Chapter XXIII - The medical treatment of swellings

Now we shall discourse on the (symptoms and) medical treatment of swellings (Shopha). 1.

The six kinds of swelling (Sopha) appearing in the particular parts of the body have already been described^[1] with the variations in their symptoms and the medical treatment to be pursued in each case. But the swelling known as the Sarva-sara Shopha (general Anasarca) may be divided into five subheads. They are as follows, namely, the Vataja, Pittaja, Kapahja Sannipataja and Vishaja (i.e., the one due to the introduction of any extraneous poison into the system). 2.

Their causes:—

The Doshas (morbific principles) become aggravated and give rise to swellings (Sopha) of the body, by such causes, as by undertaking a journey immediately after a meal, or by the use of Harita-sakas (potherbs), cakes and salts in inordinate quantities, or by the excessive use of acids by weak and emaciated persons, or by the use of clay, baked or unbaked, of lime-stones, or of the flesh of aquatic animals, or of those frequenting swampy places, excessive sexual intercourse, use of fares consisting of incompatible articles and lastly by the joltings when riding on elephants, horses, camels, in vehicles, etc., or on persons on the part of dyspeptic patients. 3.

Specific Symptoms:—

A swelling (Shopha) of the Vataja type is vermilion or black-coloured and is attended with softness and a pricking pain in the swelling which disappears at intervals. A swelling of the Pittaja type assumes a blood-red or yellow colour, swiftly expands and is attended with a burning and drawing pain (Chosha). A swelling of the Kaphaja type assumes a white or greyish colour, becomes hard, cold to the touch and glossy, is slow in its growth, and is attended with itching, pain, etc. A swelling of the Sannipatika type (due to the concerted action of all the three Doshas of the body) exhibits all the symptoms which specifically belong to each of the three above- said types. 4–7.

Symptoms of Vishaja-Shopha:—

A swelling (Shopha) which results from the contact or introduction of a (weakened) chemical poison (Gara) with or into the body, or from the use of polluted water, or by bathing in a foul and stagnant pool or tank, or by dusting the body with the powders of substances poisoned by any poisonous animal, or from the contact with weeds and plants, which have become poisoned by the urine, faecal matter, or semen of poisonous animals, is called a Vishaja swelling. The swelling is soft, pendent and persistent, expands rapidly and moves gradually (from one part of the body to the other)and is attended with a burning sensation and suppuration. 8.

Memorable Verse:—

The aggravated Doshas of the body confined in the stomach (Amashaya) give rise to a swelling in the upper part of the body. Confined in the intestines (Pakvashaya), they give rise to a swelling in the middle part of the body. If they are confined in the receptacle of the feces (Malashaya), the lower part of the body becomes swollen. The swelling extends all over the body in the event of their (Doshas) being diffused throughout the organism. 9.

Prognosis:—

An edematous swelling (Shopha) occurring in the middle part (trunk) of the body or extending all over it may be cured with difficulty as well as the one which first occurs at either (the upper or lower) half of the body and tends to extend upward. A case of swelling attended with dyspnea, thirst, weakness, fever, vomiting, hiccough, dysentery, colic (Shula), and a want of relish for food is extremely hard to cure and soon proves fatal. 10-11.

We shall now proceed to describe their general and specific remedies. The use of acids, salts, milk, curd, treacle, lard, water, oil, clarified butter, cakes and all kinds of heavy (in digestion) edibles should be refrained from in all the types of oedema (Shopha). 12–13.

The Special Treatment of Shopha:—

Traivrita (Ghrita) or castor oil should be administered for a month or a fortnight to the patient suffering from the Vataja type of oedema (Shopha). Clarified butter cooked with the decoction of the drugs of the Nyogvo- dhadi and the Aragvadhadi groups should be respectively prescribed in the Pittaja and Kaphaja types, in the Sannipataja type, the patient should be made to drink a potion of clarified butter cooked with a Patra^[2] measure of the milky exudation of the Snuhi plant and twelve Patra measures of fermented rice gruel (Kanjika) with an adequate quantity of Danti as a Kalka. The remedy in regard to a swelling due to the action of poison (Vishaja) imbibed into the system will be duly described in the Kalpa Sthana. 14.

