Now the treatment of granthi, apacī, arbuda, and galagaṇḍa is explained, as taught by Lord Dhanvantari. For these granthi swellings, the physician who knows the method should apply the treatment taught for śopha in full detail and should continually protect the person's strength, because preserved strength overcomes the strength of disease.
The commentary explains śopha-kriyā as the sequence beginning with apatarpaṇa and extending through virecana. It takes vistaraśaḥ to mean that these measures should be applied extensively or for the most part.
Key terms
granthi
A classical category of nodular swelling addressed in this chapter.
śopha-kriyā
The therapeutic sequence taught for swelling, invoked here for granthi.
apatarpaṇa
A reducing regimen identified as the beginning of the treatment sequence.
bala
The person's strength, which the passage directs the physician to preserve.
Adhikarana ௨ (௪) · Śloka ௪
தைலஂ பிபேத் ஸர்பிரதோ த்வயஂ வா தத்த்வா வஸாஂ வா த்ரிவதஂ விதத்யாத் |
அபேஹிவாதாதஶமூலஸித்தஂ வைத்யஶ்சதுஃஸ்நேஹமதோ த்வயஂ வா ||௪||
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तैलं पिबेत् सर्पिरथो द्वयं वा दत्त्वा वसां वा त्रिवृतं विदध्यात् |
अपेहिवातादशमूलसिद्धं वैद्यश्चतुःस्नेहमथो द्वयं वा ||४||
Meaning of the śloka
The physician may prescribe oil, ghee, a combination of two fats, a three-fat combination including vasā, a four-fat combination, or a suitable pair of fats. The latter preparations are described as processed with prasāriṇī and daśamūla.
The commentary places this internal oleation in an unripe granthi as preparation for drainage and cleansing. It explains the alternatives as oil, ghee, oil with ghee, three fats made from oil, ghee, and vasā, or four fats comprising ghee, oil, vasā, and marrow; any pair among them may also be used. Apehivātā is identified as prasāriṇī. One interpretation treats the first alternatives as unprocessed and the later combinations as processed with paste and decoction of prasāriṇī and daśamūla. Although the verse states the fats generally, the commentator says selection should consider doṣa involvement, cause, constitution, place, season, suitability, and associated factors. Gayī records another reading, ‘in an unripe swelling one should prepare it with daśamūla,’ and explains oil for a vāta type, ghee for a pitta type, oil for a kapha type, and combinations of two, three, or four fats for mixed types, each processed with the corresponding materials.
Key terms
sneha
Fatty substance used here for internal oleation before further treatment.
trivṛta
In this commentary, a combination of oil, ghee, and vasā.
catuḥsneha
A four-fat combination of ghee, oil, vasā, and marrow.
apehivātā
A plant name identified by the commentator as prasāriṇī.
daśamūla
The group of ten roots used to process the fats in one reading.
For a granthi attributed to vāta, a paste of hiṃsrā, rohiṇī, amṛtā, bhārgī, śyonāka, bilva, aguru, kṛṣṇagandhā, gojī, and tālapatrī is prescribed. Various forms of fomentation, poultices, and other established pastes may also be used. When the swelling has matured, it is opened, the pus removed, and the site washed with specified decoctions. It is then cleansed with sesame combined with castor leaves and rock salt. Once clean, the wound is treated with oil prepared with rāsnā and saralā, or with an oil prepared with viḍaṅga, yaṣṭīmadhuka, amṛtā, and milk.
The commentary identifies rohiṇī as kaṭukā and amṛtā as guḍūcī. It identifies kṛṣṇagandhā as śobhāñjanaka, while others understand it as śamī; gojī as gojihvikā, while others say śākhoṭaka; and tālapatrī as musalī. The other established applications are those such as mātuluṅgī taught in the mixed-treatment context. Narendra is identified as kiramālaka, and ‘water’ here means a decoction. Pañcāṅgula is castor. Another reading has ‘decoctions of the bilva and arka groups.’ Saralā is taken as trivṛt, though some identify it as the śāla tree. The clean wound is treated with oil containing powders of rāsnā and saralā, or with oil cooked using the stated pastes and four times its quantity of cow's milk.
