Now we shall discourse on the medical treatment of Chhinna cuts. An open mouthed ulcer on the side of the head * should be duly sutured as described before and firmly bandaged. An ear severed or lopped off should be sutured in the proper way and position and oil should be poured into its cavity. A Chhinna cut on the Krikatiká (lying on the posterior side of the junction of the neck and the head) and even if it allow the Váyu † (air) to escape through its cavity should be brought together and duly sutured and bandaged in a manner (so as not to leave any intervening space between-. The part thus adhesioned should be sprinkled with clarified butter prepared from goat's milk. The patient should be made to take his food lying on his back, properly secured or fastened with straps (so that he might not move his head and advised to perform all other physical acts such as, urination, defecation etc. in that position). 21-24
In the case of a lateral and wide-mouthed wound (sword-cut, etc.) on the extremeties, the bone-joints should be duly set and joined together as instructed before and the wound should be sutured and speedily bandaged in the manner of a Vellitaka bandage, or with a piece of skin or hide in the Gophaná or such other form as would seem proper and beneficial and oil should be poured over it. In the case of a wound on the back the patient should be laid on his back, while in the case of its occurring on the chest the patient should be laid on his face. * 25-27.
* Several commentators explain those that are situated either on the head or on the sides.
† The dictum that a hurt on any of the wind-carrying sounding channels is pronounced to be incurable, should not be supposed to hold good in the present case.
In the case of a hand or a leg being carried away or completely severed the wound should be cauterised with the application of hot oil and bandaged in the manner of a Kosha bandage and proper healing medicines should be applied. An oil cooked with the eight drugs Chandana, Padmaka, Rod/ira, Utpala, Priyangu, Haridrá, Madhuka, (Vasthimadhu) and milk, forms one of the most efficacious healing (Ropana) agents A Kalka of the thirteen drugs - Chandana, Karkatdkhya, the two kinds of Sahá (Mugáni and Másháni), Mánsi, (D.R. - Máshahva, Somáhva), Amritá, Harenu, Mrinála Triphalá, Padmaka and Utpala should be cooked in oil mixed with milk (four times that of oil) and the three other kinds of oily matter (lard, marrow and clarified butter) and this medicated oil should be used for sprinkling over a wound of this type for the purpose of healing (Ropana). 28.
Henceforth we shall deal with the medical treatment of Bhinna (excised) wounds. A case of an excised eye (Bhinna) should be given up as incurable. But in the case where an eye (ball) instead of being completely separated would be found to be dangling out (of its socket) the affected organ should be re-instated in its natural cavity in a manner so as not to disturb the connected Sirás (nerve arrangements) and gently pressed with the palms of the hand by first putting a lotus leaf on its (eye) surface. After that the eye should be filled (Tarpana) with the following (D.R, - Ajena in place of 'Anena" - i.e., prepared from goat's milk) medicated clarified butter, which should be as well used in the form of an errhine. The recipe is as follows: - Clarified butter prepared from goat's milk, Madhuka, Utpala, Jivaka and PJshavaka taken in equal parts should be pasted together, and cooked with sixteen seers of cow's milk and four seers of clarified butter. * The use of the medicated Ghrita thus prepared should be regarded as commendable in all types of occular hurt or injury. 29.
* For the complete elimination of the deranged Dosha i.e., pus, etc , of the wound invloved in the case - Jejjata.
He who has got a wound on his back should be laid on his face and he who has got an ulcer on his breast should be laid on his back - Differeut Reading Gayi.
In the case of a perforation of the abdomen marked by the discharge of lumps or rope-like Varti (fat) through the wound, the emitted or ejected fat-lump should be dusted with the burnt ashes (D. R.-powders) of astringent woods (such as Manu, Arjuna, etc.) and black clay (pounded together). A ligature of thread should then be bound round the fat-lump and the fat-lump cut off with a heated instrument. Honey should then be applied and the wound (Vrana) should then be duly bandaged. The patient should be caused to drink clarified butter after the full digestion of his injested food. Instead of this Ghrita, milk prepared medicinally with Yashti maddu, Lákshá and Gokshura, mixed with (a proper quantity of) sugar and castor oil (as Prakshepa) *, is equally commendable for the alleviation of the pain and the burning sensation, (in the wound or ulcer). The fat-lump (pariental fat) aforesaid causes a rumbling sound with pain in the abdomen and may prove even fatal in the event of its being left uncut. The medicated oil to be mentioned hereafter in connection with Medaja-Granthi should be applied in such cases. 30-32
* Several authorities, however, say that equal parts of clarified butter prepared from goat's milk and from cow's milk should be taken and cooked with 16 seers of cow's milk and with the four drugs as a Kalka.