The general remedies:—

Now we shall describe the general remedies (which are applicable in cases of Shotha). Any of the four Ghritas ending with the Tilvaka Ghrita which have already been mentioned under the treatment of Udara would prove remedial in a case of Shvayathu (Œdematous Swelling). The use of (the officinal) urine and the applications of the (medicated) Vartis are likewise recommended. The patient should be made to take every day the medicine known as the Navayasa^[3] through the medium of honey. He should be made to take a Dharana weight of the compound of powdered Vidanga, Ativisha, Kutaja-fruit, Bhadra-daru, Nagara and Marica in tepid water. Trikatu, Yava-kshara and powdered iron should be mixed together and administered through the medium of the decoction of Triphala; or, cow’s milk and cow’s urine, in equal proportions should be taken. As an alternative, treacle and Haritaki mixed in equal proportions should be administered. Deva-daru and Shunthi^[4] may be given; or Guggulu^[5] dissolved in cow’s urine or in the decoction of Varshabhu. Equal parts of treacle and Shringavera^[6] may as well be prescribed; or the roots of the Varshabhu pasted with the decoction of the same drug and mixed with powdered Shunthi dissolved in milk should be given to the patient every day for a month. He should take Mudga pulse fried with the clarified butter prepared by cooking it with the decoction of Trikatu and Varshabhu. Milk boiled with Pippali, Pippali- roots, Cavya, Citraka, Mayura (Apamarga) and Varshabhu, or with Sunthi and Surangi- roots, or with Trikatu, Eranda-roots and Shyama- roots, or with Varshabhu, Shunthi, Saha and Deva-daru should be given to the patient. A paste of Alavu and Vibhitaka dissolved in the washings of rice, should likewise be administered. 15.

The diet of the patient should consist of cooked barley or wheat saturated with the unsalted soup of Mudga pulse, cooked with Yava-kshara, Pippali, Marica, and Shringavera, and prepared with only a small quantity of oil or clarified butter. A decoction of Vrikshaka, Arka, Naktamala, Nimba and Varshabhu should be used in effusing (Parisheka) the affected part. It should be plastered with a compound consisting of Sarshapa, Suvarchala, Saindhava and Sharngashta, pasted together. Strong purgatives, asthapana measures and applications of Sneha, Sveda and Upanaha should be constantly employed according to the nature and instensity of the aggravated Doshas involved in the case. In a case of Shotha, other than what is the outcome or supervening symptom (Upadrava) of any other disease, the patient should be frequently bled by opening a vein of the locality. 16.

Memorable Verse:—

A patient wishing to get rid of an attack of Shopha (edematous swelling) should refrain from taking all sorts of cakes, acid substances, liquor, clay, salts, oil, clarified butter,^[7] water, heavy and indigestible articles of food, sleep in the day time, the flesh of animals other than that of the animals of the Jangala group and from visiting the bed of any woman. 17.

 

Thus ends the Twenty-third Chapter in the Chikitsita Sthana of the Sushruta Samhita which deals with the medical treatment of Shopha.

Footnotes and references:

[1]:

See Sutra-sthana, Chapter XVII.

[2]:

A Patra measure is equal to eight seers

[3]:

See Chapter XXII, para, 10, Chikitsitasthana.

[4]:

Some commentators explain that the compound of Deva-daru and Shunthi also should be taken through the medium of cow’s urine or the decoction of Varshabhu.

[5]:

According to Chakradatta’s reading, Deva-daru, Shunthi and Guggulu should be taken together with cow’s urine.

[6]:

The Shringavera in this compound may be either fresh or dried.—Ed.

[7]:

Some read “gudam” i.e., treacle in place of “ghṛta ,” clarified butter. This reading seems to be the correct one, inasmuch as it is supported by all other authoritative works on Ayurveda.—Ed.