Chapter XIX - The medical treatment of hernia

Now we shall discourse on the medical treatment of hernia, hydrocele, scrotal tumour, etc. (Vriddhi), diseases of the genital organ (Upadamsha) and elephantias is (Shlipada). 1.

In the six types of Vriddhi other than the one known as the Antra-Vriddhi (Hernia), riding on horse back, etc., excessive physical labour, fastings, sitting in an unnatural position, constant walking, voluntary restraint of any natural urging (for stool and urine, etc.), sexual intercourse and eating of food difficult of digestion should be avoided. 2.

Treatment of Vataja Vriddhi:—

In the Vataja type of Vriddhi, the patient should be first soothed (Snigdha) with the application of Traivrita Ghrita (vide, Chap. V. Chikitsita Sthana). He should then be duly fomented and subjected to a proper course of purgatives. As an alternative, he should be made to drink the expressed oil of the Koshamra, Tilvaka, or Eranda (castor) oil (as a purgative) with milk for a month. A decoction of the Vayu subduing drugs mixed with the powders of the same drugs should then be employed by an experienced physician at a proper time^[1] in the manner of a Niruha Vasti. The patient should then be made to take a meal (of boiled rice) along with meat soup; and oil cooked with Yashti madhu should be applied (in the manner of an Anuvasana measure).

Applications of Sneha (oil, etc.), poultices (Upanaha), and plasters (Pradeha) of the Vayu-subduing drugs should be applied to the affected part. If the tumour (Vriddhi) begins to suppurate, it should be made to do so fully. It should be then opened with an incision avoiding the median line (Sevani) of the perineum and the proper purifying (i.e., antiseptic and healing) measures should be resorted to in the usual way laid down (in the treatment of Dvi-vrana^[2]). 3.

Treatment of Pittaja Vriddhi:—

A case of the non-suppurated stage of Pittaja Vriddhi may be beneficially treated with the remedies laid down in connection with a case of the same type of glandular swelling (Pittaja Granthi). In the case of it being suppurated, the surgeon should open it with a knife and purify it with the application of honey and clarified butter. The incidental ulcer should then be healed up with oils and pastes of healing virtues. 4.

Treatment of Raktaja Vriddhi:—

In a case of Raktaja Vriddhi (originated through the vitiated condition of the blood), the (vitiated) blood should be drawn out by the application of leeches. As an alternative, purgatives should be administered through the medium of honey and sugar. Remedial measures described in connection with the Pittaja type of the disease should be employed both in the suppurated and the non-suppurated stages (of this type). 5.

Treatment of Kaphaja Vriddhi:—

In a case of the Kaphaja type of the disease, poultices with the heat-making^[3] drugs (i.e, Vacadi, Pippalyadi and Mushkakadi groups, etc.) pasted with cow’s urine should be applied. The patient should be made to drink a potion consisting of the decoction of Daru-Haridra mixed with the urine of a cow, and all the remedial measures with the exclusion of Vimlapana (resolution by pressure) laid down under the treatment of the Kaphaja Granthi should be employed. The tumour should be opened (with a knife) when suppurated and the oil cooked with Jati, Arushkara, Amkota and Sapta-parna should be used for the purification (disinfection) of the incidental ulcer. 6.

Treatment of Medoja Vriddhi:—

In a case of the Medoja (fat-originated) type of the disease, the affected part should be (lightly) fomented,^[4] and plasters composed of drugs (of the roots) of the Surasadi group or of the Shiro-virecana group (Ch. XXXIX. Sutra Sthana) pasted with the urine of a cow should be applied to it in a lukewarm state. The inflamed and swollen scrotal tumour, (lightly) fomented as before, should be tightened round with a piece of cloth. Then having encouraged the patient, the surgeon should open the tumour with a Vriddhipatra (knife) carefully avoiding the two testes (lying within the scrotal sac) and the median line of the perineum (Sevani). Then having carefully removed all morbid products (Medas) from its inside, Saindhava and sulphate of iron should be applied to the incised part, and the scrotum should be carefully bandaged (in the manner of a Gophana bandage). After the proper purification (disinfection) of the ulcer, its healing should be effected with the application of an oil cooked with Manahshila, Haritala (yellow oxide of arsenic), rock-salt, and Bhallataka. 7.

