Chapter XVIII - The medical treatment of Glandular Swellings

Now we shall discourse on the medical treatment of Glandular Swellings, etc. (Granthi), Scurvy (Apachi), Tumour, etc. (Arvuda) and Goitre (Gala-ganda). 1.

General treatment of Granthi:—

In the non-suppurated or acute (inflammatory) stage of Granthi, an experienced physician should prescribe the measures^[1] laid down in connection with (inflammatory) swellings (Shopha) in general. As bodily strength arrests the progress of the disease, the strength of the patient should hence be always carefully guarded against suffering any diminution in that respect. The patient should be made to drink oil, or clarified butter, or both; or he should be made to drink lard, oil and clarified butter, mixed together.^[2] Apehivata (Prasarani) and Dasha-mula cooked with the four kinds of Iardacious or emollient substances (oil, clarified butter, lard and marrow), or with any two of them should be prescribed. 2-3.

Treatment of Vataja Granthi:—

A medicinal plaster composed of Himsra, Rohini, Amrita, Bhargi, Shyonaka, Vilva, Aguru, Krishna-gandha, Goji and Tala-patri (Tala-parni—D. R) pasted together, should be applied (to the inflamed gland) in the Vataja type of Granthi. Different kinds of fomentation (Sveda), poulticing (Upanaha) and medicinal plasters (Lepa), possessed of the efficacy of subduing the deranged Vayu, should be likewise resorted to. A suppurated swelling should be opened and the pus drained. Then the incised wound should be washed with a decoction of Vilva.^[3] Arka and Narendra (Aragvadha) and purified (disinfected; with a plaster consisting of sesamum and the leaves of the Pancnagula (castor oil plants), together with Saindhava salt. After the purification, it should be healed up by applying a medicated oil, mixed with the powders of Rasna and Sarala; or by a medicated oil prepared by cooking it with Vidanga, Yashti-madhu and Amrita and cow’s milk. 4.

Treatment of Pittaja Granthi:—

In a case of the Pittaja type of the disease, leeches should be applied to the affected part, which should be further affused with milk and water. The patient should be made to drink a cold decoction of the drugs of the Kakolyadi group with the addition of sugar; or he should take the powders of Haritaki through the medium of grape-juice, or of the expressed juice of sugarcane. Hot plasters, prepared by pasting together the bark of the Madhuka (flower) tree, and of the Jambu tree, Arjuna tree, and Vetasa creeper. As an alternative, hot plasters compounded of the roots of the Trina-shunya (Ketaki), or Muchukunda mixed with sugar, should be constantly applied to the affected part. The Granthi should be opened when fully suppurated, and the pus let out; after which it should be washed with a decoction of the bark of the Vanaspati^[4] The incidental ulcer should then be purified with a plaster composed of sesamum and Yashti madhu; and lastly it should be healed up with clarified butter cooked with the drugs of the Madhura (Kakolyadi) group. 5-6.

Treatment of Kaphaja Granthi:—

In a case of the Khaphaja type of the disease, the Doshas should be first eliminated from the system with the regular and successive measures.^[5] The affected part (Granthi) should then be fomented and firmly pressed (Vimlapana) and rubbed with either the thumb, or a piece of iron rod, or stone, or with a bamboo rod in order to bring about its resolution. A plaster composed of the roots of the Vikamkata,^[6] Aragvadha, Kakananti (Gunja), Kakadani (Vayasa-tinduka), and Tapasa-Vriksha (lngudi) and with Pinda-phala (Tiktalavu), Arka,^[7] Bhargi, Karanja, Kala and Madana, pasted together, should be applied to it by an erudite physician. A glandular swelling (Kaphaja Granthi) on any part of the body other than a vital and vulnerable one (Marma) and not (otherwise) resolved and absorbed should be cut open even in its non-suppurated stage and the glands removed. The expert surgeon should then cauterize the incidental wound after the cessation of the bleeding and treat it in the manner^[8] of the Sadyo-Vrana treatment. These remedies should be employed by the experienced physician, where the swelling would be found to have assumed a large, stiff, elevated and fleshy aspect (bulging from the deeper tissues of the flesh). A Kaphaja Granthi should be opened with an incision as soon as it becomes fully suppurated and should then be washed with a decoction of appropriate medicinal drugs. The incidental ulcer should be purified (disinfected) with a purifying remedy prepared with a profuse quantity of Yava-kshara, honey and clarified butter; and finally it should be healed up by the application of an oil, cooked with Vidanga, Patha and Rohini. 7-9.