Key terms
anilaja granthi
A granthi attributed to vāta in the classical framework.
sveda
Fomentation or heating treatment described before invasive management.
upanāha
A poultice-type application.
saralā
A disputed plant identification, read as trivṛt or, by some, the śāla tree.
For a granthi attributed to pitta, leeches and irrigation with milk and water are said to be beneficial. Cooling decoctions of the kākolī group may be taken with sugar, and powdered harītakī with grape juice or sugarcane juice. Pastes made from the barks of madhūka, jambu, arjuna, and vetasa, or from specified roots with sugar, are applied repeatedly. If the swelling matures, it is opened, the pus removed, and the site washed with a decoction of the named trees. It is cleansed with sesame and yaṣṭīmadhuka, after which ghee prepared with sweet-group substances is applied.
The commentary identifies tṛṇaśūnya tubers as ketakī roots and explains abhīkṣṇam as continual or repeated application. Muculunda is identified as kaṇṭakīmadana, though others understand mucukunda. The ‘trees’ whose decoction is used for washing are vaṭa, plakṣa, pippala, and udumbara. The sweet substances used to prepare the ghee are those of the kākolī group and related materials.
Key terms
jalaukas
Leech therapy, prescribed here within the classical treatment of a pitta-attributed swelling.
pariṣecana
Pouring or irrigation over the affected site.
kākolī-varga
A classical group of substances characterized here as cooling or sweet.
muculunda
A plant name identified differently as kaṇṭakīmadana or mucukunda.
In a granthi attributed to śleṣman, after the doṣas have been removed in the prescribed sequence, the fomented swelling is to be softened or reduced by massage with the thumb, metal, stone, or a bamboo rod. A knowledgeable physician then applies a paste made from the roots or substances named as vikaṅkata, āragvadha, kākaṇantī, kākādanī, tāpasavṛkṣa, piṇḍaphala, arka, bhārgī, karañja, kālā, and madana.
The prescribed sequence is explained as beginning with oleation and fomentation. The commentary says kapha, pitta, vāta, and blood are removed through emesis, purgation, decoction enema, nasal cleansing, and bloodletting as applicable; the fomented swelling is then reduced by massage with the listed implements. It identifies vikaṅkata as kaṭāyikā, āragvadha as kiramālaka, kākaṇantī as guñjā, kākādanī as vāyasatindukā—while others read ahiṃsrā—tāpasavṛkṣa as iṅguda, piṇḍaphala as bitter bottle gourd, and kālā as kaṭuhiṃsrā.
Key terms
śleṣma-samutthita granthi
A granthi attributed to kapha in the classical framework.
vimlāpana
Softening or reducing a swelling by massage in this passage.
kākaṇantī
A plant identified here as guñjā.
kākādanī
A plant identified as vāyasatindukā, with ahiṃsrā recorded as another reading.
A granthi that has arisen away from a marma, has not subsided, and is still unripe is to be opened and removed. After bleeding has stopped, the skilled practitioner applies cautery and then follows the regimen taught for a fresh wound.
The commentary understands this specifically as a kapha-origin granthi away from a marma that has failed to settle with the previously described measures. It is opened and removed before maturation. The fresh-wound regimen is said to include applications such as honey and ghee. A variant reading is also recorded: ‘one that is away from a marma and is maturing in this manner.’
Key terms
amarmajāta
Arising away from a classically designated vital or vulnerable site.
apakva
Unripe or not suppurated.
dāha
Cauterization described after control of bleeding.
sadyaḥkṣata-vidhi
The regimen taught for management of a fresh wound.
