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: https://mathomathis.com/sushruta-samhita-medical-treatment-of-inflamed-ulcers-102/Readers 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.
Metrical Texts: The holy Dhanvantari, the foremost of the pious and the greatest of all discoursers, thus discoursed to his disciple Sushruta, the son of Vishvamitra.
Different shapes of Sores:
Author in the following section tries to describe the shapes of the various kinds of Vrana (sores or wounds) caused by weapons of variously shaped edges in the different parts of the human body. Traumatic ulcers have a variety of shapes. Some of these are elongated, others are rectangular, or triangular, or circular, while some are crescent shaped, or extended, or have a zigzag shape, and some are hollow in the middle like a saucer, and lastly some have she shapes of a barley corn (bulged out at the middle). An abscess or a swelling, due to the several Doshas and which spontaneously bursts out, may assume any of the aforesaid forms, while the one effected by a surgeon’s knife should never have a distorted or an improper shape. A surgeon thoroughly familiar with the shapes of ulcers is never puzzled at the sight of one of a terrible and distorted shape. Physicians of yore have grouped these variously shaped traumatic ulcers under six broad sub-heads, such as the Chinna (cut), Bhinna (punctured or perforated), Viddha (pierced), Kshata (contused), Piccita (crushed), and the Ghrishta (mangled or lacerated)
Definitions: A traumatic ulcer which is oblique or straight and elongated is called a Chinna (cut) ulcer, while a complete severance of a part or member of the body is also designated by that name. A perforation of any of the cavities or receptacles of the body by the tip of a Kunta, spear, Rishti, or a sword or by a horn, attended with a little discharge, constitutes what is called a Bhinna (punctured) wound or ulcer. The Amashaya (stomach), the Pakvashaya (intestines), the Agnyashaya (gall-bladder?), the Mutrashaya (urinary bladder), the Raktashaya (receptacle of blood), the heart, the Unduka and the lungs constitute what is called the Koshtha (viscus). A perforation (of the wall of any) of the Ashayas causes it to become filled with blood which is discharged through the urethra, the anus, the mouth or the nostrils and is attended with fever, thirst, fainting fits, dyspnea, burning sensations, tympanites, suppression of stool, urine and flatus (Vata) with an aversion for food, perspiration, redness of the eyes, a bloody smell in the mouth, and feted one in the body and an aching pain in the heart and in the sides.
Their detailed symptoms:- A perforation of the wall of the Amashaya (stomach) is marked by constant vomiting of blood, excessive tympanites and an excruciating pain. A perforation of the Pakvashaya fills it with blood and is attended with extreme pain, a heaviness in the limbs, coldness of the sub-umbilical region, and bleeding through the (lower) ducts and orifices of the body. Even in the absence of any perforation, the Antras (intestines) are filled with blood through the small pores or apertures in their walls in the same manner as a pitcher with its mouth firmly covered may be filled through the pores (in its sides), and a sense of heaviness is also perceived in their inside.
A wound or an ulcer caused by any sharp pointed Shalya (shaft) in any part of the body other than the aforesaid Ashayas with or without that Shalya being extricated is called a Viddha (pierced one). An ulcer which is neither a cut nor a perforation or puncture but partakes of the nature of both and is uneven is called a Kshata (wound,). A part of the body with the local bone crushed between the folds of a door or by a blow becomes extended and covered with blood and marrow and is called a Piccita (thrashed) wound or ulcer. The skin of any part of the body suffering abrasion through friction or from any other such like causes and attended with heat and a secretion is called a Ghrishta (mangled or lacerated) wound or ulcer.
Their Treatment:- A part or member of the body any wise cut, perforated, pierced or wounded which is attended with excessive bleeding and with the local Vayu enraged or aggravated by the incidental bleeding, or hemorrhage will occasion excruciating pain. Potions of Sneha (oily or fatty liquids) and using the same as a washing (in a lukewarm state) should be advised in such cases. Preparation of Veshavaras and other Krisharas largely mixed with oil or clarified butter should be used as poultices and fomentations with the Masha pulse, etc., and the use of oily ungents and emulsive Vastis (enematas) prepared with decoctions of Vayu-subduing drugs should be applied. A crushed or thrashed wound or abrasion is not attended with any excessive bleeding an absolute absence whereof, (on the contrary) gives rise to an excessive burning sensation and suppuration in the affected part. Cold washes and cooling plasters should be used in these cases for the alleviation of the burning and suppuration as well as for the cooling of the (incarcerated) heat. What has been specifically said of these six forms of ulcers, or wounds should be understood to include the treatment of all kinds of traumatic wounds or ulcers as well.
