Sushruta Samhita, Volume 6: Uttara-tantra

by Kaviraj Kunja Lal Bhishagratna | 1916 | 113,078 words

This current book, the Uttara-tantra (english translation) is the supplementary part of the Sushrutasamhita and deals various subjects such as diseases of the eye, treatment of fever, diarrhea, diseases resulting from superhuman influences, insanity, rules of health etc. The Sushruta Samhita is the most representative work of the Hindu system of m...

Chapter XLII - Symptoms and Treatment of Abdominal Tumors (Gulma)

Now we shall discourse on the chapter which deals with the symptoms and) medical treatment of Gulma (Gulma-Pratisheda). 1.

Definition and number of Gulmas:—

The fundamental principles of the body, deranged and aggravated by their respective or specific exciting causes and factors tend to accumulate in the cavity of the abdomen (Koshtha) and help the formations of balllike tumours or Gulmas ('internal tumours inculsive of those known as the phantom tumours) somewhere inside the body lying between the extreme confine of the regions of the heart and of the bladder (Vasti). The Gulma is of five kinds and found to be round or spheroid in shape and may be either fixed or mobile (lit. shifting) in their character and subject to variations in their mass and size. 2.

Localisation and nomenclature:—

They have five locations inside the abdominal cavity, viz. the two sides, the region of the heart, the. bladder (Vasti) and the region of the umbilicus). The Gulmas are so named because their root or base cannot be exactly localised as well as their cause cannot be exactly ascertained owing to the fact of their having their origin in the aggravated condition of the local bodily Vayu, or because of their being but a agglomeration of the deranged bodily Doshas in the affected locality and the shrub-like large converse outline of the surface (Gulma-shrub). Since a Gulma, like a bubble of water, is a self-contained agglomeration of the deranged bodily Doshas and freely moves about in the cavity of its growth, it is not marked by the advent of any suppurative process in its mass or body. The Gulmas are the products of either the several or concerted actions of the three Doshas, while in females a separate class of tumours (such as the ovarian or uterine tumours) intimately connected with the deranged or vitiated condition of the blood (catamenial fluid, etc) is also recognised. 3—5.

Primonitory Symptoms:—

A sense of lassitude, dulness of appetite, pain and rumbling in the intestines, suppression of stool, urine and flatus, incapacity to take food to the full, aversion to food, and an upward coursing of the internal Vayu are the indications which may be set down as the premonitory symptoms of Gulma. 6.

Specific Symptoms:—

Pain (Shula) in the region of the heart and the belly (Kukshi), dryness of the throat and of the mouth, suppression of Vayu (flatus), irregularity of digestion and all other symptoms which specifically indicate the deranged condition of the bodily Vayu are the characteristics of the Vataja-Gulma. Fever, perspiration, defective digestion, burning sensation, thirst, redness of the body (Anga-raga), bitter taste in the mouth and all other specific symptoms of the deranged Pitta mark the Pittaja type of the disease. A sensation of wetness all over the body, an aversion to food, lassitude, vomiting, water-brash, sweet taste in the mouth and all other specific indications of the deranged Kapha are exhibited in the Kaphaja type of the disease. The Tri-doshaja type exhibits the symptoms specifically belonging to each of the preceding ones and should be regarded as incurable. 7—9.

Symptoms of Raktaja-Gulma:—

The symptoms of Raktaja-Gulma are mentioned below. The bodily Vayu of a woman newly delivered of a child as well as that of a woman who has recently miscarried, or of a woman in her courses is deranged by the use of unwholesome or injudicious food (and regimen of conduct), and by supressing the discharge of the blood (lochia) it gives rise to Gulma attended with pain and burning sensation. A Gulma of this type is easily mistaken for a case of conception, which exhibits all the symptoms of pregnancy as well as those which are peculiar to the state of the Pittaja type, with the exception that the abdomen does not enlarge and there is no movement (in the womb). The medical treatment of a Gulma of the present type should be taken in hand after the lapse of the natural term of gestation and this is known as the Raktaja-Grulma[1] by the experienced physician, 1o.