Treatment of Mutraja Vriddhi:—

In a case of an enlargement of the scrotun (hydrocele) due to the derangement of urine, it should be first fomented and then a piece of cloth should be tightened rount it. A puncture should then be made in the bottom of the sac with a Vrihimukha instrument, on either side of the raphe of the perineum (Sevani). A tube open at both ends should be introduced (into the puncture) and the accumulated (morbid) fluid should be let out. The tube should then be taken off and the scrotum should be tied up with a bandage of the Sthagika pattern and the incidental ulcer should be purified and healed up with appropriate medicinal applications. 8.

Treatment of Antra-Vriddhi:—

A case of Antra-Vriddhi (hernia when strangulated) extending down to the scrotal sac (Kosha) should be given up as irremediable; but, in the case of its not being so extended, it should be treated as a case of Vataja- Vriddhi. If the colon be found to have descended down to inguinal region (Vamkshana), it should be cauterized with a heated crescent-mouthed rod (Arddha-Candra Shalaka) to prevent its descending down into the scrotal sac. A case of hernia that, in spite of all these precautions, descends down into the scrotal sac (Kosha), should be given up as irremediable. The first finger of the hand opposite^[5] the affected part (i.e., the affected testes) should be incised at its middle and cauterized.

In cases of hernia (Antra-Vriddhi) of the Vataja and of the Kaphaja type the affected part should be carefully cauterized in the above manner; but in these two cases, the Snayu (ligaments) should be cut off in addition (before cauterization). In a case of Antra-Vriddhi the veins (Shira) of the temples at the (upper) end of the ears on the opposite sides of the affection should be carefully opened avoiding the Sevani therein. 9-12.

Treatment of Upadamsa^[6]:—

In cases of the curable type of Upadamsha, Sneha (oleaginous substances) should be first applied, and tbe affected part should be fomented. Then the veins of the penis should be opened, or leeches should be applied (to the organ) for the elimination of the contaminated blood^[7] (according as the affections are more or less severe). 13.

General Treatments:—

The system of the patient should be cleansed with both emetics and purgatives in the event of an excessive aggravation of the Doshas inasmuch as the local pain and swelling would subside simultaneously with the elimination of the aggravated Doshas from the system. Medicinal Vastis (enemas) should be injected (into the rectum) in the way of a Niruha-Vasti for the elimination of the aggravated Doshas, where the weakness of the patient would prohibit the application of purgatives. 14.

Treatment of Vataja Upadamsha:—

In a case of the Vataja type of the disease, drugs such as, Propaundarika, Yashti-madhu, Varshabhu, Kushtha, Deva-daru, Sarala, Aguru and Rasna, should be used as a plaster (over the affected organ). Similarly plasters composed of Nichula, castor-seeds, and pulverised wheat and barley grains pasted with Sneha (clarified butter, oil, etc.) should be applied lukewarm to the seat of the disease, which should also be affused with a decoction of the above-mentioned drugs, viz,, Prapaundarika, etc. 15.

Treatment of Pittaja Upadamsha:—

In a case of the Pittaja type of the disease, a plaster composed of Gairika, Anjana, Yashti-madhu, Shariva, Ushira, Padmaka, (red) Chandana and Utpala mixed with a Sneha (clarified butter),^[8] or that composed of Padma, Mrinala, Sarjja_% Arjuna, Vetasa, and Yashti - madhu mixed with clarified butter should be applied to the affected organ which should be sprinkled with a solution of milk, clarified butter, sugar, sugar-cane juice and honey, or with a cold decoction of the drugs of Vata, etc. 16.

Treatment of Kaphaja Upadamsha:—

In a case of the Kaphaja type of the disease, a plaster composed of the barks of Shala, Ashva-karna, Aja-karna and Dhava pasted with Sura and mixed with oil, should be applied hot to the affected part. As an alternative, the drugs such as, Haridra, Ativisha, Musta, Sarala, Deva-daru, Patra, Patha, and Pattura should be used for similar purposes and the affected organ should be afiused with a decoction of the drugs of the Surasadi and Aragvadhadi groups. 17.

