Pramāṇa · Search · About · API

A History of Indian Medical Literature v1.c23: Part 2: Suśrutasaṃhitā

A History of Indian Medical Literature v1.c23

Language
English

Contents

Part 2: Suśrutasaṃhitā

v1.c23.2

Chapter one, called vedotpatti, begins, like the *Carakasaṃhitā*, with a story concerning the origin (utpatti)² of (āyur)veda.

v1.c23.3

A group of sages, desirous of being helpful to human beings afflicted by diseases, and wanting to preserve their own health,³ approaches Divodāsa, king of Kāśī, (an incarnation of) Dhanvantari,⁴ with the request to teach them the science of āyurveda. This group consists of Aupadhenava, Vaitaraṇa, Aurabhra, Pauṣkalāvata, Karavīra, Gopurarakṣita, Suśruta, and others (1.1–4).

v1.c23.4

Dhanvantari complies and relates that Svayambhū (= Brahmā), even before creating mankind, composed the āyurveda, which forms one of the upāṅgas of the *Atharvaveda*,⁵ in one hundred thousand verses, arranged in thousand chapters; in consideration of the short life span and restricted intelligence of men, he recast it into the following eight divisions: śalya, śālākya, kāyacikitsā, bhūtavidyā, kaumārabhṛtya, agadatantra, rasāyanatantra, and vājīkaraṇatantra (1.5–8).⁶

v1.c23.5

All the sages express the wish to receive, first of all, instruction in śalya; Suśruta is appointed as the one to ask questions, while the others will listen attentively to Dhanvantari's answers (1.9–13).

v1.c23.6

Dhanvantari begins his teaching by expounding the object (prayojana) of āyurveda: making the diseased free from disease and preserving the health of the sound; he also explains the etymology of āyurveda (1.14–15). He announces that his instruction will be in conformity with pratyakṣa (perception), āgama (authoritative scripture), anumāna (inference), and upamāna (analogy) (1.16).⁷

v1.c23.7

Śalya is declared to hold he foremost place among the branches of āyurveda, because it was applied, on the occasion of Dakṣa's⁸ sacrifice, with a view to the healing of the wounds inflicted and the restoration of the head of the sacrifice.⁹ It is pre-eminent too on account of its quick action, owing to the use of sharp and blunt instruments (śastra, yantra), caustics (kṣāra), and cautery (agni) (1.17–18).

v1.c23.8

Brahmā was the first to promulgate āyurveda; from him Prajāpati learnt it, from Prajāpati the Aśvins, from the Aśvins Indra, from Indra myself (i.e., Dhanvantari) (1.20). A verse follows, in which Dhanvantari, who calls himself Ādideva,¹⁰ announces to have appeared on the earth in order to teach surgery, as well as the other branches of medical science (1.21).

v1.c23.9

In this science, the puruṣa is the living body, composed of the five mahābhūtas. The world is divisible into beings that cannot move (sthāvara) and those that move about (jaṅgama), into fiery (āgneya) and cool (saumya) substances, into substances with a preponderance of one of the mahābhūtas, and into four classes of beings: saṃsvedaja, jarāyuja, aṇḍaja, and udbhijja¹¹ (1.22).

v1.c23.10

The four classes of diseases are defined: āgantu, śārīra, mānasa, and svābhāvika (1.23–26). ¹² The means for checking diseases are saṃśodhana, saṃśamana, (rules regarding) diet (āhāra), and (rules regarding) conduct (ācāra) (1.27).

v1.c23.11

Medicinal substances (oṣadhi) derive from immobile (sthāvara) and mobile (jaṅgama) living beings (1.28). The immobile class consists of the types called vanaspati, vṛkṣa, vīrudh, and oṣadhi; their characteristics are given (1.29). ¹³ The four classes of mobile beings are enumerated again ¹⁴ and examples are given (1.30). The parts of these beings used as medicinal substances are mentioned (1.31). Inorganic (pārthiva) substances are listed (1.32). The importance of the divisions of time for medicine is discussed (1.33–34).

v1.c23.12

The subjects dealt with so far are summarized (1.35–38). A more detailed exposition of the therapeutic science, in one hundred and twenty chapters, will now follow. It is divided into five sections: Sūtra-, Nidāna-, Śārīra-, Cikitsita- and Kalpasthāna; the remaining subjects will be dealt with in the Uttaratantra (1.39–40).

v1.c23.13

Chapter two (śiṣyopanayanīya) describes the initiation of a student. ¹⁵

v1.c23.14

Chapter three (adhyayanasampradānīya) gives a table of contents (3.3–45). ¹⁶

v1.c23.15

The necessity of both theoretical instruction and practical training in the eight-limbed science of medicine, revealed by Ādideva, is stressed (3.46–53). The chapter ends with instructions regarding the method of study (3.54–56).

v1.c23.16

Chapter four (prabhāṣaṇīya) is about the importance of correctly understanding the text of the treatise and its terminology. The textbooks called Aupadhenava, Aurabhra, Sauśruta and Pauṣkalāvata after their authors are mentioned as the basic surgical treatises (4.9).

v1.c23.17

Chapter five (agropaharaṇīya) is concerned with the arrangements preliminary to surgical interventions.

v1.c23.18

Surgical treatment (karman) consists of three stages: pūrvakarman (preliminary measures), pradhānakarman (principal measures) and paścātkarman (after-treatment) ¹⁷ (5.3). Surgical procedures (śastrakarman) are of eight kinds: chedya (excision), bhedya (incision), lekhya (scarification), vedhya (puncturing), eṣya (probing), āhārya (extraction), visrāvya (drainage), and sīvya (suturing) ¹⁸ (5.5).

v1.c23.19

The items of the equipment to be collected before performing any of these interventions, and the nursing staff, are dealt with (5.6).

v1.c23.20

The proper way of draining (an abscess) is described (5.7), followed by the characteristics of a good incision (5.8–9), praiseworthy qualities of a surgeon (5.10), the proper way of making a counter-incision (in order to assure complete drainage) (5.11) or multiple incisions (5.12). Places where an oblique or curved incision should be made are listed (5.13–14). The bad effects of an improper incision are dealt with (5.15).

v1.c23.21

Pre-and post-operative measures are discussed (5.16–17), followed by fumigation (dhūpana; 5.18),¹⁹ and protective mantras to be used in a ritual called rakṣākarman (5.19–33).²⁰

v1.c23.22

The remaining part of the chapter is devoted to after-treatment, in particular wound dressing and the change of dressings (5.34–42).

