The medical treatment of the two kinds of Upadams'a due to the concerted action of the three Doshas as well as that due to the vitiated blood (Raktaja) should be taken in hand without holding out any definite hope of recovery. The above-mentioned medicines specific to the different Doshas should be combinedly applied in these cases in consideration of the nature and intensity of the Doshas specifically involved in them. Now hear me discourse on the special treatment of Tridoshaja Upadams'a. It should be the same as in the case of a malignant ulcer (Dushta-Vrana). The putrid portion of the male organ should be cut off and the remaining portion should be fully cauterized (in the incised part) with a Jambvoshtha instrument, made red-hot in fire. Honey, and clarified butter should then be applied to the cauterized part, and medicinal plasters and oils possessed of healing properties should be applied to the incidental ulcer when it would be cleansed (disinfected). 21-22.
In a case of Elephantiasis (Slipada) due to the action of the deranged and aggravated Vátyu, the vein (Sirá) at a distance of four fingers above the instep (Gulpha) should be opened after an application of Sneha and Sveda * to the patient. Vastis should be employed when the patient has been (soothed and) restored to his former condition (with appropriate and nutritious diet, etc.). He should be made to take continuously for a month, a potion consisting of castor-oil mixed with (an adequate quantity of cow's) urine The patient should take rice as his diet with milk duly cooked with S'unthi. The use of the Traivrita Ghrita as well as cauterization of the affected part with fire is also recommended in such a case. 23
in a case of Pittaja type of Elephantiasis, the vein (Sirá) below the instep (Gulpha) should be opened. Medicinal remedies mentioned in connection with the treatment of the Pittaja type of tumours (Arvuda) and of Erysipelas (Visarpa) as well as other Pitta-subduing remedies and measures should be employed. †. 24.
in a case of the Kaphaja type of elephantiasis the principal vein (Sirá) of the first toe should be opened by an experienced surgeon and the patient should be made to take at intervals the decoction (of the Kapha-sub-duing drugs) with honey. As an alternative, the patient should be advised to take the powders (Kalka) of Abhayá mixed with any officinal kind of urine. The affected locality should be constantly plastered with the paste of Katuka, Amritá, S'unthi, Vidanga, Deva-dáru and Chitraka, or with Chitraka and Deva-dáru. An oil cooked with Vidanga, Markka, Arka, S' unthi, Chitraka, Deva-dáru, Elaká and all the five officinal kinds of salt should be given him as a potion. Cooked barley is specially recommended as diet in the present case. 25. As an alternative, the patient should be made to drink a potion of mustard oil * or of the expressed juice of the leaves of Puti-Karanja according to his capacity for the cure of Slipada. In the same way † the juice of Putranjivaka should be prescribed by a physician after a due consideration as to the strength of the patient and of the time. The same juice (i.e., of Putranjivaka) should be taken along with the juice of the bulbs of Kechuka with Pakima (vit) salt. 26.
* Chakradatta reads in place ofmeaning thereby that such Sveda and Upanáha should be applied before the incision of the vein. Gayadása also supports this reading as is evident from Dallana's commentary. - Ed.
† The panicle in the text shows that Kapha-subduing remedies and measures should also be used in all these cases.