Ashtangasamgraha 38

English (machine translation) 38

Language: English

38.1

Now we shall explain the chapter titled "Rules for Surgical Procedures". / Thus spoke the great sages beginning with Ātreya. / Thus spoke the great sages beginning with Ātreya.

Surgical procedure is indeed employed in a twofold disease requiring surgical measures, whether innate or exogenous, when it has exceeded the domain of medicine. / Whose pathways of subtle particles are contaminated, mixed, and inhabited by the doṣas.

38.3

And that disease is mostly preceded by swelling; therefore, recognizing whether it is characterized by vāta, pitta, kapha, blood, their combination, or sannipāta while it is still in the stage of swelling, out of fear of suppuration, one should employ fasting, plasters, sprinkling, bloodletting, astringent decoctions, drinking of ghee, and purification, as appropriate. / One who is thirsty touches water, or never even at the conclusion of sexual intercourse.

38.4

Even so, if it does not subside, resolution [should be attempted]; / and when it is not resolving, poulticing [is indicated], / by fist, teeth, nail pressure, or the application of poisonous bristles.

38.5

There, the signs of unripened swelling are smallness, little heat and pain, normal skin color, and firmness. / The vitiated doṣas, having gone to the pudenda, [cause] twenty-three diseases.

38.6

When suppurating, however, [the swelling] is discoloured and distended like a bladder;
it is accompanied by intense swelling, colic, redness, burning sensation, stinging heat, loss of appetite, thirst, fever, restlessness, intolerance to touch, and sleeplessness; it liquefies ghee; it dries up an ointment; it prickles as if smeared with mustard paste; it feels as though crawled over by ants, squeezed by a hand, rubbed by a finger, struck by a staff, pierced by needles, stabbed by spears, cut by a knife, bitten by scorpions, burnt by fire and caustic alkali, or churned by a firebrand.
[When caused] by the distinct doṣas, with blood, and by all of them combined; in this regard, from vāta [arises]
swelling of the penis, diverse pains, stiffness, and cracking of the skin.

38.7

When ripe, however, [the swelling shows] cessation of acute onset, shrivelling, laxity of the skin, appearance of wrinkles, pallor, elevation in the centre, rebounding upon release after being pressed with a finger, movement of pus as of water in a water-bag, itching, and relief from intense swelling, colic, and the like.

38.8

Pain does not occur without vāta, burning without pitta, or swelling without an increase of kapha;
redness [arises] from blood, and suppuration occurs from these same doṣas together with blood.

38.9

When suppuration is overdue, [the swelling] becomes hollow, thin-skinned, an abode of the doṣas,
covered with wrinkles, greyish-black, with its hairs falling out.

38.10

In certain swellings born of kapha, however, owing to depth, only the blood suppurates.
Consequently, the sign of ripeness becomes indistinct.
Where there is normal skin colour, coldness, mild pain, and stoney hardness,
one should not fall into confusion there;
they call that 'suppuration of blood'.

38.11

Now, having determined that it is properly ripe, in the case of the fearful, the aged, children, the weak, eunuchs, the emaciated, pregnant women, those afflicted with poison, and those exhausted by surgery; in those whose doṣas are aggravated by suppuration and form a mass; and in swellings situated on joints or vital spots, or small ones, one should cause bursting with sharp, hot substances;
in the others, however, incision [should be performed].

38.12

If incision is performed on an unripened [swelling], destruction of veins and ligaments, excessive haemorrhage, severe increase of pain, tearing, or traumatic erysipelas may occur.
And here it is said:
Inside or outside the penis, itchy fleshy pegs [appear].

38.13

In a ripe [swelling], on the other hand, the increased pus rapidly burns up
veins, ligaments, blood, and flesh, just as fire burns dried grass and twigs.
Neglected, these hemorrhoids destroy the penis, virility, and the vulva.