General Treatment:—

A person suffering from an attack of Vataja Gulma should be duly treated with a Sneha, purged with any fatty purgative and then treated in the proper time with Nirudha and Anuvasana Vastis. In a case of Pittaja type of the disease, the patient should be treated (rubbed) with clarified butter duly prepared and cooked with the drugs of the Kakolyadi group and then being properly purged with the compounds of sweet drugs (of the Aragvadhadi group) he should be treated with Nirudha Vastis. In a case of the Kaphaja type, the patient should be first anointed with a medicated Ghrita duly cooked and prepared with the drugs of the Pippalyadi group, then purged with a strong (Tikshna) purgative and then treated with Nirudha Vastis of the same character. In a Tri-doshaja type, measures held to be remedial for each of the Doshas should be adopted or employed. Measures laid down in connection with the Pittaja type of the disease should be as well employed in cases of Raktaja (blood-origined) Gulma in female patients. Now hear me describe the recipes of the medicines which would particularly lead to the disintegration of the blood (in cases of Raktaja Gulma). Clarified butter duly cooked and prepared with the alkaline preparation of Palasha wood (water charged with the burnt ashas of Palasha) should be internally administered, and the medicated clarified butter known as the Pippalyadi Ghrita should be employed after the manner of an Uttara-vasti. In the alternative, the discharge (of blood) should be induced with the help of the drugs of heat-making (Ushna) potency (e.g., Pippalyadi group) and measures laid down in connection with menorrhagia (Asrigdara) should be adopted after the flow has fairly set in. 11.

Anuvasana:—

The use of curd, clarified butter, oil, lard (Vasa) and marrow of Anupa (such as boar buffalo, etc.) and Audaka (aquatic) animals, boiled together and applied after the manner of an Anuvasana-vasti, proves beneficial in a case of Vataja -Gulma. The application of similar Vastis charged with a solution of clarified butter and the lard of animals of the Jangala and Eka-shapha groups proves efficacious in the Pittaja type of the disease, while the application of these containing solutions of oil and the marrow of any Jangala animal will prove beneficial in a case of the Kaphaja type[2]. 12–15.

In a case of the Vataja type of Gulma, the patient should be made to use the medicated Ghrita duly cooked with the expressed juice of Amalaka and with the Kalka of the six drugs[3] and with the admixture of sugar and Saindhava (as an after-throw). 15.

Citraka Ghrita:—

Clarified butter duly cooked with curd, fermented rice-boilings (Kanjika) as well as with the decoction of Vadara and the expressed juice of Mulaka and with the Kalka of Citraka, Tri-katu, Saindhava, Prithvika, Cavya, Dadima, Dipyaka, Granthika, Ajaji, Habusha and Dhanyaka taken in equal parts, proves curative in cases of Vataja Gulma, Shula (colic), distention of the abdomen and dulness of appetite. 16.

Hingvadi Ghrita:—

Clarified butter duly cooked with Hingu, Sauvarchala-salt, Ajaji, Vit-salt, Dadima, Dipyaka, Pushkara, Vyosha, Dhanyaka, Amla-vetasa, Yava-kshara, Citraka, Shathi, Vaca, Ajagandha, Ela and Surasa as Kalka and with the admixture of curd (Dadhi) as liquid, proves efficacious in a case of Vataja Gulma, colic-pain and suppression of stool and urine. 17.

Dadhika Ghrita:—

Clarified butter duly cooked with Vit-salt, Dadima, Saindhava, Citraka, Vyosha, Jiraka, Hingu, Sauvarchala-salt, Yava-Kshara, Kushtha, Shunthi, Vrikshamla (turmeric) and Amlavetasa as Kalka and with the expressed juice of Vija-pura and with curd weighing four times as much as of Ghrita, proves curative in cases of Gulma, enlargement of spleen and Shula. The clarified butter thus prepared is called Dadhika-Ghrita. 18.