या मांसकन्द्यः कठिना बृहत्यस्तास्वेष योज्यश्च विधिर्विधिज्ञैः |
शस्त्रेण वाऽऽपाट्य सुपक्वमाशु प्रक्षालयेत् पथ्यतमैः कषायैः ||१५||
संशोधनैस्तं च विशोधयेत्तु क्षारोत्तरैः क्षौद्रगुडप्रगाढैः |
शुद्धे च तैलं त्ववचारणीयं विडङ्गपाठारजनीविपक्वम् ||१६||
Meaning of the śloka
The same method is prescribed for large, hard māṃsakandī growths. A well-matured lesion may be opened promptly with an instrument and washed with suitable decoctions. It is then cleansed with preparations dominated by alkali and mixed thickly with honey and jaggery. Once clean, oil prepared with viḍaṅga, pāṭhā, and rajanī is applied.
The commentary describes māṃsakandī as large proliferations of flesh and extends the preceding treatment to them. Instrumental opening is reserved for a lesion away from a marma; one at a marma is treated with medicines. The suitable decoctions are those considered beneficial for kapha-origin wounds. The cleansing preparations are chiefly based on yavakṣāra. An alternative reading replaces ‘honey and jaggery’ with ‘honey and ghee.’
Key terms
māṃsakandī
A large, hard proliferation or growth of flesh in the commentator's explanation.
marma
A classically vital or vulnerable site where instrumental opening is avoided here.
kṣārottara
A preparation in which alkaline material is predominant.
yavakṣāra
A barley-derived alkaline preparation identified as the chief alkali here.
For a granthi attributed to medas, cloth coated with sesame paste is placed over it and repeatedly rubbed with heated metal without directly burning the lesion; alternatively, heating is performed with a wooden implement coated with heated lac. The passage then describes opening the unripe lesion, removing the fatty material, and cauterizing it, or opening it after maturation. It is washed with urine, cleansed with a strongly alkaline mixture containing finely ground sesame and the named mineral and other substances, rock salt, honey, and ghee, and then treated with oil prepared from two kinds of karañja, guñjā, bamboo scraping, iṅguda, and urine.
The commentary introduces this as treatment of medogranthi and identifies dārvī as a wooden implement. For an unripe lesion it explains that an instrument is introduced, the fatty material removed, and cautery applied; a mature lesion is opened and washed with cow urine or another specified urine. Cleansing then uses a preparation chiefly containing sesame, suvarcikā, yavakṣāra, rock salt, haritāla, honey, and ghee. Finally, oil cooked with a paste of the two karañjas and the other listed substances, using four times the amount of cow urine as liquid, is said to promote healing. Vaṃśāvalekha is identified as bamboo bark or scraping.
Key terms
medogranthi
A granthi classically attributed to medas or fatty tissue.
haritāla
A mineral substance included in the historical cleansing preparation.
kṣārottara
A mixture in which alkaline substances predominate.
vaṃśāvalekha
Bamboo bark or a scraping from bamboo, according to the commentary.
dārvī
A wooden implement used for indirect heating in this description.
Ghee with jīmūtaka, kośavatī, dantī, dravantī, and trivṛt is prescribed for advanced apacī and said to clear doṣas by both routes. An emetic with nirguṇḍī, jātī, barihiṣṭha, jīmūtaka, honey, and rock salt is described for severe apacī. Named oils are used for head or nasal cleansing, and madhūka, śigru, or kharamañjarī as avapīḍa.
The commentary identifies the plants and explains dvidhāpravṛtta as cleansing by both routes. It preserves alternative paste/decoction methods, a nirguṇḍī/kaiḍarya reading, and disagreement over śākhoṭaka oil. Avapīḍa is pressed nasal administration, here where excessive dryness is absent.
पार्ष्णिं प्रति द्वे दश चाङ्गुलानि मित्वेन्द्रबस्तिं परिवर्ज्य धीमान् |
विदार्य मत्स्याण्डनिभानि वैद्यो निष्कृष्य जालान्यनलं विदध्यात् ||२५||
आ गुल्फकर्णात् सुमितस्य जन्तोस्तस्याष्टभागं खुडकाद्विभज्य |
घोणर्जुवेधः सुरराजबस्तेर्हित्वाऽक्षिमात्रं त्वपरे वदन्ति ||२६||
Meaning of the śloka
A remote operation for apacī is described: after measuring from the heel and avoiding indrabasti, the site is opened, fish-roe-like fatty networks removed, and cautery applied. Another reading uses the ankle prominence and a straight puncture, with competing distances.
