౧౭. విసర్పనాడీస్తనరోగచికిత్సితం

Meaning of the śloka

Now the treatment of visarpa, nāḍī and diseases of the breast will be explained, as taught by Bhagavān Dhanvantari. Of the forms of visarpa described, the first three are curable; those arising from sannipāta and from injury are not curable.

Key terms

visarpa

A classical disease category characterized in this text by a spreading disorder; the chapter begins its treatment here.

nāḍī

In this chapter title, the classical category of a persistent tract or channel-like lesion.

stanaroga

The group of diseases affecting the breast discussed in this chapter.

sannipātaja

Arising from the combined disturbance of all three doṣas; stated here to be incurable.

kṣataja

Arising from injury; stated here to be incurable.

Meaning of the śloka

For the curable types, the physician should prepare medicated ghee using the groups of substances appropriate to each condition, and should likewise employ sprinkling or pouring treatments and external applications.

Key terms

sādhya

A type considered amenable to treatment in the classical prognosis.

pathyagaṇa

A group of substances regarded as appropriate for the particular doṣa-based form.

ghṛta

Clarified butter prepared with medicinal substances in the described treatment.

seka

A local treatment involving sprinkling or pouring liquid over the affected area.

upadeha

An external application placed upon the affected area.

Meaning of the śloka

For a vāta-origin condition, mustā, śatāhvā, suradāru, kuṣṭha, vārāhī, kustumburu, kṛṣṇagandhā, and substances belonging to the warming groups are prescribed in liquids for seka, in external pastes, and in medicated decoctions. The physician should also use the small and great thorn-named pañcamūla groups and the creeper group in external applications, seka, medicated ghee, and medicated oil.

Key terms

vātatmaka

A form attributed predominantly to vāta in the classical classification.

uṣṇagaṇa

Groups of substances classed as warming; the commentary gives bhadradāru- and pippalī-beginning groups as examples.

pañcamūla

A named group of five roots; the commentary understands four such groups here after excluding the grass group.

pradeha

A medicinal paste or coating applied externally.

kṛṣṇagandhā

A plant name read as śobhāñjanaka by the commentator, with śamī preserved as an alternative identification.

Meaning of the śloka

For pitta-origin visarpa, very cool applications are described using kaseru, śṛṅgāṭaka, padma, gundrā, śaivāla, utpala, and mud, combined with ghee and placed with cloth between the application and the body. Thin, cool applications ground with milk and ghee are also described from hrīvera, lāmajjaka, candana, srotoja, pearl, and gairika. Another soothing application uses prapauṇḍarīka, madhuka, payasyā, mañjiṣṭhikā, padmaka, candana, and sugandhikā. The passage further prescribes pouring treatments using the nyagrodha group, ghee prepared from its fresh juice, and cool milk, honey-water, sugared water, or sugarcane juice.

Key terms

pittakṛta visarpa

Visarpa attributed to pitta in the classical classification.

vastrāntara

Applied with a layer of cloth interposed, explained as permitting easier removal.

tanavaḥ

Thin or non-dense applications, intended here to avoid trapping heat.

payasyā

Identified as kṣīravidārī by one interpretation and as arkapuṣpī by Jejjaṭa.

madhūdaka

Water mixed with honey.

Meaning of the śloka

The passage describes Gauryādi ghṛta. Ghee is cooked with a paste containing gaurī, madhuka, aravinda, rodhra, ambu, rājādana, gairika, ṛṣabha, padmaka, sārivā, kākolī, medā, kumuda, utpala, candana, madhuśarkarā, drākṣā, sthirā, pṛśni, and śatāhvā. Liquids from the nyagrodha group, the sthirādi group, and the great bilvādi pañcamūla are added, together with milk. The prepared ghee is described for pouring over pitta-origin visarpa and nāḍī disorders. When taken internally, it is also claimed in the text to address visphoṭa, duṣṭavraṇa, diseases of the head, suppuration of the mouth, and certain disorders affecting children, including grahārdita and śoṣa.