v1.c23.23

Chapter six (ṛtucaryā) discusses seasonal regimen.²¹

v1.c23.24

The chapter begins with an enumeration of the units of time:²² akṣinimeṣa (the time required to pronounce a short syllable),²³ kāṣṭhā,²⁴ kalā,²⁵ muhūrta,²⁶ ahorātra (a day and a night),²⁷ pakṣa (a fortnight), and māsa a (month) (6.4–5).²⁸

v1.c23.25

The twelve months, beginning with Māgha, make up six seasons,²⁹ each consisting of two months: śiśira (the cool season) consists of Tapas (= Māgha) and Tapasya (= Phālguna), vasanta (the spring) of Madhu (= Caitra) and Mādhava (= Vaiśākha), grīṣma (the summer) of Śuci (= Jyeṣṭha or Āṣāḍha) and Śukra (= Āṣāḍha or Jyeṣṭha),³⁰ varṣāḥ (the rainy season) of Nabhas (= Śrāvaṇa) and Nabhasya (= Bhādrapada), śarad (the autumn) of Iṣa (= Āśvina) and Ūrja (= Kārttika), and hemanta (the winter) of Sahas (= Mārgaśīrṣa) and Sahasya (= Pauṣa) (6.6).³¹

v1.c23.26

The year is divided into two halves, called after the direction of the sun's course (ayana); the southern course (dakṣiṇāyana) covers varṣāḥ, śarad and hemanta, the northern course (uttarāyaṇa) śiśira, vasanta and grīṣma; the moon and the corresponding tastes are strong during the dakṣiṇāyana, the sun and the corresponding tastes during the uttarāyaṇa.³² The two ayanas together make one year; five years make one yuga. Some refer to this whole series of divisions of time as the kālacakra (wheel of time) (6.9).

v1.c23.27

In this treatise, with regard to the seasonal variations of the doṣas, the seasons are arranged thus: varṣāḥ, consisting of Bhādrapada and Āśvayuja (= Āśvina), śarad, consisting of Kārttika and Mārgaśīrṣa, hemanta, consisting of Pauṣa and Māgha, vasanta, consisting of Phālguna and Caitra, grīṣma, consisting of Vaiśākha and Jyeṣṭha, and prāvṛṣ (the early rainy season), consisting of Āṣāḍha and Śrāvaṇa (6.10).³³

v1.c23.28

The effects of the seasons on the doṣas are described. Pitta accumulates (saṃcaya) during the rains and gets excited (prakopa) in the autumn; śleṣman (= kapha) accumulates in the winter and gets excited in the spring; vāyu accumulates in the summer and gets excited during the early rains (6.11). These accumulated and excited doṣas ought to be eliminated (6.12). The diseases caused by pitta subside naturally (svabhāvatas) in the winter, those by śleṣman in the summer (nidāgha), those by vāta in the autumn (6.13). The divisions of day and night have characteristics similar to the seasons: the forenoon (pūrvāhna) is the analogue of the spring, the noon (madhyāhna) of the summer, the afternoon (aparāhna) of he early rains, the dusk (pradoṣa) of the rainy season, the midnight (ardharātra) of the autumn, the dawn (pratyuṣas) of the winter (6.14). Irregularities in the seasons, due to fate (adṛṣṭa),³⁴ cause various diseases or epidemics (maraka) (6.16–17). Sometimes, even when the seasons are regular, the people of a country may suffer through sorcery (kṛtyā), curses (abhiśāpa), the wrath of a rakṣas, or adharma.³⁵ Other causes are the exhalations of poisonous flowers, the noxious influences of planets (graha) and asterisms (nakṣatra),³⁶ and inauspicious omina (6.19).³⁷ The measures to be taken in such cases are listed (6.20).

v1.c23.29

The characteristics of the normal seasons are described, beginning with the winter and ending with the autumn (6.21–36).³⁸

v1.c23.30

Chapter seven (yantravidhi) is devoted to the blunt instruments (yantra).³⁹

v1.c23.31

The number of blunt instruments is one hundred and one; the most important among them is the hand (7.3). Śalyas cause injury (ābādha) to body and mind; yantras are the means of their removal (āharaṇa) (7.4). The yantras are of six types: svastikayantra (cruciform), saṃdaṃśayantra (pincer-like), tālayantra (picklock-like or spoon-shaped), nāḍīyantra (tubular), śalākāyantra (rod-like),⁴⁰ and upayantra (an accessory instrument) (7.5). There are twenty-four varieties of svastikayantra,⁴¹ two saṃdaṃśayantras,⁴² two tālayantras,⁴³ twenty varieties of nāḍīyantra,⁴⁴ twenty-eight varieties of śalākāyantra,⁴⁵ and twenty-five upayantras⁴⁶ (7.6). As a rule, they are made of iron (lauha), or, when it is not available, of its substitutes (7.7).⁴⁷ Their shape in general and the qualities required are mentioned (7.8–9).

v1.c23.32

The twenty-four svastikayantras are described; their mouth parts resemble the snout or beak of twenty-four different animals and birds: siṃha, vyāghra, vṛka, tarakṣu, ṛkṣa, dvīpin, mārjāra, śṛgāla, mṛgairvāruka, kāka, kaṅka, kurara, cāṣa, bhāsa, śaśaghātin, ulūka, cilli, śyena, gṛdhra, krauñca, bhṛṅgarāja, añjalikarṇa, avabhañjana, and nandīmukha;⁴⁸ they are used for removing a śalya from within a bone (7.10). The two saṃdaṃśayantras are described; they are provided with a catch (nigraha) or without it;⁴⁹ they are employed in the extraction of śalyas from the skin, muscles, sirās and snāyus (7.11).⁵⁰ The two tālayantras, with one blade (tālaka) or two blades, are useful in the removal of śalyas from the passages of the ears and the nose (7.12). The nāḍīyantras are of many varieties and applied for various purposes (7.13). The many śalākāyantras and their various uses are described (7.14). The upayantras are listed (7.15).⁵¹

v1.c23.33

The twenty-four uses of yantras are dealt with : nirghātana (wrenching out), pūraṇa (filling, with oil, etc.), bandhana (bandaging), vyūhana (retraction),⁵² vartana (approximation), cālana (displacement), vivartana (turning round),⁵³ vivaraṇa (dilatation),⁵⁴ pīḍana (squeezing), mārgaviśodhana (clearing passages), vikarṣaṇa (loosening), āharaṇa (extraction), āñchana (traction), unnamana (elevation), vinamana (depression), bhañjana (breaking),⁵⁵ unmathana (stirring with a probe), ācūṣaṇa (suction), eṣaṇa (probing), dāraṇa (splitting), ṛjūkaraṇa (straightening), prakṣālana (irrigation), pradhamana (insufflation), and pramārjana (mopping up) (7.17).

