Chapter XIV - The medical treatment of dropsy

Now we shall discourse on the medical treatment of dropsy with an abnormal condition of the abdomen (Udara). 1.

Of the eight different types of Udara, described before, those severally known as the Vaddha-guda and the Parisravi should be understood as incurable, the rest being equally hard to cure. Hence the medical treatment of all cases of Udara (abdominal dropsy) should be resorted to without holding out any positive hope of recovery. The first four types of the disease (as metioned in the list of enumeration), may prove amenable to medicine; but the rest would require Surgical treatment. All the types of the disease, however, would, with the progress of time, require a surgical operation, or (attaining an incurable stage) they may have to be abondoned. 2.

Diet of articles forbidden:—

A patient, afflicted with an attack of Udara, should forego the use of heavy (indigestible), or emollient fare, of all kinds of meats and of those that produce a state of extreme dryness in the system, or produce a slimy secretion from the channels (of the Doshas and the vital principles) of the body, or give rise to a sort of digestionary acid reaction (acid transformation in the stomach) and refrain from bathing and using effusions. Meals consisting of well cooked Shali rice, barley, wheat, or Nivara seeds should be the daily diet of such a patient. 3.

Treatment of the Vataja type:—

In a case of Vataja Udara, the body of the patient should be anointed with clarified butter cooked with the drugs of the Vidari-gandhadi group, while the one cooked with Tilvaka should be used as purgatives (Anuloma). A compound made of a copious quantity of oil of Citra seeds, mixed with a decoction of the drugs of the Vidari-gandhadi group, should be used as asthapana and Anuvasana measures. The Salvana Upanaha (poultice) should be applied to the abdomen. Milk cooked with the drugs of the Vidari-gandhadi group, or the soup of the flesh of Jangala animals should be given to the patient with his meal and the affected region should be frequently fomented. 4.

Treatment of the Pittaja Type:—

In a case of Pittaja Udara, the patient should be anointed with clarified butter cooked with the drugs of the Madhura (Kakolyadi) group. Similarly, clarified butter cooked with Shyama, Triphala and Trivrit should be used as purgatives and the decoction of the drugs of the Nyagrodhadi group, mixed with a copious quantity of sugar, honey and clarified butter, should be used as Anuvasana and A’sthapana measures. The abdomen should be poulticed with Payasa (porridge prepared with rice and milk) and the diet should consist of boiled rice and milk, cooked with the drugs of the Vidari-gandhadi group. 5.

Treatment of the Kaphaja Type:—

In a case of Kaphaja Udara, the patient should be anointed with clarified butter, cooked with the decoction of the drugs of the Pippalyadi group. Likewise, clarified butter, cooked with the milky juice of Snuhi plants, should be used as purgatives; and the decoction of the drugs of the Mushkakadi group, with a copious quantity of Trikatu, cow’s urine, Kshara (Yava-kshara) and oil, should be applied as Anuvasana and asthapana measures. A poultice (Upanaha) prepared of Shana seeds, Alasi seeds, Dhataki (flower), mustard, Mulaka seeds and Kinva should be applied (hot) to the abdomen. The diet should consist of (boiled rice well- mixed with) Kulattha soup (Yusha), profusely seasoned with powdered Trikatu, or of Payasa; and the abdomen should be frequently fomented. 6.

Treatment of Dushyodara:—

In a case of Dushyodara, the patient should be treated without giving any hope of a positive cure. Purgatives with clarified butter, cooked with the expressed juice of the Saptala and Shamkhini, should be first administered (continuously) for a fortnight or even a month; Or clarified butter, cooked with the milky juice of the Maha - vriksha, and with wine and cow’s urine, should be similarly used as a purgative. A Kalka made up of the roots of the Ashvamaraka, Gunja and Kakadani mixed with wine (Sura), should be given after the bowels had begun to move freely. As an alternative, a Krishna-Sarpa (black lance-hooded cobra) should be enraged to bite a sugarcane and this piece of sugarcane should be given to the patient to chew (and suck); or the fruits of creepers (Valli-phala) should be used (in the preceding manner); or poisonous^[1] roots and bulbs should be prescribed, whereby the disease may be cured or may take a different turn. 7.

Memorable Verse:—

A case of abdominal dropsy (Udara) of whatsoever type should be presumed to have its origin in an aggravation of the bodily Vayu and an accumulation of fecal matter in the bowels; hence frequent use of Anulomana (purgatives, etc.) is recommended in this disease. 8.