Rasona Ghrita:—

Clarified butter duly cooked with the admixture of the expressed juice of Rasona and with the decoction of (major) Panca-mula as well as with wine (Sura), Aranala (fermented rice-boilings), curd, and the expressed juice of Mulaka, with the Kalka of Vyosha, Dadima, Vrikshamla, Yamani, Cavya, Saindhava, Hingu, Amla-vetasa, Ajaji and Dipyaka (Aja-moda) taken in equal parts, includes within the range of its curative efficacy such diseases of the body as Gulma, Grahani (chronic diarrhea), piles, asthma, insanity, consumption, fever, cough, epilepsy (Apasmara), dulness of appetite, enlargement of spleen, colic, and the derangements of the bodily Vayu. 19.

An Adhaka measure each of curd, Sauviraka (a kind of Kanjika), clarified butter and the decoctions of Mudga and Kulattha pulse should be cooked with the admixture of two Pala weight of each of the following drugs, viz., Sauvarchala, Sarjika, Devadaru and Saindhava. The medicated Ghrita thus prepared proves curative in cases of Vataja Gulma and acts as a good appetiser. 20.

Ghritas in Pittaja and Raktaja Gulmas:—

Clarified butter duly cooked with the Kalka of the drugs or the Jivaniyu (Kakolyadi) group and with the decoction of the component members of the Trina-panca-mula, or of the Nyagrodhadi or of the Utpaladi group, would undoubtedly prove curative in cases of Pittaja and Raktaja Gulma. 21.

Ghritas in Kaphaja Gulma:—

A Gulma of the Kaphaja type would surely yield to the use of medicated Ghritas duly cocked with the drugs of the Dipaniya (Pippalyadi) group as Kalka with the admixture (as liquid) of the decoction of the component members of either the Aragvadhadi group, the alkaline (Mushkakadi) group or the Aragvadhadi Gana, or with the officinal group of (animal) urines. 22.

A Gulma of the Sannipatika type (due to the concerted action of all the three fundamental Doshas of the body) should be treated according to the predominance of any specific deranged bodily Dosha involved therein. The patient should be made to take at the proper time (i.e, as soon as the disease sets in) the pulverised compound known as the Hingvadì-churna or the medicated Ghrita known as Tilvaka-Sarpih or the one (viz. Shatpalaka Ghrita) which has been described as curative of the enlargement of the spleen, as these would prove curative in a case of Gulma. 23—24.

Internal use of Kshara:—

Alkaline preparation should be duly made with the following drugs, vis., the ashes of (dried stems of) Tila, Ikskuraka, Sarshapa and Yava and of (the barks of) Palasha. and of Mulaka with the urines (weighing four times as much) of a cow, she-goat, ewe, shc-ass and she-buffalo. This alkaline preparation should then be cooked in an iron vessel and on a slow fire with one Pala weight of each of the following pulverised drugs, vis, Kushtha, Saindhava, Yashti-madhu, Nagara, Vidanga and Ajamoda and with ten Tala weight of Samudra-salt thereto added and, should be taken in the form of a lambative with one or the other of clarified butter, curd, wine, fermented rice-boilings (Dhanyamla), warm water or the soup of Kulattha. The alkaline compound, thus prepared, undoubtedly proves curative in cases of Gulma and in the derangements of the bodily Vayu. Compounds consisting of Sarjika-Kshara, Kushtha and the ashes of Ketaki taken with oil[4], or of Sarjika-Kshara, Kushtha and Saidhava taken with tepid water, would subdue an attack of the deranged bodily Vayu. 25–26.

Vrishchirarishta:—

The drugs known as Vrishchira, Uruvuka, Varshabhu, the two kinds of Vrihati and Citraka should be duly boiled together with a Drona-measure of water and taken down from the oven after three-fourths of the water arc evaporated by boiling. It should then be poured into an earthen pitcher of which the interior has been previously coated with pastes of Magadhi, Citraka and honey. One Seer of powdered Pathya and four Seers of honey should be subsequently added to its contents and the pitcher should be then kept buried in a heap of husks for ten days, after which it should be taken out and its contents should be given to the patient after the digestion of his daily food. The Arishta (fermented wine) thus prepared proves curative in cases of Gulma, indigestion and aversion to food. 27.