Treatment of Medoja Granthi:—

In a case of Medoja Granthi (originated from the vitiated condition of the bodily fat) a plaster of pasted sesamum, placed inside the folds of a piece of linen, should be applied to the seat of the affected part and fomentations with hot iron-rods should be frequently applied, inasmuch as application of heat (lit.—fire) is efficacious in such cases. As an alternative, the affected part should be fomented with a ladle, pasted with heated shellac (Laksha). The Granthi (in its non-suppurated stage) should be opened by an incision and the fat removed; the incidental ulcer should then be (actually) cauterized. On the other hand, the Granthi, when fully suppurated, should be incised and washed with the urine (of a cow). Then a paste, composed of sesamum, Suvarchika, Haritala and rock-salt, pounded together and mixed with honey, clarified butter and an abundant quantity of Yava-kshara, should be applied to the incidental wound for purifying purposes. Oil, cooked with the two kinds of Karanja, Gunja, the green scrapings of bamboo, Ingudi and the urine^[9] of a cow, should be used to heal the ulcer, 10-11.

Treatment of Apachi:—

Clarified butter cooked with the fruit of Jimutaka and Kosha-vati, and with (the roots of) Danti, Dravanti and Trivrit, is a very powerful and efficacious remedy.^[10] Administered internally as well as externally, it leads to the cure of the advanced cases of Apachi. 12.

A strong emetic composed of Nirgundi, Jati (flower) and Varihistha (Vala) together with Jimutaka, profusely mixed with honey and Saindhava, should be given warm to the patient. It is a very powerful emetic, and leads to the recovery of even a malignant form of Apachi. An oil, cooked with the pastes (Kalka) of Kaitaryya,^[11] Vimbi and Karavira, may be profitably used as an errhine (Shiro-virecana). Oil cooked with the expressed juice of Shakhotaka may also be used profitably as an errhine.^[12] Avapida errhines (used in drops into the nostrils) should be applied with Madhuka-sara, Shigru-seeds and Apamarga-seeds.^[13] 13-15.

A glandular swelling (Granthi), occurring in any part of the body other than a Marma, should be opened in its non-suppurated stage and cauterized with fire;^[14] or it should be rubbed with an alkali^[15] after scarification as already advised. 16.

A length of twelve fingers should be measured (Mitva) from and above the Parshni, i.e., the posterior side of the ankle (and the space of Indra-vasti above this part should be ascertained). The Indra-vasti (occupying a space of half a finger, or, according to others, two fingers) having been carefully avoided, an excision (on the opposite side of the affection) should be made and the spawn-like glands having been removed (therefrom), the excisioned part should be cauterised with fire.

Others say that the excision should be made straight above the ankle (Ghona) after carefully avoiding the space of Indra-vasti, measuring two fingers (and to make sure an additional space of half a finger should be left out), which would be found out by taking one- eighth part (of the Jangha, i.e., the leg—excluding the _f foot and measuring twenty fingers) from the Khulaka (ankle-joint) of which the (two) Gulphas (ankles) look like the (two) ears.^[16] 17–18.

As an alternative, the region of the wrist (Manibandha) should be branded by a physician with three mark lines, one finger apart, for a radical cure of Apachi. 19.

The ashes (Masi) of the skins of a peacock, cow, lizard (Godha) and snake and of tortoise shells should be dusted (over an Apachi after lubricating it) with the (expressed) oil of the Ingudi. Medicated oils to be described under the treatment of Shlipada (elephantiasis) and Vairechanika fumes should also be applied in a case of Apachi and the diet should consist of cooked barley and Mudga pulse. 20-21.