The commentary preserves extensive disagreement over site, laterality, measurement, and indrabasti. Some operate on the leg opposite the apacī; others locate the posterior heel region. Jejjaṭa and others differ on distances. Ghoṇarjuvedha is a straight puncture near a tendon. Citations connect leg tissue with upper swellings and galamālā without resolving the variants.
The commentary extends the earlier leg operation by analogy to the arm for apacī near the axilla and elbow, giving proportional and eye-width measurements for three separated lines above the wrist.
At the powder stage, ash from peacock or a variant creature, crow, monitor lizard, snake, and tortoise is prescribed with iṅgudī oil; ślīpada oils are also allowed. Purgation, medicated smoke, and a barley-and-mung diet follow.
The commentary calls this the healing stage and the ash an alkali. Pracalāka is peacock by one view and kṛkalāsa by another. It explains verse 28 but not the later purgation, smoke, or diet.
For vātaja arbuda, warm seed, milk, ghee, water, oil, meat, or vesavāra poultices are prescribed. Tube fomentation and repeated horn bloodletting follow. Alternatively, a repeatedly processed preparation of vāta-pacifying decoction, milk, sour liquid, and fats is drunk.
The commentary identifies the seeds, explains upanāha as binding, and adds milk and ghee with associated rakta and pitta. Śatapāka is hundredfold processing. Trivṛta is alternatively ghee, oil, and animal fat; another view follows the apatānaka method.
स्वेदोपनाहा मृदवस्तु कार्याः पित्तार्बुदे कायविरेचनं च |
विघृष्य चोदुम्बरशाकगोजीपत्रैर्भृशं क्षौद्रयुतैः प्रलिम्पेत् ||३२||
श्लक्ष्णीकृतैः सर्जरसप्रियङ्गुपत्तङ्गरोध्राञ्जनयष्टिकाह्वैः |
विस्राव्य चारग्वधगोजिसोमाः श्यामा च योज्या कुशलेन लेपे ||३३||
श्यामागिरिह्वाञ्जनकीरसेषु द्राक्षारसे सप्तलिकारसे च |
घृतं पिबेत् क्लीतकसम्प्रसिद्धं पित्तार्बुदी तज्जठरी च जन्तुः ||३४||
Meaning of the śloka
For pittaja arbuda, gentle fomentation, mild poultices, and bodily purgation are prescribed. The lesion is rubbed with honey-coated leaves, treated with named pastes after drainage, and a medicated cleansing ghee is taken.
Gentle fomentation is liquid heat and the poultice is not very hot. Bodily purgation excludes head-cleansing. Alternative identities for gojī and soma are preserved, and the ghee is interpreted for pittaja arbuda and pittodara.
For cleansed kaphaja arbuda, blood is let and a paste of two-route cleansing substances applied. Other applications combine bird excreta, bronze residue, named plants, urine, and kākādanī root, or use alkali.
The commentary specifies emesis and alābu bloodletting and identifies the ingredients. One reading combines urine with alkali; another, kṣārapraghṛṣṭaiḥ, means processing the substances with alkaline water.
A paste of niṣpāva, oil-cake, and kulattha, made thick with meat and mixed with the watery portion of curd, is to be applied so that worms become stupefied and flies release them. When the projecting part has been eaten by the worms and only a little remains, it is scraped and then cauterized. A lesion with a small root is wrapped with plates of tin, copper, lead, or iron. Alkali, fire, and surgical instruments are to be employed repeatedly by an attentive physician without harming vital structures. A decoction of āsphoṭa, jātī, and karavīra leaves is prescribed for cleansing the wound. Once clean, oil prepared with bhārgī, viḍaṅga, pāṭhā, and triphalā is applied; lesions that ripen accidentally are managed according to the stated sequence for suppuration.