Powders of Patha, Nikumbha, Rajani, Tri-katu, Tri-phala, Agnika (Citraka), Saindhava- salt and Vriksha-vija (Indra-yava) in equal parts should be taken with matured treacle of their combin d weight; or the powders of the above drugs with pulverised Pathya (weighing a fourth part only of the other powders taken together) should be cooked with cow’s urine (weighing four times) to a thick consistency and made into pills which should be taken in an empty stomach (by the patient). These medicines would radically cure the cases of Gulma, enlarged spleen, indigestion, heart-disease, chronic diarrhea and violent forms of chlorosis, 28.

Blood-letting':—

Blood-letting by the application of leeches or by venesection should be effected in a case of elevated and immobile (unshifting) Gulma characterised by Shula, burning sensation, inflamation and piercing pain. 29.

Diet and Sveda:—

Drinks composed of the meat-essence of an animal of the Jangala group, profusely salted with Saindhava and mixed with clarified butter and Tri-katu and taken lukewarm are good for Gulma-patients Peyas prepared with the Vayu-subduing drugs and the soup of Kulattha -pulse cooked with a Sneha as well as the Khada-yusha prepared with Panca-mula also are likewise efficacious as Diet. Draughts of milk with Ardraka should be prescribed in a case of Gulma attended with the suppression of stool and flatus. Fomentation (Sveda) after the manner of Kumbhika, Pinda and Ishtaka (see Chapter XXXII) Chikitsita Sthana) are also efficacious. 30—32.

Purgatives preceded by the application of fomentation should be exhibited to a Gulma-patient, since it is extremely difficult to purge him. Vilepana (massage of the Gulma), application of unguents and poultices, Samdahana (cauterisation) as well as tepid fomentation after the manner of Salvana-Sveda and the like arc likewise applicable. Medicated Ghritas, powders and Vartis mentioned in connection with the treatment of Udara as well as medicated salts mentioned under the head Udaramaya[5] are likewise applicable in the present disease. 33–34.

Medicated Plugs or Vartis made of Samudra[6], Ardraka, Sarshapa (mustard) and a profuse quantity of Marica pasted together should be inserted into the rectum in suppression of stool and flatus in a case of Gulma. Arishtas made with Danti -roots, Citraka- roots, or with the Vayu-subduing drugs according to the manner laid down in the Sutra-sthana should be prescribed, or the patient should be made to use the duly fried tender sprouts of Putika and Nripa-Vriksha. A Gulma patient with the upward coursing of his bodily Vayu should not be treated with Nirudha-Vasti. 35—37.

Compounds of Trivit and Shunthi or of treacle and powdered Haritaki[7] as well as of Guggulu, Trivit, Danti, Dravanti, Saindkava and Vaca should be administered through milk, wine or the expressed juice of grapes, according to the strength (of the disease and of the patient). Pilu made into a paste and salted with the addition of Saindhava should also be similarly taken. Wine surcharged with Pippali, Pippali- roots, Cavya, Citraka and Saindkava and taken at an opportune moment (i.e., when attended with tympanities, etc.) would prove readily curative in a case of Gulma. A Gulma-patient afflicted with a suppression of stool and of flatus should take barley with milk or Kulmasha (Masha-cakes) profusely saturated with salt and clarified butter. 38–39.

Supervening Symptoms:—

If Shula which is its supervening symptom anyhow appears whereupon the patient suffers a kind of digging and piercing pain resembling that arising from the piercing of a dart, there will also appear the following distressing concomitants according to the Dosha or Doshas involved, viz., supression of stool and urine, difficult respiration, and numbness or stiffness of the limbs (in cases of aggravated Vayu), thirst, burning sensation, vertigo, ill-digestion of food, and excess of the colic pain (in cases of aggravated Pitta), and goose-flesh, aversion to food, vomiting, increase of pain after the taking of food and a sense of lassitude in the limbs (in cases of aggravated- Kapha). The course of medical treatment in such cases should be determined by the nature and number of the deranged bodily Doshas specifically lying at the root and should be as follows. 40.

