In a case of the Medoja (fat-originated) type of the disease, the affected part should be (lightly) fomented, * and plasters composed of drugs (of the roots) of the Surasádi group or of the S'iro-virechana group (Ch. XXXIX. Sutra Sthána) pasted with the urine of a cow should be applied to it in a lukewarm state. The inflamed and swollen scrotal tumour, (lightly) fomented as before, should be tightened round with a piece of cloth. Then having encouraged the patient, the surgeon should open the tumour with a Widdhipatra (knife) carefully avoiding the two testes (lying within the scrotal sac) and the median line of the perineum (Sevani). Then having carefully removed all morbid products (Medas) from its inside, Saindhava and sulphate of iron should be applied to the incised part, and the scrotum should be carefully bandaged (in the manner of a Gophaná bandage). After the proper purification (disinfection) of the ulcer, its healing should be effected with the application of an oil cooked with Manahs'ilá, Haritála (yellow oxide of arsenic), rock-salt, and Bhallátaka. 7.
* The fomentation should be applied according to S'ivadás'a, with balls of cow-dung, etc., slightly heated. It should be noted in this connection that strong fomentations should not, in any case, be applied to the testes.
In a case of an enlargement of the scrotun (hydrocele) due to the derangement of urine, it should be first fomented and then a piece of cloth should be tightened rount it. A puncture should then be made in the bottom of the sac with a Vrihimukha instrument, on either side of the raphe of the perineum (Sevani). A tube open at both ends should be introduced (into the puncture) and the accumulated (morbid) fluid should be let out. The tube should then be taken off and the scrotum should be tied up with a bandage of the Sthagiká pattern and the incidental ulcer should be purified and healed up with appropriate medicinal applications. 8.
A case of Antra-Vriddhi (hernia when strangulated) extending down to the scrotal sac (Kosha) should be given up as irremediable; but, in the case of its not being so extended, it should be treated as a case of Vátaja-Vriddhi. If the colon be found to have descended down to inguinal region (Vamkshana), it should be cauterized with a heated crescent-mouthed rod (Arddha-Chandra S'aláká) to prevent its descending down into the scrotal sac. A case of hernia that, in spite of all these precautions, descends down into the scrotal sac (Kosha), should be given up as irremediable. The first finger of the hand opposite * the affected part (i.e., the affected testes) should be incised at its middle and cauterized.
* Incision and cauterization should be performed in the thumb of the right hand, if the left testis is affected, and in case the affection is in the right testis, incision and cauteriza;ion should be made in the thumb of the left hand.
In cases of hernia (Antra-Vriddhi) of the Vátaja and of the Kaphaja type the affected part should be carefully cauteuized in the above manner; but in these two cases, the Snáyu (ligamenis) should be cut off in addition (before cauterization). In a case of Antra-Vriddhi the veins (S'irá) of the temples at the (upper) end of the ears on the opposite sides of the affection should be carefully opened avoiding the Sevani therein. 9-12.