Now the treatment of śopha is explained, as taught by Bhagavān Dhanvantari. Localized śopha arising in a bodily part has previously been described in six forms, together with its distinguishing features and treatment. Sarvasara, the form that spreads throughout the body, is fivefold: caused by vāta, pitta, śleṣman, their combined disturbance, or poison.
The commentary derives avayavasamuttha as that which arises and remains localized in a particular bodily part. It says that ‘described’ refers to the preceding teaching. One interpretation takes the word ‘and’ as including causes and other matters that were not expressly stated; another understands causes and related matters as already included by the word lakṣaṇa; yet another says ‘and’ includes the absence of treatment for incurable forms. Sarvasara is explained as that which moves or spreads everywhere, because it has the capacity to extend throughout the body.
Key terms
śopha
Swelling, the condition whose treatment is introduced in this chapter.
avayavasamuttha
Arising and remaining localized in a bodily part, according to the commentary.
sarvasara
A form of swelling capable of spreading throughout the body.
sannipāta
The combined disturbance of vāta, pitta, and śleṣman listed as one cause.
viṣa
Poison, listed as a cause of one form of generalized swelling.
तत्रापतर्पितस्याध्वगमनादतिमात्रमभ्यवहरतो वा पिष्टान्नहरितकशाकलवणानि क्षीणस्य वाऽतिमात्रमम्लमुपसेवमानस्य मृत्पक्वलोष्टकटशर्करानूपौदकमांससेवनादजीर्णिनो वा ग्राम्यधर्मसेवनाद्विरुद्धाहारसेवनात् वा हस्त्यश्वोष्ट्ररथपदातिसङ्क्षोभणादयो सितस्य दोषा धातून् प्रदूष्य श्वयथुमापादयन्त्यखिले शरीरे ||४||
Meaning of the śloka
The doṣas may vitiate the bodily tissues and produce swelling throughout the body under the following circumstances: excessive travel while depleted; excessive intake of flour-based foods, green vegetables, or salt; excessive sour food by a weakened person; eating earth, baked clay, coarse mineral-like matter, or meat of marsh-dwelling and aquatic animals; sexual activity during indigestion; incompatible foods; or excessive jolting from travel by elephant, horse, camel, chariot, or on foot.
The commentary introduces these dietary and behavioral causes for the aggravation of doṣas throughout the body in the five varieties of sarvasara. Apatarpita means emaciated or depleted by drying diet and conduct such as fasting, exercise, or emesis, after which excessive travel is a causative activity. Excessive intake applies to flour preparations and the other listed foods; flour-based food also represents heavy foods generally. Haritaka is explained as a group of green plants including kuṭhera, śigru, surasa, sumukha, suri, and bhūtṛṇa. Kṣīṇa means a person already lean or depleted. The commentary identifies mṛt as earth, pakvaloṣṭa as fire-baked clay, kaṭaśarkarā as fire-burnt gravel-like material, ānūpa animals with examples such as buffalo, and aquatic animals with fish as an example. Grāmyadharma means sexual intercourse, specifically while indigestion is present. Viruddha food refers to the incompatible combinations taught in the earlier Hitāhitīya chapter. Saṅkṣobhaṇa means shaking or jolting, and ‘the whole body’ means the entire bodily frame.
Key terms
apatarpita
A depleted or emaciated state attributed here to drying diet and activities.
sarvasara
Generalized swelling whose causes are being described.
viruddhāhāra
Foods or food combinations regarded as incompatible in the referenced earlier teaching.
grāmyadharma
Sexual intercourse; the commentary specifies its occurrence during indigestion here.
saṅkṣobhaṇa
Marked bodily shaking or jolting during the listed forms of travel.
