Now the treatment of kṣudraroga is explained, as taught by Dhanvantari. An unripe ajagallikā is to be treated with leeches and with external pastes made from the named alkaline substances, or with a paste of śyāmā, lāṅgalikī, and pāṭhā. Once it has ripened, it is to be managed according to the previously described principles for wounds.
The commentary identifies śukti as water-shell, śrughṇī as svarjikā, and yava as the familiar barley; it explains that the word kṣāra applies separately to each. Gayī gives a different sequence: an unripe ajagallikā is first coated with a paste of yavakṣāra, śukti, and saurāṣṭrī, and is then drained with leeches. This order is supported by the general statement that application of a paste is the first measure for all swellings.
Key terms
ajagallikā
A named minor disease or localized swelling treated here according to whether it is unripe or ripe.
jalaukā
A leech used here for therapeutic blood removal.
kṣāra
An alkaline substance; the commentary applies this designation to each named ingredient.
vraṇavidhāna
The previously taught method for managing a wound.
For the conditions named andhālajī, yavaprakhyā, panasī, kacchapī, and pāṣāṇagardabha, fomentation is prescribed first. A paste of manaḥśilā, tāla, kuṣṭha, and dāru is then applied. When the lesions have fully ripened, they are opened and subsequently managed like wounds.
🔊 Audio coming soon
Hide commentary
अन्धेत्यादि||५-६||
Meaning of the commentary
The supplied commentary only marks the beginning and verse range of this passage and gives no further explanation of its terms or reasoning.
Key terms
svēda (sveda)
Fomentation or application of warmth, prescribed as the initial measure.
manaḥśilā
A named mineral ingredient in the external paste.
paripāka
The stage at which a lesion is considered fully ripened.
vraṇavat
To be managed in the manner prescribed for a wound.
The conditions vivṛtā, indravṛddhā, gardabhī, jālagardabha, irivellī, gandhanāmnī, kakṣā, and visphoṭaka are to be treated by the measures prescribed for pitta-origin visarpa. Once the lesions have ripened, healing is to be promoted with ghee prepared using sweet-category medicinal substances.
🔊 Audio coming soon
Hide commentary
मधुरौषधानि काकोल्यादीनि||७-८||
Meaning of the commentary
The commentary explains that the sweet-category medicines intended here are those beginning with kākolī.
Key terms
visphoṭaka
A named eruptive or blistering condition in this group of minor diseases.
pittaja visarpa
Pitta-associated visarpa whose treatment is used here as the model.
madhurauṣadha
Medicines of the sweet category, identified by the commentary as the group beginning with kākolī.
Cipya or cippa is moistened with hot water; the affected tissue is excised and allowed to drain. It is then anointed with mechanically pressed oil, dusted with sarja powder, and treated with a bandage. If this cannot be done, the text prescribes cautery, followed by healing oil prepared with sweet-category medicines. The same method is prescribed for kunakha, while anuśayī is to be treated like a kapha-type vidradhi.
The commentary interprets utkṛtya as excising ripened, unhealthy flesh. Cakrataila means oil pressed by a mechanical wheel, distinguished from oil pressed by hand or another means. It also preserves a variant passage: cippa is treated by bloodletting and cleansing; after heat has subsided it is irrigated with warm water, appropriately excised with an instrument, and drained. The wound is then cleansed with pastes of śilā, tejovatī, rocanā, and rasāñjana, and healing is promoted with sesame oil prepared from haridrā, aguru, kālīyaka, and rasāñjana. The commentator identifies this entire method as the regimen for cippa.
Key terms
cipya (cippa)
A named lesion for which excision, drainage, and wound care are described.
cakrataila
Oil extracted by a mechanical wheel or press.
agnidāha
Thermal cautery prescribed when the preceding measure is considered impracticable.
kunakha
A nail disorder to which the same regimen is extended.
anuśayī
A named lesion to be managed by analogy with kapha-type vidradhi.