The following three compounds, vis., (1) Pathya, the three kinds of salt (Saindhava, Sauvarchala and Vit) Yava-Kshara, Hingu, Tumburu, Pushkara, Yamani, Haridra, Vidanga and Anila-vetasa; (2) Vidari, Triphala, Satavari, Shringata, Guda-sharkara (Gangeri-phala), Kashmari-phala, Yashthi-madhu, Parushaka, Hima (sandal wood) and (3) Shad-grantha (Vaca), Ativisha, Deva-daru, Pathya, Markka, Vrikshaka, Pippali-mida, Cavya, Nagara, Kshara (Yava-kshara) and Citraka should be respectively given in the Vataja, Pittaja and Kaphaja types of the disease. The medium through which these compounds should be given would be tepid Amla-Kanjika, luke-warm milk and tepid water respectively. The preceding three compounds should be jointly administered in sets of two or three when two or three Doshas arc involved in any case. 41.

Sprinkling (of water), baths, plaster (Pradcha) unguents and dietetic treatment should be similarly applied in Vataja cases. Contacts with vessels filled with cold water should be applied in Pittaja cases, while the use of emetics, rubbing, fomentation (Sveda), fasting and ether Kapha-subduing remedies should be recommended in Kaphaja types. Applications of Sneha and such-like remedial measures are specifically recommended in the disease, according to the Dosha or Doshas involved in each case. 42.

Prohibited articles:—

A person suffering from Gulma, should refrain from taking Vallura (dried meat), Mulaka (radish), fish, dried pot-herbs, any preparation of pease, Aluka, (potato of any kind) and any kind of sweet fruit. 43.

Causes and symptoms of Shula:—

Now I shall deal with the causes, the characteristic symptoms and the treatment of Sula occurring in any specific locality of a Gulma even without its actual presence or formation therein. A voluntary retention of flatus (Vata), stool or urine, over-eating, indigestion, eating before the digestion of previous food, over-exertion, use of articles of food which are incompatible in their combination, drinking water when hungry, use of germinated grains, dry food or cakes of dry meat, as well as the use of other such-like articles of fare, derange and aggravate the bodily Vayu, which produces a violent cutting and spasmodic pain (Shula) in the main cavity of the trunk (Koshtha). The patient complains of as if being pierced with a Samku (spear) in the inside and of a feeling of suffocation under the influence of that excruciating pain, which fact has determined the nomenclature of Sh ula (lit.—a spear). 44—45.

Vataja Shula:—

The patient experiences a violent colic whenever in an empty stomach and he feels a difficulty of respiration. The limbs seem to be numbed or stuffed and the flatus, stool and urine are evacuated with the greatest difficulty—these are the symptoms which mark the Vataja type of the disease. 46.

Pittaja Shula:—

Thirst and a burning sensation in the body attended with an excruciating pain, giddiness, loss of consciousness, desire for cold things and amelioration on application of cooling measures, are the specific features of the Pittaja type. 47.

Kaphaja and Sannipatika Shulas:—

An agonising pain attended with nausea, excessive fullness of the stomach and a sense of heaviness in the limbs arc the indications which distinguish the Kaphaja type of the disease. The type due to the concerted action of the three simultaneously deranged Doshas of the body (Sannipatika Shula) exhibits all the series of symptoms which respectively mark the preceding types, and hence it is said to be incurable. 48-49.

