiryya, Prakiryya^[3], Varshabhu, Punarnava^[4], Citraka, Shathi, Snuhi, Varunaka, Pushkara, Danti and Haritaki and one Prastha measure of each of the following, viz., barley, Kola and Kulattha pulse should be boiled with a Drona measure of water. The decoction should be boiled down to its quarter part, removed from the fire, and strained. It should then be cooked with a Prastha measure (four seers) of clarified butter with half a Pala weight of each of the following drugs, viz., Vaca, Trivrit, Kampilla, Bhargi, Nichula, Shunthi, Gaja-Pippali, Vidanga and Shirisha as Kalka. It is called the Dhanvantara-Ghrita^[5] and covers within the range of its therapeutic application Meha (urinary diseases), swelling, (Shotha), Kushtha, Gulma, Ascites, hemorrhoids, enlargement of the spleen, carbuncles (Pidaka) and abscesses. 7.

Ordinary purgatives fail to produce any satisfactory effect in cases of Madhu-Meha owing to the excessive accumulation and pervasion of Medas (fat) in the organism of the patient. Hence strong Sodhana (purgatives) should be employed in such cases. In all types of Meha, attended with Pidaka (eruptions or abscesses) and other complications, the perspiration and expectorations, etc. of a Prameha-patient acquire a sweet taste and smell like that of honey. Hence they are technically known as Madhu-Meha (to all intents and purposes. Fomentation (of any kind) is forbidden in the case of a patient suffering from Madhu-Meha, since it might lead to the gradual emaciation of his frame by drying up the organic fat (Medas), which is usually found to abound in his organism. The aggravated Doshas of the body fail to make an upward passage in the organism of a Prameha-patient, owing to the weakness of the channels of chyle, blood, Kapha and Pitta (as well as for an exhausted condition of the nerves in his body) and the Doshas are thus forced to course in and confine themselves into the lower part of the body where their incarceration helps the easy formation of Pidakas (abscesses), etc. Such a Pidaka should be remedied with the measures described in connection with Vranas, as soon as the process of suppuration would set in; whereas it should be treated as a swelling in its unsuppurated stage. Medicated oils should be likewise employed for the purposes of healing (Ropana,), etc. 8.

A decoction of the drugs of the Aragvadhadi group should be used for the purpose of raising up (Utsadana) the cavity of the incidental ulcer; that of the Shala-saradi group should be used for sprinkling purposes; that of the drugs of the Pippalyadi group should be given as food and drinks. A pulverised compound of Patha, Citraka, Sharmgashta, Kshudra, Vrihati, Shoma-valka, Saptaparna, Aragvadha and Kutaja roots mixed with honey should be internally given to the patient.

Shala-saradi Avaleha:—

A decoction of (one hundred Pala weight of) the drugs of the Shala-saradi group should be made by boiling it (in sixteen times the weight of water) down to a quarter part (of the water) and then duly filtered (through a piece of linen). It should be cooked again very carefully, so that it may not be burnt; powders of Amalaka,^[6] Rodhra, Priyamgu, Danti, black-iron and copper should then be added to it just before the completion of the cooking, so that it may be reduced to the consistency of an Avaleha (lambative). It should then be removed from the fire and kept in a closed earthen pitcher. The patient should take an adequate dose of this medicine as it is a sovereign remedy for all types of Prameha. 9.

Navayasa-Churna:—

Equal parts of the powders of the following nine drugs, viz., Triphala, Citraka, Trikatu, Vidanga and Musta, and nine parts of powdered black-iron^[7] should be mixed together and taken in adequate doses with honey and clarified butter. This is called the Navayasa Churna, which proves curative in abdominal obesity, improves the impaired digestion and acts as a prophylactic against hemorrhoids, swelling, jaundice, Kushtha, indigestion, cough, asthma and Prameha, etc. 10.