General Treatment:—

Now we shall describe a few general medicinal compounds (which may be used with advantage in cases of Udara). They are as follows;—Castor oil with milk or with the urine of a cow should be taken for a month or two. No water should be taken during the period, or the patient should forego the use of water and all other food, but drink only the urine of a she-buffalo and (cow’s) milk;^[2] or he should live upon the milk of a she-camel alone, foregoing the use of rice and water and submit himself to a course of Pippali for one month in the manner described before (under the treatment of Maha-Vatavyadhi),^[3] or take the oil of the Nikunibha with Saindhava-salt and powdered Ajatmoda dissolved in it. The said oil (of Nikumbha), cooked with a hundred Patra weight of the expressed juice of Ardraka and Shringavera (fresh ginger), should be applied in the event of there being any Shula (colic pain), due to the action of the deranged and aggravated Vayu. Milk, boiled with the expressed juice of Shringavera (fresh ginger), should be taken. A paste-compound of Cavya and Shringavera, or a paste-compound of Sarala, Deva-daru and Citraka (with milk), or a paste-compound of Murangi, Shalaparni, Shyarna and Punarnava (with milk), or the oil of Joytishka seed, mixed with milk, Svarjika and Asafetida, should be administered to the patient. 9.

He should take Haritaki with treacle, or a thousand Pippali soaked (twenty one times) with the milky juice of the Snuhi plant (in the manner of Bhavana saturation), should be gradually consumed. Powdered Pippali and Haritaki should be soaked with the milky juice of the Snuhi plant (and dried in the sun). Utkarika should now be preapared with this compound and given to the patient, io.

The Haritaki Ghrita:—

A Prastha measure of powdered Haritaki should be mixed with an Adhaka measure of clarified butter and heated over a charcoal fire by stirring it up quickly with a ladle; when well mixed, the compound should be poured into an earthen pitcher, which should be kept well corked and buried in a heap of barley for a fortnight. The pitcher should then be taken out and the compound should be strained and cooked again with an adequate^[4] quantity of the decoction of Haritaki, Kanjika (fermented rice-gruel) and curd. The patient should use this medicine for a month or a fortnight in proper doses and with adequate vehicles, n.

The Maha-vriksha Ghrita:—

A quantity of the milky juice (one fourth of the cow’s milk in quantity) of the Maha-vriksha (Snuhi plant), should be boiled with cow’s milk. Then it should be removed from the oven, cooled down and churned (with a churning rod). The butter thus prepared and cooked again with the milky exudations of the Maha-vriksha (and an adequate quantity of water) should be given to the patient for a month or a fortnight in adequate doses and with proper vehicles. 12.

The Cavyadi Ghrita:—

Half a Karsha (one Tola) measure of each of the following drugs, viz., Cavya, Citraka, Danti, Ativisha, Haridra, Shamkhini, Trivrit and Trikatu, together with an eight Karsha measure of the inner pulps of the fruit (seeds) of the Raja-vriksha, two Pala weight of the milky juice of the Maha-vriksha, eight Pala weight of cow’s milk and eight Pala weight of cow’s urine, should be cooked^[5] with a Prastha measure (four seers) of clarified butter. The medicated Ghrita, thus prepared, should be given in convenient doses to the patient for the period of a month or a fortnight. 13.

The aforesaid three Ghritas (Haritaki-Ghrita, Maha- vriksha-Ghrita and Cavyadi-Ghrita) and the Tilvaka- Ghrita (mentioned in the chapter dealing with Vata- vyadi) should be employed, whenever purgatives would be necessary in cases of Udara, internal tumour (Gulma), abscess, Ashthila, Anaha, Kushtha, insanity and epilepsy. 14.

Constant use of (cow’s) urine or (any kind of) Asava, Arishta or wine, cooked with the milky exudation of Maha-vriksha,^[6] is recommended. A decoction of purgative drugs, thickened with an admixture, in copious quantity, of powdered Shunthi and Deva-daru, may be used with advantage in this desease.