Treatment of cuts or incised wounds etc.— Medical treatment of Chinna cuts. An open mouthed ulcer on the side of the head should be duly sutured as described before and firmly bandaged. An ear severed or lopped off should be sutured in the proper way and position and oil should be poured into its cavity. A Chinna cut on the Krikatika (lying on the posterior side of the junction of the neck and the head) and even if it allow the Vayu (air) to escape through its cavity should be brought together and duly sutured and bandaged in a manner (so as not to leave any intervening space between). The part thus adhesioned should be sprinkled with clarified butter prepared from goat’s milk. The patient should be made to take his food lying on his back, properly secured or fastened with straps (so that he might not move his head and advised to perform all other physical acts such as, urination, defecation etc, in that position).
In the case of a lateral and wide-mouthed wound (sword-cut, etc.) on the extremeties, the bone-joints should be duly set and joined together as instructed before and the wound should be sutured and speedily bandaged in the manner of a Vellitaka bandage, or with a piece of skin or hide in the Gophana or such other form as would seem proper and beneficial and oil should be poured over it. In the case of a wound on the back the patient should be laid on his back, while in the case of its occurring on the chest the patient should be laid on his face
In the case of a hand or a leg being carried away or completely severed the wound should be cauterised with the application of hot oil and bandaged in the manner of a Kosha bandage and proper healing medicines should be applied. An oil cooked with the eight drugs Chandana, Padmaka, Rodhra, Utpala, Priyangu, Haridra, Madhuka, (Yasthimadhu) and milk, forms one of the most efficacious healing (Ropana) agents. A Kalka of the thirteen drugs —Chandana, Karkatakhya, the two kinds of Saha (Mugani and Mashani), Mansi, (D.R.—Mashahva, Somahva), Amrita, Harenu, Mrinala (,?) Triphala, Padmaka and Utpala should be cooked in oil mixed with milk (four times that of oil) and the three other kinds of oily matter (lard, marrow and clarified butter) and this medicated oil should be used for sprinkling over a wound of this type for the purpose of healing (Ropana)
Medical Treatment of Bhinna:— Medical treatment of Bhinna (excised) wounds. A case of an excised eye (Bhinna) should be given up as incurable. But in the case where an eye (ball) instead of being completely separated would be found to be dangling out (of its socket) the affected organ should be re-instated in its natural cavity in a manner so as not to disturb the connected Shiras (nerve arrangements) and gently pressed with the palms of the hand by first putting a lotus leaf on its (eye) surface. After that the eye should be filled (Tarpana) with the following (D.R, —Ajena in place of ‘Anena’—i.e., prepared from goat’s milk) medicated clarified butter, which should be as well used in the form of an errhine. The recipe is as follows:—Clarified butter prepared from goat’s milk, Madhuka, Utpala, Jivaka and Rishavaka taken in equal parts should be pasted together, and cooked with sixteen seers of cow’s milk and four seers of clarified butter.The use of the medicated Ghrita thus prepared should be regarded as commendable in all types of occular hurt or injury.
In the case of a perforation of the abdomen marked by the discharge of lumps or rope-like Varti (fat) through the wound, the emitted or ejected fat-lump should be dusted with the burnt ashes (D. R.—powders) of astringent woods (such as Manu, Arjuna, etc.) and black clay (pounded together). A ligature of thread should then be bou id round the fat-lump and the fat- lump cut off with a heated instrument. Honey should then be applied and the wound (Vrana) should then be duly bandaged. The patient should be caused to drink clarified butter after the full digestion of his injested food. Instead of this Ghrita, milk prepared medicinally with Yashti-maddu, Laksha and Gokshura, mixed with (a proper quantity of) sugar and castor oil (as Prakshepa), is equally commendable for the alleviation of the pain and the burning sensation, (in the wound or ulcer). The fat-lump (pariental fat) aforesaid causes a rumbling sound with pain in the abdomen and may prove even fatal in the event of its being left uncut. The medicated oil to be mentioned hereafter in connection with Medaja-Granthi should be applied in such cases.
Foreign bodies (Salya) piercing into any of the Koshthas after having run through the (seven layers of) skin, whether passing through the veins, etc., (muscles, nerves, bones or joints, or not, produces the distressing symptoms described before (Ch. III.—Sutra). The blood (of the affected chamber or receptacle) in such case lies incarcerated therein in the event of its failing to find an outlet and causes a pallor of the face and a coldness of the extremities and of the face in the patient. Respiration becomes cold, the eyes red-coloured, the bowels constipated and the abdomen distended. The manifestation of these symptoms indicates the incurable character of the disease. Emesis is beneficial in the case where the blood would be found to be confined in the Amashaya (stomach). Purgatives should unhesitatingly be prescribed where the blood would be found to have been lodged in the Pakvashaya (intestines) and Asthapana measures without oil should be employed with hot, purifying (Shodhana) substances (such as the cow-urine, etc.) The patient should be made to drink a Yavagu (gruel) with Saindhava salt and his diet should consist of boiled rice mixed with the soup of barley, Kola and Kulalttha pulse divested of oil.