The above remedial measures, viz., plasters, sprinkling (Parisheka), blood-letting and Samshodhana (i.e., application of purgatives, emetics, etc.) as well as those described in the Sutra Sthana (and the first Chapter of the Chikitsita Sthana), should be resorted to in a case of (non suppurated) Upadamsha. The physician should try his best to arrest the setting in of suppuration (in a case of Upadamsha) inasmuch as suppuration in (and consequent putrefaction of) the (local) veins, ligaments, skin and flesh would lead to the destruction of the organ (Dhvaja). An incision should be made as soon as suppuration would set in, and the pus and other putrid matters being drawn out, the incised part should be plastered with the paste of sesamum mixed with honey and clarified butter. The incidental ulcer should be washed with a decoction^[9] of the leaves of Karavira, of Jati and Aragvadha, or of Vaijayanti and Arka. 18.

The use of a medicinal plaster composed of the fine powders of Saurashtra-mrittika, Gairika, Tuttha, Pushpa-Kasisa, Saindhava, Rodhra, Rasanjana, Daru - Haridra, Haritala, Manahshila, Harenuka and Ela, mixed with honey is highly recommended in all cases of Upadamsha. 19.

A decoction of the tender leaves of Jambu, Amra, Sumanas, Nimba, Shveta, and of Kamboji^[10] and the barks of Shallaki, Vadara, Vilva, Palasha, Jinisha and of the Kshiri trees, as well as Triphala should be used by the physician for constantly washing the ulcer. Oil cooked with the preceding decoction, with the Kalkas of Goji, Vidanga and Yashti-madhu, as well as with the different spices (Eladi group should be used as the best remedy for the purpose of the healing up (Ropana) of an Upadamsha-ulcer of whatsoever type. The use of a pulverised compound composed of Svarjika, Tuttha, Kasisa, Shalleya, Rasanjana_y and Manahshila taken in equal parts arrests the extension of an ulcer and Visarpa. Cases of Upadamsha and Visarpa readily yield to the application of a pulverised compound of the ashes of Gundra, Haritala and Manahshila. An (external) application of Bhrimgaraja_ì Triphala and Danti mixed with the powders of copper and iron, destroys Upadamsha just as the thunder bolt of Indra (completely) destroys a tree. 20.

Treatment of Tridoshaja and Raktaja Upadamsha:—

The medical treatment of the two kinds of Upadamsha due to the concerted action of the three Doshas as well as that due to the vitiated blood (Raktaja) should be taken in hand without holding out any definite hope of recovery. The above-mentioned medicines specific to the different Doshas should be combinedly applied in these cases in consideration of the nature and intensity of the Doshas specifically involved in them. Now hear me discourse on the special treatment of Tridoshaja Upadamsha. It should be the same as in the case of a malignant ulcer (Dushta-Vrana). The putrid portion of the male organ should be cut off and the remaining portion should be fully cauterized (in the incised part) with a Jambvoshtha instrument, made red-hot in fire. Honey, and clarified butter should then be applied to the cauterized part, and medicinal plasters and oils possessed of healing properties should be applied to the incidental ulcer when it would be cleansed (disinfected). 21-22.

Treatment of Shlipada:—

In a case of Elephantiasis (Shlipada) due to the action of the deranged and aggravated Vayu, the vein (Shira) at a distance of four fingers above the instep (Gulpha) should be opened after an application of Sneha and Sveda^[11] to the patient. Vastis should be employed when the patient has been (soothed and) restored to his former condition (with appropriate and nutritious diet, etc.). He should be made to take continuously for a month, a potion consisting of castor-oil mixed with (an adequate quantity of cow’s) urine The patient should take rice as his diet with milk duly cooked with Shunthi. The use of the Traivrita Ghrita as well as cauterization of the affected part with fire is also recommended in such a case. 23

Treatment of Pittaja Shlipada:—

In a case of Pittaja type of Elephantiasis, the vein (Shira) below the instep (Gulpha) should be opened. Medicinal remedies mentioned in connection with the treatment of the Pittaja type of tumours (Arvuda) and of Erysipelas (Visarpa) as well as other Pitta-subduing remedies and measures should be employed^[12]. 24.

Treatment of Kaphaja Shlipada:—

In a case of the Kaphaja type of elephantiasis the principal vein (Shira) of the first toe should be opened by an experienced surgeon and the patient should be made to take at intervals the decoction (of the Kapha-subduing drugs) with honey. As an alternative, the patient should be advised to take the powders (Kalka) of Abhaya mixed with any officinal kind of urine. The affected locality should be constantly plastered with the paste of Katuka, Amrita, Shuntki, Vidanga, Deva-daru and Citraka, or with Citraka and Deva-daru. An oil cooked with Vidanga, Marica, Arka, Shunthi, Citraka, Deva-daru, Elaka and all the five officinal kinds of salt should be given him as a potion. Cooked barley is specially recommended as diet in the present case. 25.