Treatment of Vataja Arvuda:—

In a case of Vataja Arvuda, a poultice composed of Karkaruka, Ervaruka, cocoanut, Piyala and castor seeds, boiled with milk, water and clarified butter, and mixed with oil, should be applied lukewarm (to the tumour). As an alternative, a poultice made up of boiled meat or of Vesha-vara, should be applied to it. Fomentation of the part in the manner of a Nadi-sveda (application of medicated fumes through a pipe; should be applied by an experienced physician and the (vitiated) blood (of the locality) should be repeatedly cuffed off with a horn. Shatahva or Trivrit^[17], boiled with the decoction of the Vayu-subduing drugs and with milk and Kanjika, should be given to the patient. 22-23.

Treatment of Pittaja Arvuda:—

Applications of mild fomentations and poultices (to the affected part) and of purgatives are efficacious in Pittaja Arvuda. The tumour should be well rubbed with (the rough surface of) the leaves of the Udumbara, Shaka, or of the Goji and it should be plastered over with the fine powders of Sarja-rasa, Priyangu, Pattanga (red sandal wood), Rodhra, Anjana^[18] and Yashtimadhu, mixed with honey. As an alternative, a plaster composed of Aragvadha, Goji, Soma and Shyama, pasted together should be applied to it after the secretion Visrava. Clarified butter, cooked with Klitaka (as a Kalka) and with the decoction of Shyama, Girihva, Anjanaki, Draksha and Saptalika should be prescribed for internal application in a case of Pittaja Arvuda and of abdominal dropsy (Jathara) of the Pittaja type. 24-26.

Treatment of Kaphaja Arvuda:—

In cases of the Kaphaja type of Arvuda blood should be let out from the affected part after the system of the patient has been cleansed (by emetics and purgatives). Then a medicinal plaster composed of the drugs,^[19] which are efficacious in correcting the Doshas, confined to the upper and lower parts of the organism, should be applied hot to the tumour. Or a plaster composed of Kansya-nila, Shuka, Langalakhya and Kakadani roots, and the dung of a Kapota and of Paravata pasted together with urine, or with alkaline water should be applied to it. The Kalkas (pastes) of Nishpava (Shimbi), Pinyaka (oil-cakes of sesamum) and Kulattha pulse, pasted with curd-cream and an abundunt quantity of flesh, should be used in plastering the affected part so that worms and parasites may be produced in the ulcer and flies attracted to it (and so consume the ulcer). A small portion of the ulcer, left unconsumed (un-eaten) by worms and parasites, etc., should be scarified and the ulcer should then be cauterised with fire. 27-28.

A comparatively superficial tumour (Arvuda; should be covered with thin leaves of zinc, copper, lead, or of iron, and cauterization with fire or with an alkali as well as surgical operations should be carefully and repeatedly resorted to, so as not to hurt, nor in any way injure the body. The incidental ulcer should be washed with the decoction of the leaves of the Asphota, Jati, and Karavira for the purpose of purification. A medicated oil, cooked with Bhargi, Vidanga, Patha, and Triphala should then be used as a healing remedy. An experienced physician should treat a tumour, spontaneously suppurating, in the manner of a suppurated ulcer. 29-31.

Treatment of Medoja Arvuda:—

A Medoja Arvuda (fat origined tumour) should be first fomented and then incised. The blood in its inside having been cleansed it should be quickly sutured and then plastered over with a compound composed of Haridra, Griha-dhuma (soot of a room), Rodhra, Pattanga, Manah-shila and Haritala pounded together and mixed with a proper quantity of honey. After its purification, thus produced, it should be treated with the application of Karanja-Taila (prescribed before in cases of Vidradhi). Even the least particle of Doshas (pus, etc.) in a tumour, left unremoved, would lead to a fresh growth of the excrescence and bring on death just like the least particle of an unextinguished fire. Hence it should be destroyed in its entirety. 32–33.

Treatment of Vataja Gala-ganda:—

A case of the Vataja type of Gala-ganda (goitre) should be treated with fomentations of the vapours of the decoctions of tender leaves of the Vayu-subduing drugs prepared by boiling them with Kanjika, various kinds of urine and milk as well as with minced meat and oil, and should be applied in the manner of a Nadisveda. After this fomentation, the contents should be carefully drained (from inside the goitre). Then after having duly purified (the incidental ulcer), it should be plastered with a medicinal compound composed of (the seeds of) the Shana, Atasi, Mulaka, Shigru and sesamum and Kinva and the piths of the Piyala, or with that composed of Kala, Amrita, Shigru, Punarnava, Arka, Gaja-pippali, Karahata (Madana) and Kushtha, or with that composed of Ekaishika, V rikshaka and Tilvaka. All of them should be pasted with Sura and Kanjika and applied hot to the affected part. The internal use of a medicated oil, cooked^[20] with Amrita, Nimba, Hamsahva, Vrikshaka, Pippali, Vala, Ati-vala, and Deva-daru, always proves efficacious in a case of goitre. 34-36.