तत्र वातश्वयथुररुणः कृष्णो वा मृदुरनवस्थितास्तोदादयश्चात्र वेदनाविशेषाः; पित्तश्वयथुः पीतः सरक्तो वा मृदुः शीघ्रानुसार्यूषादयश्चात्र वेदनाविशेषाः; श्लेष्मश्वयथुः पाण्डुः शुक्लो वा स्निग्धः कठिनः शीतो मन्दानुसारी, कण्ड्वादयश्चात्र वेदनाविशेषाः; सन्निपातश्वयथुः सर्ववर्णवेदनः; विषनिमित्तस्तु गरोपयोगाद्दुष्टतोयसेवनात् प्रकुथितोदकावगाहनात् सविषसत्त्वदिग्धचूर्णेनावचूर्णनाद्वा सविषमूत्रपुरीषशुक्रस्पृष्टानां वा तृणकाष्ठादीनां संस्पर्शनात्, स तु मृदुः क्षिप्रोत्थानोऽवलम्बी चलोऽचलो वा दाहपाकरागप्रायश्च भवति ||५||
भवन्ति चात्र- दोषाः श्वयथुमूर्ध्वं हि कुर्वन्त्यामाशयस्थिताः |
पक्वाशयस्था मध्ये च वर्चःस्थानगतास्त्वधः ||६||
कृत्स्नं देहमनुप्राप्ताः कुर्युः सर्वसरं तथा |७|
Meaning of the śloka
Vāta-associated swelling is slightly red or dark, soft, and variable in location, with pricking and related pains. Pitta-associated swelling is yellow or reddish, soft, and spreads quickly, with heat and related sensations. Śleṣman-associated swelling is pale or white, unctuous, firm, cold, and slow to spread, with itching and related sensations. Swelling from the combined doṣas displays the colors and pains of all of them. Poison-associated swelling may follow internal or external exposure to gara, contaminated water, immersion in putrefied water, dust contaminated by poisonous creatures, or contact with grass, wood, and similar objects touched by their urine, feces, or reproductive fluid. It is described as soft, rapidly arising, dependent or hanging, mobile or fixed, and marked especially by burning, suppuration, and redness. Doṣas situated in the āmāśaya produce swelling above; those in the pakvāśaya produce it in the middle; those reaching the site of feces produce it below. When they extend through the entire body, they produce sarvasara.
The commentary explains aruṇa as slightly red. The sensations beginning with ūṣa include warmth, burning pain, and intense heat; those beginning with itching include itching and heaviness. Gara exposure may be external as well as internal. Prakotha means putrefaction: the passage includes external immersion in water made putrid by poisonous insects or similar creatures. Dusting may involve powders contaminated by the saliva or other material of poisonous creatures. Some authorities identify the expression for a poisonous-creature powder with a shrub called vṛścikālīnāma. The supplied commentary is marked for verses 5–6 and ends with a dash; it does not separately explain the final line numbered 7 in the stored passage.
Key terms
śvayathu
Swelling, classified here by doṣic or poison-associated features.
sarvasara
Swelling produced when the doṣas are described as extending through the entire body.
gara
A toxic substance or poisoning exposure understood by the commentary as internal or external.
prakotha
Putrefaction or a putrid condition, here describing contaminated water.
āmāśaya
A classical bodily site associated in this verse with swelling occurring above.
pakvāśaya
A classical bodily site associated in this verse with swelling in the middle region.
Swelling situated in the middle region of the body is difficult to treat, as is swelling that spreads throughout the body. Swelling confined to one half of the body is an ominous sign, and so is swelling that spreads upward. A swollen person is said to decline when the condition is accompanied by breathlessness, thirst, weakness, fever, vomiting, loss of appetite, hiccup, diarrhoea, or cough. The text then announces that the remedies for these conditions will be described both generally and according to their particular forms.
The commentary explains that the prognosis varies with the bodily location and manner in which the swelling develops. Swelling in the middle region is difficult because, like sannipāta fever, its therapeutic requirements are mutually opposed. Ardhāṅga means swelling limited to one side, divided along landmarks such as half of the nose, heart, and navel, or a transverse division at the navel. Ariṣṭabhūta means resembling an ariṣṭa or ominous sign, rather than necessarily being the sign itself. For a man, swelling beginning in the feet and spreading upward is described as ominous; by rearranging the construction and citing another verse, the commentary adds that swelling descending from the head is ominous for a woman. It explains that swelling can still be called sarvasara even when described by upper, middle, or lower location, just as a cloth may be called burnt when only one part is burnt. The listed complications indicate incurability. The final words promise both general and specific treatment.
Key terms
śvayathu
Swelling or oedematous enlargement discussed as the chapter's subject.
madhyadeśa
The middle region of the body, where swelling is described as difficult to treat.
ardhāṅga
One half of the body affected by swelling, as further delimited in the commentary.
ariṣṭabhūta
Resembling an ominous prognostic sign.
sarvasara
Swelling understood as spreading broadly through the body, even when a particular region is emphasized.