But Gayi recommends only four seers of clarified butter prepared from goat's milk cooked with 16 seers of cow's milk and the four drugs as a Kalka.
Foreign bodies (Salya) piercing into any of the Koshthas after having run through the (seven layers of) skin, whether passing through the veins, etc , (muscles, nerves, bones or joints, or not, produces the distressing symptoms described before (Ch. III. - Sutra). The blood (of the affected chamber or receptacle) in such case lies incarcerated therein in the event of its failing to find an outlet and causes a pallor of the face and a coldness of the extremities and of the face in the patient. Respiration becomes cold, the eyes red-coloured, the bowels constipated and the abdomen distended. The manifestation of these symptoms indicates the incurable character of the disease. 33-34.
* This explanation is given on the authority of old Vágabhata. Dallana, however, explains the verse in a different way. He explains it to mean two different preparations of milk - one with Yashti-madhu and mixed with sugar and castor oil as a Prakshepa and the other with Gokshura and mixed with Lákshá and castor oil as a Prakshepa.
A third interpretation would make three preparations of milk prepared separately with Yashti-madhu, Lákshá and Gokshura - sugar and castor oil being mixed in the first (as Prakshepa) and castor oil alone in the second and third.
A fourth preparation would be to prepare the milk separately with Yashlimadhu, Lákshá and Gokshura as in the preceding case - without the addition of castor oil (as Prakshepa).
Emesis is beneficial in the case where the blood would be found to be confined in the Amás'aya (stomach). Purgatives should unhesitatingly be prescribed where the blood would be found to have been lodged in the Pakvás'aya (intestines) and Asthápana measures without oil should be employed with hot, purifying (Sodhana) substances (such as the cow-urine, etc.) The patient should be made to drink a Yavágu (gruel) with Saindhava salt and his diet should consist of boiled rice mixed with the soup of barley, Kola and Kulalttha pulse divested of oil. 35-36.
In a case of a perforation or piercing of any of the bodily Koshthas attended with excessive haemorrhage or bleeding, the patient should be caused to drink (a potion of animal) blood and such a case marked by the passage of stool, urine, etc., through their proper channels of outlet and by the absence of fever and tympanites and other dangerous symptoms, (Upadrava), may end in the ultimate recovery of the patient. 37-38.
In a case of a perforation of the Koshtha (abdomen) where the intestines have protruded or bulged out in an untorn condition, they should be gently re-introduced into the cavity and placed in their original position, and not otherwise. According to others, however, large black ants should be applied even to the perforated intestines in such a case and their bodies should be separated from their heads after they had firmly bitten the perforated parts with their claws. After that the intestines with the heads of the ants attached to them should be gently pushed back into the cavity and reinstated in their original situation therein. The bulged out intestines should be rinsed with grass, blood and dust, washed with milk and lubricated with clarified butter and gently re-introduced into the cavity of the abdomen with the hand with its finger nails cleanly paired. The dried intestines should be washed with milk and lubricated with clarified butter before introducing it into their former and natural place in the abdomen. 39-41.
In a case where the intestines could be but partially introduced, the three following measures should be adopted. The interior of the throat of the patient should be gently rubbed with a finger [and the urging for vomiting thus engendered, would help the full introduction of the intestines into the abdominal cavity]. As an alternative, he should be enlivened with sprays of cold water; or he should be caught hold of by his hands and lifted up into the air with the help of strong attendants and shaken in a manner that would bring about a complete introduction of the intestines into the natural position in the abdominal cavity. They should be so introduced as to press upon their specific (Maladhara) Kalá (facia). 42-43.
In a case where the re-introduction of the intestines into the abdominal cavity would be found to be difficult owing to the narrowness or largeness of the orifice of the wound, it should be extended or widened with a small or slight incisiona ccording to requirements, and the intestines re-introduced into their proper place. The orifice or mouth of the wound should be forthwith carefully sutured as soon as the intestines would be found to have been introduced into their right place. Intestines dislodged from their proper seat, or not introduced into their correct position, or coiled up into a lump bring on death. 44-46.