Treatment of Kaphaja Gala-ganda:—

A case of the Kaphaja type of goitre should be treated with applications of fomentation and poultice and should be duly drained (Visrava). Then a medicinal plaster composed of Aja-gandha, Ati-visha, Vishalya, Vishanika, Kushtha, Shukahvaya, Gunja (taken in equal parts) and pasted with the alkaline water prepared from the ashes of the Palasha wood should be applied hot to the affected part. A medicated oil cooked with the drugs of the Pippalyadi group and mixed with the five officinal kinds of salt should be taken by the patient. Emetics, errhines and inhalations of Vairechanika-dhuma are beneficial in such cases. In the Vataja and the Kaphaja types of goitre (Gala-ganda), the skilful physician should employ suppurating measures in partially suppurated cases. The patient’s diet should consist of rice, barley and Mudga soup and should be taken with honey, Trikatu, cow’s urine, fresh ginger, Patola and Nimba. 37-39.

Treatment of Medoja Gala-ganda:—

In a case of a Medoja goitre (due to the deranged fat), the patient should be first made to use oleaginous substances (internally and externally) and venesection should then be resorted to, as advised before (Sharira-Sthana, Ch VIII). A hot plaster composed of Shyama (Trivrit), Sudha, Mandura, Danti and Rasanjana pasted together should be applied to the seat of the disease. Powders of the essential parts (Sara) of a Shala tree mixed with cow’s urine may be given every morning with advantage.

As an alternative, the Goitre (Gala ganda) should be opened, its fatty contents fully removed and the wound then sutured. Or it should be cauterised with the application of heated animal marrow, clarified butter, lard, or honey; after which it should be lubricated with clarified butter and honey (mixed together), and a pulverised compound of Kasisa, Tuttha, and Gorocanay should be applied to it; or after lubricating it with oil, it should be dusted with the ashes of cow- dung and of Shala-sara. Daily washings with the decoction of Triphala, hard bandaging and a diet of barley, prove efficacious (in cases of goitre). 40.

 

Thus ends the Eighteenth Chapter of the Chikitsita Sthana in the Sushruta Samhita, which deals with the medical treatment of Glands, Scrofula, Tumour and Goitre.

Footnotes and references:

[1]:

Beginning with Apatarpana up to the purgative measures.

[2]:

Oil, clarified butter and lard mixed together is technically called the “Trivrita”—Dallana.

In the case of a Vátaja Granthi, a potion of oil cooked with the decoction and paste (Kalka) of the Váyu-subduing drugs should be prescribed for the patient ; in the case of a Pittaja Granthi, clarified butter cooked with the decoction and Kalka of the Pitta-subduing drugs should be administered in the same manner ; while in the case of a Kaphaja Granthi, oil cooked with the decoction and Kalka of the Kapha-subduing drugs should be taken by the patient. But in a case of Granthi due to the concerted action of the two, or three of the Doshas, any compound medicated oil, prepared by cooking any two, three, or four of the oily substances, viz., oil, clarified butter, lard and marrow, with the decoction and Kalka of those drugs which are antidotes to the said Doshas, should be prescribed for the patient as drinks.

[3]:

Some read “vilvarkagaṇaditoyaiḥ” and explain that the decoctions of the Vilvadi and the Arkadi groups are to be taken for the purpose.

[4]:

The Vanaspati class consists of Vata, Plaksha, Ashvattha and Udumbara trees.

[5]:

These are the applications of Sneha, fomentation, emetics, purgatives, asthapana, Shiro-virecana and blood-letting.

[6]:

Dallana explains “Vikamkata” as “Kanta-karika,” but it means Sruva (called Vainch in Bengal) and Shivadasa also explains it as such.— Ed.