शोफिनः सर्व एव परिहरेयुरम्ललवणदधिगुडवसापयस्तैलघृतपिष्टमयगुरूणि ||१०||
तत्र वातश्वयथौ त्रैवृतमेरण्डतैलं वा मासमर्धमासं वा पाययेत्, न्यग्रोधादिककषायसिद्धं सर्पिः पित्तश्वयथौ, आरग्वधादिसिद्धं सर्पिः श्लेष्मश्वयथौ, सन्निपातश्वयथौ स्नुहीक्षीरपात्रं द्वादशभिरम्लपात्रैः प्रतिसंसृज्य दन्तीद्रवन्तीप्रतीवापं सर्पिः पाचयित्वा पाययेत्, विषनिमित्तेषु कल्पेषु प्रतीकारः ||११||
Meaning of the śloka
All persons with swelling should avoid sour and salty foods, curd, jaggery, animal fat, milk, oil, ghee, foods made from flour, and heavy foods. For swelling attributed to vāta, the text prescribes either traivṛta or castor oil for a month or half a month. For pitta-associated swelling it prescribes ghee prepared with the Nyagrodhādi group, and for kapha-associated swelling ghee prepared with the Āragvadhādi group. For swelling involving all three doṣas, it describes ghee prepared from snuhī latex combined with twelve measures of sour liquid and a paste of dantī and dravantī. Swelling caused by poison is to be managed by the countermeasures taught in the sections on poisons.
The commentary introduces this as the first account of treatment according to the particular type. It interprets traivṛta as a combination surrounded or composed with three fats, excluding marrow, while Jejjaṭācārya instead understands a preparation with all four fats; this disagreement is preserved. The choice between one month and half a month depends on the patient's strength or the strength of the doṣa. A pātra is identified as an āḍhaka, and the sour liquid as kāñjika. Dravantī is explained as cīritapatrā, a variety of dantī. The paste of dantī and dravantī is said to be one quarter of the quantity of fat, and the amount of ghee is stated as one āḍhaka.
Key terms
traivṛta
A classical fatty preparation interpreted here in two different ways by the commentators.
Nyagrodhādi
The named group used to prepare ghee for pitta-associated swelling.
Āragvadhādi
The named group used to prepare ghee for kapha-associated swelling.
snuhī-kṣīra
The latex of snuhī included in the preparation for swelling attributed to all three doṣas.
dravantī
A plant identified by the commentary as cīritapatrā and as a variety of dantī.
अत ऊर्ध्वं सामान्यचिकित्सितमुपदेक्ष्यामः- तिल्वकघृतचतुर्थानि यान्युक्तान्युदरेषु ततोऽन्यतममुपयुज्यमानं श्वयथुमपहन्ति, मूत्रवर्तिक्रियां वा सेवेत, नवायसं वाऽहरहर्मधुना, विडङ्गातिविषाकुटजफलभद्रदारुनागरमरिचचूर्णं वा धरणमुष्णाम्बुना, त्रिकटुक्षारायश्चूर्णानि वा त्रिफलाकषायेण, मूत्रं वा तुल्यक्षीरं, हरीतकीं वा तुल्यगुडामुपयुञ्जीत, देवदारुशुण्ठीं वा, गुग्गुलुं वा मूत्रेण वर्षाभूकषायानुपानं वा, तुल्यगुडं शृङ्गवेरं वा, वर्षाभूकषायं मूलकल्कं वा सशृङ्गवेरं पयोऽनुपानमहरहर्मासं, व्योषवर्षाभूकषायसिद्धेन वा सर्पिषा मुद्गोलुम्बान् भक्षयेत्, पिप्पलीपिप्पलीमूलचव्यचित्रकमयूरकवर्षाभूसिद्धं वा क्षीरं पिबेत्, सहौषधमुरङ्गीमूलसिद्धं वा, त्रिकटुकैरण्डश्यामामूलसिद्धं वा, वर्षाभूशृङ्गवेरसहादेवदारुसिद्धं वा, तथाऽलाबूबिभीतकफलकल्कं वा तण्डुलाम्बुना; क्षारपिप्पलीमरिचशृङ्गवेरानुसिद्धेन च मुद्गयूषेणालवणेनाल्पस्नेहेन भोजयेद्यवान्नं गोधूमान्नं वा; वृक्षकार्कनक्तमालनिम्बवर्षाभूक्वाथैश्च परिषेकः; सर्षपसुवर्चलासैन्धवशार्ङ्गेष्टाभिश्च प्रदेहः कार्यः; यथादोषं च वमनविरेचनास्थापनानि तीक्ष्णान्यजस्रमुपसेवेत, स्नेहस्वेदोपनाहांश्च; सिराभिश्चाभीक्ष्णं शोणितमवसेचयेदन्यत्रोपद्रवशोफादिति ||१२||
Meaning of the śloka
The text next gives general treatment for swelling. It lists one of four Tilvaka-containing ghees previously taught for abdominal disorders, the procedure called mūtravarti, navāyasa with honey, and numerous powders, decoctions, pastes, medicated ghees, milks, and other preparations involving the named plants, mineral alkali, iron, cow urine, milk, jaggery, or warm water. It also describes a lightly unctuous, salt-free meal of barley or wheat with green-gram soup prepared with pungent substances; pouring decoctions over the body; and applying pastes of the listed ingredients. According to the doṣa, it recommends repeated strong emesis, purgation, and āsthāpana enema, together with oleation, sudation, and poultices. Except in swelling associated with a complication, it also describes repeated removal of blood through veins.
