Mathomathis would like to present an article on Sushruta Samhita | Medical treatment of inflamed ulcers based on the book Sushruta Samhita, volume 4: Cikitsasthana by Kaviraj Kunja Lal Bhishagratna | 1911 | 123,229 words. The article is a continuation from the previous article which was on: Sushruta Samhita | Fracture Treatment In Vedas – Ancient IndiaReaders are expected to complete reading the previous article, before proceeding further. Also, the article was adopted from the website: https://www.wisdomlib.org/, a detailed explanation is available on the website.
Ulcers may be grouped under two heads according as they are Idiopathic or Traumatic in their origin. The first group includes within its boundary all ulcers that are caused through the vitiated condition of the blood or the several deranged conditions of the Vayu, Pitta and Kapha, or are due to their concerted action (Sannipata), while the second group embraces those which are caused by the bites of men, beasts, birds, ferocious animals, reptiles or lizards, or by a fall, pressure and blow, or by fire, alkali, poison, or irritant drugs, or through injuries inflicted by pointed wood, skeletal bones, horns, discus, arrows, axes, tridents, or Kuntas (a kind of shovel), or such other weapons. Although both these classes of ulcers possess many features in common, they have been grouped under two distinct heads on account of the diversity of their origin, the difference in remedial measures to be adopted in their treatment, and the variation in their strength and tenacity. Hence the chapter is called Dvivraniya.
In all cases of traumatic ulcers, cooling measures should be at once resorted to, just after (the fall or blow or stroke), for the cooling of the expanding (radiating) heat of the incidenta ulcer, in the manner laid down in respect of (the pacification of enraged) Pitta, and a compound of honey and clarified butter should be applied on the wounded locality for the adhesion (Sandhana) of the lacerated parts, [and for the pacification, i.e, restoration to normal state, of the local blood and Vayu aggravated through an obstruction of their passage]. Hence arises the necessity of making the two-fold classification of ulcers. After that (a week) a traumatic ulcer should be treated as an idiopathic one (to all intents and purposes), inasmuch as it is found to be associated with deranged Vayu, Pitta or Kapha Hence at that stage the medical treatment of both the forms of ulcer is (practically) the same.
In short, ulcers are further subdivided (particularly) into fifteen groups, according to the presence of the morbific diathesis (deranged Vayu, Pitta Kapha and blood therein). Several authorities, by adding the simple uncomplicated ulcers (unassociated with any of the morbific principles of the deranged Vayu, Pitta, etc.) to the list, hold the number of types to be sixteen. (Practically they are innumerable, according to the combinations made of the deranged Vayu, etc. and the different Dhatus of the system). Symptoms of ulcer may be divided into two kinds viz., General and Specific. Pain is the general characteristic (of all forms of ulcer), while the symptoms, which are exhibited in each case according to the virtue of the deranged Vayu, Pitta, etc., involved therein, are called the Specific ones. A Vrana is so named from its etymology (the term being derived from the root Vrana—to break) and signifies a cracked or broken condition of the skin and flesh of the afflicted part) of the body.
- The Vataja-Ulcer: The ulcer assumes a brown or vermilion color and exudes a thin, slimy and cold secretion, largely attended with tension, throbbing and a sort of pricking and piercing pain (in its inside), which seems as if being expanded and extended. This type of ulcer does not extend much and is characterized by a complete destruction of the tissue (flesh).
- The Pittaja ulcer is rapid in its growth. It assumes a bluish yellow color, exudes a hot secretion resembling the washings of Kimshuka flowers, and is attended with burning, suppuration and redness, being surrounded with eruptions of small yellow-colored pustules.
- The Kaphaja ulcer is found to be extended and raised around its margin and is accompanied by an irresistible itching sensation. It is thick and compact (in its depth), covered with a large number of vessels and membranous tissues (Shira-snayu-jala), grey in color, slightly painful, hard and heavy, and exudes a thick, cold, white and slimy secretion.
- The Raktaja ulcer (resulting from a vitiated condition of the blood) looks like a lump of red coral. It is often found to be surrounded by black vesicles and pustules and to smell like a strong alkali. It becomes painful and produces a sensation, as if fumes were escaping out (of it). Bleeding (is present) and the specific symptoms of the Pittaja type are likewise found to supervene.
The Vata-Pittaja Type
- An ulcer due to the concerted action of the deranged Vayu and Pitta is marked by a pricking and burning pain and a red or vermilion color. A sensation of fumes arising out of it (is also felt) and the ulcer exudes a secretion which partakes of the characteristic colors of both the deranged Vayu and Pitta. An itching and piercing pain is felt in the ulcer due to the combined action of the deranged Vayu and Kapha (Kapha-Vataja type), which becomes heavy and indurated, constantly discharging a cold, slimy secretion.
- An ulcer resulting from the deranged condition of the Pitta and Kapha (Kapha-Pittaja type) becomes heavy, hot and yellow. It is marked by a burning sensation and exudes a pale, yellow-coloured secretion.
- An ulcer marked by the aggravated condition of the deranged Vayu and blood (Vata-Raktaja type) is dry and thin and is largely attended with a piercing pain and anesthesia. It exudes blood or a vermil-coloured secretion and is marked by the combined hues respectively peculiar to the deranged Vayu and blood.
- An ulcer due to the combined action of the deranged Pitta and blood (Kakta-Pittaja type) is marked by a color which resembles the surface cream of clarified butter. It smells like the washing of fish, is soft, spreading (erysipelatous), and secretes a hot blackish matter.
- An ulcer due to the combined action of the deranged Kapha and blood (Kapha-Raktaja type) is red-colored, heavy, slimy, glossy and indurated. It is usually marked by itching and exudes a yellowish bloody secretion.
- An ulcer due to the concerted action of the deranged Vayu, Pitta and blood (Vata-Pitta-Raktaja type) is marked by a sort of throbbing, pricking and burning pain. It discharges a flow of thin yellowish blood and produces a sensation, as if fumes were escaping (out of its cavity).
- An ulcer due to the concerted action of the deranged Vayu, Kapha and blood (Vata-Shleshma-Raktaja type) is usually attended with itching, throbbing and tingling sensations and thick, grey, blood-streaked discharge.
- An ulcer associated with the deranged Kapha, Pitta, and blood (Kapha-Pitta- Raktaja type) is largely attended with redness, itching, suppuration and burning sensation. It emits a thick, greyish, bloody secretion.
- An ulcer marked by the concerted action of the deranged Vayu, Pitta and Kapha (Sannipatika) is attended with diverse kinds of pain, secretion, color, etc., peculiar to each of these types.
- An ulcer associated with the combined action of the deranged Vayu, Pitta, Kapha and blood (Vata-Pitta-Kapha-Raktaja type) is attended with a sensation, as if it were being burnt and lacerated. It is largely accompanied by throbbing, itching sensation, a sort of pricking and burning pain, with complete anaesthesia in the locality; redness, suppuration, various other kinds of colour, pain and secretion are its further characteristics.
- An ulcer (Vrana) which is of the same colour with the back of the tongue, soft, glossy, smooth, painless, well-shaped and marked by the absence of any kind of secretion whatsoever, is called a clean ulcer (Shuddha- Vrana).