Sushruta Samhita, volume 1: Sutrasthana
Chapter XIX - Care of the wounded
First of all a suitable chamber should be sought and selected for a patient, suffering from an ulcer. It should be roomy and spacious and situated in a commendable site.
Diseases, which are physical, mental or traumatic in their origin, can never attack a person who dwells in a clean and spacious chamber, protected from excessive heat, and strong gusts of wind.
The bed should be spread clean, ample and comfortable, with the head of the beadstead turned towards the east, and provided with some kind of a weapon.
In a spacious and well-spread bed, an ulcer-patient can toss about and move his limbs with the greatest comfort. The reason for the head being turned towards the east is that the patient may easily make obeisance to the (demons and) celestial spirits, who inhabit that quarter of the sky. Thus the patient shall lie in comfortable posture, attended upon by his sweet-talking friends and relations.
The friends and relations of a patient shall alleviate, the pain of his ulcer with pleasant and interesting topics, and by solacing him with the prospect of a speedy recovery. An ulcer-patient should not sleep in the day time, as it tends to aggravate the pain, swelling and redness of the ulcer, increases its exudations, and gives rise to itching and heaviness of the limbs.
The patient must carefully protect the ulcer when moving any of his limbs, such as standing up, or sitting down, or turning on his sides, or while moving about, or speaking in a loud voice.
An ulcer-patient, even if he feels himself strong and capable, should avoid a standing or sitting posture, as well as locomotion, and day-sleep. These acts done to excess, or a long confinement to bed would aggravate the bodily Vayu, thus causing pain in the ulcer.
He should studiously avoid the company and touch of, and even conversation with, women with whom he can legitimately have intercourse.
A diet consisting of newly harvested Dhanyam, Masha pulse, Sesamum, Kalaya, Kulattha, and Nishpaba should be avoided by an ulcer-patient. The pot-herbs known as Haritaka-shaka, acid, saline or pungent substances, treacle and its modifications, cakes, dried meat, dried pot-herbs, goat’s flesh, mutton, meat of animals which are amphibious in their habits or which live close to water, lard, cold water, Krishara (a composition prepared with sesamum, Masha pulse and rice), Payasa (a sweetened preparation of rice, milk and sugar boiled together), curd, milk and whey should be regarded as unwholesome.
Vegetables and articles which belong to the groups commencing from the one technically known as the Nava-Dhanya-Varga, and ending with the one known as the Takra-Varga, should be understood as possessed of the property of increasing the pus in an ulcer and of aggravating the deranged bodily humours. If in the habit of taking wine, an ulcer-patient will do well to avoid the use of spirituous liquors, such as Mairaya, Arishta, asava, Sidhu, Sura and its varieties. An ulcer may develop into one of a malignant type through the use of a wine which is acid in its taste, or is sharp, dry and heat-making in its potency, or is followed by almost instantaneous intoxication.
An ulcer-patient should avoid all things that retard the progress of a rapid cure, such as wind, dust, smoke, exposure to heat and cold, over-eating, unpleasant sounds and sights, envy, humiliation, fear, anger, grief, scheming, keeping of late hours, sitting or lying in an uneven posture, fasting, garrulousness, physical exercise, leaping or a standing posture, locomotion, exposure to cold winds, ingestion of unwholesome, incompatible or indigestible substances, and flea-bites on the affected locality.
The food, partaken of by a weakened and emaciated ulcer-patient, is not fully digested owing to the above mentioned, and other multifarious causes. The undigested food violently disturbs and aggravates the bodily humours, which move about in the body and give rise to swelling, secretion, burning pain and suppuration in the ulcer.
An ulcer-patient should always be clad in clean and white garments, have his hair and nails closely clipped and pared off, and live in humble devotion to the Brahmans, to the gods and the preceptors. The rites of benediction and divine peace should be done unto him. Wherefore? Because the monsters and demons of mighty prowess, who are the attendants of the gods Pashupati, Kuvera and Kumara, roam about in quest of prey, and visit the bedside of an ulcer-patient out of their fondness for flesh and blood, being attracted thereto by the smell of the secreted and morbid matter in the ulcer. These evil spirits come to take away the life of a patient in a case which is doomed to terminate fatally, while in a successful case their advent is due to the desire of extorting sacrificial oblations from him.
Authoritative verse on the subject:—
These honour-seeking evil spirits should be worshipped and propitiated with the whole heart; and offerings of burning incense sticks, edibles and sacrifices, etc. should be made to them with the greatest humility.
The evil spirits, worshipped and propitiated as above, spare the life of a self-controlled patient (out of compassion). Hence he shall be kept in a chamber furnished with flowers, garlands, weapons, fried paddy, and lamps kept continuously burning. His friends and relations should regale him with fond and loving topics to drive away the feeling of sleepiness with the prospect of a speedy cure.
Morning and evening, the physicians and the Brah-mans should perform the rites of benediction, over him, as laid down in the Rik, Yajuh, Saman and the Atharva Vedas.
For ten consecutive days, the room of the patient should be diligently fumigated, morning and evening, with the fumes of mustard, Arishta-leaves, clarified-butter and salt made into a kind of incense stick.
Drugs such as Chhatra, Atichhatra, Languli, Jatila, Bramhacharini, Lakshmi, Guha, Atiguha, Shata-viryaya, Sahasra-viryaya and white mustard seeds should be placed on the head of the patient.
The patient should be fanned with blowing chowries so that the ulcer may not be in any way thrashed or lacerated during the fanning. The ulcer should not be scratched or pressed. The patient should be carefully watched, while asleep. Demons, that get abroad in the night, fly from the presence of an ulcer-patient protected as above, as herds of deer fly from the forest where lions are found.
Regimen of diet and conduct:—
An ulcer-patient living on a diet consisting of old and boiled Shali rice, not extremely liquefied, and treated with clarified-butter, and taken with the cooked meat of animals of the Jangala species, soon gets rid of his disease. A diet consisting of boiled rice, the pot-herbs known as the Tanduliyaka, Jivanti, Sunishannaka, Vastuka, immature Mulaka, Vartaku, Patola and Karavella, fried with Saindhava (rock-salt) and clarified-butter, and seasoned with the expressed Juice of Dhadima and amalaka, or of Mudga soup treated as above, should be prescribed for the patient. Barley powder, Vilepi, Kulmasha and boiled water, should be likewise given to the patient for food and drink. Fatigue or physical exercise causes the ulcer to swell, while the keeping of late hours increases the local redness. A sleep during the day under the circumstance would give rise to pain in the affected part, while a coitus may bring on the death of the patient.
An ulcer-patient, not given to sleep in the day, and liying in a room protected from gusts of wind, and strictly following the instructions of his physician, (surgeon) is healed in the course of a very short time and will enjoy a long life through the observance of the abovesaid regimen of diet and conduct. This is the dictum of Dhanvantari.
Thus ends the nineteenth Chapter of the Sutrasthana in the Sushruta Samhita which treats of the nursing or management of an ulcer-patient.