Key terms

Gauryādi ghṛta

The named medicated-ghee preparation described in verses 10–13.

gaurī

Identified as haridrā by the commentator, while another interpretation takes it as gorocanā.

prastha

A classical measure; the commentary equates the stated amount of ghee here with thirty-two pala.

kalka

The paste component of the preparation; authorities cited in the commentary differ between four and eight pala.

duṣṭavraṇa

A classically described impaired or difficult wound for which the text claims benefit.

Meaning of the śloka

For kapha-origin visarpa, the passage describes an external application ground with cow urine from ajā, aśvagandhā, saralā, kālā, and ekaiṣikā, or alternatively ajaśṛṅgī, and claims that it acts quickly. It also lists kālānusāryā, aguru, coca, guñjā, rāsnā, vacā, śītaśiva, indraparṇī, pālindī, muñjāta, and mahīkadamba as useful in kapha-origin forms.

Key terms

kaphaja visarpa

Visarpa attributed to kapha in the classical classification.

ekaiṣikā

Identified as śatāvarī by one view and as a variety of trivṛt by another.

ajaśṛṅgī

Identified as chāgalaviṣāṇikā in one account and as karkaṭaśṛṅgī by Gayadāsa.

indraparṇī

Identified as indravāruṇī, alongside Gayadāsa's variant reading indrapuṣpī, identified as lāṅgalakī.

mahīkadamba

Identified as alambuṣā or muṇḍitikā, while Jejjaṭa gives bhūkadamba.

Meaning of the śloka

The discerning physician should employ the group of medicines beginning with Varuṇa in all the indicated therapeutic applications. In visarpa, purification and bloodletting are described as the foremost treatments. After thoroughly cleansing every lesion that has suppurated, the learned physician should treat it according to the previously stated sequence for wound care.

Key terms

Varuṇādi gaṇa (varuṇādi-gaṇa)

The classical group of substances beginning with Varuṇa, prescribed here for the indicated applications.

visarpa

The spreading disorder discussed in this part of the chapter; the classical term is retained without assigning one modern diagnosis.

saṃśodhana

Purificatory treatment, contrasted by the commentary with the pacifying treatment mentioned earlier.

śoṇitamokṣaṇa (śoṇita-mokṣaṇa)

Bloodletting; the commentary specifies leech application in this context.

vraṇakrama (vraṇa-krama)

The previously described sequence of care for a wound.

Meaning of the śloka

A nāḍī arising from all three doṣas is said not to be curable, while the other four types can be managed only with effort. For a vāta-origin nāḍī, the passage first prescribes an external poultice; the entire course of pus is then to be opened. A dressing made from a paste of sesame, fruits of Apāmārga, and rock salt is to be applied. For washing the wound, Mahāpañcamūla together with Hiṃsrā, Haridrā, Kaṭukā, Balā, Gojihvikā, and the root of Bilva is prescribed. Combining these substances, oil is to be prepared for cleansing, filling, and healing the wound.

Key terms

nāḍī

A classical term for a channel-like, discharging wound condition in this passage, retained without imposing one modern diagnosis.

tridoṣaprabhavā (tridoṣa-prabhavā)

Arising from all three doṣas; this type is described as incurable in the verse.

upanāha

An external poultice or bandaged application; the commentary preserves disagreement about whether its purpose is maturation or vāta alleviation.

pūyagati (pūya-gati)

The full path or tract followed by pus.

Mahāpañcamūla (mahā-pañcamūla)

The classical group of five major roots included in the wound-washing decoction.

śodhana-pūraṇa-ropaṇa

Cleansing, filling, and promoting healing of the wound, the three stated purposes of the prepared oil.

Meaning of the śloka

For a pitta-type nāḍī, the learned physician is first directed to apply warm, porridge-like poultices prepared with milk and ghee. After using a surgical instrument, the tract is to be filled with pastes of sesame, Nāgadantī, and Yaṣṭyāhva. For regular washing, Niśā together with Soma and Nimba is prescribed for use by a skilled practitioner.

Key terms

pittātmikā nāḍī

A nāḍī condition characterized in the classical account as being of pitta nature.

utkārikā

A porridge-like external preparation, glossed by the commentary as lapsikā.

Nāgadantī (nāgadantī)

A named ingredient identified by the commentary as Dantī.

Yaṣṭyāhva (yaṣṭyāhva)

A named ingredient included in the paste placed in the tract.

