Plugs or lints plastered with a paste of the purifying drugs (enumerated before) should be inserted into an ulcer with any foreign matter (e.g., pus) lying embedded in it, or into one with a deep but narrow opening, or into one situated in a fleshy part of the body. An ulcer full of putrid flesh and marked by the action of the highly deranged Doshas (Váyu and Kapha) should be purified with a paste of the aforesaid available drugs making up the plug. An ulcer of a Pittaja origin, which is deep-seated and attended with a burning sensation and with suppuration, should be purified with the application of a medicated clarified butter, prepared with the purifying drugs with an admixture of Kárpása-phala *. An intelligent Surgeon should purify an ulcer with raised flesh, and which is dry and is attended with scanty secretion with an application of medicated mustard oil. An indurated ulcer, refusing to be purified with the foregoing medicated oils, should be purified with a duly prepared decoction of the drugs enumerated before (Sutra, chap. 38, - the Sálasáradi group) and prepared in the following manner of Rasa-kriya. A decoction of the said drugs duly prepared should be saturated with an after-throw of Haritála, Manahs'ilá, Kásisa and Sauráshtra earth, and well compounded together; the preparation should also be mixed with the expressed juice of Mátulunga and with honey. The medicine thus prepared should be applied to the ulcer on every third or fourth day. 59.
Deep† and foul-smelling ulcers covered with layers of deranged fat (phlegmonous ulcer) should be purified by the learned physician with the powders of the drugs with which the purifying plug or the lint has been enjoined to be plastered (Ajagandhá, &c). Decoctions of the drugs which are possessed of the virtue of setting in a process of granulation (Ropana, in an ulcer, such as Vata, etc. as stated before, should be used by a surgeon (Vaidya) after it had been found to have been thoroughly purified. Medicated plugs, composed of drugs possessing healing properties (such as, Soma, Amritá, As'vagandhá, etc.) should be inserted in deep-seated ulcers, when cleansed and unattended with pain. 60-62.
* The total weight of the purifying drugs should be equal to that of the Kárpása-phala alone and they should be boiled together with four times their quantity of clarified butter and with sixteen times of water.
† There is a different reading of "Agambhira" in place of "Gabhira," but Gayi thinks the emendation undesirable.
A Kalka or a levigated paste of sesamum and honey (mentioned in the Mis'raka Chapter) should be applied for the purpose of healing up an ulcer situated in a muscular part from which all putrid flesh has been removed or sloughed off and which exhibited a clear cavity. This paste (of sesamum) tends to allay the deranged Váyu through its sweet taste, oleaginous-ness and heat-making potency; subdues the deranged Pitta through its astringent, sweet and bitter taste and proves beneficial even in the case of the deranged Kapha through its heat-producing potency and bitter and astringent taste. An application of the levigated paste of sesamum mixed with the drugs of purifying and healing properties tends to purify and heal up an ulcer. An application of the levigated paste of sesamum mixed with honey and Nimba-leaves leads to the purification of sores; whereas an application of the same paste (ie , sesamum, honey and leaves of Nimba), mixed with clarified butter tends to heal up the ulcer. Several authorities atribute the same virtue to a barley-paste. * Levigated pastes of barley and of sesamum (or a paste of barley mixed with sesamum) contribute to the resolution or subsidence of a non-suppurated swelling, fully suppurate one which is partially suppurated, lead to the spontaneous bursting of a fully suppurated one, and purify as well as heal up one that has already burst out. 63-65.
An ulcer,whicb is due to the effects of poison, vitiated blood, or aggravated Pitta, and which is deep-seated or is of traumatic origin, should be healed up with a medicated clarified butter prepared with the drugs of healing virtues (Ropaniya - enumerated before) and milk. An ulcer marked by an aggravated condition of the deranged & Jejjada and Gayadása interpret the term to mean "barley-paste mixed with sesamum."
Váyu and Kapha should be healed up with the application of an oil, boiled and prepared with the proper purifying drugs mentioned before. 66 67.
Rasa-kriya * with the two kinds of Haridrá should be resorted to for the purpose of healing up an ulcer, in which bandaging is forbidden (such as those due to the deranged Pitta or blood, or to blow, etc. or to the effects of poison), and an ulcer appearing on the moveable joints, which, though exhibiting all the features of a well-cleansed sore, has not been marked by any process of healthy granulation †. Healing medicinal powders should be used in the case of an ulcer which is confined to the skin, and is firm-fleshed and marked by the absence of any irregularity in its shape (i.e., not uneven in its margin). The mode of applying medicinal powders, as stated in the Sutra-sthana, should be adopted in the present instance. 68-69.
The healing and purifying measures described above should be deemed equally applicable to, and efficacious in cases of ulcers in general with regard to their Doshas (both idiopathic and traumatic). The success of these measures has been witnessed in thousands of cases and has been recorded in the Sátras (authorised works on medicine). Hence they should be used as incantations without any doubt as to their tested and infallible efficacy. An intelligent physician should employ the drugs, mentioned before, in any of the seven forms (either in the shape of a decoction, or a plug, or a paste, or through the medium of medicated oils and clarified butter, or in the shape of Rasa-kriyá, or as powders), according to the requirements of each case. 70.
* The decoction of Triphalá and the drugs of the Nyagrodhádi group should be duly prepared, filtered and then condensed to the consistency of treacle. Powders of Haridrá and Dáru-haridrá should be then thrown into it. In the end, the whole preparation should be well-stirred, mixed with honey and applied. This is what is called Rasa-kriyá.
† Several editions read "though cleansed yet ungranulating ulcers."
The drugs which constitute the two groups of Pancha-mulas (major and minor), as well as those of the Váyu-subduing group, should be employed in the case of an ulcer due to the aggravated Váyu in any of the seven forms - decoction, etc. Similarly the drugs which are included within the groups of Nyagrodhádi or Kákolyádi should be used in any of those seven forms, in the case of an ulcer due to the aggravated Pitta (for the purification and healing thereof). Drugs which form the group of Aragvadhádi, as well as those which have been described as heat-making in their potency, should be used in any of those seven aforesaid forms, in the case of an ulcer due to the deranged Kapha. The drugs of two or three of those groups, should be combinedly used in any of those seven forms, in connection with an ulcer marked by the aggravated condition of any two or three of the deranged Doshas respectively. 71-74.
Vátaja ulcers with severe pain and secretion should be fumigated with the fumes of Kshauma, barley, clarified butter and other proper fumigating substances [such as turpentine and resin (gum of Sála tree)]. 75.