In a case of a perforation or piercing of any of the bodily Koshthas attended with excessive hemorrhage or bleeding, the patient should be caused to drink (a potion of animal) blood and such a case marked by the passage of stool, urine, etc., through their proper channels of outlet and by the absence of fever and tympanites and other dangerous symptoms, (Upadrava), may end in the ultimate recovery of the patient.
In a case of a perforation of the Koshtha (abdomen) where the intestines have protruded or bulged out in an untorn condition, they should be gently re-introduced into the cavity and placed in their original position, and not otherwise. According to others, however, large black ants should be applied even to the perforated intestines in such a case and their bodies should be separated from their heads after they had firmly bitten the perforated parts with their claws. After that the intestines with the heads of the ants attached to them should be gently pushed back into the cavity and reinstated in their original situation therein. The bulged out intestines should be rinsed with grass, blood and dust, washed with milk and lubricated with clarified butter and gently re-introduced into the cavity of the abdomen with the hand with its finger nails cleanly paired. The dried intestines should be washed with milk and lubricated with clarified butter before introducing it into their former and natural place in the abdomen.
In a case where the intestines could be but partially introduced, the three following measures should be adopted. The interior of the throat of the patient should be gently rubbed with a finger [and the urging for vomiting thus engendered, would help the full introduction of the intestines into the abdominal cavity]. As an alternative, he should be enlivened with sprays of cold water; or he should be caught hold of by his hands and lifted up into the air with the help of strong attendants and shaken in a manner that would bring about a complete introduction of the intestines into the natural position in the abdominal cavity. They should be so introduced as to press upon their specific (Maladhara) Kala (facia).
In a case where the re-introduction of the intestines into the abdominal cavity would be found to be difficult owing to the narrowness or largeness of the orifice of the wound, it should be extended or widened with a small or slight incision according to requirements, and the intestines re-introduced into their proper place. The orifice or mouth of the wound should be forthwith carefully sutured as soon as the intestines would be found to have been introduced into their right place. Intestines dislodged from their proper seat, or not introduced into their correct position, or coiled up into a lump bring on death.
Subsequent Treatment:— [After the full and correct introduction of the intestines] the wound should be bandaged with a piece of silk-cloth saturated with clarified butter, and the patient should be given a draught of tepid clarified butter (D. R. tepid milk) with castor oil for an easy passage of the stool and downward coursing of the Vayu (spontaneous emission of the flatus). Then, for its healing up (Ropana), a medicated oil, prepared with the bark of the Asvakarna, Dhava> Shalmali, Mesha-shringi, Shallaki, Arjuna, Vidari, and Kshiri trees and Vala roots should be applied to the wound. For a year the patient should live a life of strictest conticence and forego all kinds of physical exercise.
The legs and the eyes of the patient should be washed and sprinkled with water in the event of the bursting out of the testicles which should be introduced into their proper place within the scrotum, and sewn up in the manner of a Tunna-sevani (raised seam). The scrotum should be bandaged in the shape of a Gophana-Vandha and a restraining apparatus (Ghatta- Yantra) placed round the waist of the patient (to guard it against its oscillations or hanging down). The wound should not be lubricated with any kind of oil or Ghrita inasmuch as it would make the wound moist and slimy. The wound should be healed with a medicated oil prepared with Kalanusari, Aguru, Ela, Jati flower, Chandana, Padmaka, Manahshila, Devadaru, Amrita and sulphate of copper (pounded together).
A plug of hair should be inserted into a wound on the head, after having extracted the foreign matter therefrom, with a view to arrest the exuding of the brain matter (Mastulunga) which invariably proves fatal to the patient through the aggravation of the deranged Vayu in consequence thereof. The hairs of the plug should be taken out one by one as the healing process progresses (granulation). An oleaginous medicated plug or lint should be inserted into a wound on any other part of the body, which should be treated with the measures and remedial agents laid down in connection with a traumatic ulcer after having first allowed the vitiated blood to escape.
The medicated oil known as the Chakra-taila should be poured (frequently applied) by means of a slender pipe into an ulcer (wound) which is deep-seated but narrow-mouthed, after first letting out the vitiated blood. An oil duly prepared and boiled with Samanga, Haridra, Padma, Trivarga Tuttha, Vidanga, Katuka, Pathya, Guduci and Karanja acts as a good healing (Ropana) agent (in these cases). The use of an oil prepared with Talisha, Padmaka, Mansi, Harenu, Aguru, Chandana, and the two kinds of Haridra, Padma-vija, Ushira and Yashti-madhu acts as a good healing remedy in cases of traumatic ulcers.