Anaha Varti:—

A Pala weight of the emetic and purgative drugs and the same weight of the fine powders of the drugs of each of the Vacadi, Pippalyadi and the Haridradi group, and all the officinal kinds of salt should be mixed (with four or eight times that of) the urine (of a cow, buffalo, etc.). Then this (mixture) compound should be boiled and cooked over a gentle fire with a Prastha measure of the milky juice of Maha-vriksha by constantly stirring it with a ladle. Precaution should be taken so that the Kalkas may not be scorched or burnt. This medicinal compound, when properly prepared, should be removed from the fire and when cooled should then be made into pills (Gutika), each being an Aksha (two Tolas) in weight. These pills should be given once, twice or thrice daily according to the exigency of the case and the capacity of the patient for a period of three or four consecutive months. The medicine is known as the Anaha-varti, and is specially beneficial in cases of Maha-vyadhi, and is equally efficacious in destroying intestinal worms. These pills, if regularly used, prove beneficial in cases pf cough, asthma, Kushtha, parasites, catarrh, indigestion, aversion to food and Udavarta. 15.

Second Anaha-Varti:—

The inner pulp of the seeds of Madana fruits with Kutaja, Jimutaka, Ikshvaku (bitter gourd), Dhamargava, Trivrit, Trikatu, mustard seed and rock-salt, should be pasted together with either the milky juice of Maha-vriksha or with the urine of a cow; and the paste should be made into thumb-shaped plugs (Varti). In a case of Anaha of the patient already suffering from Udara, the outer end of his rectum should be lubricated with oil and salt and one or two of the plugs should be inserted therein. The application of this Anaha-varti should as well be applied in cases of Udavarta, due to a suppression or retention of stool, urine, and Vata (flatus) and in cases of tympanites (Adhmana) and distention of the abdomen (Anaha). 16.

Treatment of Plihodara:—

In a case of Plihodara,^[7] applications of Sneha (oil, etc.) and Sveda (fomentations) should be made and the patient should be fed on boiled rice mixed with milk-curd. Then the vein (Shira) inside the elbow of his left hand, should be duly opened. The spleen should be rubbed with the hand for the proper out-flow of its deranged blood (for the relief of that enlarged organ). Then having properly cleansed his system, the physician should advise the patient to take the alkali of marine oyster-shells through the medium of milk. As an alternative, Yava-kshara should be given to him with Sauvarchika and Hingu, or with filtered alkali (made with the ashes) of Palasa wood. As an alternative, the alkali of Parijataka, lkshvaku and Apamarga, mixed with oil, should be prescribed; or the decoction of Shobhanjana, mixed with Citraka, Saindhava and Pippali, or the alkali of Puti-karanja, filtered with Kanjika and mixed with a copious quantity of Vid salt (black salt) and powdered Pippali should be administerd. 17.

Shat-palaka Ghrita:—

One pala weight of each of the following drugs, viz, Pippali, Pippali-roots_ì Citraka, Shunthi, Yava-kshara and Saindhava should be cooked with one Prastha measure of clarified butter and the same quantity of milk^[8]. The medicated Ghrita thus prepared is called the Shat-palaka-Ghrita. It is highly efficacious in cases of an enlargement of the spleen, impaired digestion, Gulma, dropsy, Udavarta, swelling (Shvayathu), jaundice, cough, asthma, catarrh, Urdhva- Vata and Vishama-Jvara. In cases of Udara attended with impaired digestion, the Hingvadi Churna should be prescribed. These measures should be as well employed in a case of an enlargement of the liver (Yakrit), but the speciality is that the vein (inside the elbow) of the right hand (instead of the left hand) should be opened in this case. 18.

Metrical Text:—

After slightly bending down the wrist (of the left hand), the vein in connection with the thumb of the left hand should be cauterized with a (burning) Sara for the purpose of giving relief in a case of enlarged spleen. 19.

Treatment of Vaddha-gudodara, etc.:—

In cases of the Vaddha-guda (Entertis) and the Parisravi types of Udara, the patient should be first treated with emulsive measures and fomentations and then anointed with a sneha. Then an incision should be made on the left side of the abdomen below the umbilicus and four fingers to the left of the line of hair which stretches downward from the navel. The intestine to the length of four fingers should be gently drawn out; any stone, any dry hardened substance (Scybalum?), or any hair found stiffing to the intestine should be carefully examined and removed. Then the intestine should be moistened with honey and clarified butter. It should then be gently replaced in its original position and the mouth of the incision in the abdomen should be sewn up. 20.

Treatment of Parisravi-Udara:—

In cases of the Parisravi type of Udara, the obstructing matter should be similarly removed (from the intestines), as in the preceding case, and the secreting intestine should be purified. The (two ends of the severed intestines should be firmly pressed and adhered together and large black ants should be applied to these spots to grip them fastly with their claws. Then the bodies of the ants having their heads firmly adhering to the spots, as directed, should be severed and the intestines should be gently reintroduced into their original position (with the severed heads of the ants adhering to the ends of the incision) and sutured up, as in the preceding case. A union or adhesion of the incidental wound should then be duly effected. The seam should now be plastered with black earth mixed with Yashtimadhu and duly bandaged. The surgeon should cause the patient to be removed to a chamber protected from the wind and give him the necessary instructions. The patient should be made to sit in a vessel full of oil or clarified butter and his diet should consist only of milk. 21.

