Chapter XVI - The medical treatment of Abscesses and Tumours

Now we shall discourse on the medical treatment of Abscesses and Tumours (Vidradhi). 1.

Of the six types of Vidradhis, the one of the Sanni-patika type should be regarded as incurable In all other types curative measures^[1] should be speedily resorted to in their unsuppurated stage, as in the treatment of a case of Sopha (inflammatory swelling or boil). 2.

Treatment of Vataja-Vidradhi:—

In a case of Vataja Vidradhi, a compact or thick plaster (Alepa) composed of pasted Murangi-roots,^[2] mixed with clarified butter, oil and lard (Vasa), should be applied lukewarm. The flesh of the animals which frequent swamps and marshes as well as of aquatic animals boiled with the drugs of the Kakolyadi group, Kanjika, salt, barley powder and Sneha (clarified butter, etc.), should be applied as a poultice (Upanaha and the affected part should be constantly fomented with (warm) Veshavara, Krishara, milk and Payasa. Blood-letting should also be resorted to. 3.

If, in spite of the use of the preceding remedies, suppuration should begin to set in, suppurating measures should be resorted to and the abscess (finally) lanced with a knife. Cleansing measures should then be applied to the (incidental) ulcer. After incision, the ulcer should be washed with a decoction of the Panca-mula; and an oil cooked with the drugs of the Bhadra-darvadi group and Yashti-madhu, and, mixed with an abundant quantity of salt, should be used in filling (healing up) the cavity of the wound. The cleansing of the ulcer should be effected with the powdered Vairechanika (purgative) drugs mixed with Traivrita^[3] and the healing should be effected with Traivrita cooked with the drugs of the Prithak-parnyadi group. 4-6.

Treatment of Pittaja Vidradhi:—

In a case of Pittaja Vidradhi a plaster (Pradeha) composed of sugar, fried paddy, Yashti-Madhu and Sariva pasted with milk should be applied, As an alternative, a plaster composed of Payasya, Ushira and (red) sandal wood pasted with milk should be used. Cold infusions of Pakya (Yava-kshara), sugarcane-juice and milk, and jivaniya-Ghrita mixed with sugar should be used in afifusing the abscess. The patient should be advised to lick a lambative composed of powdered Haritaki and Trivrit saturated with honey; and leeches should be applied (to an unsuppurated) abscess for letting out the blood. An intelligent surgeon should (lance a suppurated abscess and) wash the incidental ulcer with a decoction of Kshira-Vriksha or of aquatic bulbs. Poultices of sesamum and Yashti-Madhu mixed with honey and clarified butter should then be applied to it and bandaged with a piece of thin linen. Clarified butter cooked with Prapaundarika, Manjishtha, Yashti-Madhu, Ushira, Padmaka, Haridra and milk, should be used to heal up the cavity of a Pittaja ulcer by (inducing granulation). As an alternative, clarified butter cooked with Kshira-Shukla, Prithakparni, Samanga, Rodhra, Chandana and the tender leaves and bark of the drugs of the Nyagrodhadi group should be employed for the same end. 7–10.

Karanjadya Ghrita:—

A Karsha measure of each of the following drugs, viz., the tender leaves and fruits of the Naktamala, the leaves of the Sumana (Jati flower), Patola and of Arishta, Haridra, Daru-Haridra, wax, Yashti-Madhu, Tikta-Rohini, Priyangu^[4] Kusha-roots, Nichula-bark, Manjishtha, sandal wood, Ushira, Utpala, Sariva and Trivrit should be cooked with a Prastha measure of clarified butter. This medicated Ghrita is called the Karanjadya Ghrita, and it will cure malignant ulcers (Dushta-Vrana) and act as a purifier in sinus and recent ulcers, etc., burns and scalds, deep sores and even deep-seated sinuses. 11.

Treatment of Kaphaja Vidradhi:—

In a case of Kaphaja Vidradhi, the seat of affection should be fomented with a heated brick, sand, iron, cow-dung, husks, ashes and cow’s urine.^[5] The Doshas involved in such a case should be curbed down by a constant use of medicinal decoctions, emetics, plasters (alepa) and poultices (Upanaha). The vitiated blood of the locality should be cuffed out with an Alavu-yantra (gourd). The abscess when suppurated should be (lanced and) washed with a decoction of Aragvadha. The sore of such an ulcer should be filled up (healed) with a medicinal compound consisting of the paste of Haridra Trivrit, Shaktu, sesamum and honey and bandaged in the manner described before. After that, a medicated oil properly cooked with a paste of Kulatthika, Danti, Trivrit, Shyama, Arka, Tilvaka, cow’s urine and rock- salt should be applied in such a case. 12-13.

