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AYANAACADEMYby Dr Vijaya Dwarampudi
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21. śūkarōgacikitsitam

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Adhikarana 1 (1-2) · Śloka 2

athātaḥ śūkadōṣacikitsitaṁ vyākhyāsyāmaḥ ||1|| yathōvāca bhagavān dhanvantariḥ ||2||

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अथातः शूकदोषचिकित्सितं व्याख्यास्यामः ||१|| यथोवाच भगवान् धन्वन्तरिः ||२||

Meaning of the śloka

Now the treatment of disorders caused by śūka will be explained, as taught by the revered Dhanvantari.

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śūkādidōṣacikitsitamiti jñēyam, ādiśabdasya luptatvāt; tatrādiśabdēna nidānōktā abhighātanimittā durbhaganimittāścātra jñātavyāḥ||1-2||

Meaning of the commentary

The commentary says that the chapter title should be understood as ‘treatment of disorders caused by śūka and other causes,’ because a word meaning ‘and others’ has been omitted. This implied expression includes the disorders described in the diagnostic section as arising from injury and from durbhaga-related causes.

Key terms

śūkadoṣa
The class of disorders whose treatment is introduced in this chapter.
abhighātanimitta
Arising from injury, included by the commentary under the omitted ‘other’ causes.
durbhāganimitta
A source category named by the commentary whose precise contextual sense requires specialist confirmation.
Dhanvantari
The authoritative teacher to whom the instruction is attributed.

Adhikarana 2 (3) · Śloka 3

saṁlikhya sarṣapīṁ samyak kaṣāyairavacūrṇayēt | kaṣāyēṣvēva tailaṁ ca kurvīta vraṇarōpaṇam ||3||

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संलिख्य सर्षपीं सम्यक् कषायैरवचूर्णयेत् | कषायेष्वेव तैलं च कुर्वीत व्रणरोपणम् ||३||

Meaning of the śloka

After properly scraping the sarṣapī lesion, it should be dusted with astringent medicinal powders. A wound-healing oil should also be prepared from those same astringent substances.

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saṁlikhyētyādi| kaṣāyairiti kaṣāyavr̥kṣacūrṇairavacūrṇayēt, kaṣāyavr̥kṣairmiśrakōktaśōdhanakaṣāyasādhanadravyaiścūrṇīkr̥tairavacūrṇayēdityarthaḥ| tēṣu rōpaṇakaṣāyasādhanadravyēṣu pādikēṣu jalaṁ caturguṇaṁ dattvā rōpaṇaṁ tailaṁ kuryāt||3||

Meaning of the commentary

The commentary explains that the dusting powders are made from astringent trees, specifically the cleansing-decoction ingredients stated in the Miśraka section after they have been powdered. For the healing oil, the wound-healing decoction ingredients are used in one-quarter proportion and cooked with four times as much water.

Key terms

sarṣapī
The named lesion treated in this passage.
saṃlikhya
Having scraped or scarified the lesion.
kaṣāya
Astringent medicinal substances, understood here as powdered trees and as ingredients for the oil.
vraṇaropaṇa taila
An oil intended to promote healing of the wound.

Adhikarana 3 (4) · Śloka 4

aṣṭhīlikāṁ jalaukōbhirgrāhayēcca punaḥ punaḥ | tathā cānupaśāmyantīṁ kaphagranthivaduddharēt ||4||

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अष्ठीलिकां जलौकोभिर्ग्राहयेच्च पुनः पुनः | तथा चानुपशाम्यन्तीं कफग्रन्थिवदुद्धरेत् ||४||

Meaning of the śloka

For aṣṭhīlikā, leeches should be applied repeatedly. If the condition still does not subside, it should be removed in the manner prescribed for a kapha-granthi.

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aṣṭhīlikāmityādi| kaphagranthēriva śastrēṇōddharaṇam||4||

Meaning of the commentary

The commentary specifies that removal is performed with a surgical instrument, just as for a kapha-granthi.