Loharishta:—

A decoction of the drugs of the Shala-saradi group should be made by boiling it down to a quarter part (of the original quantity of water). Then it should be duly filtered; when cooled, a quantity (i.e., fifty Pala weight) of Makshika-honey^[8] should be added to it. A quantity of purified treacle^[9] reduced to the consistency of Phanita as well as fine powders of the drugs of the Pippalyadi group should be mixed with it. A strong and well cleansed (earthen) pitcher saturated with clarified butter should be purified (in the usual way) and its interior plastered with coating of honey and powdered Pippali made into a thin paste. The medicinal compound prepared as above should be kept in the pitcher. After that, thin foils of steel made red-hot in a fire of Khadira wood should be immersed into the compound prepared before. Then the pitcher with the steel-foils immersed into its contents should be kept buried in a heap of barley for three or four months or until the steel-foils are entirely eaten away by the medicine and the characteristic flavour is produced. It should be used in proper doses every morning and a suitable diet should be given to the patient after its use. It reduces fat, improves the impaired digestion and proves efficacious in cases of swellings, internal tumours, Kushtha, Meha, jaundice, dropsy of the spleen (Plihodara), chronic fever, and excessive urination (dribbling of urine). This preparation is called Loharishta^[10] and it is a highly efficacious remedy. 11.

Traits of cure:—

The cure of Prameha-patients should be understood from the non-slimy and unturbid condition of the urine and from its clear transparent aspect and bitter or pungent taste. 12.

 

Thus ends the twelfth Chapter of the Chikitsita Sthana in the Sushruta Sambita which deals with the medical treatment of Prameha-Pidaka.

Footnotes and references:

[1]:

Astringent drugs of fig-tree (Vata-tree), etc.—D. R.

[2]:

On the failure of the above treatment it would spontaneously burst out and secrete pus and force its way inside, which would lead gradually to widen its mouth or fissure, and help its running into an incurable stage.—Dallana.

[3]:

“Udakirya and Prakirya” are the two kinds of Karanja.

[4]:

“Varshabhu and Punarnava” are the two kinds of Punarnava (i.e., red and white).

[5]:

According to Dallana, the introduction of this medicated Ghrita into the text is an interpolation. Since Jejjata has not explained it in his commentary, Dallana does not explain it. Chakradatta, however, mentions this Ghrita in his compilation, though with some additions and alterations under the treatment of Prameha.—Ed.

[6]:

Chakradatta reads “Shiva” in place of “Amalaka” and does not include “Priyamgu” in the list. According to some commentators the total weight of the after-throw (Prakshepa) would be a quarter part of the total weight of the drugs boiled; whereas, according to others, the different drugs for Prakshepa would weigh one Pala each.

[7]:

Charaka and Chakrapani Datta insert this medicine among the curatives of “Pandu-roga”, Shivadasa (the commentator) advises to take “Manduia-iron” instead of “black-iron In the practical field also we derive great and good effects in cases of spleen and liver diseases and specially in cases of infantile liver and heart diseases.—Ed.

[8]:

Dallana says that fifty Pala weight of each of the two substances—Madhvasava and Phanita, and twenty-five Pala weight of each of the following substances., viz., the powders of the drugs of the Pippalyadi group and steel-foils, should be taken in preparing it. But Gayadasa explains that such a quantity of old and matured honey should be mixed with the decoction as will sweeten it; the same quantity of old and matured Phanita treacle should be taken; the powders of Pippalyadi group should be added to it till it gets a slight astringent (Katuka) taste.

Some commentators, however, hold that the honey, the powders of the drugs of the Pippalyadi group and of the steel-foils should be each a quarter part of the decoction in weight.

Dallana explains the term “Madhu” as the Asava prepared of honey. Gayadasa, however, explains it simply as honey.

[9]:

The Phanita should be refined by dissolving it in the decoction of the drugs of the Shala-saradi group and then filtere.—Dallana,

[10]:

The recipe of Loharishta, according to Vagbhata, is as follows:—

The drugs of the Asanadi group (which corresponds with Sushruta’s Shala-saradi group), each weighing twenty Palas, should be boiled in eight Dronas of water down to a quarter part of its weight. Two hundred Pala weight of treacle and half an Adhaka (four seers) of honey and the powders of the drugs of the Vatsakadi group (which corresponds with the Pippalyadi group of Sushruta), each weighing one Pala, should be mixed with the above decoction when cooled. A (new earthen) pitcher should be plastered inside with (an adequate quantity of) Pippali-powder and honey, the outer side being plastered with shellac. The above preparation should now be poured into this pitcher which should be kept in a heap of barley. A fire should be kindled with Khadira charcoal. Thin iron-foils should be alternately heated in this fire and immersed in the above preparation until the iron-foils are powdered.

Vagbhata gives the name of Ayaskriti to this preparation.

We, however, follow Vagbhata in the preparation of this Arishta with good results.—Ed.