v1.c23.34

The twelve defects of a yantra are enumerated (7.19). The ideal yantra is characterized (7.20). Some general guidelines are given (7.21). The kaṅkamukhayantra (one of the svastikayantras) is praised as the foremost among the yantras (7.21).⁵⁶

v1.c23.35

Chapter eight (śastrāvacāraṇīya)⁵⁷ is devoted to the twenty sharp instruments (śastra).⁵⁸

v1.c23.36

This group consists of: maṇḍalāgra (circular-headed),⁵⁹ karapattra (saw),⁶⁰ vṛddhipattra (scalpel),⁶¹ nakhaśastra (nail-parer),⁶² mudrikā (ring knife),⁶³ utpalapattraka (lancet),⁶⁴ ardhadhāra (single-edged knife),⁶⁵ sūcī (suturing needle),⁶⁶ kuśapattra (bistoury),⁶⁷ āṭīmukha (āṭī-bill scissors),⁶⁸ śarārimukha (śarāri-bill scissors),⁶⁹ antarmukha (curved bistoury), 70 trikūrcaka, 71 kuthārikā, 72 vrīhimukha (trocar), 73 ārā (awl), 74 vetasapattraka (a kind of scalpel), 75 baḍiśa (a sharp hook), 76 dantaśaṅku (tooth-scaler), 77 and eṣaṇī (a sharp probe) (8.3). 78

v1.c23.37

Maṇḍalāgra79 and karapattra are used for chedana (excision) and lekhana (scarification, scraping); vṛddhipattra, 80 nakhaśastra, mudrikā, utpalapattraka and ardhadhāra for chedana and bhedana (incision); sūcī, 81 kuśapattra, 82 ātīmukha, śarārimukha, antarmukha and trikūrcaka for visrāvaṇa (drainage); kuthārikā, 83 vrīhimukha, 84 ārā, 85 vetasapattraka and sūcī86 for vyadhana (puncturing); baḍiśa 87 and dantaśaṅku for āharaṇa (extraction); the eṣaṇī88 for eṣaṇa (probing) and ānulomya;89 the sūcī for śivana (suturing) (8.4).

v1.c23.38

The correct ways of handling the śastras are described (8.5), the way they are named (8.6), their sizes (8.7), their qualities (8.8) and defects (8.9), and the thickness of their edges (dhārā) (8.10). The shapes of baḍiśa, dantaśaṅku and eṣaṇī are dealt with (8.11).

v1.c23.39

Three kinds of tempering (pāyanā) are described: by means of caustics (kṣāra), water, and oils; the purposes of śastras tempered in a particular way are enumerated (8.12). 90

v1.c23.40

Śastras should be sharpened with a smooth stone (ślakṣṇaśilā); 91 their edges should be smoothened with a piece (phalaka) of śālmalī wood (8.13).

v1.c23.41

Accessory śastras (anuśastra) 92 are the following: bamboo (tvaksāra), sphaṭika (quartz), glass (kāca), 93 kuruvinda, 94 leeches, fire, caustics, the nails, leaves of gojī, śephālikā and śāka, (the shoots of) karīra, 95 hairs, and the fingers (8.15). Their uses are specified (8.16–19a). A wise (physician) should get the sharp instruments of pure 96 iron 97 (āyasa) manufactured by a skillful 98 and experienced blacksmith (karmāra) 99 (8.19b-f).

v1.c23.42

Chapter nine (yogyāsūtrīya) is about the practical training in surgical operations. 100 The importance of the acquisition of practical skills, next to study of the textbooks, is stressed (9.3). Objects on which to practise excision, incision, etc., are enumerated (9.4). 101

v1.c23.43

Chapter ten (viśīkhānupraveśanīya) 102 gives general directions for visiting a patient. 103 A fully qualified physician should, after obtaining royal permission, go to visit his patients, appropriately dressed, 104 without ostentation, friendly inclined, etc. (10.3). At a time when the signs regarding the messenger (dūta) 105 and the various kinds of omina 106 are auspicious, he should make his way to the patient's house and examine him by inspection, palpation and interrogation. Some say that this is usually sufficient, 107 which, however, is not correct. There are six ways of obtaining knowledge about diseases (vijñānopāya): the five senses and interrogation (10.4). The signs discernible by each of the senses and the information obtainable by questioning are dealt with in more detail (10.5). 108

v1.c23.44

After carrying out this examination completely, the physician should cure the curable ones and give palliative treatment to the palliable ones; incurable ones should not be treated, and pathological conditions that have persisted for more than a year should, as a rule, be avoided (10.6). A summarizing verse follows (10.7). 109 Types of patients in whom even curable diseases become most difficult to manage are enumerated (10.8). The chapters ends with a verse on the proper behaviour towards women (10.9).

v1.c23.45

Chapter eleven (kṣārapākavidhi) deals with the preparation and uses of caustics (kṣāra). 110

v1.c23.46

The importance of caustics is emphasized (11.3). The term kṣāra is derived from kṣar- or kṣaṇ- (11.4). 111 The properties and actions of caustics are enumerated (11.5). Two types of caustic are distinguished: for external application (pratisāraṇīya) and for internal administration (pānīya) (11.6). Their indications are listed (10.7–8), followed by the contra-indications for the pānīya type (11.9). A pānīya kṣāra should be prepared in the same way as a pratisāraṇīya (11.10).

v1.c23.47

The pratisāraṇīya kṣāra is of three kinds: weak (mṛdu), moderate (madhya) and strong (tīkṣṇa) (11.11). The preparation of the moderate variety is elaborately described, 112 followed by the preparation of the weak variety, also called saṃivyūhima, and the strong variety, also called pākya (11.11–13). 113

v1.c23.48

The eight good qualities of a kṣāra are enumerated (11.16), followed by its eight defects (11.17).

v1.c23.49

The correct way of applying a kṣāra is described (11.18); turning black of the diseased part is the sign of proper burning (dagdhalakṣaṇa) by the caustic; when this occurs, neutralization (śamana) by an acid should follow (11.19). A particular ointment should be applied if the diseased part does not come off (11.20–21). The granulation (ropaṇa) of the wound should be promoted by a particular paste (11.22ab). The way in which acids neutralize caustics is explained (11.22cd–25). 114 The signs of adequate, inadequate and excessive application are mentioned (11.26), followed by the way to treat the lesion (kṣāradagdhavraṇa) (11.27).

v1.c23.50

Patients and disorders, as well as sites, which are unsuitable for treatment with a kṣāra, are discussed (11.28–30).

v1.c23.51

Chapter twelve (agnikarmavidhi) is about cauterization (agnikarman), 115 characterized as superior to treatment with a caustic (12.3). 116

v1.c23.52

The means for carrying out cautery are: long pepper (pippalī), goat’s dung, the tooth of a cow, an arrow (śara), 117 or a śalākā for skin lesions; a jāmbavauṣṭha 118 or a similar instrument made of a metal for lesions of the muscles; honey, guḍa (treacle) or a fatty substance 119 for lesions of sirās, snāyus, sandhis and bones (12.4). 120

v1.c23.53

The seasons for the application of cautery are discussed (12.5). The preliminary treatment is described (12.6). Some are of the opinion that only skin and muscles are to be cauterized, but in this treatise the sirās, etc., can be treated as well (12.7). 121

v1.c23.54

The signs of adequate cauterization of skin, muscles, sirās and snāyus, sandhis and bones (12.8), specific sites for cauterization in particular diseases (12.9), and the indications are listed (12.10).

v1.c23.55

Various patterns of cautery are described: circles (valaya), dots (bindu), lines (vilekhā), 122 and patterns produced by rubbing (pratisāraṇa) 123 (12.11). 124

v1.c23.56

The after-treatment is dealt with (12.13); the contra-indications are listed (12.14).

