Chapter XVII - The medical treatment of erysipelas

Now we shall discourse on the medical treatment of erysipelas, etc., (Visarpa), sinus, etc., (Nadi- Vrana) and diseases of the mammary glands (Stana-roga). 1.

Of the types of erysipelas (Visarpa) the first three (viz., the Vataja, Pittaja and Kaphaja ones) are curable; the two remaining types, viz,, those caused by the concerted action of the three Doshas (of the body) and those originating from wounds (Kshataja) should be considered as incurable. In cases of the curable types, medicated Ghritas, plasters (Upadehas) and affusions (Seka) prepared with the drugs (antidotal to the specific aggravated Dosha or Doshas (involved in the case) should be prescribed. 2.

Treatment of Vataja Visarpa:—

In cases of the Vataja type of the disease, Musta, Shatahva, Suradaru, Kushtha, Varahi, Kustumburu (Dhanyaka) Krishna-gandha, and the drugs of a heat-making potency (Ushna-gana)^[1] should be used in preparing the medicinal washings (Seka), plasters and Ghritas. The drugs respectively included within the groups of the Vrihat- Panca-mula and the Svalpa-Panca-mula, the Kantaka-Panca-mula and the Valli-Panca-mula should be (separately) used to prepare the medicinal plasters, affusions, medicated Ghritas and as well as the necessary oils. 3.

Treatment of Pittaja Visarpa:—

In cases of Pittaja Visarpa, a plaster consisting of Kasheruka, Shringa-taka, Padma, Gundra (Guduci), Shaivala, Utpala and clay pasted together and mixed. with clarified butter, should be wrapped^[2] in a piece of linen, and applied cool to the affected part. A paste composed of Hrivera, Lamajjaka (Ushira-mula), Chandana, Srotoja (Rasanjana), Mukta, Mani and Gairika, pasted together with milk and mixed with clarified butter should be applied thin and cool to the affected part to alleviate the pain. Pittaja erysipelas readily yields to the application of a medicinal plaster composed of Prapaundarika, Yashti-madhu, Payasya,^[3] Manjishtha, Padmaka, Chandana and Sugandhika pasted together. Decoctions of the drugs of the Nyagrodhadi group should be used in washing (the affected part); or clarified butter should be cooked with the expressed juice of the above drugs and employed in the case. The part may be affused (Seka) with cold milk (or water), or with water mixed with honey or sugar, or with the expressed juice of the sugarcane. 4-5.

Gauryadi Ghrita:—

A Prastha measure of clarified butter should be cooked with the Kalka of Gauri,^[4] Yashti-madhu, Aravinda, Rodkra, Ambu, Rajadana, Gairika, Rishabhaka, Padmaka, Sariva, Kakoli, Meda, Kumuda, Utpala, Chandana, Madhu - Sharkara, Draksha, Sthira, Prishni-parni, and Shatahva taken in equal parts (and weighing one seer^[5] in all) and with the decoctions, weighing four times that of the Ghrita, of the drugs of the Nyagrodhadi, Sthiradi (minor Panca-mula) and Vilvadi (major Panca-mula) groups together with the same weight (sixteen seers) of milk. The washing (of the affected part) with this medicated Ghrita proves curative in Pittaja erysipelas and sinus. Visphota (boils), head diseases, malignant sores and inflammatory affections of the mouth, yield to the internal use of this Ghrita. It is called the Gauryyadi Ghrita and is highly efficacious in the derangements to which children are liable, (commonly) attributed to the malignant influences of evil stars, as well as in cases of emaciated ones. 6.

Treatment of Kaphaja Visarpa:—

Cases of the Kaphaja type of Visarpa readily yield to a proper application of a medicinal plaster (Pradeha) composed of Aja-gandha, Ashva-gandha, Sarala,^[6] Kala, Ekaìshika^[7] and Aja-shringi^[8] pasted with the urine of a cow. Drugs, such as Kalanusarya, Aguru, Chocha (cardamom), Gunja, Rasna, Vaca, Shita-shiva, Indra-parni, Palindi, Munjata and Mahi-Kadamba (applied similarly) are also efficacious in the present type. Drugs of the Varunadi group may be used in any form (such as plasters, washes, etc.), for erysipelas. Blood-letting (by means of leeches) and Samshodhana (purifying) measures are the principal remedies in all cases of this disease (Visarpa). Suppurated erysipelas should be first purified and then treated with the remedies described in the treatment of Vrana (ulcer). 7-8.

