The ulcer should first be searched with a probe or director and, after an operation, an alkali should be applied to it. To remove all sloughed off or sloughing flesh and membranes cauterization with fire is forbidden. [The fissures of pus (sinuses) and sloughed off flesh should be first drawn out]. A plaster of clarified butter and pasted sesamum should then be applied to it, and the ulcer duly bandaged. Clarified butter should be constantly applied over the bandage which should be removed on the third day. Cleansing or disinfecting (S'odhana) measures should then be used by the surgeon, according to the Doshas involved in the ulcer, and the successive healing (Ropana) measures resorted after its being properly purified (S'odhana). 6
In a case of the Parisravi (exuding) type, where there is bleeding and secretion from the ulcer, the sinus and the cavities of pus should be first removed and then cauterized with an alkali or with fire by an intelligent surgeon. The region of the anus should then be kept wet by the sprinkling of lukewarm Anu-toila (described in thechapteron Váta-vyádhi). Warm plasters, or poultices, mixed with Yavakshára and the urine (of a cow) should then be applied. Decoction of the emetic drugs as the seeds of Madana, etc.), should also be sprinkled slightly on the affected part. The ulcer when found to be softened and nearly free from pain and secretion (owing to the preceding measures) should be searched with a probe and the principal sinus should be cut open and again completely cauterized with fire or with an alkali. The incisions should be made in the shape or form of a Kharjura-patra (leaf of the date-palm) Ardha-chandra (half-moon), Chandra-chakra (moon's disc), Suchi-mukha (needle's mouth), or Avámmukha (with downward mouth). After that the ulcer should be purified with mild cleansing or disinfecting remedies (as described above) 7.
In the case of an infant cauterization with fire or with an alkali, the use of strong purgatives and surgical operations arc forbidden in the case of the disease (Bhagandara), whether outer mouthed or inter-mouthed. Medicinal remedies calculated to be mild, though keen in their efficacy, should be used in such cases. A plug or a Varti in the shape of a wick and made of powdered Aragvadha, Haridrá and Kálá, mixed with honey and clarified butter, should be inserted into the ulcer for purifying purposes. This medicinal compound speedily brings about the healing of a sinus, just as the wind will drive away a cloud. 8 - 9
The sinus in a fistula of traumatic origin should be carefully cut open by a surgeon (with a knife) and cauterized, according to the rules laid down, with a red-hot Jambvoshtha (instrument) or with a red-hot director (Saláká). Vermifugal remedies should be applied to it, and measures laid down in connection with the extraction of a Salya from the body should be carefully resorted to. 10,