Key terms

aṣṭhīlikā
The named firm lesion treated in this passage.
jalaukā
A leech, used here for repeated blood removal.
kapha-granthi
A kapha-associated nodular swelling whose method of removal supplies the comparison.
śastra
A surgical instrument used for the stated removal.

Adhikarana 4 (5-6) · Śloka 6

svēdayēdgrathitaṁ śaśvannāḍīsvēdēna buddhimān | sukhōṣṇairupanāhaiśca susnigdhairupanāhayēt ||5|| kumbhīkāṁ pākamāpannāṁ bhindyācchuddhāṁ tu rōpayēt | tailēna triphalālōdhratindukāmrātakēna tu ||6||

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स्वेदयेद्ग्रथितं शश्वन्नाडीस्वेदेन बुद्धिमान् | सुखोष्णैरुपनाहैश्च सुस्निग्धैरुपनाहयेत् ||५|| कुम्भीकां पाकमापन्नां भिन्द्याच्छुद्धां तु रोपयेत् | तैलेन त्रिफलालोध्रतिन्दुकाम्रातकेन तु ||६||

Meaning of the śloka

A grathita lesion should be fomented regularly with tubular steam and covered with comfortably warm, well-oiled poultices. When a kumbhīkā lesion has reached suppuration, it should be opened; after it has been cleansed, healing should be promoted with oil prepared from triphalā, lodhra, tinduka, and āmrātaka.

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svēdayēdityādi| śaśvat pratidinam| susnigdhairityupanāhaviśēṣaṇam| tailēna triphalādikalkapādēna jalacaturguṇasiddhēna rōpayēt||5-6||

Meaning of the commentary

The commentary explains śaśvat as ‘every day’ and states that ‘well-oiled’ qualifies the poultices. It further says that the healing oil is cooked with a paste of triphalā and the other named ingredients in one-quarter proportion and with four times as much water.

Key terms

grathita
The named indurated or knotted lesion for which fomentation and poulticing are described.
nāḍīsveda
Fomentation in which heat or steam is conveyed through a tube.
upanāha
A warm, unctuous poultice or bandaged application.
kumbhīkā
The named lesion that is opened after reaching the suppurative stage.
vraṇaropaṇa
Promotion of wound healing after cleansing.

Adhikarana 5 (7) · Śloka 7

grāhayitvā jalaukōbhiralajīṁ sēcayēttataḥ | kaṣāyaistēṣu siddhaṁ ca tailaṁ rōpaṇamiṣyatē ||7||

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ग्राहयित्वा जलौकोभिरलजीं सेचयेत्ततः | कषायैस्तेषु सिद्धं च तैलं रोपणमिष्यते ||७||

Meaning of the śloka

After applying leeches to alajī, the affected area should be irrigated. Oil prepared with decoctions of astringent trees is regarded as promoting healing.

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grāhayitvētyādi| kaṣāyaiḥ kaṣāyavr̥kṣakaṣāyaiḥ, kaṣāyavr̥kṣāḥ plakṣādayaḥ||7||

Meaning of the commentary

The commentary explains that the word kaṣāya refers here to decoctions of astringent trees, including plakṣa and others.

Key terms

alajī
The classical disorder treated in this passage.
jalaukā
A leech used for bloodletting in the described historical treatment.
kaṣāyavṛkṣa
Astringent trees, such as plakṣa, whose decoctions are used to prepare the oil.
ropaṇa
Promoting the healing of the affected tissue.

Adhikarana 6 (8) · Śloka 8

balātailēna kōṣṇēna mr̥ditaṁ pariṣēcayēt | madhuraiḥ sarpiṣā snigdhaiḥ sukhōṣṇairupanāhayēt ||8||

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बलातैलेन कोष्णेन मृदितं परिषेचयेत् | मधुरैः सर्पिषा स्निग्धैः सुखोष्णैरुपनाहयेत् ||८||

Meaning of the śloka

The affected area, after gentle manipulation, should be irrigated with lukewarm balā oil. It should then be covered with a comfortably warm, unctuous poultice made with substances of the madhura group and ghee.