As an alternative, the patient should be made to drink a potion of mustard oil^[13] or of the expressed juice of the leaves of Puti-Karanja according to his capacity for the cure of Shlipada. In the same way^[14] the juice of Putranjivaka should be prescribed by a physician after a due consideration as to the strength of the patient and of the time. The same juice (i.e., of Putranjivaka) should be taken along with the juice of the bulbs of Kecuka with Pakima (vit) salt. 26.

The Alkaline Remedies:—

An alkali should be prepared from the ashes of Kakadani, Kakajangha, Vrihati, Kantakarika, Kadamba-pushpa, Mandari, Lamba Sukanasa in the usual way by filtering them (twenty one times) after dissolving them in cow’s urine.

The expressed juice of Kakodumbarika, Sukanasa and the decoction of Madana fruit should be mixed with the above alkaline preparation (and duly cooked in the manner of Kshara-paka). Diseases, such as Slipada (Elephantiasis), Apachi (Scrofula), Gala-ganda (Goitre), Grahani (chronic diarrhea), aversion to food and the affections of all kinds of poison, yield to the internal use of this alkaline preparation. An oil cooked with the aforesaid drugs, if used as errhines and anointments, will cure all the foregoing maladies as well as malignant ulcers (Dushta-vrana). 27.

The ashes of the Dravanti, Trivrit, Danti, Nili, Shyama, Saptala and Shamkhini should be filtered in the way of preparing alkalies after dissolving them in cow’s urine. The solution, thus prepared, should be boiled with a decoction of Triphala. Taken internally it tends to act in the lower part of the body (i.e, it moves the bowels). This medicine produces the same effect as the preceding ones. 28.

 

Thus ends the nineteenth Chapter of the Chikitsita Sthana in the Sushruta Samhita which deals with the medical treatment of Vriddhi, Upadamsha and Shlipada.

Footnotes and references:

[1]:

After a period of one week from the time of the application of purgatives and in case the patient is strong enough to undergo the Niruha. Vasti measure.

[2]:

According to Gayadasa, the measures to be adopted should be those laid down in the Mishraka chapter (Chap. XXV).

[3]:

Some say that the heat-producing drugs are those comprised in the Aja-gandhadi group mentioned in the Mishraka chapter, Sutra Sthana.

[4]:

The fomentation should be applied according to Shivadasha, with balls of cow-dung, etc., slightly heated. It should be noted in this connection that strong fomentations should not, in any case, be applied to the testes.

[5]:

Incision and cauterization should be performed in the thumb of the right hand, if the left testis is affected, and in case the affection is in the right testis, incision and cauterization should be made in the thumb of the left hand.

[6]:

See note, Chapter XII., Nidana Sthana.

[7]:

Jejjata holds that leeches should be applied in a case of superficial Upadamsha.

[8]:

According to Shivadasa the Sneha to be used in the plaster should be clarified butter washed a hundred times.

[9]:

According to Chakradatta the five kinds of leaves should be separately used in the preparations of the decoctions for washing.

[10]:

“Mashaparni” according to Gayadasa.

[11]:

Chakradatta reads “snehasvedopanahaṃshca” in place of “snehasvedopapanne” meaning thereby that such Sveda and Upanaha should be applied before the incision of the vein. Gayadasa also supports this reading as is evident from Dallana’s commentary.—Ed.

[12]:

The particle “ca” in the text shows that Kapha-subduing remedies and measures should also be used in all these cases.

[13]:

Chakradatta reads “pivet sarṣapa tailena” in place of “pivet sarṣapa tailaṃ va” which shows that the expressed juice of Puti-Karanja leaves should be taken with mustard oil and not separately. Dallana evidently supports this in his commentary. That Chakradatta’s reading is the correct one is also evident from the next copulet which says that the expressed juice of Putranjivaka should be taken in the preceding manner. This “preceding manner” evidently means “with mustard oil”, and unless’ we accept Chakradatta’s reading, the expression would be unmeaning.—Ed.

[14]:

It evidently means that the expressed juice of Putranjivaka should be taken with mustard oil—see last note.—Ed.