38.14

He who through ignorance cuts an unripened [swelling], and he who neglects a ripe one,
those two should be regarded like outcasts, acting without discernment.
Firm [eruptions] having the size and shape of mustard seeds are called sarṣapikās.

38.15

Before the surgical operation, one should feed [the patient] desired food and give him strong liquor to drink;
he does not faint owing to the presence of food, and intoxicated, he does not perceive the knife.
That [condition] called avamantha arises from kapha and blood, endowed with pain and horripilation.

38.16

Except in obstructed labour, abdominal disease, urinary calculus, and diseases of the mouth.
Then, having collected instruments, surgical knives, caustic alkali, fire, the jambu-lipped cautery, lint, compresses, leaves, thread, leather bandages, honey, unctuous substances, decoctions, ointments, pastes, sprinkler-pots, cauldrons of cold and warm water, fans, and all other requisites used for wounds; resting on a bed; with steady, affectionate, and strong attendants present; on an auspicious day and hour; the physician having worshipped brāhmaṇas with curds, unbroken rice grains, food, drink, gold, and jewels, having bowed to his chosen deity, performed auspicious rites, and having seated or laid the patient who has eaten facing east, having restrained him, facing west, avoiding vital spots, veins, ligaments, joints, bones, and arteries, should apply the knife in the direction of the hairs until pus is seen.
He should withdraw the knife in a single stroke and quickly.

38.17

Even in large suppurations, the incision mark is said to be two finger-breadths [long].
Having observed an interval of two finger-breadths or three finger-breadths, he should probe with the left index finger in an open area, and with a probe in a region that is not very open, deep, and fleshy;
in the opposite [kind of lesion], or in one that is extremely narrow, with the shoot of a karīra or the like, or with a hog's bristle.
A boil resembling a black gram or green gram, studded with boils,
resembling the pericarp of a lotus, should be known as puṣkarikā.

38.18

Wherever he recognizes a sinus has gone, and wherever there is an overhang,
there he should make an incision that is well-divided, free of sinus recesses,
long, and wide, so that the doṣa does not remain.

38.19

Courage, swift action, a sharp knife, absence of sweat and trembling,
and lack of confusion are praised in a physician during surgical operations.

38.20

There, on the eyebrows, cheeks, forehead, eye-sockets, lips, gums, nape of the neck, throat, collarbone, axillae, abdomen, and groins, a transverse incision is desired.
Elsewhere, however, injury to veins and ligaments, severe pain, delayed healing of the wound, and elevated flesh arise from a transverse incision.

38.21

Then, having withdrawn the knife, having comforted the patient with cold water, having pressed the wound all around with the fingers, washed it with a decoction, and removed the fluid from the wound with a compress; having fumigated the wound with pain-relieving and demon-destroying substances—guggulu, agaru, sarjarasa, vacā, white mustard, hiṅgu, rock salt, and nimba leaves, along with ghee; having applied a wick smeared with the appropriate medicine, honey, ghee, and sesame paste; having filled it with paste; having covered it with not-too-roasted barley flour smeared with ghee and well-kneaded with water at the edge of a vessel using the fingers of the right hand; having placed a thick pad, and laid a soft bandage on either the left or right side that is straight, untwisted, and unwrinkled, he should bandage it.
[The condition] subsides with pain and burning, and sometimes proceeds to suppuration.

38.22

Wounds arising from vāta and śleṣman there he should wrap two or three times;
those born of pitta, blood, or trauma, having encircled only once.
That which has lost sensation, is accompanied by kapha, and has itching and hardness;

38.23

If, however, pain from the surgical wound is persistent, he should sprinkle the wound with warm liquorice-ghee.
And taking water from a water-pot, sprinkling it, and scattering it around, he should perform protective rites for him with parṇaśabarī and other [chants], to prevent possession by demons.
He should also offer an oblation to them,
and wear on his head:

38.24

Lakṣmī, guhā, atiguhā, jaṭilā, brahmacāriṇī,
vacā, chatrā, aticchatrā, dūrvā, and also white mustard seeds.
The stream of urine then emerges with a weak flow, accompanied by pain,
and there is obstruction to the opening of the glans; that disease is niruddhamaṇi.