General treatment:—

The symptoms have been described. Now hear me describe the mode of medical treatment (to be generally pursued in curing a case of Shula) Since the deranged bodily Vayu (which is the principal and immediately exciting factor is very active in its operation, hence it should be speedily subdued. Fomentations with Payasa, Krishara or cooked meat saturated with any Sneha (clarified butter, etc.) should be resorted to. Fomentation naturally gives relief to a patient suffering from Sula. The patient should take cooked Trivrit -l eaves (as pot-herbs) with his meals cooked with a Sneha (clarified butter) and served hot; or he should eat the tender sprouts of Chiravilva fried with oil, or drink the meat-essence of the flesh of any birds of the Jangala group charged with a Sneha, or take the meat of any animal of the Vileshaya group. 50.

Treatment of Vataja Shula:

Sura, Sauviraka (fermented rice boilings), Shukta, the cream of curd and Udashvit (half-diluted Takra) saturated with Kala-salt[8], should be taken in a case of Vataja Shula. The soup of Kuluttha with an adequate quantity of the acid articles (e.g., pomegranate, etc.) and cooked with the soup of Lava bird salted with Saindhava and seasoned with pepper, exercise a curative efficacy in a case of the Vayu-origined type. The compound of Vidanga, Shigru, Kampilla, Pathya, Shyama, Amla-vetasa, Surasa, Ashva-karna and Sauvarchala should be taken with wine in an attack of the Vayu-origined type of Shula. 51—52.

A pulverised compound consisting of Prithvika, Ajaji, Cavika, Yavani, Vyosha, Citraka, Pippali, Pippala-mula and Saindhava pounded together should be taken with milk or Kambalika or Madhvasava (wine of honey) or Chukra or Sura (wine) or with Sauviraka (fermented rice-boilings) as alternatives. The above pulverised compound should be soaked in the expressed juice of Matulunga and with the decoction of Badara several times after the manner of Bhavana saturation, and the compound should be taken with a profuse quantity of Hingu, and with sugar. A Varti made of the same powders and pulverised (pith of) Dadima wood mixed together should be licked with treacle or honey or taken with wine in cases of Vataja Sula as giving an instantaneous relief. 53.

In a case of Sula due to hunger, light and sparing diet should be given with lukewarm milk, Yavagu or meat-soup charged with clarified butter. Emulsive diet should be given in a case of Vataja Shula to a patient of dry or parched organism, use of well seasoned Ghrita-puras being specially recommended. The patient should also take Varuni wine wherefrom he will get relief. 54—55-

Treatment Of Pittaja Shula:—

The treatment of Vataja Shula has been described above. Now I shall narrate the therapeutic agents and remedies in respect of Pittaja-Shula. A person afflicted with an attack of the present type of the disease, should be made to vomit without any violent effort by drinking (a stomachful of) cold water. He should have recourse to cooling measures and avoid all heat-making ones. Vessels of copper, silver, or precious stones and cooling gems and filled up to the brim with water, should be placed upon the seat of affection (Shula) in his body. Treacle, barley, Shali rice, milk, (draughts of, clarified butter, purgatives, the flesh of any Jangala animals—these should be prescribed in cases of Pittaja Sula. All Pitta-generating articles should be avoided and those which soothe the Pitta should be used. The soup of the meat of Jangala animals may be taken with sugar as an alternative. Parushaka, grapes, dates and aquatic fruits such as Shringataka, etc., should also be taken with sugar as they tend to relieve Pittaja Shula. 56.

Treatment of Kaphaja Shula:—

A fit of Shula due to the action of the deranged Kapha is aggravated just after eating. Vomiting should be induced in such a case with draughts of the decoction of Pippali[9]. Dry fomentations and other heating measures should be likewise resorted to and the patient should be made to take Pippali and Shunthi (in any shape) in cases of Kaphaja Sula. Patha, Vaca, Tri-katu, and Katuka-rohini should be used with the decoction of Citraka, or the soup (of any Shula-subduing article) should be taken with an equal part of Arjaka. 57–58.

