In cases of the Vaddha-guda (Entertis) and the Parisrávi types of Udara, the patient should be first treated with emulsive measures and fomentations and then anointed with a sneha. Then an incision should be made on the left side of the abdomen below the umbilicus and four fingers to the left of the line of hair which stretches downward from the navel. The intestine to the length of four fingers should be gently drawn out * any stone, any dry hardened substance (Scybalum?), or any hair found stiffing to the intestine should be carefully examined and removed. Then the intestine should be moistened with honey and clarified butter. It should then be gently replaced in its original position and the mouth of the incision in the abdomen should be sewn up. 20.
In cases of the Parisrávi type of Udara, the obstructing matter should be similarly removed (from the intestines), as in the preceding case, and the secreting intestine should be purified. The (two ends of the severed intestines should be firmly pressed and adhered together and large black ants should be applied to these spots to grip them fastly with their claws. Then the bodies of the ants having their heads firmly adhering to the spots, as directed, should be severed and the intestines should be gently reintroduced into their original position (with the severed heads of the ants adhering to the ends of the incision) and sutured up, as in the preceding case. A union or adhesion of the incidental wound should then be duly effected. The seam should now be plastered with black earth mixed with Yashti-madhu and duly bandaged. The surgeon should cause the patient to be removed to a chamber protected from the wind and give him the necessary instructions. The patient should be made to sit in a vessel full of oil or clarified butter and his diet should consist only of milk. 21.
A patient afflicted with Jalodara (ascites) should be first anointed with medicated oils, possessed of Váyu-subduing virtues, and fomented with hot water. Then his friends and relatives should be asked to hold him firmly by his arm-pits, when the surgeon would make a puncture with a surgical instrument, known as the Vrihi-mukha, on the left side of the abdomen below the umbilicus, to the breadth of the thumb in depth and at a distance of four fingers to the left of the dividing line of hairs in the abdomen. Simultaneously with that, a metal tube or a bird's quill, open at both ends, should be introduced through the passage of the puncture to allow the morbific fluids (Doshodoka) accumulated in the abdomen, to ooze out. And then having removed the tube or the quill, the puncture should be lubricated with oil and Saindhava salt and bandaged in the manner described in connection with the bandaging of ulcers.
The entire quantity of the morbific fluid should not be allowed to ooze out in a single day, inasmuch as thirst, fever, aching of the limbs, dysentery, dyspnoea and a burning of the feet (Páda-dáha) might supervene in consequence, or as it might lead to a fresh accumulation of matter in the abdomen, in the event of the patient being of a weak constitution. Hence it should be gradually tapped at intervals of three, four, five, six, eight, ten, twelve, or of even sixteen days. After the complete outflow of the fluid, the abdomen should be firmly tied with a piece of flannel, silk-cloth or leather, inasmuch as this would prevent its flatulent distention.
Diet: - For six months the patient should take his food only with milk or with the soup (Rasa) of Jángala animals.
The diet * for the next three months should consist of (meals taken with) milk diluted (and boiled) with an equal quantity of water or with the soup of flesh of animals of the Jángala group seasoned with the juice of acid fruits. During the next three months it should consist of light and wholesome meals. This rule observed for a year brings about a cure. 22.
Skilled physicians should prescribe boiled milk and the soup of the flesh Vágbhata following Charaka says: of animals of the Jángala group as food and drink in all cases of Udara and use these as Asthápana measures and as purgatives as well. 23.
* The use of water is forbidden during these nine months.
During the fust six months, drinking, washing, etc., should be done with milk or the soup of Jángala animals. After this period, the said purposes should be served with half-diluted milk or meat-soup seasoned with the juice of acid fruits. Water may be used during the period of the next three months - -Dallana.
The patient should live only on milk for six months. After this period, he should live on porridge (Peyá) boiled with milk; and for the next three months he should live on boiled S'yámá-rice with milk, or with the soup of meat seasoned with the juice or acid fruits and mixed with clarified butter and a small quantity of salt.
The water of tender and green cicoanuts is used in cases of Udara in place of pure drinking water with benefit. - Ed.
Thus ends the fourteenth Chapter in the Chikitsita Sthánam of the Sus'ruta Samhitá which deals with the treatment of Udara.