Vidārikā is first anointed, fomented, and gently reduced, then coated with a well-ground paste of nagavṛttika, varṣābhū, and bilva root. If it has become wound-like, cleansing is performed and an oil cooked with astringent and sweet-category medicines is used for healing. An unripe vidārikā may instead be drained by superficial punctures or leeches and covered with a paste of ajakarṇa and pālāśa root. A ripe lesion is opened with an instrument, dressed with a paste of paṭola and picumarda mixed with sesame and ghee, bandaged, washed with decoctions of latex-bearing trees and khadira, cleansed, and then healed.
The commentary explains vimlāpya as gentle manipulation with the thumb and similar means. It identifies nagavṛttika as jiṅginī, popularly called guḍamajjanikā, while others call it vṛścikālī. The astringent medicines are the group beginning with nyagrodha, and the sweet medicines are those beginning with kākolī. Ajakarṇa is identified as sarja, pālāśa here as śaṭī, and picumarda as nimba. The latex-bearing trees are listed as vaṭa, udumbara, plakṣa, pippala, and gardabhāṇḍa.
Key terms
vidārikā
A named swelling or lesion treated differently at unripe, ripe, and wound-like stages.
vimlāpana
Gentle manipulation or reduction, explained as being performed with the thumb and similar means.
pracchāna
Superficial puncturing or scarification for blood drainage.
kṣīravṛkṣa
Latex-bearing trees whose decoctions are prescribed for washing the wound.
Śarkarārbuda is to be treated according to the method for medōrbuda. Kacchū, vicarcikā, and pāmā are to be managed like kuṣṭha. Recommended external measures include pastes of wax, śatāhvā, and white mustard, or vacā, dārvī, and mustard; naktamāla oil may also be used. For anointing, the text prescribes a heartwood-derived oil cooked with pungent medicines.
The commentary says that naktamāla oil may be used uncooked, while another reading understands it as oil prepared with pungent medicines. Sārataila is explained as oil derived from heartwoods such as śiṃśapā, aguru, sarala, and devadāru, and the pungent medicines are those beginning with pippalī. It also records a textual variant reading sāralam tailam instead of sāratailam; under that reading, oil from sarala heartwood is to be prepared according to the general method for medicated fats. These alternatives are left unresolved.
Key terms
śarkarārbuda
A classical mass-like disorder treated by analogy with medōrbuda.
kacchū
A named itching or skin disorder grouped here with vicarcikā and pāmā.
sārataila
Oil derived from the heartwood of named trees according to the main commentary reading.
sāralam tailam
An alternative reading interpreted as oil from sarala heartwood.
For pādadārī, a vein is punctured and fomentation and oil application are employed. A foot paste is praised that combines beeswax, animal fat, marrow, sarja powder, and ghee with yavakṣāra and gairika.
The commentary specifies the sequence: oleation and fomentation are performed first, and only afterward is the vein punctured. It identifies yavāhva in the verse as yavakṣāra.
Key terms
pādadārī
A classical condition involving fissuring of the feet.
sirāviddha
Puncturing a vein for therapeutic blood removal.
yavakṣāra
Alkali prepared from barley, identified by the commentary as yavāhva.
gairika
A red mineral substance included in the foot paste.
For alasa, the feet are washed with āranāla and a paste of nimba, tila, kāsīsa, āla, and saindhava is considered beneficial. The passage also prescribes lākṣā liquid with abhayā, or bloodletting; mustard oil prepared in a decoction of kaṇṭakārī; or rubbing with powders of kāsīsa, rocanā, and śilā.
The commentary identifies śilā as manaḥśilā and explains pratisāraṇa as rubbing or friction. It gives no further explanation of the formula or alternatives.
Key terms
alasa
A named disorder of the feet addressed by external applications and bloodletting.