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balētyādi| madhurāṇi kākōlyādīni||8||

Meaning of the commentary

The commentary identifies the madhura substances as kākolī and the other drugs of that group. It provides no further explanation of the procedure.

Key terms

balātaila
Oil prepared with balā, used here for lukewarm irrigation.
mṛdita
Gently pressed or manipulated before irrigation.
madhura
The sweet-category substances, explained by the commentary as kākolī and related drugs.
upanāha
A warm, unctuous poultice applied externally.

Adhikarana 7 (9) · Śloka 9

sammūḍhapiḍakāṁ kṣipraṁ jalaukōbhirupācarēt | bhittvā paryāgatāṁ cāpi lēpayēt kṣaudrasarpiṣā ||9||

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सम्मूढपिडकां क्षिप्रं जलौकोभिरुपाचरेत् | भित्त्वा पर्यागतां चापि लेपयेत् क्षौद्रसर्पिषा ||९||

Meaning of the śloka

Sammūḍhapiḍakā should promptly be treated with leeches. When the swelling has matured, it is opened and then dressed with honey and ghee.

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sammūḍhētyādi| paryāgatā pakvā||9||

Meaning of the commentary

The commentary explains paryāgatā as pakvā, meaning that the lesion has matured or reached the stage of suppuration.

Key terms

sammūḍhapiḍakā
The classical localized swelling or eruption addressed here.
jalaukā
A leech used for bloodletting in the historical regimen.
paryāgatā
A lesion that has matured; the commentary glosses it as pakvā.
kṣaudrasarpis
Honey and ghee used together as a topical dressing.

Adhikarana 8 (10-12) · Śloka 12

avamanthē gatē pākaṁ bhinnē tailaṁ vidhīyatē | dhavāśvakarṇapattaṅgasallakītindukīkr̥tam ||10|| kriyāṁ puṣkarikāyāṁ tu śītāṁ sarvāṁ prayōjayēt | jalaukōbhirharēccāsr̥k sarpiṣā cāvasēcayēt ||11|| sparśahānyāṁ harēdraktaṁ pradihyānmadhurairapi | kṣīrēkṣurasasarpirbhiḥ sēcayēcca suśītalaiḥ ||12||

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अवमन्थे गते पाकं भिन्ने तैलं विधीयते | धवाश्वकर्णपत्तङ्गसल्लकीतिन्दुकीकृतम् ||१०|| क्रियां पुष्करिकायां तु शीतां सर्वां प्रयोजयेत् | जलौकोभिर्हरेच्चासृक् सर्पिषा चावसेचयेत् ||११|| स्पर्शहान्यां हरेद्रक्तं प्रदिह्यान्मधुरैरपि | क्षीरेक्षुरससर्पिर्भिः सेचयेच्च सुशीतलैः ||१२||

Meaning of the śloka

When avamantha has suppurated and has been opened, oil prepared with dhava, aśvakarṇa, pattaṅga, sallakī, and tindukī is prescribed. In puṣkarikā, all treatment should be cooling: blood is removed with leeches and the area is irrigated with ghee. In loss of sensation, bloodletting is performed, a paste of madhura substances is applied, and very cool milk, sugarcane juice, and ghee are used for irrigation.

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avamanthētyādi| aśvakarṇaḥ pūrvadēśē ‘gandhamuṇḍa’ iti khyātō'śvatthasadr̥śaḥ| pattaṅgaṁ raktacandanam||10-12||

Meaning of the commentary

The commentary identifies aśvakarṇa as a tree known in the eastern region as gandhamuṇḍa and resembling aśvattha. It identifies pattaṅga as red sandalwood. It does not further explain the disease names or the remaining measures in verses 10–12.

Key terms

avamantha
A classical disorder treated here after suppuration and opening.
puṣkarikā
A classical condition for which cooling measures and leech bloodletting are prescribed.
sparśahāni
Loss or impairment of tactile sensation in the affected area.
aśvakarṇa
A named tree described by the commentary as gandhamuṇḍa in the eastern region and as resembling aśvattha.
pattaṅga
A substance identified by the commentary as red sandalwood.