The commentary identifies niṣpāva as śimba and explains that the worms become senseless and fall, while the flies release the worms. The remaining projection is small because worms have eaten it. Asakṛt means repeatedly, and apramatta emphasizes careful attention. Āsphoṭā is identified as sārivā. After cleansing, the bhārgī-containing oil is used for healing and is prepared according to the general method for medicated oil. Yadṛcchayā is explained as an unexpected occurrence, such as one produced by trauma or another unintended cause.
Key terms
kṛmi
Worms used in the historical removal process described in the passage.
kṣāra
An alkaline cauterizing substance mentioned among repeated local measures.
A medorbuda is first fomented, then opened and cleansed; after bleeding has ceased, it is promptly sutured. The wound is then contracted with powders of haridrā, household soot, rodhra, and pataṅga, combined with manaḥśilā and āla and made thick with honey. When the wound is clean, karañja oil is applied. If an arbuda is treated while some causative disorder remains, it soon recurs; therefore it is to be removed without residue, because what remains may destroy the person just as a remaining fire does.
The commentary identifies pataṅga as red wood and āla as haritāla. It says that the karañja oil is the preparation taught for vidradhi, while recording another opinion that the oil expressed from karañja fruit itself is intended. The passage's rationale is that incomplete removal permits recurrence.
Key terms
medorbuda
A classical fatty mass category discussed here.
arbuda
A classical term for a mass or swelling; it does not by itself specify a modern diagnosis.
manaḥśilā
A mineral substance included in the historical wound powder.
haritāla
The mineral identified by the commentary for āla.
karañjataila
Karañja oil, whose precise preparation is interpreted in two ways by the commentary.
For a vāta-origin swelling of the neck, fomentation is first given through a tube with leaves of vāta-relieving drugs, using various sour liquids, urine preparations, warm milk, oil, and meat preparations as contextually indicated. After fomentation, drainage is performed attentively, and the cleansed lesion is covered with a poultice. Repeated applications are described using sesame together with the listed seeds, roots, plants, and fermented sour liquid. Oil prepared with amṛtavallī, nimba, haṃsāhvayā, vṛkṣaka, pippalī, the two balās, and devadāru is prescribed for regular internal use in galagaṇḍa.
Patrabhaṅga means tender leaves and anilaghna means vāta-relieving. The commentary differentiates the fomentation liquid by the stated condition: leaves such as eraṇḍa in uncombined vāta, sour liquids such as kāñjika when pitta obstructs vāta, urine-decocted materials when kapha obstructs it, milk when rakta obstructs it, and meat broth or meat cooked with leaves when vāta arises from depletion of tissues. Drainage is explained as using leeches or venesection near the root of the thigh. After removal of blood and other material, the galagaṇḍa is continuously poulticed with the named seeds. The commentator observes that Suśruta can call blood removal śuddhi, while the Caraka statement that purification has four kinds is regarded as a general rule rather than an exhaustive restriction. Kiṇva is the fermenting seed of surā. The commentary supplies plant identifications, including haṃsāhvayā as haṃsapadī and vṛkṣaka as kuṭaja, while preserving an alternative identification of ekaiṣikā as either ambaṣṭhā or, according to some, trivṛt. The final syntax means that the prepared oil is to be drunk.
Key terms
galagaṇḍa
A classical category of swelling in the neck region.
anilaghna
A substance described as counteracting vāta.
visrāvaṇa
Drainage or evacuation, interpreted here to include blood-removing procedures.
upanāha
A warm or covering poultice applied to the cleansed lesion.
ekaiṣikā
A plant variously identified as ambaṣṭhā or trivṛt.
A kapha-origin swelling is fomented with sudation and poultices and then drained. Afterwards, the listed plants are ground in water prepared with palāśa ash and applied while comfortably warm. Oil prepared with pippalī and related ingredients and combined with the five salts is prescribed internally. Therapeutic emesis, cleansing through the head, and evacuative smoke are also said to be beneficial. If a vāta- or kapha-origin swelling reaches suppuration, the physician is to follow the established sequence for managing suppuration.