38.25

He should thus fumigate the bed, seat, and other [articles] twice a day with guggulu and the other [substances].
Likewise, he should follow the conduct prescribed for oleation and the daily regimen.

38.26

And particularly from daytime sleep, swelling, itching, redness, pain, and pus increase in an ulcer.

38.27

If semen is agitated and discharged in women through recollection, touch, or sight [of them], / he would incur the disorders arising from sexual intercourse even without contact. / Due to the vitiation of vāta and blood, one should know that as śataponaka.

38.28

And one should feed him according to his suitability any one of aged śāli rice, ṣaṣṭika rice, barley, or wheat, accompanied by soup of mudga, masūra, āḍhakī, or satīna, or meat juice of wild animals, prepared with jīvantī, suniṣaṇṇaka, taṇḍulīyaka, vāstuka, vārtāka, paṭola, kāravellaka, young radish, and vegetable greens, along with pomegranate, āmalaka, and rock salt, lubricated with ghee, light, in small quantity, and followed by warm water. / In this way, what he eats properly undergoes digestion. / From indigestion, the disturbance of vāta and the other [doṣas] becomes powerful; / thence he may incur swelling, pain, suppuration, burning, and abdominal distension.

38.29

He should avoid fresh grain, māṣa, kalāya, kulattha, niṣpāva, śimbī, cold water, wine, sugarcane juice, milk, pastry preparations, sesame preparations, dried vegetables, dried meat, raw vegetables, sour, salty, pungent, and alkaline substances, and meat of marsh animals.

38.30

This group beginning with fresh grain causes [vitiation of] all doṣas in one who has an ulcer. / Sharp, hot, dry, and sour wine quickly destroys an ulcer. / [When there is] pain in the penis and severe agony, one should know that as an asṛgarbuda.

38.31

And he should be fanned with young uśīra, and one should not knock against it. / One should not prick it, nor scratch it, and should protect it while moving about.

38.32

Listening to affectionate, agreeable stories of loving, elder twice-born people, / hopeful for release from illness, he quickly dispels the ulcer. / One should know those ripened by sannipāta as tilakālaka.

38.33

And on the third day again, one should perform ulcer management such as washing, as previously. / Due to opening it on the second day, the ulcer becomes knotted, heals after a long time, and becomes severely painful. / One should avoid the four doṣas and treat the remaining ones quickly.

38.34

And one should not apply a medicated wick or medicine that is excessively unctuous or dry, excessively loose or tight, coarse, or badly placed. / From excessive unctuousness comes moistness; / from excessive dryness, cutting and pain; / from excessive looseness, incomplete cleansing; / from tightness, irritation; and from coarseness and bad placement, friction against the ulcer margins. / Due to improper posture of limbs during sleep, excessive indulgence in sexual intercourse, / vitiated menstrual fluid, unsuitable substances, defect of the seed, or by fate,

38.35

One must certainly place a medicated wick in an ulcer that has a cavity. / For a medicated wick situated within an ulcer that has putrid flesh, overhangs, sinuses, or contains pus / quickly purifies it. / A sensation like crawling of ants, stiffness, roughness, and noise,

38.36

An unripe swelling that has been opened, however, one should treat with ripening agents / by means of foods and warm poultices that are not excessively conflicting with the ulcer. / Displacement, pain in the groin, flanks, and so forth, and gradually gulma, / and various respective bodily disorders of its own—that affliction is remembered as vātika.

38.37

In the case of an ulcer that is suturable, however, having removed movable bones, foreign bodies, dust, grass, hair, dried blood, and the like, having properly set severed or dangling flesh, joints, and bones in their proper place, and when the bleeding has stopped, one should sew appropriately with a needle threaded with any one of sinew, thread, or hair, / or with the barks of hemp, aśmantaka, mūrvā, or flax.

