Kavalika' (Tow)

Any soft stuffing or tow (such as the leaves or the bark of trees of medicinal virtues) between the medicine applied over an ulcer and the bandaging linen is called the Kavalika (medicated tow). The tow or the Kavalika should be placed thickly (on the seat of affection); and then the physician (surgeon) having pressed it with his left hand should * place a piece of straight, soft, untwisted, and unfolded or unshrivelled linen over it, and then firmly tie up the bandage in a manner so as not to leave any knot over the seat of the ulcer, or to cause any discomfort to the patient.

* Carefully examining whether the applied remedy had been uniformly distributed over the diseased surface and whether the contemplated pattern of bandage would be actually suited to the case.

Introduction Of Lint

A Visheshika (lint) saturated with honey, clarified butter, and a medicinal paste should be inserted into the ulcer. Care should be taken not to introduce the lint extremely dry, or oily (oversoaked in a lubricating or oily medicinal preparation), inasmuch as an over-lubricated lint would give rise to an excessive formation of slimy mucus in the ulcer, whereas, its parched substitute would bring about the friction and the consequent breaking of the edges of the ulcer, like one misplaced or wrongly inserted.

A bandage should be tied in any of the three ways of Gadha, Sama and Shithila fastenings according to the shape and seat of the ulcer. * A tight bandage (Gadha-Vandha) should be tied round the buttocks, round the sides, round the arm-pits, round the inguinal regions, round the breast or round the head. A bandage of the Sama pattern should be fastened round the ears, round the extremities (hands and legs), round the face, round the throat, round the lips, round the penis, round the scrotum, round the back, round the belly and the chest. A loose bandaging (Shithila-Vandha) should be the rule in the region of the eyes and locations of important joints or unions.

Additional Text

A bandage, tightly tied round an ulcerated or affected part of the body without causing any pain or discomfort to the patient, is called a Gadha-Vandha, while the one which is loosely bound is called Shithila, the one neither too tight nor too loose being called a Sama-Vandha.

An ulcer, brought about or characterised by the symptoms of the deranged Pittam and occurring at a place where a tight bandaging is indicated, should be fastened with one of the Sama-Vandha class, and with a Shithila bandage where one of the Sama type would be indicated; whereas it should not be bandaged at all in the event of a loose bandage (Shithila-Vandha) being indicated. The same rule should be observed in the case of an ulcer caused through a diseased or contaminated state of the blood. Similarly, in the case of an ulcer produced through a deranged condition of the Kapham, a loose bandaging, otherwise enjoined to be adopted, should be substituted for one of the same pattern. A tight bandage should give place to a lighter one under the same circumstances, and such a procedure should be deemed as holding good even in the case of an ulcer caused by the action of the deranged Vayu.

In summer and autumn, the bandage of an ulcer, due to the vitiated blood or Pittam, should be changed twice a day; while the one tied round an ulcer of the deranged Vayu or Kapham, should be changed on each third day in spring and Hemanta. Similarly, an ulcer, marked by the action of the deranged Vayu, should be bandaged twice a day. "Thou shalt exercise thy own discretion, and vary or adopt the preceding rules of bandaging according to the exigencies of each case."

A medicated lint fails to have any efficacy but rather tends to augment the local pain and swelling where a bandage, enjoined to be loosely bound, or bound up with moderate and uniform steadiness (Sama-Vandha), is replaced by a tight or deep fastened one (Gadha-Vandha). A loose bandage, injudiciously used in a case where a tight or a moderately firm bandage should have been used, would cause the medicine to fall off from the lint and give rise to the consequent friction and laceration of the edges of the ulcer. Similarly, a moderately firm and steady bandage (Sama-Vandha) fastened in a case where a light or loose bandage should have been used, would fail to produce any effect. A proper bandage would lead to the subsidence of pain, and the softening of the edges of the ulcer, thus bringing about a purification of the local blood.