All kinds of tone-giving and constructive measures should be adopted in the case of a patient weak and emaciated with the troubles of a long-standing sore, taking full precaution not to tax his digestive powers. Anti-toxic (Vishaghna) medicines and measures and symptoms of poisonings will be described under their respective heads in the Kalpa-Sthánam. 104-105.
* The leaf which does not poison the Sneha and the essence of the medicinal drugs placed in a folded piece of linen (and applied over an ulcer is the proper leaf and) should be used for tying over the paste.
Siro-virechana measures (errhines) should be resorted to by skilful physicians in respect of ulcers situated in the clavicle regions and marked by itching and swelling. The use of medicated (fatty) snuff (Nasya) is recommended in cases where the ulcers would be found to be seated in the regions above the clavicles and marked by an aggravated condition of the deranged Váyu, pain, and absence of the oily matter. 106-107.
Medicated gargles (consisting of decoctions of drugs) of purifying or healing virtues either hot or cold * (according to requirements) should be used in the case of an ulcer in the mouth, for the purpose of alleviating the Doshas therein, for allaying the local pain and burning, and for removing the impurities of the teeth and the tongue. 108.
Inhaling of smoke or vapours (of medicated drugs) should be prescribed in cases of ulcers of the deranged Váyu and Kapha attended with swelling, secretion and pain and situated in the region above the clavicles. Application of honey and clarified butter, separately or mixed together should be prescribed in cases of extended or elongated ulcers which are traumatic or incidental in their character (Sadyo-Vrana) for allaying the heat of the ulcer and for bringing about its adhesion. Surgical instruments should be used in connection with an ulcer which is deep-seated but provided with a narrow orifice and which is due to the penetration of a Salya (shaft) and which could not be removed with the hand alone. 109-111.
* Hot gargles are recommended in cases of ulcers of the deranged Váyu and Kapha while cold ones in cases of ulcers of the aggravated Pitta and blood.
The diet of an ulcer-patient should in all cases be made to consist of food which is light in quantity as well as in quality, demulcent, heat-making (in potency) and possessed of appetising properties. * Protective rites should be performed for the safety of an ulcer-patient from the influences of malignant stars and spirits with the major and the minor duties (Yama and Niyama) enjoined to be practised on his behalf. 112-113.
The causes of ulcers are six †; their seats in the body number eighty ‡ in all; the features which characterise them are five §. The medicinal measures and remedies in respect of ulcers are sixty || in number. And these ulcers are curable with the help or co-operation of the four necessary factors (the physician, the medicines, the nurse and the patient). 114.
The comparatively smaller number of drugs which I have mentioned (under the heads of Ropana, Sodhana, etc., in the present chapter) from fear of prolixity, may be increased in combination with other drugs or substances of similar virtue, (digestionary transformation and potency, etc.) without any apprehension
* See Chap. XIX. - Sutra-Sthánam.
† The six causes of an ulcer are Váyu, Pitta, Kapha, Sannipáta, S'onita aud Agantu.
‡ The eight seats of an ulcer are Tvak, Mánsa, S'irá, Snayu, Sandhi, Asthi, Koshiha and Marma.
§ The five symptoms of an ulcer are due to Váta, Pitta, Kapha, of doing any mischief thereby. Recipes consisting of rare or a large number of drugs or ingredients, should be made up with as many of them as would be available in the absence of all of them, as mentioned in the present work. A drug belonging to any particular Gana or group if separately described as non-efficacious to any specific disease, should be omitted whereas a drug not belonging to a group may be added to it if it is elsewhere laid down as positively beneficial thereto. 115-117.
Sannipata and Agantu. The symptoms due to S'onita being identical with those due to Pitta, are not separately counted.
|| The sixty medicinal measures and remedies are those described before in the present chapter.
Upadrava: - The distressing supervening symptoms which are found to attend a case of ulcer, are quite different from those of an ulcer-patient. Those which confine themselves solely to the ulcer are five in all - smell, colour, etc., and those which are exclusively manifest in the patient are fever, diarrhoea, hiccup, vomiting, fainting fits, aversion to food, cough, difficult breathing, indigestion and thirst. The medical treatment of ulcers though described in detail in the present chapter, will be further dealt with in the next chapter on Sadyo-Vrana. 118-120.
Thus ends the first Chapter of the Chikitsita-Sthánam in the Sus'ruta Samhitá which deals with the treatment of the two kinds of ulcer.