38.38

The varieties of suturing, in brief, are four: / namely, goṣphaṇikā [sling], tunnasīvana [interrupted seam], vellitaka [running or winding seam], and rajjugranthibandhana [rope-knot binding]. / Their distinction in form is simply according to their names; / and their use depends on the wound. / And one should not insert the needle too close, too far, or taking up too little or too much [tissue]. / Having observed it thus properly sutured, having dusted it with powders of collyrium, madhuka, nimba, lodhra, priyaṅgu, sallakī fruit, and charcoal of linen cloth mixed with honey and ghee, one should apply bandaging and the like as before. / Vāyu, causing pain, corrupts the female genital tract; that is prākcaraṇā.

38.39

Unsuturable are ulcers in the groin, chest, armpits, and so forth, in moving parts, in places of little flesh, ulcers emitting air, those with blood or foreign bodies inside, and those caused by poison, fire, or caustic alkali. / She discharges frothy menstrual blood with difficulty, turned upward.

38.40

Suturable, however, are those arising from fat, split or scraped [growths], kapha nodules, an ear with a small lobe, and fresh wounds, / in immovable and fleshy regions such as the head, forehead, eye-socket, ear, nose, cheek, lips, nape of the neck, arms, abdomen, buttocks, anus, genital organ, and scrotum. / It kills each child as it is born, arising from dryness and vitiated menstrual fluid.

38.41

Kośa, dāma, utsaṅga, svastika, anuvellita, muttolī, maṇḍala, sthavikā, yamaka, khaṭvā, cīna, vibandha, vitāna, goṣphaṇā, and pañcāṅgī are the fifteen varieties of bandages. / Their shapes are generally explained by their very names. / Pressed by food, [vāyu] situated in the channel of the female organ bends / the opening along with bone and flesh, causing intense pain; that is antarmukhī.

38.42

Among them, one should apply kośa to the joints of the fingers; / dāma to a constricted limb; / utsaṅga to a dangling [part]; / svastika to joints, the hair-whorls, between the eyebrows, between the breasts, the belly, the eyes, cheeks, and ears; / anuvellita to the extremities; / muttolī to the neck and the penis; / maṇḍala to a round limb; / sthavikā to the thumb, fingers, tip of the penis, and enlargement of the scrotum; / yamaka to twin ulcers; / khaṭvā to the jaw, temples, and cheeks; / cīna to the outer corners of the eyes; / vibandha to the abdomen, thighs, and back; / vitāna to broad limbs such as the head; / goṣphaṇa to the nose, lips, and chin joints; / and pañcāṅgī above the clavicle. / Whichever is well suited to a particular region, one should apply it there, / but not over the ulcer [itself] and such that it does not cause distress. / It makes the woman's genital tract have a minute opening; that is sūcimukhī.

38.43

Bandaging is desired when vāta is vitiated, when [the tissue is] vitiated, and in fractures and ulcers. / Among them, in the latter two, bandaging is twofold by distinction into left and right. / It also causes drying of the female genital tract; it is called śuṣkā, accompanied by severe pain.

38.44

It is threefold everywhere according to being tight, loose, or moderate. / In kapha and vāta it is thick and tight; in pitta and blood, thin and loose. / The woman in whom it vomits [the semen], with pain or without pain, is regarded as vāminī.

38.45

The bandage should be moderate in wounds caused by vāta and pitta, as well as in wounds caused by kapha and pitta. / Likewise, one should bind tightly on the buttocks, armpits, groins, thighs, and head; / moderately on the limbs, face, throat, ears, penis, scrotum, back, sides, abdomen, and chest; / and loosely on the eyes and joints. / A woman who hates men and has no breasts is known as a ṣaṇḍā, having no sexual desire.