āranāla
A fermented sour liquid used here to wash the feet.
raktamokṣaṇa
Therapeutic removal of blood.
pratisāraṇa
Rubbing an affected area with a powdered substance.
manaḥśilā
The mineral substance intended by śilā according to the commentary.
The commentary explains that kadara is first cut out with a surgical instrument and then cauterized specifically with oil heated by fire, because oil is understood to enter minute pathways. It also preserves another view: every fatty substance heated by fire has this penetrating quality, so any such substance may be used.
Key terms
kadara
The named localized lesion treated in this passage.
utkṛtya
Having excised or cut out.
sneha
An unctuous or fatty substance, interpreted here principally as oil.
dāha
Therapeutic burning or cauterization in the historical procedure.
For indralupta, after oleation and fomentation, a vein on the head is to be opened. Pastes containing marica with śilā, kāsīsa, and tuttha, or a paste of kuṭannaṭa and dāru, are recommended. Alternatively, the area is deeply scarified and repeatedly covered with guñjā paste for relief, or rasāyana is undertaken. Oil prepared with mālatī, karavīra, agni, and naktamāla is praised for massage as a foremost remedy for indralupta.
The commentary identifies kuṭannaṭa as tagara. It interprets the recommendation of rasāyana as indicating that the disorder is difficult to treat and cannot be removed without rasāyana, which it identifies with the eighteen divine medicinal plants and Soma, king of medicines. For the final oil, it applies the standard rules of medicated-oil preparation: pungent oil is cooked with a paste of jāti and the other named plants and four times its quantity of cow urine, then used to anoint the head.
Key terms
indralupta
The classical scalp or hair-loss disorder addressed here.
sirāmokṣa
Opening a vein for therapeutic blood removal.
pracchana
Scarification by repeated superficial incisions, described here as deep.
rasāyana
A specialized restorative regimen, interpreted here through divine medicinal plants and Soma.
guñjā
A named toxic plant used in the historical topical paste.
For arūṃṣikā, after blood has been removed, the area is irrigated with neem water. It is then covered with horse-dung liquid mixed with saindhava, or with pastes containing haritāla, niśā, neem, and paṭola-derived substances. Another paste may contain yaṣṭī, blue lotus, castor, and mārkava. The oil praised for indralupta is also recommended for massage.
The commentary specifies that blood is removed again with leeches and that neem decoction is poured all around the affected area. It then directs application of horse-dung liquid with abundant powdered saindhava. It identifies mārkava as bhṛṅgarāja and allows either the group beginning with haritāla or that beginning with madhuka as a paste. Massage with the jāti-based oil described for indralupta is said to cleanse and heal arūṃṣikā.
Key terms
arūṃṣikā
The named scalp or skin disorder treated in this passage.
jalaukā
A leech used here for therapeutic blood removal.
haritāla
A mineral substance used in a historical topical paste.
mārkava
Identified by the commentary as bhṛṅgarāja.
śodhana-ropaṇa
Cleansing and healing, the effects attributed to the medicated oil.
For dāruṇaka, after oleation and fomentation, a vein on the head is to be punctured. Avapīḍa, śirobasti, and massage are to be employed, and water made alkaline with kodrava grass is praised for washing.
The commentary says that treatment for palita is being deferred: ‘later’ refers to the treatment taught in the Miśraka section.
Key terms
palita
The classical condition whose treatment is deferred to a later section.
upariṣṭāt
Later or subsequently in the text.
Miśraka
The later treatment section to which the commentary directs the reader.
Adhikarana १४ (३१) · Śloka ३२
मसूरिकायां कुष्ठघ्नलेपनादिक्रिया हिता ||३१||
पित्तश्लेष्मविसर्पोक्ता क्रिया वा सम्प्रशस्यते |३२|
Meaning of the śloka
For masūrikā, measures beginning with pastes described as countering kuṣṭha are beneficial. Alternatively, the treatment prescribed for pitta- and kapha-associated visarpa is especially recommended.