Seeds and roots of Eranda, Gokshura -roots, Shala-parni, Prishni-parni, Brihati, Kantakari, Shrigala-vinna (a kind of Prishni-parni), Sahadeva, Mahasaha (Mashaparni), Kshudra-saha (Mudga-parni) and Ikshuraka-roots should be duly boiled with a Drona measure (sixty-four seers) of water and should be boiled till reduced to a quarter part. This decoction should be used with the admixture of Yava-kshara[10]. By this compound attacks of Vataja, Pittaja, Kaphaja and Tri-doshaja types of Shula would be thrown off just as the floating clouds are shattered and driven by the wind. Pippali, Yava, Citraka, Ushira and S arjika-kshara should be burnt together and reduced to ashes. Taken with tepid water, this compound proves curative in an attack of Kaphaja Shula. 59–60.

Symptoms of Parshva-Shula:—

The deranged Kapha in the regions of the Parshva (sides) arrests the course of local Vayu which thus irritated causes an immediate distention of the abdomen and a rumbling in the intestines. A pricking pain is felt in the affected part, which seems as if being pierced with needles, and the patient complains of insomnia and has no relish for food and his respiration becomes painful and difficult. The disease is named Parshva-Shula (side-colic) and is brought on by the action of the deranged Vayu and Kapha. 61.

Treatment of Parshva-Shula:—

A pulverised compound of Pushkara- roots, Hingu, Sauvarchala, Vit-salt, Saindhava, Tumburu and Pathya should be taken with a decoction of barley in a case of (colic) pain at the sides, at the region of the heart and at the region of the bladder. The medicated Ghrita mentioned in connection with abdominal dropsy due to the enlarged spleen, or clarified butter mixed with Hingu should be as well administered in such cases. Vija-puraka-Sara[11] duly cooked in milk as well as draughts of castor oil mixed with wine, Mastu, milk or meat-soup (whichever of these may be conducive to the health of the patient) should be taken and the diet should be taken with milk or with the meat-soup of Jangala animals. 62.

Symptoms of Kukshi-Shula:—

The deranged and aggravated bodily Vayu, affecting the fire of digestion and incarcerated in the region of the Kukshi (loins) interferes with the digestion of the food previously taken which remains stiff and undigested in consequence. The patient breathes heavily owing to the accumulation of undigested (fecal) matter and tosses about in agony of pain, finding no relief in any posture whatever, whether sitting or lying. The disease is called Kukshi-Shula, and is due to indigestion incidental to the action of the deranged bodily Vayu. 63.

Treatment of Kukshi-Shula:—

Vomiting should be induced and fasting should be prescribed in the case according to the strength of the patient. Acid and appetising drugs should be employed for the alleviation of the Doshas (Vayu and Ama). A decoction of Nagara, Dipyaka, Cavya, Hingu, Sauvarchala, Vit,[12] and the seeds of Matulunga, Shyanta, Uruvuka, Brihati and of Kantakari, should be taken for the relief of the pain (Shula). Vaca, Sauvarchala, Hingu, Kushtha Ativisha, Abhaya and Kutaja- seeds taken together would instantaneously relieve Shula. Purgatives should be administered, and Sneha-Vastis and Nirudha-Vastis should be applied for the amelioration of the deranged Doshas according to their nature and intensity. Sneha-Sveda and poultices should be applied and Dhanyamla (fermented paddy-boilings) should be employed as washes. 64-66.

Symptoms and treatment of Hricchula:—

The deranged bodily Vayu aggravated by the vitiated Rasa (chyle) and incarcerated in the region of the heart through the action of the deranged Pitta and Kapha, produces Shula (pain) in the heart and gives rise to difficulty of respiration. This disease which is called Hricchula (cardiac colic) is ushered in through the action of the deranged Vayu and Rasa of the body. Remedial measures mentioned in connection with the treatment of the diseases of the heart should be as well employed in the present malady. 67–68.

Symptoms of Vasti-Shula and Mutra-Shula:—

The local Vayu aggravated by the suppression of stool and urine is incarcerated in the region of the Vasti (bladder) and gives rise to a pain in the bladder, in the groins and about the umbilicus causing a further suppression of the stool, urine and flatus. The disease is called Vasti-Shula (bladder colic) and is due to the action of the deranged bodily Vayu. A cutting pain experienced in the genital, the intestines and the loins as well as at the sides and in the inguinal regions and about the umbilicus and causing a complete suppression of urine, is called Mutra-Shula. The disease should be likewise attributed to the action of the deranged bodily Vayu 69–70.