Adhikarana 9 (13) · Śloka 13

piḍakāmuttamākhyāṁ ca baḍiśēnōddharēdbhiṣak | uddhr̥tya madhusaṁyuktaiḥ kaṣāyairavacūrṇayēt ||13||

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पिडकामुत्तमाख्यां च बडिशेनोद्धरेद्भिषक् | उद्धृत्य मधुसंयुक्तैः कषायैरवचूर्णयेत् ||१३||

Meaning of the śloka

The physician should remove the lesion called uttamā with a hook. After removing it, the site should be dusted with medicinal powders combined with honey.

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piḍakāmityādi| kaṣāyaiḥ cūrṇairityarthaḥ| śōdhanakālē tu śōdhanadravyaiścūrṇīkr̥tairavacūrṇayēt, rōpaṇakālē tu rōpaṇairēva||13||

Meaning of the commentary

The commentary explains that kaṣāya here means powdered medicinal substances. During the cleansing (śodhana) stage, powders made from cleansing substances should be sprinkled; during the healing (ropaṇa) stage, substances intended for healing should be used instead.

Key terms

uttamā piḍakā
The named lesion addressed in this passage.
baḍiśa
A hook described as the instrument for removing the lesion.
śodhana
The cleansing stage of wound management in the commentary.
ropaṇa
The healing stage for which healing substances are selected.

Adhikarana 10 (14) · Śloka 15

rasakriyā vidhātavyā likhitē śatapōnakē | pr̥thakparṇyādisiddhaṁ ca dēyaṁ tailamanantaram ||14|| kriyāṁ kuryādbhiṣak prājñastvakpākasya visarpavat |15|

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रसक्रिया विधातव्या लिखिते शतपोनके | पृथक्पर्ण्यादिसिद्धं च देयं तैलमनन्तरम् ||१४|| क्रियां कुर्याद्भिषक् प्राज्ञस्त्वक्पाकस्य विसर्पवत् |१५|

Meaning of the śloka

After the śataponaka lesion has been scraped, a rasakriyā preparation should be applied. Oil prepared with the group beginning with pṛthakparṇī should then be given. A knowledgeable physician should manage tvakpāka in the manner described for visarpa.

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rasakriyētyādi| rasakriyā phāṇitākr̥tiḥ, śōdhanakālē śōdhanadravyakaṣāyakr̥tā, rōpaṇakālē rōpaṇadravyakaṣāyakr̥tā| pr̥thakparṇyādisiddhaṁ tailaṁ sāmānyasnēhaparibhāṣākalpēna; pr̥thakparṇyādīni miśrakē rōpaṇaghr̥tapaṭhitāni kākōlyādivarjitāni| visarpavat pittavisarpavadityarthaḥ||14||-

Meaning of the commentary

The commentary defines rasakriyā as a preparation with the consistency of phāṇita. In the cleansing stage it is made from a decoction of cleansing substances, and in the healing stage from a decoction of healing substances. The oil with pṛthakparṇī and related substances is to be prepared according to the general method for medicated oils. The relevant pṛthakparṇī group is the one listed for the healing ghee in the Miśraka section, excluding the kākolī group. ‘As for visarpa’ is explained specifically as treatment following that for pittaja visarpa. The supplied commentary ends abruptly after the verse reference.

Key terms

śataponaka
The named lesion that the verse describes as having been scraped.
rasakriyā
A concentrated preparation described by the commentary as having a phāṇita-like consistency.
pṛthakparṇī
The first-named substance in the group used to prepare the medicated oil.
tvakpāka
A named disorder whose management is compared here with that of pittaja visarpa.
visarpa
The classical disease category used as the treatment comparison; the commentary specifies its pittaja form.