Treatment of Nadi-vrana:—

A Case of Nadi-Vrana (sinus) due to the concerted action of the three Doshas (Sannipataja) baffles all cure, while the four remaining types are amenable to careful medical treatment. Poultices (Upanaha)^[9] should be applied at the outset in the Vataja Nadi-Vrana and then the course of the pus-channels should be (ascertained and) fully opened (with a knife) and bandaged with a paste of sesamum, Apamarga- seeds and Saindhava salt. A decoction of (the drugs of) the Vrihat-Panca-mula group should be constantly used in washing the ulcer. Oil^[10] duly cooked with the followiug drugs, viz., Himsra, Haridra, Katuka, Vala, Gojihvika and Vilva -roots should be used for the purification, filling up and healing of the sores of the sinus. 9–11.

Treatment of Pittaja Nadi:—

In a case of Pittaja sinus, an intelligent surgeon should employ a porridge (Utkarika) mixed with milk and clarified butter as a poultice. Then having opened the sinus with a knife, a plaster composed of Tila, Naga-danti and Yashti-madhu should be applied to heal it. A decoction of Soma, Nimba and Haridra should be used by a skillful surgeon in washing the ulcer daily. A medicated Ghrita cooked with Shyama, Trivrit, Triphala, Haridray Daru-Haridra, Rodhra and Kutaja and with milk should be used to lubricate (Tarpana) the sinus. This Ghrita will even heal a sinus affecting the Koshtha. 12-13.

Treatment of Kaphaja Nadi:—

In a case of the Kaphaja type of the Nadi, the sinus should be duly poulticed (Upanaha) with Kulattha, white mustard seeds, Shaktu and Kinva. When softened by its application, the direction of the sinus (with the help of a director) should be first ascertained; and an expert surgeon should then open it fully with a knife and plaster it with a compound composed of Nimba, sesamum, Saindhava salt and Saurashtra-mrittika. A decoction (Sva-rasa-lit.—expressed juiced of the Karanja, Nimba, Jati, Aksha and Pilu should be used in washing the incidental ulcer. Oil duly cooked with Suvarchika, Saindhava, Citraka, Nikumbha, Tali^[11] Nala, Rupika and Apamarga- seeds and with cow’s urine should be used for healing purposes. 14.

Treatment of Shalyaja Nadi:—

In a case of Shalyaja Nadi (incidental to any foreign matter into the body), the Salya should be first extracted by an incision into the sinus. Then having fully cleansed the channel, the ulcer should be purified with a plaster of sesamum profusely saturated with honey and clarified butter. It should b3 then healed up. Oil cooked with the decoction of the tender fruits of the Kumbhika, Kharjura, Kapittha, Vilva and the Vanaspatis (Vata, etc.), and with the Kalkas of Musta, Sarala, Priyangu, Sugandhika, Mocarasa,^[12] Ahi-pushpa (Nagesvara), Rodhra and Dhataki flowers leads to a speedy healing up (granulation) of ulcers (Vrana) and traumatic sinuses. 15.

Treatment with Kshara-Sutra:—

An erudite surgeon should open a sinus, occurring in any of the Marmas, or in a weak, timid, or emaciated person with an alkalined string (Kshara-Sutra), and not with a surgical knife. The course of the sinus should be first ascertained with a director; and a needle, threaded with a string of alkalined thread should be passed from one end of the sinus and quickly drawn out through the other. Then the two ends of the thread should be firmly fastened together. An intelligent surgeon should likewise pass another alkalined thread in the event of the alkali of the first thread being comparatively weak. This should be repeated till the sinus completely bursts out. The surgeon should know that the same procedure may be as well adopted in cases of fistula-in-ano. Similarly in cases of tumours (Arvuda), etc. they should be lifted up (with the hand) and tied round at their base with an alkalined thread, or it should be punctured around with a kind of needle with their mouth resembling a barley corn and then tied again at their base with an alkalined thread. After their bursting (and falling off), they should be treated as common ulcers (Vrana). 16.

The different kinds of Plug-Stick (Varti) described in the Dvi-Vraniya Chapter (Chikitsita—chap.-1.) may be similarly used with advantage in all cases of sinus. The use of a plug made of the following drugs, viz., the bark and fruit of the Ghonta, (the five officinal kinds of) salt,^[13] Laksha, Puga and the leaves of the Alavana^[14] pasted together with the milky juice of the Snuhi and Arka leads to the speedy healing up of a sinus. The powdered^[15] stones of Vibhitaka, mangoe fruits, Vata - sprouts, Harenu, Shamkhini- seed, Varahi-kanda mixed with oil can also be used in a case of sinus. 17-19.

The seeds of the Dhustura, Madana and Kodrava, Koshataki, Shuka-nasa, Mriga-bhojani and the seeds and flowers of the Amkota should be pounded together and applied to a sinus (Nadi) after having washed it with a decoction of Laksha. Cases of sinus speedily yield to the curative efficacy of the application of these powders mixed with oil. The use of the oil cooked with cow’s urine and with the preceding drugs (as Kalkas) brings about the healing up of a sinus in seven nights. 20-21.