v1.c23.57

Burns (dagdha) form the next subject of this chapter. 125 Two groups are distinguished, caused by dry heat and by heated fatty substances, and four degrees: pluṣṭa (singeing), durdagdha (blister formation), samyagdagdha (proper application), and atidagdha (a deep burn); their characteristics are described (12.15–16). 126 The pathogenesis of burns is explained (12.17–19ab). The management of the four kinds of burns is discussed (12.20–27ab), followed by an ointment for all kinds of burns (12.27cd–28), and the treatment of scalds by heated oils and fatty substances (12.29ab).

v1.c23.58

Next, the symptoms of smoke poisoning (dhūmopahata) are described (12.29cd–32) and its management by emetics, gargles (kavalagraha), evacuation of the head (śirovirecana), and diet (12.33–37).

v1.c23.59

The chapter ends with the treatment of those afflicted with the effects of hot winds (uṣṇavātadagdha), the heat of the sun (ātapadagdha), cold rains (śītavarṣadagdha), and cold winds (śītāniladagdha). Severe cases of sunstroke (atitejodagdha) and lightning burns (indravajrāgnidagdha) cannot successfully be treated (12.38–39). 127

v1.c23.60

Chapter thirteen (jalaukāvacāraṇīya) deals with the application of leeches. 128

v1.c23.61

Groups of patients in whom bloodletting by means of leeches is preferable to other procedures are mentioned (13.3).

v1.c23.62

Bloodletting (raktāvasecana) can be carried out by means of cow’s horns (śṛṅga), 129 leeches (jalaukā) and gourds (alābu) respectively; horns are preferable when the blood is deranged (upaṣṛṣṭa) by vāta, leeches when by pitta, gourds when by kapha (13.4–7). 130 Cupping by means of a horn or gourd is described (13.8). The name of leech (jalāyuka, jalaukas) is explained (13.9).

v1.c23.63

Six poisonous and six non-poisonous kinds of leeches are distinguished (13.10). 131 The names of the poisonous leeches are: kṛṣṇā, karburā, alagardā, 132 indrāyudhā, 133 sāmudrikā, and gocandanā. A description of these leeches follows. 134 The symptoms of leech-bites and their treatment by means of a compound drug, called mahāgada, 135 are discussed; patients bitten by an indrāyudhā are, however, incurable (13.11). The names of the non-poisonous leeches are: kapilā, piṅgalā, śaṅkumukhī, mūṣikā, puṇḍarīkamukhī, and sāvarikā. 136 A description of these leeches follows (13.12). 137 Non-poisonous leeches, with good qualities, are found in the Yavana, 138 Pāṇḍya, 139 Sahya, 140 and Pautana 141 countries (13.13). 142

v1.c23.64

The habitats of poisonous and non-poisonous leeches are described (13.14–15). The collection and storage of leeches is dealt with (13.16–17). Leeches regarded as unfit are described (13.18). The application of leeches is dealt with, their withdrawal, and their emptying. 143 An insufficiently emptied leech develops an incurable disease called indramada (13.19–22). 144 The treatment of the wounds after the application of leeches is discussed (13.23).

v1.c23.65

Chapter fourteen (śoṇitavarṇanīya) describes blood.

v1.c23.66

The chapter opens with the formation of rasa (the nutrient fluid) from the ingested food; this rasa is the extremely subtle essence (sāra) derived from the food; its seat is the heart 145 and it is of a saumya character (14.3). 146 The watery rasa gets coloured by tejas¹⁴⁷ in liver and spleen (14.4–5). The rajas¹⁴⁸ of females is derived from the same rasa; it begins to appear at the age of twelve, ceases at the age of fifty, and is of an āgneya (fiery) nature (14.6–7).

v1.c23.67

Others are of the opinion that the life-blood (jīvarakta) is composed of the five mahābhūtas, since their qualities are present in it (14.8–9).

v1.c23.68

Rasa gives rise to blood (rakta), from which muscular tissue (māṃsa) is produced; muscular tissue gives rise to fatty tissue (medas), from which osseous tissue (asthi) is produced, which in its turn gives rise to bone marrow (majjan); bone marrow gives rise to semen (śukra).¹⁴⁹

v1.c23.69

The pre-eminence of rasa as the primary source of the other elements (dhātu) is emphasized (14.10–12). The derivation of the term rasa is discussed (14.13). Each step in the transformational chain of the elements takes 3,015 kalās;¹⁵⁰ the entire series takes 18,090 kalās, which view is accepted in this as well as in other treatises (14.14–15).¹⁵¹

v1.c23.70

Aphrodisiacs possess, by dint of their special power and qualities (svabalaguṇotkarṣa), the ability to form semen more quickly (14.17). Semen, as well as the secondary sexual characteristics, are compared to the fragrance in a flower bud; both, being imperceptible at first, make their appearance in the course of time (14.18).¹⁵² The rasa derived from the food is, however, unable to replenish the body of old people (14.19).

v1.c23.71

The elements (dhātu) are called thus because they support (dhāraṇa) the body (14.20).

v1.c23.72

The characteristics of blood corrupted by each of the doṣas, by two and by all three dosas are described (14.21), followed by those of blood in its normal condition (14.22).¹⁵³

v1.c23.73

Bloodletting (raktavisrāvaṇa) constitutes the next subject.¹⁵⁴ Contra-indications are mentioned first (14.24).¹⁵⁵ There are two kinds of bloodletting by means of sharp instruments:¹⁵⁶ pracchāna (scarification)¹⁵⁷ and sirāvyadhana (venepuncture or phlebotomy)¹⁵⁸ (14.25). The technique is described (14.26).¹⁵⁹ The causes of an insufficient flow of blood are dealt with (14.27–28), followed by the symptoms in such a case (14.29). The causes and symptoms of an excessive flow are described too (14.30). Proper bloodletting, its effects and advantages are discussed (14.31–34). Powders to increase the blood flow, styptics (raktasthāpana)¹⁶⁰ and other methods of checking the bleeding are described (14.35–36), followed by dietary instructions (14.37–38).

v1.c23.74

Four ways of arresting haemorrhage and their indications are discussed: saṃdhāna¹⁶¹ (contraction of the vessels) by means of astringent (kaṣāya) fluids, skandana¹⁶² (thickening of the blood) by cold applications, pācana (desiccation of the wound) by means of ashes, and dahana (cauterization) (14.39–42). A small amount of impure blood that remains (in the system) after bloodletting does not require any further treatment (14.43). Blood should be protected carefully, because it constitutes the root of the body and is the substance that sustains it (14.44). The treatment of excited vāyu after bloodletting closes the chapter (14–45).