🔊 Audio coming soon
Hide commentary
मसूरिकायामित्यादि| आदिशब्देनोद्वर्तनघृतादि||३१||-
Meaning of the commentary
The commentary explains that the word ‘and so forth’ includes measures such as dry rubbing and the use of ghee.
Key terms
masūrikā
The classical eruptive disorder addressed here.
kuṣṭhaghna
Described in the source as countering disorders within the kuṣṭha category.
visarpa
A classical spreading disorder whose pitta- and kapha-oriented treatment is referenced.
udvartana
Dry rubbing or powder massage, included by the commentary.
The commentary distinguishes the methods by suitability: kṣāra is used for lesions appropriate for alkali, while fire is used for those not to be treated with kṣāra.
Key terms
jatumaṇi
One of three named skin lesions treated by excision and cautery.
maṣaka
One of the named skin lesions in the passage.
tilakālaka
One of the named pigmented lesions in the passage.
kṣāra
A caustic alkaline preparation used for cauterization.
agni
Fire or thermal cautery used where alkali is considered unsuitable.
Adhikarana १६ (३३-३६) · Śloka ३६
न्यच्छेव्यङ्गे सिरामोक्षो नीलिकायां च शस्यते ||३३||
यथान्यायं यथाभ्यासं लालाट्यादिसिराव्यधः |
घृष्ट्वा दिह्यात्त्वचं पिष्ट्वा क्षीरिणां क्षीरसंयुताम् ||३४||
बलातिबलयष्ट्याह्वरजनीर्वा प्रलेपनम् |
पयस्यागुरुकालीयलेपनं वा सगैरिकम् ||३५||
क्षौद्राज्ययुक्तया लिम्पेद्दंष्ट्रया शूकरस्य च |
कपित्थराजादनयोः कल्कं वा हितमुच्यते ||३६||
Meaning of the śloka
For nyaccha, vyaṅga, and nīlikā, bloodletting from veins is praised. According to proper method and established practice, veins of the forehead and related sites are punctured. After rubbing the area, it may be covered with a paste of the bark of latex-yielding trees mixed with their latex; or with balā, atibalā, yaṣṭyāhva, and rajanī. Other recommended pastes contain payasyā, aguru, kālīya, and gairika; a boar's tusk mixed with honey and ghee; or kapittha and rājādana.
The commentary explains that rubbing is performed with substances such as sea foam. The latex-yielding trees are the five trees beginning with vaṭa, whose bark is ground for the paste. It identifies payasyā as arkapuṣpī and kālīya as black sandalwood.
Key terms
nyaccha
A named discoloration or skin condition treated in this passage.
vyaṅga
A named facial discoloration in the classical context.
nīlikā
A named dark or bluish discoloration in the classical context.
sirāmokṣa
Therapeutic opening of veins for blood removal.
kṣīrī vṛkṣa
Latex-yielding trees, interpreted as a group of five beginning with vaṭa.
For these eruptions occurring in youth, emesis is especially recommended. A paste containing vacā, rodhra, saindhava, and mustard may be applied; alternatively, a paste of kustumburu, vacā, lodhra, and kuṣṭha is said to be beneficial.
🔊 Audio coming soon
Hide commentary
यौवने इत्यादि| एष अनन्तरोक्तः||३७||-
Meaning of the commentary
The commentary states that ‘these’ refers to the condition described immediately before this passage. It provides no further explanation of the formulations.
Key terms
yauvane piḍakā
Eruptions occurring in youth, referring back to the immediately preceding condition.
chardana
Therapeutic emesis in the classical treatment described here.
vacā
A named medicinal substance included in both topical combinations.
In the condition called padminīkaṇṭaka, emesis with nīmba water is prescribed. Ghee prepared with that same substance and mixed with honey is then given for drinking. A paste of nīmba and āragvadha is said to be useful for external rubbing.
The commentary explains that the nīmba-āragvadha kalka is intended for utsādana, meaning external rubbing or frictional application. It notes that the word kaṣāya can denote a paste here, citing the statement that kaṣāya preparations are of five kinds.
