The ulcer assumes a brown or vermilion colour and exudes a thin, slimy and cold secretion, largely attended with tension, throbbing and a sort of pricking and piercing pain (in its inside), which seems as if being expanded and extended. This type of ulcer does not extend much and is characterised by a complete destruction of the tissue (flesh). The Pittaja ulcer is rapid in its growth. It assumes a bluish yellow colour, exudes a hot secretion resembling the washings of Kims'uka flowers, and is attended with burning, suppuration and redness, being surrounded with eruptions of small yellow-coloured pustules. The Kaphaja ulcer is found to be extended and raised around its margin and is accompanied by an irresistible itching sensation. It is thick and compact (in its depth), covered with a large number of vessels and membranous tissues (Sirá-snáyu-jála), grey in colour, slightly painful, hard and heavy, and exudes a thick, cold, white and slimy secretion. The Raktaja ulcer (resulting from a vitiated condition of the blood) looks like a lump of red coral. It is often found to be surrounded by black vesicles and pustules and to smell like a strong alkali. It becomes painful and produces a sensation, as if fumes were escaping out (of it). Bleeding (is present) and the specific symptoms of the Pittaja type are likewise found to supervene. 6 - 9.
An ulcer due to the concerted action of the deranged Váyu and Pitta is marked by a pricking and burning pain and a red or vermilion colour. A sensation of fumes arising out of it (is also felt) and the ulcer exudes a secretion which partakes of the characteristic colours of both the deranged Váyu and Pitta. An itching and piercing pain is felt in the ulcer due to the combined action of the deranged Váyu and Kapha (Kapha-Vataja type), which becomes heavy and indurated, constantly discharging a cold, slimy secretion. An ulcer resulting from the deranged condition of the Pitta and Kapha (Kapha-Pittaja type) becomes heavy, hot and yellow. It is marked by a burning sensatian and exudes a pale, yellow-coloured secretion. An ulcer marked by the aggravated condition of the deranged Váyu and blood (Váta-Raktaja type) is dry and thin and is largely attended with a piercing pain and anaesthesia. It exudes blood or a vermil-coloured secretion and is marked by the combined hues respectively peculiar to the deranged Váyu and blood. An ulcer due to the combined action of the deranged Pitta and blood (Rakta-Pittaja type) is marked by a colour which resembles the surface cream of clarified butter. It smells like the washing of fish, is soft, spreading (erysipelatous), and secretes a hot blackish matter. An ulcer due to the combined action of the deranged Kapha and blood (Kapha-Raktaja type) is red-coloured, heavy, slimy, glossy and indurated. It is usually marked by itching and exudes a yellowish bloody secretion. An ulcer due to the concerted action of the deranged Váyu, Pitta and blood (Váta-Pitta-Raktaja type) is marked by a sort of throbbing, pricking and burning pain. It discharges a flow of thin yellowish blood and produces a sensation, as if fumes were escaping (out of its cavity). An ulcer due to the concerted action of the deranged Váyu, Kapha and blood (Váta-Sleshma-Raktaja type) is usually attended with itching, throbbing and tingling sensations and thick, grey, blood-streaked discharge. An ulcer associated with the deranged Kapha, Pitta, and blood (Kapha-Pitta-Raktaja type) is largely attended with redness, itching, suppuration and burning sensation. It emits a thick, greyish, bloody secretion. An ulcer marked by the concerted action of the deranged Váyu, Pitta and Kapha (Sánnipátika) is attended with diverse kinds of pain, secretion, colour, etc. peculiar to each of these types. An ulcer associated with the combined action of the deranged Váyu, Pitta, Kapha and blood (Váta-Pitta-Kapha-Raktaja type) is attended with a sensation, as if it were being burnt and lacerated. It is largely accompanied by throbbing, itching sensation, a sort of pricking and burning pain, with complete anaesthesia in the locality; redness, suppuration, various other kinds of colour, pain and secretion are its further characteristics. 10 - 20.
An ulcer (Vrana) which is of the same colour with the back of the tongue, soft, glossy, smooth, painless, well-shaped and marked by the absence of any kind of secretion whatsoever, is called a clean ulcer (Suddha-Vrana). 21.
The medical (and surgical) treatment of a Vrana (ulcer) admits of being divided into sixty * different factors, such as, - Apatarpana (fasting or low diet), Alepa (plastering), Parisheka (irrigating or spraying), Abhyanga (anointing), Sveda (fomentations, etc.), Vimlápana (resolution by massage or rubbing), Upanáha (poultice), Páchana (inducing suppuration), Visrávana (evacuating or draining), Sneha (internal use of medicated oils, ghrita, etc.), Vamana (emetics), Virechana (purgatives), Chhedana (excision), Bhedana (opening - e.g., of an abscess), Dárana (bursting by medicinal applications), Lekhana (scraping), Aharana (extraction, Eshana (probing), Vyadhana (puncturing - opening a vein), Vidrávana (inducing discharge), Sivana (suturing), Sandhána (helping re-union or adhesion), Pidana (pressing), Sonitásthápana (arrest of bleeding), Nirvápana (cooling application), Utkariká (massive poultices), Kasháya (washing with decoctions), Varti (lint or plug), Kalka (paste), Ghrita (application of medicated clarified butter), Taila (application of medicated oil Rasa-kriyá (application of drug-extracts), Avachurnana (dusting with medicinal powders), Vrana-Dhupana (fumigation of an ulcer), Utsádana (raising of the margins or bed of an ulcer), Avasádana (destruction of exuberant granulation), Mridu-Karma (softening), Dáruna-Karma (hardening of soft parts), Kshára-Karma (application of caustics), Agni-Karma (cauterization), Krishna-Karma (blackening), Pándu-Karma (making yellow-coloured cicatrices), Pratisárana (rubbing with medicinal powders), Roma-sanjanana (growing of hairs), Lomápaharana (epilation), Vasti-karma (application of enemas), Uttara-Vasti-karma (urethral and vaginal injections), Vandha (bandaging), Patradána (application of certain leaves - vide Infra), Krimighna (Vermifugal measures), Vrimhana (application of restorative tonics), Vishaghna (disinfectant or anti-poisonous applications), Siro-virechana (errhines), Nasya (snuff), Kavala-dhárana (holding in the mouth of certain drug-masses for diseases of the oral cavity or gargling), Dhuma (smoking or vapouring), Madhu-sarpih (honey and clarified butter), Yantra (mechanical contrivances, eg., pulleys, &c), Ahára (diet) and Rakshá-Vidhána (protection from the influence of malicious spirits). 22.