v1.c23.75

Chapter fifteen (doṣadhātumalakṣayavṛddhivijñānīya) discusses the signs of decrease (kṣaya) and increase (vṛddhi) of doṣas, dhātus and malas.¹⁶³

v1.c23.76

The functions of each of the five kinds of vāyu, pitta and kapha are enumerated (15.4),¹⁶⁴ followed by the functions of the seven bodily elements (dhātu), the three main impurities (mala), i.e., faeces (purīṣa), urine (mūtra) and sweat (sveda), and the female procreational fluid (ārtava) (15.5). All these constituents should be protected in the proper way (15.6).

v1.c23.77

The chapter proceeds with the description of the signs of decrease of each doṣa (15.7)¹⁶⁵ and the treatment of these conditions (15.8),¹⁶⁶ the signs of decrease of each dhātu (15.9)¹⁶⁷ and the treatment of these conditions (15.10), the signs of decrease of each mala and the treatment of these conditions (15.11), the signs of decrease of the ārtava and the breast milk (stanya), as well as the signs pointing to a defective development of the foetus (garbhakṣaya),¹⁶⁸ followed by the treatment of these conditions (15.12).

v1.c23.78

The signs of increase of all the mentioned elements are described, followed by the general treatment of these conditions (15.13–17).

v1.c23.79

The next subject is ojas, in this treatise regarded as identical with bala.¹⁶⁹ Bala and ojas¹⁷⁰ are described, together with their functions (15.19–22). Three disorders of ojas/bala are distinguished and characterized: visraṃsa (dislodgment), vyāpad (derangement) and kṣaya (decrease) (15.23–28ab);¹⁷¹ the management and degrees of curability of these disorders are dealt with (15.28–31).

v1.c23.80

Sthaulya (obesity) and kārśya (leanness) constitute the next subjects. Their causes, features and management are dealt with (15.32–33).¹⁷² An average build (madhyaśarīra) is regarded as the best; leanness is preferable to obesity (15.34–36).

v1.c23.81

The normal values (parimāṇa) of doṣas, dhātus and malas cannot be ascertained, due to their variations;¹⁷³ a physician should for that reason infer their equilibrium or degree of disorder; it is his task to maintain the equilibrium when present and to establish it gradually when out of order (15.37–40).

v1.c23.82

The chapter ends with the definition of a healthy person (svastha) (15.41).

v1.c23.83

Chapter sixteen (karṇavyadhabandhavidhi) is concerned with the piercing (vyadha) and repair (bandha) of the ears.¹⁷⁴

v1.c23.84

The age at which a child's ears should be pierced¹⁷⁵ and the technique of piercing are discussed (16.3–4).¹⁷⁶

v1.c23.85

The complications (upadrava) which may arise when an ignorant physician accidentally (yadṛcchayā) pierces one of the three sirās called kālikā, marmarikā and lohitikā are described (16.5), followed by the management of improper piercing, the care after a proper technique has been employed, and the gradual dilatation of the hole (16.6–8).

v1.c23.86

The next subject is formed by the repair (saṃdhāna) of ear lobules which split during the process of dilatation, either on account of (corrupted) doṣas or due to a trauma (abhighāta) (16.9).¹⁷⁷

v1.c23.87

Fifteen types of split earlobes and their repair are described.¹⁷⁸ Their names are: nemisaṃdhānaka, utpalabhedyaka, vallūraka, āsaṅgima, gaṇḍakarṇa, āhārya, nirvedhima, vyāyojima, kapātasandhika, ardhakapātasandhika, saṃkṣipta, hīnakarṇa, vallīkarṇa, yaṣṭikarṇa, and kākauṣṭhaka. The first ten of these types may be repaired successfully, the treatment of the last five is likely to fail due to complications (16.10). Special procedures to be employed in difficult cases are added (16.11–13).

v1.c23.88

The technique of reconstructing an absent earlobe by means of a pedicle flap from the cheek is succinctly dealt with in one verse (16.14).¹⁷⁹

v1.c23.89

The repair techniques in general are more elaborately described in prose (16.15), followed by post-operative precautions to be observed (16.16), contra-indications (16.17),¹⁸⁰ and after-treatment (16.18).

v1.c23.90

Subjects discussed next are: the techniques of elongating the earlobes (pālīvardhana) (16.19–25);¹⁸¹ diseases of the earlobes (karṇapālyāmaya) caused by the doṣas, and their treatment (additional verses 1–5);¹⁸² a series of particular complications (upadrava) and their treatment;¹⁸³ the names of these complications are: utpāṭaka, utpuṭaka, śyāva (discoloration), sakaṇḍūka (itching), avamanthaka, kaṇḍūmant (severe itching), granthika (keloid), jambula, śrāvin (formation of a discharge), dāhavant (the occurrence of a burning sensation) (additional verses 6–19).

v1.c23.91

The chapter ends with the famous verses on plastic surgery.¹⁸⁴ Reconstruction of a cut off nose¹⁸⁵ by means of a flap of skin is described (16.27–31),¹⁸⁶ followed by a similar technique for repairing a cleft lip (16.32).

v1.c23.92

Chapter seventeen (āmapakvaiṣaṇīya) is devoted to the knowledge (eṣaṇa) concerning unripe (āma) and ripe (pakva) (inflammatory swellings).

v1.c23.93

Subjects dealt with are: the characterization of śopha (swelling) (17.3); the signs of the six types of śopha, caused by one of the three doṣas, all three together, blood, and a trauma (the āgantu type) (17.4); the signs of śopha, when unripe (āma), ripening (pacyamāna) and ripe (pakva) (17.5); a real vaidya as the one who can recognize these stages (17.6); two competing theories about the patho-physiological processes leading to suppuration (pāka) (17.7–8); the dangers when an unripe swelling is incised or a ripe swelling not incised (17.9); the pre-operative regimen (17.11–13); the dangers of leaving śopha untreated (17.14) and the advantages of starting its management early (17.15); the necessity of draining pus (pūya) (17.16); the seven main ways of treating a vraṇa (ulcer or inflamed wound):¹⁸⁷ vimlāpana (light massage), avasecana (bloodletting and other eliminative procedures), upanāha (the application of poultices), pāṭana (operative procedures), śodhana (purification), ropaṇa (granulation-promoting measures), and vailkṭāpaha (restoration of the natural colour and the growth of hair)¹⁸⁸ (17.17–18).¹⁸⁹

v1.c23.94

Chapter eighteen (vraṇālepanabandha) is devoted to pastes (ālepana) and bandages (bandha) to be employed in the treatment of sores (vraṇa).¹⁹⁰

v1.c23.95

Subjects discussed in its first part are: the importance of pastes and bandages (18.3); the rule that a paste should be applied against the direction of the hair (pratiloma) and the reasons for doing so (18.4); a desiccated paste should not be used, unless pressure (pīdana) is required (18.5); the three types of paste: pralepa (a thin paste), pradeha (a thick paste) and ālepa (a paste of medium consistency); their actions and indications; the nature of a kalka,¹⁹¹ its actions and indications (18.6); actions and uses of an ālepa (18.7–9); a special rule for the ingredients of an ālepana in disorders caused by vāta, pitta or kapha (18.10); 192 the thickness of an ālepa (18.11); 193 the appropriate time for ālepana (18.12–12); a lepa should always be freshly prepared (18.14–15).