Key terms
padminīkaṇṭaka
The classical disorder being treated in this passage.
nīmba
The named substance used in the emetic liquid, medicated ghee, and external preparation.
utsādana
External rubbing or frictional application, as explained by the commentary.
kalka
A paste preparation; the commentary says kaṣāya is used in this sense here.
For parivṛtti, the affected skin is anointed with ghee, thoroughly fomented, and bandaged with an upanāha. After further anointing, the skin is gradually brought forward while the glans is pressed. Once the glans has moved within the skin, fomenting poultices made with vāta-relieving substances such as those of the sālvaṇa group are applied for three or five nights. Vāta-relieving bastis and unctuous foods are also prescribed. In this way the physician treats vapāṭikā according to the doṣa.
The commentary glosses upanāhayet as ‘should bind or bandage’ and specifies that the subsequent anointing is with ghee. It says the alternatives of one, three, or five nights are selected according to whether the strength of the doṣa is mild, moderate, or severe.
Key terms
parivṛtti
The genital condition addressed by the initial manipulative treatment.
maṇi
The glans in this anatomical context.
upanāha
A warm poultice and bandaging application; the commentary emphasizes binding.
vapāṭikā
The classical condition said to be treated by these measures.
basti
A classical enema therapy prescribed here for vāta.
For niruddhaprakaśa, a ghee-anointed tube open at both ends—made of iron, wood, or lac—is described as being introduced. Irrigation is prescribed with the fat and marrow of śiśumāra and boar, or with mechanically pressed oil combined with vāta-relieving substances. Every third day, a properly fitting, progressively thicker tube is introduced so that the channel is gradually widened, while unctuous food is given. Alternatively, the seam-like tissue is incised or released and managed like a fresh wound. The conditions sanniruddhaguda, valmīka, and vahnīrohiṇī are to be declared grave or uncertain in prognosis before treatment suited to each is undertaken. Agnirohiṇī is treated by the method stated for visarpa, and sanniruddhaguda by the procedure described for niruddhaprakaśa.
The commentary identifies dāravī as wooden and jatukṛtā as made of lac. It describes śiśumāra as a known aquatic animal and cakrataila as oil pressed by a mechanical device. For the surgical alternative, it explains that the tissue causing narrowing of the urinary passage is cut with an instrument after avoiding or releasing the sevanī. If the resulting opening does not mature adequately, it describes enlarging the opening at the glans in the same manner. The supplied commentary ends after its explanation of verses 43–47 and does not separately explain the final line.
Key terms
niruddhaprakaśa
A classical condition involving narrowing or obstruction at the genital or urinary opening.
nāḍī
A tubular instrument used here for gradual dilation.
sevanī
A seam-like anatomical line that the procedure directs the physician to avoid or release.
sadyakṣata
A fresh wound, whose management is used as the postoperative analogy.
pratyākhyāya
Declaring the grave or uncertain prognosis before undertaking treatment.
A valmīka lesion is described as being excised with an instrument, treated with alkali and heat, cleansed according to the method stated for arbuda, and then healed. When the valmīka is not greatly enlarged and does not arise at a vital point, purification and bloodletting are prescribed. Warm, unctuous pastes and poultices are then made from the listed roots, guḍūcī, salt, palala, and roasted-grain flour. Once suppuration and all tracts have been identified, the physician incises and cauterizes them, removes unhealthy tissue, applies alkali, and promotes healing after the wound is clean. Nīmba oil prepared with the named aromatic and mineral substances is recommended for healing. A swollen valmīka above the hands or feet and surrounded by many openings is said to be unsuitable for treatment.