Symptoms of Vit-Shula:—

The bodily Vayu deranged and aggravated by the use of dry food, etc., affects or impairs the digestive fire and obstructs the evacuation of feces accumulated in the bowels and gives rise to an excruciating pain in the locality by stuffing or choking the channels of the intestines. The pain is first experienced in the region of the right or left Kukshi (loin), but it soon extends over the whole abdomen with rumbling sounds therein. Thirst becomes unquenchable and vertigo and epileptic fits follow in its train, and the patient finds no relief even after the evacuation of the bladder and of the bowels. This disease is called Vit-Shula and is a very violent one. 71.

Treatment:—

An experienced physician should instantly employ (in such cases) the medicinal remedies which have the virtue of eliminating the deranged Doshas from the system. Fomentations, emetics as well as Sneha-Vastis and Nirudha-Vastis should be applied, and the bowel-cleansing compounds dealt with before should be administered. Medicinal measures mentioned in connection with the treatment of Udavarta should be likewise employed with advantage. 72.

Symptoms of Annaja Shula:—

A voracious eating in an impaired state of digestive fire, aggravate the local Vayu which makes the food taken remain stiffed in the Koshtha. The food thus undigested in the Koshtha causes an intolerable colic, which brings on a distension of the abdomen, epileptic fits, eructation, nausea and an attack of Vilambika. The patient shivers, vomits, or passes stool, and even loses consciousness. Anti-colic (pain-killing) pills, powders and medicinal Ksharas are recommended in the case. All the medical remedies applicable in cases of Gulma should likewise be applied in cases of Shula. 73—74.

 

Thus ends the forty-second chapter of the Uttara-Tantra in the Sushruta Samhita which deals with the medical treatment of Gulma.

Footnotes and references:

1.

This Raktaja Gulma is peculiar to the females only. But some authorities are of opinion that a kind of Raktaja (blood-origined) Gulma due to the vitiated blood of the organism may be possible both in the males and females.

2.

Dallana recommends the use of Vāyu subduing, Pitta-subduing and Kapha-subduing drugs as Kalka in the preparation of these three Vastis respectively.

3.

The six drugs to be used as Kalka are

  1. Pippali,
  2. Pippali-mula,
  3. Cavya,
  4. Citraka,
  5. Nāgara
  6. and Yava-kshāra

taken one Pala of each.

4.

According to Dallara, Sarjikā-Kshāra, Kushtha and Yava-Kshāra with oil would form the 1st compound and the Ketakā-Kshāra with oil would form a separate compound.

5.

Udarāmaya may mean either indigestion or ascites. Anilāmaya (Vāta-vyādhi) is a variant addopted by Dallana and is undoubtedly preferable since there are several medicated salts e.g., Patra-Lavana, Kānda-Lavana, in the treatment of Vāta-Vyādhi. See Chap. IV, Chikitsita Sthāna.

6.

According to some ‘Sāmudra’ means Sāmudra-salt and others, it means Samudra-Phena.

7.

According to some commentators the first two compounds should be taken with water.

8.

Kāla Havana generally means ‘Vit-salt’, but here, according to Dallana, it means ‘Snuvarchala-salt’.

9.

Some commentators, according to Dallana, take Pippali to mean seeds of Madana-phala.

10.

The total weight of the drugs should be 8 seers, according to Dallana. According to others, however, it should be 12 seers. The preparation should be used in any shape both internally and externally e.g., bath, washings, etc.

11.

Vijapuraka-sāra, according to Dallana, means the fruit of Vija-puraka. Vijaka-sāra (the pith of Vijaka) is, however, a variant.

12.

Hingu, Sauvarchala and Vit salt should be used as an after-throw.

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