The commentary introduces this as treatment for kapha-origin galagaṇḍa because a separate pitta-origin type is not recognized here. The sudation is dry, and the poultice contains alkali and urine. It gives identifications for ajagandhā, viśalyā, viṣāṇikā, and śukāhvaya. Daśārdhasaṅkhyaiḥ lavaṇaiḥ means the five salts, and the oil is prepared with decoction and paste of pippalī and the other ingredients. Pākaṅgatayoḥ refers to vāta- and kapha-origin swellings that have reached suppuration.
Key terms
kaphasambhava
Described as arising from kapha in the classical classification.
pañcalavaṇa
The group of five salts intended by the phrase 'half of ten.'
mūrdhavirecana
A classical evacuative procedure directed through the head or nasal route.
vairecanika dhūma
Evacuative medicinal smoke described as beneficial here.
For galagaṇḍa, the passage recommends edible preparations and barley foods combined with kaṭutrika and honey and processed with urine, together with mung-bean soups containing fresh ginger, paṭola, and nimba.
The commentary presents this formulation as applicable to all forms of galagaṇḍa. Bhakṣya refers to foods such as dhānollumba, and yavānna to barley preparations such as gṛñjana. Samūtra means that the edible preparations and barley are steamed or cooked with urine and then dried. They are combined with kaṭutrika and honey. Maudga rasa means mung-bean soup, and saśṛṅgavera indicates that it is given with fresh ginger.
Key terms
kaṭutrika
The classical group of three pungent substances used here with honey.
yavānna
Foods prepared from barley.
maudga rasa
A soup or liquid preparation made from mudga, or mung bean.
śṛṅgavera
Ginger, specified by the commentary as fresh ginger in this passage.
galagaṇḍa
The classical neck-swelling category for which these foods are prescribed.
For a galagaṇḍa arising from medas, a vein previously specified is punctured after the person's body has been oleated. A topical paste is described using śyāmā, sudhā, iron residue or excrement, dantī, rasa, and añjana. Alternatively, the heartwood of śāla and related trees is stirred with urine and taken in the morning. Another course is to cut open the swelling, remove the fatty material, and suture it, or to cauterize it with marrow, ghee, fat, and honey. After cauterization, ghee and honey are applied, followed by powders of kāsīsa and tuttha mixed with gorocanā. Oil is applied, then ash derived from heartwood and cow dung. Regular washing with triphalā decoction, firm bandaging, and a barley diet are also prescribed.
The vein intended is the one previously specified near the thigh joint. The commentary identifies śyāmā as trivṛt and sudhā as sehuṇḍa. It explains lohapurīṣa as iron residue, but records another view that loha means agaru and purīṣa means pigeon or dove droppings. A karṣa measure of heartwood paste from śāla and related trees is said to be drunk with cow urine; Jejjaṭa instead says that ash produced from the heartwood is stirred into urine and drunk. After cauterization, honey and ghee constitute the subsequent treatment, followed by powder of kāsīsa, tuttha, and gorocanā on the wound. Sārodbhava is understood as produced from the heartwood of śāla and related trees, and triphalā decoction is used for washing.
Key terms
medaḥsamuttha galagaṇḍa
A classical neck swelling described as arising from medas.
sirāvyadha
Puncturing a vein for blood removal.
lohapurīṣa
Read as iron residue, with an alternative parsing involving agaru and bird droppings.
sārodbhava
Material derived from the heartwood of śāla and related trees, interpreted as paste or ash in differing readings.
kāsīsa
A mineral substance applied as powder to the wound in the historical regimen.
tuttha
A mineral substance combined with kāsīsa and gorocanā.
The commentary closes the eighteenth chapter of the Cikitsāsthāna in Dalhaṇa's Nibandhasaṅgraha commentary on the Suśruta Saṃhitā. The supplied text contains the variant spelling Dalhaṇa/Dalhana in the commentator's name.
Key terms
Cikitsāsthāna
The section of the Suśruta Saṃhitā concerned with treatment.
granthi
A classical category of nodular swelling named in the chapter title.
apacī
A classical swelling category named in the chapter title.
arbuda
A classical mass category named in the chapter title.
galagaṇḍa
A classical neck-swelling category named in the chapter title.