The commentary argues that treatment may still be attempted even for conditions classed as incurable, such as valmīka and agnirohiṇī, because treatment should continue while life remains and, through fate, a person showing fatal signs may sometimes survive. It supplies an omitted sense: purification is done ‘with medicine.’ It identifies ārevata as kiramālaka, śyāmā as a variety of trivṛt, palala as sesame paste, upanāha here as a measure promoting suppuration, and kālānusārī as kṛṣṇasārivā.
Key terms
valmīka
A classical lesion characterized in this passage by swelling, openings, and tracts.
kṣāra
A caustic alkaline substance applied to unhealthy tissue.
śoṇitamokṣaṇa
Therapeutic removal of blood.
gati
A tract or extension of the lesion that is to be identified before incision.
pratyākhyeya
A condition considered unsuitable for treatment or carrying a grave prognosis.
For a child with ahipūtanā, the nursing mother's breast milk is first purified. Drinking ghee cooked with paṭola leaf, triphalā, rasāñjana, and añjana is said to remove even a difficult case. A decoction of triphalā, kola, and khadira is prescribed for wound healing. External pastes are made either from kāsīsa, rocanā, tuttha, haritāla, and rasāñjana ground with a sour liquid, or from badarī bark with saindhava. Powder prepared from potsherd and tuttha is applied at the stage appropriate for powders. Muṣkakacchū is treated in the same manner as ahipūtanā and pāma.
The commentary clarifies that the group beginning with kāsīsa is ground with a sour liquid such as fermented gruel for external application, with badarī bark and saindhava as an alternative paste. Kapāla means a fragment of a fired earthen vessel. For muṣkakacchū, the measures stated for ahipūtanā—including drinking ghee and the other treatments—are used, except for purification of the nursing mother.
Key terms
ahipūtanā
A classical disorder of a child addressed with measures involving both the nursing mother and the child.
dhātrī
The nursing mother or wet nurse whose milk is addressed in the regimen.
vraṇaropaṇa
Promotion of wound healing.
haritāla
A mineral substance included in an external paste.
muṣkakacchū
A classical itching disorder of the scrotal region treated by analogy here.
In gudabhraṃśa, the prolapsed tissue is fomented, anointed with an unctuous substance, and replaced. A sling-like leather bandage with a central opening is applied to allow the passage of vāyu, and repeated fomentation is prescribed. Mahat pañcamūla and a mouse with its intestines removed are cooked in milk; oil is then prepared in that liquid with vāta-relieving medicines. This oil is said to treat difficult rectal prolapse through drinking and external anointing.
The commentary gives preparation details: an eviscerated mouse and a prastha of mahat pañcamūla are cooked with a prastha of milk and three times as much water. When a prastha of milk remains, a kuḍava of oil and one-quarter measure of a paste from the bhadradāru group are added and cooked. The resulting oil is used for drinking and anointing according to the person's strength.
Key terms
gudabhraṃśa
Prolapse of rectal tissue in the classical context.
gophaṇābandha
A sling-like retaining bandage described with a central opening.
mahat pañcamūla
The classical group of five large roots used in the preparation.
pānābhyaṅga
Use both by drinking and by external oil application.
Adhikarana पुष्पिका · Śloka २०
इति सुश्रुतसंहितायां चिकित्सास्थाने क्षुद्ररोगचिकित्सितं नाम विंशोऽध्यायः ||२०||
Meaning of the śloka
Thus ends the twentieth chapter of the Cikitsāsthāna in the Suśruta Saṃhitā, entitled ‘Treatment of Minor Disorders.’
The commentary closes the twentieth chapter of the Cikitsāsthāna in Dalhaṇa's Nibandhasaṅgraha commentary on the Suśruta Saṃhitā. The supplied text preserves a variant spelling in the commentator's name, represented as Dalha/Dalhana.
Key terms
kṣudrarogacikitsita
The chapter devoted to treatment of the group called minor disorders.
Cikitsāsthāna
The section of the Suśruta Saṃhitā concerned with treatment.
Nibandhasaṅgraha
The title of Dalhaṇa's commentary on the Suśruta Saṃhitā.