[7]:

Chakradatta does not read “Arka” in the list.

[8]:

Applications of honey, clarified butter, etc.

[9]:

Cow’s urine measuring four times the oil should be taken in the preparation of this medicated oil.

[10]:

In preparing this medicated Ghrita, the quantity of clarified butter should be taken four times as much as the combined weight of the Kalka (paste). These should be boiled with water, taken four times as much as the quantity of clarified butter. Some authorities, however, are of opinion that both the paste (Kalka) and the decoction of the drugs are to be taken in its preparation.

[11]:

Some read ‘Nirgundi’ after it.

[12]:

This medicated oil should be cooked without any Kalka. But some are of opinion that both the decoction and the Kalka of Shakhotaka should be used.

[13]:

Madhuka-sara mixed with tepid water and the expressed juice of Shigru-seeds and of Apamarga-seeds should be used.

[14]:

In cases of the preponderance of Vayu and of Kapha.

[15]:

In cases of the preponderance of Pitta.

[16]:

There is a good deal of difference as to the reading and explanation of this passage amongst the different commentators. The different explanations arise from the different interpretations put upon the word in the Text, “parṣṇiṃ prati dvadasha caṅgulani etc.”

The words “parṣṇiṃ prati” may mean either of the following.

(1) On the opposite side of the Parshni. Vagbhata subscribes to this view.

(2) On the opposite (i.e., the other) Parshni, that is to say, if the affection be on the right side of the body the operation should be made on the Parshni of the left leg and so on. Vriddha Vagbhata subscribes to this interpretation in the clearest language.

(3) In the region of the Parshni, i.e., on the dorsal side of the leg.

The different commentators, again, do not agree as to the seat and extent of the excision. Some say that the operation should be made above the Indra-vasti and the extent should be two fingers in length. Vagbhata seems to subscribe to this view. Others hold that the operation should be made below the Indra-vasti and the extent should be two fingers’ length: Dallana is of this opinion. A third class of commentators assert that the whole extent of the length from above the Parshni up to the Indra vasti should be opened.

As to the extent of the Indra-vasti, again, there is a difference. According to Dallana it occupies a space of two fingers. But Jejjata holds that it occupies a space of half a finger only. The Indra-vasti (Marma) is situated twelve fingers above (i.e., in the thirteenth finger of) the Parshni. The reading in the printed editions of the text is “bhitva”, whereas Vrinda and Chakradatta read “mitva”. Dallana’s reading also evidently is “mitva”. “bhitva” would be quite redundant and as “mitva” gives a better meaning, we accept this reading.

Now we come to the second stanza. Commentators differ more in the exposition of this stanza than of the former. By the expression “agulphakarṇat (?)” is meant by some commentators “from the Gulpha to the Kama.” Others, however, mean to take it as an adjective to and explain it as meaning “from above the Khulaka whereof the Gulphas look like the Karnas.” As regards the expression “ghoṇarjuvedhaḥ”, some are inclined to think that the excision should be made straight above the Ghona (i.e., the posterior part and especially the big vein there which looks like the nose (Ghona) of the ankle-joint).

Others, however, read it as “ghoṇarjave'dhaḥ” and explain it (ghoṇarjave + adhaḥ) as meaning “in a straight line with the Ghona (which may mean either the nose or the big vein (Kandara) at the heel looking like the nose (Ghona) of the ankle-joint and below the Indra-vasti”.

Dallana says that the part to be excisioned, according to the first stanza, is below the Indra-vasti and that, according to the second, is above tbe lndra-vasti. We also think that the seat of the Indra-vasti should be carefully avoided and an excision should be made both above and below the Indra-vasti, according to the requirements in each case.

[17]:

There is a different reading “???? ???” in place of “??? ???”. In that case, roots of white Trivrit should be boiled with the decoction, etc.

[18]:

Chakradatta reads “Arjuna” in place of “Anjana”.

[19]:

These are the drugs included in the emetic and purgative groups (see chap. XXXIX. Sutra Sthana).

[20]:

Some say that the oil should be prepared with the decoction as well as with Kalka of the said drugs. Others, however, hold that water should be used in the preparation of the oil and the said drugs should be used only as a Kalka.