The application of the oil cooked with the roots of the Pinditaka treated with the expressed juice of the Varaha-kanda in the manner of a Bhavana saturation and with the bulbs of Suvaha brings about a speedy and effective remedy for a sinus. The same effect is produced by an application of the oil cooked with the bulbs of the the Vajra-kanda. 22.

Bhallatakadya Taila:—

The use of the oil cooked with the paste (Kalka) of Bhallataka, Arka, Marica, Saindhava salt, Vidanga, Haridra, Daru-Haridra and Citraka and with the expressed juice of the Bhringa-raja readily cures cases of sinus, Apachi and ulcer due to Vayu and Kapha. 23.

Treatment of Stana-roga:—

In cases of a derangement of the milk (of the breast) a draught of clarified butter should be quickly given to the Dhatri (mother or wet-nurse) by the physician; and in the evening a draught composed of the decoction of Nimba, mixed with honey and Magadhika, should be given to her for emetic purposes. Next day she should take a meal (of boiled rice) with the soup (Yusha) of Mudga pulse. The use of emetics should be continued for three, four, or six days; or she should be made to drink a potion of clarified butter (cooked) with Triphala. A decoction of Bhargi, Ativisha, Vaca, Sura-daru, Patha, the drugs of the Mustadi Gana, Murva and Katu-rohini, or that of the drugs of the Aragvadhadi group mixed with honey, should be given to the Dhatri (wet-nurse) for the purification of her breast-milk. 26.

The above are the general remedial measures which are to be adopted in the affections of breast-milk. Any other defect in the breast-milk should be corrected specially with an eye to the nature of the Dosha involved in the case. In cases of inflammatory swellings of the breasts, the physician should remedy them by means of any one of the various measures laid down under the head of Vidradhi with a due consideration to the requirements of each particular case. Medicinal remedies should only be internally employed and no poultices should be applied for the speedy suppuration of the swelling of the breast, even if found to have already commenced to suppurate; since the breasts are of an extremely soft and fleshy growth, any tight bandaging about those parts may be followed by local sloughing or even bursting. In a case where suppuration had already taken place, an operation should be made in the affected part, avoiding the milk-carrying veins as well as the nipple with its black surroundings. In all the cases of Stana-Vidradhi—whether non-suppurated, suppurating, or suppurated—the milk should be pressed out from the breast of the Dhatri^[16] 27-29.

 

Thus ends the Seventeenth Chapter of the Chikitsita Sthana in the Sushruta Samhita which deals with the treatment of erysipelas, sinus and the diseases of the mammary glands.

Footnotes and references:

[1]:

Chakradatta reads “Arka”, Vamsha and Artagala instead of the drugs of a heat-making potency. Dallana explains the drugs of a heat-making potency to be the drugs of the Bhadra-darvadi and the Pippalyadi groups.

[2]:

In order to facilitate its removal.

[3]:

It means “Kshira-vidari”. Jejjata explains it as “Arka-pushpi”.

[4]:

Some explain it as “Haridra”, while others explain it as “Gorocana”.

[5]:

Dallana, however, says that these drugs will weigh four Palas i.e., half a seer in all.

[6]:

“Sarala” here means “Trivrit”. Chakradatta reads “saraṇa” which also means “Trivrit”.

[7]:

‘Ekaishika,” according to Dallana, would mean Shatavari but Shivadasa explains it as Patha.

[8]:

Gayadasa explains it as Karkata-Shringi.

[9]:

Poulticing with the drugs which induce suppuration is not approved of by Gayadasa.

[10]:

Four seers of oil, the (Kalka) drugs combindely weighing one seer and sixteen seers of water are to be taken in its preparation.—Dallana.

[11]:

Dallana’s reading evidently is “Tali-lala” and he explains it as the roots of “Bhumyamalaki”. Chakradatta also prescribes this oil but he takes “Nilika” instead of “Tali”, Shivadasa, again, in his commentary quotes from Sushruta but reads “Nili-Nala” in place of “Tala-Nala.”

[12]:

“Moca-rasa” is explained by Dallana to be “Shobhanjana,” but it generally means “Shalmali-veshta,”and Shivadasa explains it as such.—Ed.

[13]:

According to Chakradatta’s reading and Shivadasa’s commentary thereon, only the Saindhava (instead of the five officinal kinds of salt) should be taken. We, however, follow Dallana’s interpretation with good results.

[14]:

“Alavana” has been explained by Dallana as “Kaka-mardanika” and by Shivadasa as “Jyotishmati”. Shivadasa is, however, followed in practice in this case.

[15]:

According to some different reading “burnt ashes” (instead of powders) of the drugs should be taken. In our humble opinion the reading in the text seems to be the correct one,

[16]:

The milk should be pressed out of the Dhatri’s breasts in the non-suppurated stage, to alleviate the burning sensation therein, in the suppurating Stage for the avoidance of further suppuration, and in the suppurated s tage for the prevention of sores, sinus, etc.