Blood-letting should be resorted to in a case of newly formed swelling for its resolution and for alleviating the pain. Bleeding (Visrávana) is recommended in the case of an ulcer which is indurated, marked by a considerable swelling and inflammation and is reddish black or red-coloured, extremely painful, gagged in its shape and considerably extended at its base (congested), specially in the case of a poisonous ulcer, for the subsidence of the pain and for warding off a process of suppuratiou therein, either by applying leeches or by opening (a vein in the locality) by means of an instrument. An ulcer-patient of a dry or parched temperament affected with distressing supervenients or ulcer-cachixia or who is weak should be made to drink an emulsive potion cooked with (a decoction of) appropriate drugs. A patient afflicted with an ulcer with an elevated margin and attended with swelling and specially marked by the presence of the deranged Kapha and by a flow of blackish red blood should be treated with emetics. Ulcer-experts recommend purgatives to a patient afflicted with an old or long-standing ulcer, attended with a deranged condition of the Váyu and Pitta. An excision should be made into an ulcer which refuses to suppurate and which is of a hard and indurated character attended with sloughing of the local nerves and ligaments (Snáyu). An opening or excision (Bhedana) should be made into an ulcer (Vrana) in the inside of which pus has accumalated and makes it heave up and which not finding any outlet consequently eats into the underlying tissues and makes fissures and cavities. 40-46. Measures which contribute to a spontaneous bursting by medicinal applications (Dárana) of a swelling should be adopted in the case of an infant or an old or enfeebled patient, or of one incapable of bearing the pain (of a surgical operation), or of a person of a timid disposition, as well as in the case of a woman, and in the case of swellings which appear on the vulnerable parts (Marmas) of the body. Remedies which lead to the spontaneous bursting of a swelling should be applied by a wise physician to a well-suppurated swelling drawn up and with all its pus gathered to a head; or an alkaline substance should be applied on its surface and a bursting should be effected when the Doshas are found to be just aggravated by the incarcerated pus. 47,
An ulcer which is indurated, whose edges are thick and rounded, which has been repeatedly burst open, and the flesh of whose cavity is hard and elevated, should be scarified by a surgeon; or, in other words, an indurated ulcer should be deeply scarified, one with thick and rounded edges should be excessively scarified, while the one which has been repeatedly burst open should be entirely scraped off. An ulcer with a hard and elevated bed should be scraped evenly and longitudinally along the length of its cavity. In the absence of a scarifying instrument, the act should be performed with a piece of Kshauma (cloth made of the fibres of an Atasi plant), a linen (Plota) or a cotton pad (Pichu), or with such alkaline substances as nitrate of potash, Samudra-phena, rock-salt, or rough leaves of trees (e. g., those of Udumbara, &c). 48.
The cavities or courses of a sinus, or of an ulcer which had any foreign matter lying imbedded in its inside, or which takes a crooked or round about direction, as well as of the one formed into cavities within its interior, should be probed by gently introducing the tender fibres of bamboo sprouts (Karira), a (lock of) hair, a finger, or an indicator into its inside. The course of a sinus occurring about the anus or in the region of the eyes (Netra-Vartma) should be probed with the slender fibres of Chuchchu, Upodiká, or Karira, in the event of their mouths being narrow and attended with bleeding. The Salya (incarcerated pus, etc.) should be extricated, whether the mouth of the sinus is constricted or otherwise, in conformityw with the directions laid down before on that behalf. In diseases amenable to acts of puncturing (Vyadhana), the knife should be inserted into the seat of the disease to a proper depth and extent, to be determined by its situation in the body, and the Doshas (pus, etc.) should be let out, as stated before. Ulcers with a wide mouth, unattended with any symptoms of suppuration, and occurring in a fleshy part of the body, should be sutured up, and the adhesion (San-dhána) of the edges should likewise be effected, as directed before. A plaster composed of drugs (capable of drawing out and secreting the pus), as described before, should be applied around the mouth of an ulcer seated in any of the Marmas (vulnerable parts), or full of pus in its inside, with a narrow-mouthed aperture. The plaster should be removed when dry, and should not be applied on the orifice of the ulcer, as it would, in that case, interfere with the spontaneous secretion of pus (Dosha). 49-54.
* This scraping off of the ulcer should be done by an instrument of Surgery and not by any rough leaf or the like, mentioned hereafter.
* Styptic measures are of four kinds - Sandhana, Skandana, Páchana, and Dahana. See Sutra-Sthánam, Chap. XIV.
An ulcer attended with fever, suppuration and burning sensation due to the excited state of the deranged Pitta and congestion of blood should be allayed (Nir-vapana - literally putting out) with suitable and proper medicinal remedies. It should be allayed with compounds made up of the proper cooling drugs (of the Mis'raka chapter), pasted with milk and lubricated with clarified butter. Cooling plasters (Lepa) should then be applied as well. 55-56.
An ulcer whose flesh is eaten away, which discharges a thin secretion, or is non-suppurating in its character, and is marked by roughness, hardness, shivering and the presence of an aching and piercing pain, should be fomented with a poultice-like efficacious preparation (Utkáriká )cooked with the drugs of Váyu-subduing properties, those included within the Amla-varga, and those which belong to the Kákolyádi group, and with the oily seeds (such as linseed, sesamum, mustard, castor, etc.). An indurated, painful, faetid, moist and slimy ulcer should be washed with a disinfectant or purifying lotion consisting of a decoction of the drugs mentioned before for the purpose. 57-58.