The commentary identifies the four Tilvaka ghees as three preparations previously described, beginning with the one containing a prastha of harītakī powder, plus the Tilvaka preparation taught under vāta disorders. It says that mūtravarti refers to the same procedure taught for abdominal disease, and navāyasa to the preparation taught in the treatment of prameha-piḍakā. Dharaṇa is glossed as one karṣa; kṣāra as barley alkali; and ayas as iron. Equal milk means two pala each of cow urine and cow's milk. Several ingredients are identified: varṣābhū as red punarnavā, mayūraka as apāmārga, sahā as māṣaparṇī, muraṅgī as śobhāñjanaka, vṛkṣaka as kuṭaja, naktamāla as mahākarañja, suvarcalā as sūryāvarta, and śārṅgeṣṭā as kākajaṅghā. Mudgolumba means green gram that is boiled and slightly roasted. The alternative between barley and wheat depends on what suits the person. Anuviddha means permeated or combined, though some read anusiddha. Pradeha means an external paste, and ajasra means repeatedly; the commentary supplies 'a strong person' as the understood subject. It reports a variant reading of 'swelling with complications' as 'generalized swelling.' Some authorities reject as non-authoritative a reading that forbids blood removal in generalized swelling. Others reconcile the injunction and prohibition by limiting repeated blood removal to localized sarvasara that has not subsided with cooling, heating, unctuous, drying, and related measures.
Key terms
sāmānya-cikitsita
General treatment presented for swelling rather than treatment limited to one doṣic form.
Tilvaka-ghṛta
A group of four classical ghee preparations linked by the commentary to earlier teachings.
mūtravarti-kriyā
A named procedure referred back to the treatment of abdominal disease; its details are not supplied here.
āsthāpana
A decoction-based enema included among repeated strong cleansing measures.
śoṇitāvasecana
Removal or letting of blood, whose indication and exception are disputed in the commentary.
A person wishing to overcome śopha should avoid foods made from flour, sour substances, salts, alcoholic drink, earth or clay, daytime sleep, the item expressed in the source as ajāṅgala, sexual intercourse, ghee, oil, milk, and foods that are heavy to digest.
The commentary introduces this as the verse beginning with piṣṭānna and records a variant reading: some manuscripts read ‘striyo guḍaṃ’ (‘women and jaggery’) in place of the corresponding words in the received text. It gives no further explanation of the listed restrictions.
Key terms
śopha
Swelling, the condition whose management is the subject of this chapter.
piṣṭānna
Food preparations made from flour, listed here among items to avoid.
divāsvapna
Sleeping during the daytime, listed as a behavior to avoid.
guru
Heavy to digest; a quality of food the verse advises avoiding.
guḍa
Jaggery, present only in the variant reading reported by the commentary.
Thus ends the twenty-third chapter of the Cikitsāsthāna in the Suśruta commentary entitled Nibandhasaṅgraha, composed by Śrī Dalhaṇa. The supplied source marks a spelling-order variant in the commentator’s name as Dalha(hla)ṇa.
Key terms
Cikitsāsthāna
The section of the Suśruta Saṃhitā concerned with treatment, in which this chapter occurs.
śothacikitsita
The chapter title in the closing verse, meaning treatment of swelling.
Nibandhasaṅgraha
The title of Dalhaṇa’s commentary on the Suśruta Saṃhitā.
Dalhaṇa
The commentator named in the colophon, with a variant spelling marked in the supplied source.