38.46

In wounds born of vāta and śleṣman, [one should bandage] moderately on a loose site, / tightly on a moderate site, / and more tightly on a tight site; / likewise, [it should be changed] after three days in cold season and spring. / But in [conditions of] pitta and blood, [one should bandage] moderately on a tight site, / loosely on a moderate site, / and not at all on a loose site; / likewise, [it should be changed] in the evening and in the morning in autumn and summer. / Moreover, if not bandaged, by contact with bites, mosquitoes, grass, wood, dust, cold, wind, sun, and the like, afflicted by various complications, it attains the state of a vitiated wound. / And in that case, unctuous substance does not stay long; / the medicine dries quickly; / it heals with difficulty; / and when healed, discoloration occurs. / Furthermore: / It makes [the vagina] dilated, prolapsed, painful as if affected by vāta, / and with protruding flesh; they call this mahāyoni, which has great pain.

38.47

What is crushed, churned, fractured, dislocated, or torn open, / or severed in bone, sinew, or vessel, heals swiftly by bandaging. / It causes [a condition] accompanied by burning, suppuration, heating sensation, foul odor, and fever, / with extremely hot, copious, putrid-smelling, blue, yellow, and black menstrual fluid.

38.48

In all activities such as rising and lying down, [the patient] is not troubled; / [the wound which was] with everted lips, elevated, uneven, hard, and excessively painful,

38.49

becomes even, soft, painless, and quickly cleanses and heals. / For [wounds] that are fixed, have little flesh, and do not heal due to dryness, / the medicine should be covered with leaves according to the doṣa and according to the season. / [The vagina that is] cold, itchy, pale, slimy, and has a discharge of that kind— / that is a ślaiṣmikī disorder.

38.50

With [leaves] that are neither old nor too young, free of holes, well-placed all around, / washed, and not rough, derived from latex-bearing trees, bhūrja, arjuna, and kadamba. / That [disorder] in which there is burning sensation, emaciation, and discoloration is lohitakṣayā.

38.51

Boils of lepers, of those burned by fire, and of those suffering from madhumeha, / caruncles, [wounds from] rat-poison, those burned by caustic, and those accompanied by poison— / The vagina becomes corrupted by wind accompanied by pitta.

38.52

should not be bandaged when there is suppuration of flesh and severe suppuration of the rectum, / [or when they are] sloughing off, accompanied by pain and burning, and spreading in the state of swelling. / Causing heaviness in the bladder and abdomen, diarrhea, and anorexia, / producing pain and pricking sensation in the pelvis and groins, and fever—that is pariplutā.

38.53

In whichever wound, through lack of protection, a fly deposits worms, / these, devouring it, produce pain, swelling, and discharge of blood.

38.54

There, one should employ the Surasādi group in washing and filling [the wound], / or the barks of saptaparṇa, karañja, arka, nimba, and rājādana. / Having generated organisms, itchy, and through itching excessively fond of sexual intercourse,

38.55

A paste mixed with cow's urine as an application, or irrigation with alkali water, is beneficial; / or having covered the wound with a lump of meat, one should quickly extract them. / It produces a caruncle in the vagina that obstructs the path of menstrual fluid.

38.56

And in those various states as they arise, taking into account the doṣas and other factors, one should treat with treatments according to their respective nature. / Accompanied by their respective complications, that is the sānnipātikī disorder.

38.57

And one should not hastily cause this [wound] to heal over while there is internal morbid matter, / for even with a minor improper regimen, having formed an internal cavity, it flares up again; / therefore, one should heal it only when thoroughly cleansed. / Then she does not conceive an embryo, and contracts severe diseases, / such as menorrhagia, piles, and abdominal swelling, and afflictions caused by vāta and the like.

Commentaries (1)

Śaśilekhā — Indu, Sanskrit

Linked texts (1)

Aṣṭāṅgasaṃgraha — Vāgbhaṭa, Sanskrit