v1.c23.96

The subjects of the second part are: bandaging materials (vraṇabandhanadravya) (18.16); 194 the fourteen types of bandage: 195 kośa, 196 dāman, 197 svastika, 198 anuvelita, 199 pratolī or mutolī, 200 maṇḍala, 201 sthagikā, 202 yamaka, 203 khaṭvā, 204 cīna, 205 vibandha, 206 vitāna, 207 gophaṇā, 208 and pañcāṅgī 209 (18.17); 210 the places of the body where to apply these bandages (18.18); technical rules (18.19–21); 211 three kinds of bandages: tight (gāḍha), even (sama) and loose (śithila), their characteristics and indications (18.22–25); the frequency of changing the dressing (18.26); the bad effects of improper bandaging, the advantages of correct bandaging, the disadvantages of not applying a bandage (18.27–31); contra-indications for applying a bandage (18.32–34); the site of the sore, the doṣa(s) involved, (the nature of) the sore and the season as the chief elements to be taken into consideration when selecting the proper bandage (18.35); the three types of making a knot (yantraṇā): above, laterally of, and below (the sore) (18.36). The chapter ends with a series of verses that give a summary of its contents (18.37–45). 212

v1.c23.97

Chapter nineteen (vraṇitopāsanīya) is devoted to the care of patients suffering from vraṇa.

v1.c23.98

The subjects dealt with are: the selection of an appropriate sick room (āgāra) (19.3–4); the bed of the patient (19.5–6); 213 the importance of friendly company (19.7–8); rules for the patient (19.9–20); the effects of not observing the prescribed regimen (19.21–22); special rules aiming at warding off malevolent beings (rakṣas), attracted by the sore(s); these beings belong to the attendants of Paśupati, 214 Kubera and Kumāra (19.23); various measures to ward off these beings ((19.24–26); the recitation of benedictory verses (āśīrvidhāna) from the four Vedas by priests and physicians to protect the patient (19.27); fumigation as a protective measure (19.28); protective plants to be placed upon the head of the patient (19.29); various measures promoting healing of a vraṇa (19.30–37).

v1.c23.99

Chapter twenty (hitāhitīya) is devoted to wholesome (hita) and harmful (ahita) (diet and regimen).

v1.c23.100

Subjects dealt with are: the thesis that no medicinal substance is either entirely wholesome or unwholesome; the rejection of this thesis, because these substances are of three categories: beneficial, non-beneficial, or of a mixed character (20.3–4); a list of articles of diet which are most wholesome (pathyatama) (20.5); regimen declared to be most wholesome (20.6); articles of diet and regimen of a mixed character (20.7); combinations of substances which become equivalent to poisons (20.8); a second discourse on the thesis that no substance is either entirely wholesome or unwholesome (20.10–12); a list of insalutary combinations of articles of diet (20.13); 215 incompatibilities regarding prepared dishes (20.14); 216 quantitative incompatibilities (20.15); 217 incompatibilities regarding taste (rasa), potency (vīrya) and vipāka (20.16); 218 articles of diet to be avoided are those with an excess of any property (20.17); the harmful effects of incompatible substances and the management of the disorders resulting; circumstances which diminish the bad effects (20.18–22); the properties and actions of winds coming from the east, south, west, and north (20.23–30).

v1.c23.101

Chapter twenty-one (vraṇapraśna) is concerned with questions (praśna) relating to sores (vraṇa).

v1.c23.102

Subjects dealt with in the first part of the chapter are: the three doṣas support the body, like the pillars (sthūṇā) of a house; the body is called tristhūṇa for that reason; when deranged (vyāpanna), the same doṣas bring about the body’s dissolution (pralaya); the three doṣas, together with blood as the fourth, are always present in the body, maintaining it (21.3–4); the etymologies of the names of the doṣas (21.5); the chief seats (sthāna) of the doṣas; vāta is located in the śroṇi (pelvic region) and guda (recto-anal region), pitta between pakvāśaya and āmāśaya, 219 kapha in the āmāśaya 220 (21.6); the seats of the five kinds of pitta and kapha 221 (21.7); the maintaining functions of kapha, pitta and vāta are likened to the emission (visarga), absorption (ādāna), and the capacity of imparting motion (vikṣepa) of moon, sun and wind respectively (21.8); the relationship between pitta and agni; the internal fire (antaragni) is declared to be the same as pitta (21.9); 222 the seats and functions of the five kinds of pitta: pācaka, located between pakvāśaya and āmāśaya, rañjaka, located in liver and spleen, sādhaka, located in the heart, ālocaka, located in the eyes, and bhrājaka, located in the skin (21.10); 223 the qualities of pitta (21.11); 224 the seats and functions of the five kinds of kapha, located in the āmāśaya, chest, root of the tongue and throat, head, and junctures (sandhi) respectively (21.12–14); 225 the qualities of kapha (21.15); 226 the main seats (liver and spleen) and function of blood (21.16); the qualities of blood: neither hot nor cold, sweet (madhura), oleaginous (snigdha), red in colour, heavy (guru), of a musty smell (visra), and with a vidāha like that of pitta (21.17). 227

v1.c23.103

The second part of the chapter is devoted to the six stages of development of a disease, which are called kriyākāla because they necessitate treatment. 228 The symptoms of accumulation (saṃcaya) of the doṣas, the first stage, are described (21.18); 229 the second stage, excitement (prakopa) of the doṣas, is elaborately discussed; the factors leading to excitement of each of the doṣas and blood are separately enumerated, followed each time by the seasons, parts of day and night, and stages of the digestive process during which this excitation is likely to occur (21.19–26); the symptoms of excitement are listed (21.27); the third stage, spread (prasara) of the doṣas, 230 impelled by vāta, throughout the body, shows fifteen varieties, dependent on the number of doṣas involved 231 and all their combinations (21.28); the way morbid changes (vikāra) are produced during this stage, their management, and the signs indicating prasara are dealt with (21.29–32); the fourth stage is called sthānasaṃśraya because localized disorders, or even generalized ones, begin to appear; these disorders may affect a particular part of the body or one of the seven elements; the characteristic sign of this stage is the prodrome (pūrvarūpa) (21.33); the fifth stage (vyakti) 232 is characterized by the appearance of the fully manifest signs (pravyaktalakṣaṇa) 233 of particular diseases (21.34); the sixth stage (bheda) 234 is that in which sores appear and generalized diseases become chronic (21.35); a good physician is he who has acquired an accurate knowledge of these six stages (21.36).

v1.c23.104

The doṣas should be eliminated in the stage of accumulation in order to prevent that the next steps of the process are reached (21.37). A partially excited doṣa may get more excited when it comes in contact with a (completely) excited one (21.38).²³⁵ The most excited one of a combination of doṣas should be counteracted first (21.39).

v1.c23.105

The chapter ends with the etymology of the term vraṇa (21.40).