Soma (soma)

A disputed ingredient variously identified as Soma, Somalatā, or Kaṭphala; Gayī rejects the last identification.

Niśā (niśā)

A named substance prescribed with Soma and Nimba for washing.

Meaning of the śloka

Ghee is to be prepared with milk and with Śyāmā, Tribhaṇḍī, Triphalā, the two Haridrās, Rodhra, and Vṛkṣaka. Used to nourish the wound, it is said to overcome even a tract that has extended into the internal cavity.

Key terms

Śyāmā (śyāmā)

A named ingredient identified by the commentary as Vṛddhadāruka.

Tribhaṇḍī (tribhaṇḍī)

A named ingredient identified by the commentary as Trivṛt.

Vṛkṣaka (vṛkṣaka)

A named ingredient identified by the commentary as Kuṭaja.

vraṇatarpaṇa (vraṇa-tarpaṇa)

Nourishing or sustaining treatment of the wound with the prepared ghee.

koṣṭhagatā gati (koṣṭha-gatā gati)

A tract described as having extended into an internal cavity or deep body space.

Meaning of the śloka

For a kapha-origin nāḍī, the passage prescribes a thorough poultice with Kulattha, Siddhārthaka, Śaktu, and Kiṇva. Once softened, the physician is to probe it, determine the course of the tract, and use a surgical instrument so that nothing remains untreated. Nimba and sesame combined with Dantī, Saurāṣṭrajā, and rock salt are to be placed in the wound. Fresh juices of Karañja, Nimba, Jāti, Akṣa, and Pīlu are prescribed for washing. Oil prepared with Suvarcikā, rock salt, Citraka, Nikumbha, Tālītala, Rūpikā, fruits of Apāmārga, and urine is described as beneficial.

Key terms

kaphotthā nāḍī

A nāḍī condition described as arising from kapha.

Kiṇva (kiṇva)

The fermenting starter used for surā, according to the commentary.

eṣya gatiṃ viditvā

After probing and determining the course of the tract.

Saurāṣṭrajā (saurāṣṭrajā)

A named substance identified by the commentary as Tuvaramṛttikā.

Tālītala (tālītala)

Identified as Muśalī root, although an alternative reading gives Nala.

Rūpikā (rūpikā)

Identified as Śvetārka; another textual reading places it alongside Nīlīphala.

Meaning of the śloka

A nāḍī caused by a retained foreign body is to be opened; the foreign body is removed and the tract thoroughly cleansed. It is then to be cleansed with sesame richly mixed with honey and ghee, after which measures to promote rapid healing are prescribed. A decoction is prepared from the tender fruits of Kumbhīka, Kharjūra, Kapittha, Bilva, and the vanaspati trees. Oil is cooked with this decoction and Mustā, Saralā, Priyaṅgu, Sugandhikā, Mocarasa, Ahipuṣpa, Rodhra, and Dhātakī. The text states that by this means a foreign-body-origin nāḍī, or a wound, heals readily and quickly.

Key terms

śalyaprabhavā nāḍī (śalya-prabhavā nāḍī)

A nāḍī tract attributed in the passage to a retained foreign body.

śalya

A foreign body that the passage directs the practitioner to remove.

mārga

The course or tract that is to be thoroughly cleansed after removal of the foreign body.

śalāṭu

Tender or immature fruits, specified by the commentary for Kumbhīka and the other named plants.

Mocarasa (mocarasa)

A named ingredient identified by the commentary as Śālmalī-cumpa.

Ahipuṣpa (ahipuṣpa)

A named ingredient identified by the commentary as Nāgakeśara.

Meaning of the śloka

For a person who is emaciated, weak, or fearful, and for a nāḍī that is situated near a marma, the discerning physician is instructed to divide it with a kṣārasūtra rather than a surgical instrument. The course is first traced with a probe; a needle carrying the kṣārasūtra is placed at the end of the tract, raised, and promptly withdrawn. The ends of the thread are brought together and firmly tied. After assessing the strength of the alkali, another alkali-coated thread is introduced, continuing until the tract is divided. The same method is stated for bhagandara. In arbuda and related swellings, a thread is placed at the root after lifting the lesion; broad-rooted lesions may be pierced around their circumference with curved needles and tied at the root, and the resulting wound is then treated.