Adhikarana 11 (15-18) · Śloka 18

raktavidradhivaccāpi kriyā śōṇitajē'rbudē ||15|| kaṣāyakalkasarpīṁṣi tailaṁ cūrṇaṁ rasakriyām | śōdhanaṁ rōpaṇaṁ caiva vīkṣya vīkṣyāvacārayēt ||16|| hitaṁ ca sarpiṣaḥ pānaṁ pathyaṁ cāpi virēcanam | hitaḥ śōṇitamōkṣaśca yaccāpi laghu bhōjanam ||17|| arbudaṁ māṁsapākaṁ ca vidradhiṁ tilakālakam | pratyākhyāya prakurvīta bhiṣak samyak pratikriyām ||18||

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रक्तविद्रधिवच्चापि क्रिया शोणितजेऽर्बुदे ||१५|| कषायकल्कसर्पींषि तैलं चूर्णं रसक्रियाम् | शोधनं रोपणं चैव वीक्ष्य वीक्ष्यावचारयेत् ||१६|| हितं च सर्पिषः पानं पथ्यं चापि विरेचनम् | हितः शोणितमोक्षश्च यच्चापि लघु भोजनम् ||१७|| अर्बुदं मांसपाकं च विद्रधिं तिलकालकम् | प्रत्याख्याय प्रकुर्वीत भिषक् सम्यक् प्रतिक्रियाम् ||१८||

Meaning of the śloka

A blood-origin arbuda should also be managed in the manner described for a blood-origin vidradhi. Decoctions, pastes, ghee preparations, oils, powders, and rasakriyā, together with cleansing and healing measures, should be employed only after repeatedly assessing the condition. Drinking ghee, suitable purgation, bloodletting, and light food are also said to be beneficial. For arbuda, māṃsapāka, vidradhi, and tilakālaka, the physician should first give a guarded prognosis and then undertake the appropriate treatment carefully.

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raktētyādi| śōṇitajē arbudē liṅgajē raktārbudē| vīkṣya vīkṣyēti dvivraṇīyōktāmavasthāṁ samyak nirūpyētyarthaḥ| avacārayēt kaṣāyādīnītyarthaḥ||15-18||

Meaning of the commentary

The commentary identifies the blood-origin arbuda here as the raktārbuda occurring in the genital organ. The repeated expression ‘after assessing’ means that the physician should correctly determine the wound stage described in the Dvivraṇīya section. ‘Should employ’ refers to the decoctions and the other measures listed in the verse.

Key terms

śoṇitaja arbuda
A blood-origin arbuda; the commentary specifies raktārbuda of the genital organ.
vidradhi
A named swelling or lesion whose blood-origin treatment is used as the comparison.
śodhana
Cleansing measures selected according to the assessed stage of the lesion.
ropaṇa
Healing measures selected according to the assessed stage of the lesion.
pratyākhyāya
Giving a guarded or unfavorable prognosis before undertaking treatment.
tilakālaka
One of the named serious conditions for which the verse requires prognostic caution.

Adhikarana puṣpikā · Śloka 21

iti suśrutasaṁhitāyāṁ cikitsāsthānē śūkarōgacikitsitaṁ nāmaikaviṁśō'dhyāyaḥ ||21||

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इति सुश्रुतसंहितायां चिकित्सास्थाने शूकरोगचिकित्सितं नामैकविंशोऽध्यायः ||२१||

Meaning of the śloka

Thus ends the twenty-first chapter of the Cikitsāsthāna in the Suśruta Saṃhitā, entitled ‘Treatment of Śūkaroga.’

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iti śrīḍalha(hla)ṇaviracitāyāṁ nibandhasaṅgrahākhyāyāṁ suśrutavyākhyāyāṁ cikitsāsthānē ēkaviṁśatitamō'dhyāyaḥ||21||

Meaning of the commentary

Thus ends the twenty-first chapter of the Cikitsāsthāna in Dalhaṇa’s commentary on Suśruta called the Nibandhasaṅgraha. The supplied source records a spelling variant in Dalhaṇa’s name as ‘Dalha(hla)ṇa.’

Key terms

Cikitsāsthāna
The section of the Suśruta Saṃhitā devoted to treatment.
Śūkarogacikitsita
The chapter title, meaning the treatment of Śūkaroga.
Nibandhasaṅgraha
The title of Dalhaṇa’s commentary on the Suśruta Saṃhitā.
← 20. kṣudrarōgacikitsitam22. mukharōgacikitsitam →