v1.c23.106

Chapter twenty-two (vraṇāsrāvavijñānīya) is about sores, their discharges (srāva),²³⁶ and some other subjects.

v1.c23.107

Subjects dealt with are: the eight substrates (vastu) of sores: skin, muscular tissue, sirās, snāyus, osseous tissue, junctures (sandhi), viscera (koṣṭha), and vital spots (marman) (22.3);²³⁷ a sore in the first of these substrates, which makes the skin burst, is easy to treat; sores in the remaining substrates are difficult to manage (22.4);²³⁸ the shapes (ākṛti) of sores: oblong (āyata), rectangular (caturasra), round (vṛtta), triangular (tripuṭaka); sores with other, irregular shapes (vikṛtākṛti) are difficult to treat (22.5);²³⁹ sores heal rapidly when the patient keeps to the rules concerning diet and conduct and when the physician is competent (22.6); the characteristic features of corrupted sores (duṣṭavraṇa): a very narrow opening (atisaṃvṛta), a very wide opening (ativivṛta), excessive induration (atikaṭhina), excessive softness (atimṛdu), excessive elevation (atyutsanna), excessive depression (atyavasanna), excessive coldness (atiśīta), excessive heat (atyuṣṇa), a fierce (bhairava) aspect due to the presence of a black, red, yellow, white, or other colour, being filled with foul-smelling (pūti) pus (pūya),²⁴⁰ muscular tissue, sirās, snāyus, etc., and discharging foul-smelling pus, deviation from the usual track (unmārgin),²⁴¹ a pouchy aspect (utsaṅgin),²⁴² an unpleasant (amanojña) aspect and smell, severe pain (vedanā), association with an excessive burning sensation, suppuration (pāka), redness (rāga), itching, swelling, and boils (piḍakā), a discharge of corrupted blood, and chronicity (dīrghakālānubandhin);²⁴³ these types should be arranged in six groups, dependent on the excess (ucchrāya) of the doṣa(s) involved,²⁴⁴ and treated accordingly (22.7); types of discharge (srāva) according to the substrate of the sore and the doṣa(s) involved (22.8);²⁴⁵ incurable discharges (22.9–10); types of painful sensations (vedanā), caused by vāta, pitta, blood, kapha, and all the doṣas together (22.11);²⁴⁶ the colours of sores, dependent on the doṣa(s) involved (22.12).²⁴⁷

v1.c23.108

The chapter ends with a verse expounding that the characteristics of sores as described also apply to all kinds of swelling (śopha) (22.13).

v1.c23.109

Chapter twenty-three (kṛtyākṛtyavidhi) is devoted to tractable (kṛtya) and intractable (akṛtya) (lesions).

v1.c23.110

Its subjects are: the qualities of an easily curable patient (23.3);²⁴⁸ the opposite qualities, leading to incurability (23.4);²⁴⁹ sites where sores easily heal (23.5); sites, along with other features, which make sores difficult to treat (duścikitsya) (23.6); other conditions making sores curable with difficulty (23.7); conditions making sores amenable to palliative treatment (yāpya) only (23.8); without treatment, curable sores become palliable, palliable ones incurable, and incurable ones fatal (23.9); the definition of palliability (23.10–11); features of incurable sores (23.12); 250 some kinds of āgantu (traumatic) sores which are curable, whereas the same kinds caused by the doṣas are incurable (23.13); a sore that spreads (to other elements of the body) and becomes deep-seated should be regarded as incurable (23.14–16); sores with opposite qualities are easily curable (23.17); the characteristics of a clean (śuddha), healing, and healed (samyagrūḍha) sore (23.18–20); causes making a healed sore re-open (23.21).

v1.c23.111

Chapter twenty-four (vyādhisamuddeśīya) discusses the classification of diseases.

v1.c23.112

Diseases are of two categories: curable by surgical means (śastrasādhya) and curable by means of oleation and related procedures; oleation, etc., are not contra-indicated in the first category, but surgery should not be carried out if oleation, etc., are thought to be adequate (24.3).

v1.c23.113

All the diseases will be dealt with in this treatise. As already mentioned, 251 disease (vyādhi) is a condition associated with suffering (duḥkhasaṃyoga). This suffering is of three types: ādhyātmika (of internal origin), ādhibhautika (of external origin) and ādHidaivika (of celestial or divine origin). 252 These types are divided into seven groups: ādibalapravṛtta, janmabalapravṛtta, doṣabalapravṛtta, saṃghātabalapravṛtta, kālabalapravṛtta, daivabalapravṛtta, and svabhāvabalapravṛtta (24.4). 253

v1.c23.114

Ādibalapravṛtta are the diseases resulting from a defect (doṣa) of semen (śukra) or female procreational fluid (śoṇita), which means that they are transmitted by one of the parents; examples are kuṣṭha and arśas (haemorrhoids). Janmabalapravṛtta diseases result from transgressions (apacāra) of the mother (during pregnancy); they are either caused by the rasa (derived from an improper diet) or neglect of the pregnant woman’s cravings (dauhṛda); examples are paṅgu (lameness), jātyandha (congenital blindness), badhira (deafness), mūka (dumbness), minmina (a nasal voice), and vāmana (dwarfism). Doṣabalapravṛtta are the diseases arising from (an already present) illness (ātaṅka), 254 as well as those caused by a faulty diet (āhāra) and conduct (ācāra); they are of two kinds again: originating from the āmāśaya or the pakvāśaya; they are of two kinds too when distinguished into bodily and mental ones. 255 These three groups together constitute the diseases called ādhyātmika.

v1.c23.115

Saṃghātabalapravṛtta are those āgantu 256 disorders which are caused by contests (vigraha) of a weaker with a stronger one; they are of two kinds: brought about by sharp objects (śastra) 257 and by wild animals (vyāla). 258 These are the disorders called ādhibhautika.

v1.c23.116

Kālabalapravṛtta are the disorders caused by cold, heat, wind, rain, the heat of the sun (ātapa), etc.; they are of two kinds: arising from seasonal abnormalities (vyāpannartuka) or arising (even) when the seasons are normal. 259

v1.c23.117

Daivabalapravṛtta are the disorders resulting from offenses against the gods 260 (devadroha), curses (abhiśaptaka), Atharvavedic charms (atharvaṇa), and upasarga; 261 they are of two kinds: caused by lightning and thunder, or by Piśācas and other (malevolent beings); they are of two kinds again when divided into saṃsargaja 262 and ākasmika. 263

v1.c23.118

Svabhāvabalapravṛtta diseases are of natural origin: hunger, thirst, ageing, death, sleep, etc.; they are of two kinds: occurring at the proper time (kālaja) or at an improper time (akālaja); they appear in those taking care of themselves (parirakṣaṇa) or those neglecting the rules regarding health respectively. These are the disorders called ādhidaivika (24.7).

v1.c23.119

All the diseases are rooted in vāta, pitta and kapha; in the same way all the evolutes (vikāra) derive from sattva, rajas and tamas.264 The diversity of the diseases arises from the interplay (saṃsarga) among doṣas, dhātus and malas, the specificity of their seats (āyatanaviśeṣa), and their (various) causes (nimitta). They are called after the dhātu that has been corrupted by a doṣa (24.8).

