* N. B. Authorities, however, differ in enumerating these factors, although every one of them sticks to the total number of sixty.
Of these, Kasháya, Varti, Kalka, Ghrita, Taila, Rasa-kriyá and Avachurnana are the measures for the cleansing (Sodhana) of an ulcer and for helping its granulation (Ropana). The eight acts (from Chhedana to Sivana) are surgical operations. We have already spoken of such acts as Sonitásthápana, Kshara-karma, Agni-karma, Yantra, Ahára, Rakshá-vidhána and Vandha-Vidhaná (in the Sutra-sthána). Later on, we shall discourse on Sneha, Sveda, Vamana, Virechana, Vasti, Uttara-vasti, Siro-virechana, Nasya, Dhuma, and Kavala-dhárana. Of the remaining measures we shall speak in the present chapter. 23.
There are six kinds of swellings (Sophas),as described before, and the following eleven measures, commencing with Apatarpana and ending in Virechana, should be regarded as their cure. These are the proper remedies for a swelling and do not (cease to be efficacious in, nor) prove hostile to cases of swelling which are transformed into ulcers. The other measures should be deemed as remedial to ulcers but Apatarpana is the first, general and principal remedy in all types of swellings (Sophas). 24.
Apatarpana (fasting) should be prescribed in the case of a patient, full of enraged Doshas, as well as, in one having his organic principles (Dhátus) and refuse matters (Malas) of the system, deranged by them, for the purpose of bringing them to their normal condition, with a regard both to their nature and to the strength, age, etc. of the patient. Persons afflicted with diseases which result from the up-coursing of the deranged Váyu (Urdhva-váta) such as cough, asthma, etc. or with thirst, hunger, dryness of the mouth and fatigue, as well as old men, infants, weak persons, men of timid dispositions and pregnant women should never fast. A swelling and an extremely painful ulcer should be respectively treated with a proper medicated plaster at the very outset. The pain in such a case will yield to the medicinal plaster as a blazing room or house is readily extinguished by means of steady watering. Such plasters not only give comfort to the patient (by removing the pain and leading to the absorption of the swelling), but heaves up the bed of the sore or the ulcer and contributes to its speedy purification and healing up (granulation). 25 - 28.
In the case of a swelling brought on by the deranged Váyu, the affected part should be washed or sprinkled (Parisheka) with a warm lotion of clarified butter, oil, Dhányámla and essence of meat or with a decoction of the drugs that tend to pacify the enraged Váyu and to relieve the pain. A swelling due to the action of the deranged Pitta or blood or to the effect of a blow or poison should be washed or sprinkled with a lotion of milk, clarified butter, honey and sugar dissolved in water, the expressed juice of sugar-cane and a cold decoction of the drugs of the Madhura group (Kákolyádi-gana) and the Kshira-Vrikshas. A Kaphaja swelling on the body should be washed or sprinkled with a Iuke-warm lotion of oil, cow's urine, alkaline solution, wine (Surá), Sukta and with a decoction of drugs that destroy the deranged Kapha. 29 - 31.
As a fire is put out by jets of water, so the fire of the deranged morbific principles (Doshágni) of the body are speedily subdued and put down by the application of (medicinal lotions) washes. 32.
An anointing (Abhyanga), duly prescribed and used with a full regard to the nature of the aggravated Doshas, leads to their pacification (restoration to the normal condition) and to softness (subsidence) of the swelling. 33.
An application of an anointment (Abhyanga) should precede the measures of fomentation, resolution, etc , while it should follow all evacuating measures, etc. A painful, extended and indurated swelling, as well as an ulcer of a similar nature, should be fomented, while an act of Vimlápana (resolution by gentle massage) should be done in respect of a fixed or unfluctuating swelling attended with little or no pain whatsoever. A wise physician should first annoint and foment the part and then gently and slowly press it with a bamboo-reed or with the back of his thumb or palm. A non-suppurated swelling or one that is partially suppurated should be treated with poultice (Upanáha), which would lead to its resolution or suppuration, as the case might be. A swelling, not resolved or not subsiding even after the adoption of the measures beginning with Apatarpana and ending in Virechana (in the given list), should be caused to suppurate with the drugs enumerated in the chapter of Mis'raka, such as curd, whey, wine (Surá), Sukta and Dhányámla (a kind of fermented paddy gruel). They should be formed into a paste and the paste should be cooked into an efficacious poultice-like composition (Utkáriká), and mixed with salt and oil or clarified butter, it should be applied over the affected part (swelling) and bandaged with the leaves of an Eranda plant. The patient should be allowed to take a wholesome (i.e., which does not produce Kapha) diet as soon as suppuration would set in (in the swelling). 34-39.