A cut wound (Kshata) should be treated with its own specific measures and remedies, while a bruised one (Piccita) should be treated (to all intents and purposes) as a case of Bhagna (bone-fracture). The first treatment of a mangled or contused wound (Ghrishta) is to extinguish pain, after which it should be dusted with the powder of proper medicinal drugs (such as Shala, Sarja, Arjuna, etc.).
In the case of a dislocation of any part of the body, caused by a fall (from a tree), or in the event of having been run over or trampled down (Mathita—by a carriage or by a beast), or of being wounded (by a blow, etc.), the patient should be kept immersed in a large tank (Droni) of oil and the diet should consist of the soup or essence (Rasa) of meat. A man fatigued (from the labours of a journey), or hurt at any of the Marmas, should be likewise treated with the preceding measures. Oil or clarified butter should be always administered as drinks, washes or external healing applications for an ulcer-patient with a due regard to his temperament and the nature of the season. Medicated Ghritas, yet to be mentioned in connection with the medical treatment of a Pittaja abscess, should be used as well in the case of a traumatic ulcer (according to its respective indications). A physician should wash a traumatic ulcer attended with an aching pain either with a Vala-oil or tepid clarified butter (according to the nature of the season and the temperament of the patient).
An oil cooked with Samanga, Rajani, Padma (Bhargi), Pathya, sulphate of copper, Suvarckala, Padmaka, Lodhra, Yashti-madhuka, Vidanga, Harenuka, Talisha-patra, Nalada (Jatamansi), (red) Chandana, Padma- keshara, Manjishtha, Ushira, Laksha, and the tender leaves of Kshiri trees, Piyala seeds, raw and tender Tinduka fruit, or with as many of them as would be available, should be regarded as a good healing remedy in respect of all non-malignant traumatic sores or ulcers. Applications of astringent, sweet, cooling and oily medicines should be used for a week in a case of a traumatic ulcer (Sadyo-vrana), after which those mentioned before, in the Chapter of Divraniya, should be adopted.
Treatment of Dushta-Vrana:— In the case of a malignant ulcer (Dushta-Vrana) emetics, errhines, purgatives, Asthapana, fasting, specific sorts of diet (composed of bitter, pungent and astringent things) and blood-letting, should be prescribed (according to the requirements of each case). The ulcer or sore should be washed with the decoctions of the drugs of both the Aragvadhadi and the Surasadi ganas, and an oil cooked with a decoction of the said drugs should be applied to the wound for the purification (Shodhana) thereof. As an alternative, an oil boiled and prepared in an alkaline water or solution (four times that of oil) with a Kalka of alkaline substances (such as Ghantaparuli, Palasha, etc.) should be used for that end. Oil cooked with Dravanti (Shatamuli, according to certain authorities, Mushika-parni according to others), Chiravilva, Danti, Citraka, Prithvika Nimba-leaves, Kasisa, Tuttha, Trivrit, Tejovati, Nili (indigo), the two kinds of Haridra, Saindhava salt, Tila, Bhumi-Kadamba, Suvaha, Shukakhyay Langalahvay Naipali, Jaliniy Madayanti, Mrigadani, Sudha, Murva, Arka, Kitari, Haritala, and Karanjay or with as many of them as would be available, should be used for the purification (of a malignant sore or ulcer). If found applicable, a medicated Ghrita prepared and cooked with the foregoing drugs and substances as Kalka should be used for the same purpose. In the case of a malignant ulcer, due to the aggravated Vayu, the purifying remedy should consist of a Kalka of Saindhava salt, Trivrit and castor leaves. In the case of a (malignant) Pittaja sore, the remedy should consist of a Kalka of Trivrit; Haridra, Yashtimadhu and Tila. In the case of a malignant ulcer, caused by the aggravated Kapha, the purifying remedial agent should consist of Tila, Tejohva, Danti, Svarjika and Citraka roots. An ulcer brought on owing to the presence of the virus of Meha or Kushtha in the system, measures and remedies mentioned under the treatment of Dushta-vrana should be adopted and used.
The recognized school of physicians, which recognizes these six types of traumatic sores, does not add to the list, herein mentioned, other types of ulcers, whereas vain pedagogues try to swell it with a larger number of types by adding connotative prefixes and suffixes to the names of the aforesaid six. It is mere vain-gloriousness on their part to say so, since all the other types that they can devise are but single instances and can be made to fall under one of these six general heads. Hence there should be only six kinds (of traumatic sores) and not more.
This concludes the section of the Chikitsita Sthana of the Sushruta Samhita which deals with the treatment of Sadyo-vrana (traumatic sores).