v1.c23.120

Disorders (vikāra) arising from a corrupted condition (doṣa) of rasa, rakta, 265 māṃsa, medas, asthi, majjā, and śukra 266 are enumerated, followed by those appearing when the seats of the malas 267 and indriyas (senses)268 are in a corrupted condition (24.9).

v1.c23.121

Diseases arise there, where the excited doṣas, circulating in the body, get obstructed due to an abnormality (vaguṇya) of the channels (kha) (24.10). Diseases are always associated with the doṣas, but the production (utpatti) of a disease can only come about in the presence of an accessory cause (nimitta) (24.11).

v1.c23.122

Chapter twenty-five (aṣṭavidhaśastrakarmīya) is devoted to the eight surgical procedures (śastrakarman).269

v1.c23.123

The subjects are: disorders to be treated by means of excision (chedya), incision (bhedya), scarification (lekhya), puncturing (vedhya), probing (eṣya), extraction (āhārya), drainage (srāvya), and suturing (sīvya) (25.3–17ab);270 contra-indications for suturing (25.17cd–18ab); wound toilet before suturing (25.18cd–19); the technique of suturing and the materials to be used (25.20–21); various types of suturing: vellitaka (curved),271 gophaṇikā (reinforcing), 272 tunnasevanī (a suture of the darning type), 273 ṛjugranthi (interrupted), 274 etc. (25.22); the three types of suturing needles (sūcī): circular (vṛttā), straight (āyatā), and semicircular (dhanurvakrā); the uses of these types (25.23–25ab); the correct distance to be observed in making a suture (25.25cd–26); 275 after-treatment: dressing, powdering (pratisāraṇa) and bandaging (25.27–28); the four misfortunes (vyāpad) of surgical interventions: incisions that are too small (hīna), too large (atirikta), or slanting (tiryañc), and self-injury on the part of the physician as the fourth type (25.30); complications due to errors of the surgeon (25.31–32); the signs of injury to vital spots in general (marman), sirās, snāyus, junctures (sandhi), bones, and māṃsamarman (25.33–40); self-injury (25.41); care to be taken with regard to sharp instruments (25.42); the importance of trust (viśvāsa) on the part of the patient (25.43–44); the praise of a reliable physician (25.45); the occasional necessity of having recourse to more than one surgical intervention (25.46).

v1.c23.124

Chapter twenty-six (pranaṣṭaśalyavijñānīya) is devoted to the knowledge about śalyas276 invisibly lodged (pranaṣṭa) (in the body). 277

v1.c23.125

The subjects discussed are: the etymology of the term śalya (26.3); the two types of śalya: arising within the body (śārīra) and coming from outside (āgantuka) (26.4); anything giving rise to pain (ābādha) all over the body is called śalya, and śalyaśāstra is the science concerned with śalyas (26.5). The śārīra type of śalya consists of teeth, hairs, nails, etc., as well as corrupted bodily elements (dhātu), foods (anna), impurities (mala) and doṣas; all the other ones belong to the āgantuka type (26.6); the āgantuka śalya may be (pieces of) metal (loha), bamboo (veṇu), wood (vṛkṣa), grass, horn or bone; out of these, the metallic ones, and among the metallic ones, arrows (śara), should be taken into consideration primarily; arrows are of two types: barbed (karṇin) and smooth (ślakṣṇa), and of various shapes (26.7);278 the five directions from which a śalya may enter the body (26.8); the sites where it may lodge (26.9); the general features after entry; the specific signs of a śalya lodged in the skin, muscular tissue, a muscular belly (peśī), a sirā, snāyu, or dhamanī, a bone, a cavity within a bone (asthivivara), a juncture, the viscera (koṣṭha), or a marman (26.10); prognostic features (26.11); procedures for detecting śalyas which are invisibly lodged somewhere within the body (26.12); general tests which may be helpful in localizing a śalya (26.13); other signs indicating the site of a śalya (26.14–15); exploration of the track with a probe (eṣaṇī) (26.16–17); sequelae of unextracted śalyas (26.18–22).

v1.c23.126

Chapter twenty-seven (śalyāpanayanīya)279 is about the removal (apanayana) of śalyas.280

v1.c23.127

The subjects dealt with are: the two types of śalya: fixed (avabaddha) and loose (anavabaddha) (27.3); the fifteen measures for the removal (uddharaṇa) of loose śalyas: svabhāva (natural bodily functions), pācana (maturation), bhedana (incision), dāraṇa (causing a burst), pīḍana (squeezing), pramārjana (cleansing), nirdhmāpana (blowing), vamana (emesis), virecana (purgation), prakṣālana (irrigation), pratimarśa,281 pravāhaṇa (straining), ācūṣaṇa (sucking), ayaskānta (a magnet), and harṣa (cheering) (27.4); indications for each of these measures (27.5); two ways of removing (āharaṇa) a śalya: in the opposite direction (pratiloma) or in the direction of entry (anuloma);282 indications for the pratiloma and anuloma techniques (27.6–7); a sharp-pointed (chedanīyamukha) śalya, if protruding (uttuṇḍita), should be manually removed after making an incision (27.8); the same type of śalya283 is to be removed manually through its own track if lodged in the belly (kukṣi),284 chest, an armpit (kakṣa), groin (vaṅkṣaṇa), or intercostal space (parśukāntara) (27.9); if manual removal proves to be impossible, then the track should be widened with a sharp instrument and the śalya removed with a blunt instrument (27.10); measures to be taken if the patient faints (27.11); post-operative care; the techniques to be employed in some difficult cases (27.12);285 the removal of a śalya located in the vicinity of the heart (27.13); the removal of a śalya that has penetrated into the cavity of a bone or has got a stuck in a bone; the shaft (vāraṅga) of such a śalya should be tied to a bow-string, the other end of which is to be fastened to the rein of a horse with a pañcāṅgī bandage;286 the horse should be whipped, and, when it lifts its head forcibly, the śalya comes out; or, a strong branch of a tree should be bent and tied to the śalya, which comes out when the branch straightens (27.14);287 a protruding (uttuṇḍita) śalya, located where it cannot be removed surgically, should be loosened by strokes of an aṣṭhilā,288 stone or mallet (mudgara), and removed through its own track by means of a blunt instrument (27.15); the extraction of barbed arrows (27.16); the removal of lac (jātuṣa) from the throat by means of a heated śalākā inserted into a hollow tube; a related method for the removal of other substances (27.17–18); the removal of a śalya consisting of bone or a similar substance when stuck up in the throat (27.19); treatment of a patient whose belly is filled up with water (27.20); 289 the treatment to be applied when a morsel of food (grāsaśalya) is arrested in the throat (27.21); treatment of strangling (27.22). The chapter ends with some general directions (27.23–26).

First 126 of 1,086 passages. Read on

Linked texts (6)