Treatment of Udakodara:—

A patient afflicted with Jalodara (ascites) should be first anointed with medicated oils, possessed of Vayu-subduing virtues, and fomented with hot water. Then his friends and relatives should be asked to hold him firmly by his arm-pits, when the surgeon would make a puncture with a surgical instrument, known as the Vrihi-mukha, on the left side of the abdomen below the umbilicus, to the breadth of the thumb in depth and at a distance of four fingers to the left of the dividing line of hairs in the abdomen. Simultaneously with that, a metal tube or a bird’s quill, open at both ends, should be introduced through the passage of the puncture to allow the morbific fluids (Doshodoka), accumulated in the abdomen, to ooze out. And then having removed the tube or the quill, the puncture should be lubricated with oil and Saindhava salt and bandaged in the manner described in connection with the bandaging of ulcers.

The entire quantity of the morbific fluid should not be allowed to ooze out in a single day, inasmuch as thirst, fever, aching of the limbs, dysentery, dyspnea and a burning of the feet (Pada-daha) might supervene in consequence, or as it might lead to a fresh accumulation of matter in the abdomen, in the event of the patient being of a weak constitution. Hence it should be gradually tapped at intervals of three, four, five, six, eight, ten, twelve, or of even sixteen days. After the complete outflow of the fluid, the abdomen should be firmly tied with a piece of flannel, silk-cloth or leather, inasmuch as this would prevent its flatulent distention.

Diet:—

For six months the patient should take his food only with milk or with the soup (Rasa) of Jangala animals.

The diet^[9] for the next three months should consist of (meals taken with) milk diluted (and boiled) with an equal quantity of water or with the soup of flesh of animals of the Jangala group seasoned with the juice of acid fruits. During the next three months it should consist of light and wholesome meals. This rule observed for a year brings about a cure. 22.

Memorable Verse:—

Skilled physicians should prescribe boiled milk and the soup of the flesh of animals of the Jangala group as food and drink in all cases of Udara and use these as asthapana measures and as purgatives as well. 23.

 

Thus ends the fourteenth Chapter in the Chikitsita Sthana of the Sushruta Samhita which deals with the treatment of Udara.

Footnotes and references:

[1]:

If this be not done, the patient is sure to die j but it is not certain whether he would get any relief from this treatment. It being, however, possible in some cases to save the life of a patient by the application of this medicine, it should be used, as the last resort with the permission of the king.—Dallana.

[2]:

The milk here, says Dallana on the authority of Jejjata, should be buffalo’s milk. But, according to Vagbhata and Shivadasa, the commentator of Chakradatta, cow’s milk should be used.—Ed.

[3]:

The Pippalis shohld be taken with milk only in the present instance,

[4]:

Each of the three things (liquids) should be four times as much as the clarified butter.

[5]:

In the absence of any mention about the quantity of water to be added, four times as much of water should be added for the completion of the preparation according to the general maxim.—Ed.

[6]:

Dallana explains the sentence as follows:—

Asavas, Arishtas and Suras should be prepared with urine (instead of the liquid i.e., water) and the milky exudation of Maha-vriksha (as an after-throw), and should be constantly used.

[7]:

Dropsical swelling of the abdomen owing to an enlargement of the spleen.

[8]:

The practice, in this case, is to add twelve Seers (three prastha measures) of water to the Prastha measure of milk at the time of cooking.

[9]:

The use of water is forbidden during these nine months.

“During the first six months, drinking, washing, etc., should be done with milk or the soup of Jangala animals. After this period, the said purposes should be served with half-diluted milk or meat-soup seasoned with the juice of acid fruits. Water may be used during the period of the next three ninths.”—Dallana.

Vagbhata following Charaka says: —

“The patient should live only on milk for six months. After this period, he should live on porridge (Peya) boiled with milk; and for the next three months he should live on boiled Shyama-rice with milk, or with the soup of meat seasoned with the juice or acid fruits and mixed with clarified butter and a small quantity of salt.”

The water of tender and green cocoanuts is used in cases of Udara in place of pure drinking water with benefit.—Ed.