Key terms

nāḍī

A pathological tract or channel described in this chapter, retained as a classical clinical term.

marma

A classically designated vital or vulnerable anatomical site near which direct cutting is avoided here.

kṣārasūtra

A thread coated with an alkaline substance, described here as a historical means of gradually dividing a tract or lesion base.

bhagandara

A classical disease category for which the same thread procedure is stated.

arbuda

A classical term for a swelling or mass treated at its root in this passage.

granthi

A nodular swelling included by the commentary under the expression arbudādi.

Meaning of the śloka

For all nāḍī tracts, the physician is directed to use the cleansing wicks taught in the chapter on two kinds of wounds. The passage then lists several compound wicks, powders, ashes, and medicated oils made from named plant, mineral, and animal-derived substances, sometimes combined with latex, honey, salt, urine, or other liquids. These preparations are said to cleanse or remove the tract, including tracts attributed to kapha and vāta, apacī, and wounds.

Key terms

varti

A medicated wick described for cleansing a pathological tract.

nāḍī

The pathological tract or channel targeted by the preparations in this passage.

śodhana

Cleansing, specifically the intended action of the wicks and wound preparations here.

lākṣodaka

A liquid or decoction associated with lākṣā, used for washing or mixing according to differing interpretations.

apacī

A classical disease category mentioned among the conditions the final oil is said to address.

suvahā

A named plant whose identification is disputed in the commentary.

Meaning of the śloka

When breast milk has become altered, the physician is instructed to give the wet nurse ghee and induce vomiting later in the day with a neem decoction combined with honey and māgadhikā. On the day after vomiting, her food is to be mung broth. Vomiting may be repeated after intervals of three, four, or six days, or she may drink ghee prepared with triphalā. For cleansing the milk, the wet nurse is directed to take a decoction containing the named substances Bhārgī, vacā, ativisā, suradāru, pāṭhā, the mustādi group, madhurasā, and kaṭurohiṇī, or preferably a decoction from the āragvadhādi group with honey. After these general measures, doṣas that have entered the milk are to be pacified individually with their respective opposing measures.

Key terms

stanya

Breast milk, described here as altered through the presence of doṣas.

dhātrī

The wet nurse or nursing woman who is the subject of the regimen.

vamana

Therapeutically induced vomiting in the historical regimen.

saṃśodhana

Cleansing, here described as a means of purifying breast milk.

saṃśamana

Pacification after cleansing, directed according to the particular doṣa involved.

yathāsvam

According to each one individually, explained as applying the corresponding opposing measure to each doṣa.

Meaning of the śloka

After examining a disease arising in the breast, the physician should repeatedly apply the treatment described for vidradhi. Even while it is maturing, an attempt is to be made to bring it to suppuration through suitable food and without poultices, because the breast, being composed of soft tissue, quickly undergoes extensive putrefactive change and may rupture when poulticed. Once it is fully suppurated, an incision is prescribed while avoiding the milk-carrying channels and the dark nipple-and-areola region. In the unripe, inflamed, and suppurated stages, the wet nurse's breasts are to be emptied regularly.

Key terms

stanotthita roga

A disease arising in the breast.

vidradhi

The classical disease category whose treatment is extended to the breast condition.

upanāha

A poultice, prohibited here because the commentary says it strongly hastens suppuration.

prakotha

Putrefactive deterioration of tissue, as explained by the commentary.

dugdhahariṇī nāḍī

A milk-carrying channel that the verse directs the physician to avoid during incision.

nirduhīta

To empty or express the breast, prescribed regularly across the stated stages.

Meaning of the śloka

Thus ends the seventeenth chapter of the Cikitsāsthāna in the Sushruta Samhita, entitled ‘Treatment of Visarpa, Nāḍī, and Diseases of the Breast.’

Key terms

Cikitsāsthāna (cikitsāsthāna)

The treatment section of the Sushruta Samhita.

visarpa

A classical disease category included in the chapter title.

nāḍī

A pathological tract or channel included in the chapter title.

stanaroga

Diseases of the breast, the third subject named in the chapter title.

Nibandhasaṅgraha (nibandhasaṅgraha)

The title of Dalhaṇa's commentary named in the colophon.