Treatment of agantuja and Raktaja Vidradhi:—

In a case of abscess of traumatic (Agantuja) origin, or due to the vitiated condition of the blood (Raktaja), all the measures and remedies laid down in connection with those of the Pittaja type should be employed by a skilled surgeon. 14

Treatment of internal Vidradhi:—

case of an unsuppurated internal abscess yields to the use of a potion consisting of a decoction of the drugs of the Varunadi group saturated with the powders (Kalka) of those of the Ushakadi group. Clarified butter cooked with the decoction of the drugs of the two preceding groups, as well as clarified butter cooked with purgative drugs, taken every morning, will cure an internal abscess in a very short time. The decoctions of the above groups should be mixed with Sneha (oil or clarified butter) and speedily used as an asthapana as well as an Anuvasana measure. The bark of Madhu-shigru mixed with the powders of the drugs antidotal to the Doshas involved in the case, being administered in food and drink and used as a plaster, proves curative in a case of an internal abscess in its unsuppurated stage. As an alternative, the said drug (i.e., Madhu shigru) should be taken with water, Dhanyamla, cow’s urine, or Sura (wine). Purified Shilajatu, Guggulu, Shunthi, or Deva - daru, dissolved in the decoction of the drugs antidotal to the aggravated Doshas involved in the case, should be administered. Applications of poultices, Sneha-Karma (emollient measures), as well as Anulomana (Vayu-subduing) measures should be frequently resorted to in such cases. 15-20.

The veins (Shira) should be opened in a case of the Kaphaja type of abscess as directed before; while some authorities advise to open the veins at the arms in cases of Raktaja, Vataja and Pittaja types. 21.

Treatment of Suppurated internal Vidradhi:—

A suppurated internal Vidradhi having bulged up (above the surface of the body) should be opened with a knife and treated in the manner of an (incidental) ulcer. Whether the pus drains through the lower or the upper channel of the body (rectum or mouth) the patient should be made to take the drugs of the Varunadi group or Madhu-shigru mixed with (a copious quantity of) Maireya, Sura, Asava, or Kanjika. The diet should consist of rice boiled and cooked with white mustard seed in the decoction of Madhu-shigru and taken with the soup of barley, Kola and Kulalttha pulse. The Tilvaka Ghrita (Chikitsa Sthana, ch. IV.), or clarified butter cooked with the decoction of the Trivritadi group, should be taken every morning in adequate doses for the purpose. Particular care should be taken by the phsyician to guard against the suppuration of an internal abscess, since suppuration in such cases leads but to a slender hope of success. 22-23.

Treatment of Majja-jata Vidradhi:—

The medical treatment of a patient, afflicated with a Majja-jata abscess (abscess affecting the marrow), should be taken in hand without holding out any definite hope of recovery fas a proper course of treatment in such cases does not invariably prove successful). Sneha-karma (anointments, etc.) and fomentations should be first resorted to, after which blood-letting should be made; and the remedial measures of the present chapter should be then employed. When it reaches the suppurating stage, the bone should be operated upon, and after the full elimination of the pus and the putrid matter from the incised ulcer, purifying remedies should be employed. The incidental ulcer should be washed with the decoction of the bitter drugs and the Tikta- Sarpis^[6] should be used. An intelligent physician should apply the decoction of the drugs of the Samshodhaniya group, if the oozing out of the marrow is not arrested. A medicated oil cooked with Priyangu, Dhataki, Rodhra, Katphala, Nemi^[7] and Saindhava salt should be used in healing up an ulcer incidental to an opened up Vidradhi. 24–25.

 

Thus ends the sixteenth Chapter of the Chikitsita Sthana in the Sushruta Samhita which deals with the treatment of abscess.

Footnotes and references:

[1]:

Commencing with Apatarpana up to purgative measures (Chikitsa, chapter.–I).

[2]:

Both Dallana and Chakrapani Datta read “Vataghna” in place of “Murangi” of the text. Dallana explains the term “Vataghna” as the “Bhadra-darvadi group” and Shiva-dasa, the commentator of Chakrapani, explains it as the “Dasha-mula”. Both of them, however, say that he different reading is “Surangi” meaning “Shobhanjana.” “Murangi” also means “Shobhanjana.”—Ep.

[3]:

“Traivrita” is a technical term and means clarified butter mixed with the three other lardacious substances, viz., oil, lard and marrow. Vide Chikitsita Sthana. Chapter—V.

[4]:

Chakrapani Datta in his compilation does not include Priyangu, Kusha-roots add Nichula-bark in the list but he reads both the kinds of Sariva, i.e., Anantamula and Shyama-lata.

[5]:

In Chakradatta, the reading is “mūlapiṣṭaiḥ (?)” i.e., pasted in cow’s urine, instead of “mūnnairuṣṇai (?) |” Shivadasa, the commentator, however, holds that this reading is not authoritative, though he says that some commentators have accepted it.

[6]:

This medicated Ghrita (Chikitsita Sthana, Ch. IX) may be used both internally and externally with good results. Ed.

[7]:

Dallana reads “Tini” in place of “Nemi,” both of which, however, mean “Tinisha”. Chakradatta does not include “Saindhava” in the list, but reads “Tinisha-tvaca” in place of “Nemi-Saindhavam”. Shivadasa, however, adds another reading “Tinisha Dhavam” on the authority of Candrala.