Treatment has three stages: purvakarma, the preparatory measures; pradhanakarma, the principal procedure; and pashchatkarma, the subsequent care. These will be explained in relation to each disorder.
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pūrvakarmētyādi tatraikē- “laṅghanādi virēkāntaṁ pūrvakarma vraṇasya ca| pāṭanaṁ rōpaṇaṁ yacca pradhānaṁ karma tat smr̥tam| balavarṇāgnikāryaṁ tu paścātkarma samādiśēt’’- iti; anyē tu saṁśōdhyasya pācanasnēhanasvēdanāni pūrvakarma, vamanavirēcanabastinasyasirāmōkṣaṇāni pradhānaṁ karma, pēyādyannasaṁsarjanaṁ paścātkarma; aparē tu cayādīnāṁ pūrvarūpāntānāmātaṅkōtpattēḥ prāgyat kriyatē tat pūrvakarma, ātaṅkōtpattau yat tat pradhānaṁ karma, nivr̥ttātaṅkasyānubandhōpacaraṇāya yat tat paścātkarma| idaṁ tat pūrvakarmētyādi iha kathaṁ nōdāhriyata iti praṣṭuruttaramāha- tadvyādhimityādi|- taditi trividhaṁ karma vyādhiṁ vyādhiṁ pratyupadēkṣyāmaḥ; na iha, granthagauravabhayāt||3||
Meaning of the commentary
Several interpretations of the three stages are preserved. One describes measures from langhana through purgation as preliminary care for a wound, opening and healing the wound as the principal treatment, and measures concerning strength, complexion and agni as subsequent care. Another applies the division to a person undergoing shodhana: pachana, oleation and sweating are preliminary; emesis, purgation, basti, nasya and venesection are principal procedures; and a gradual dietary sequence beginning with peya is subsequent care. A third makes the division according to the course of illness: measures before its manifestation, from accumulation through premonitory signs, are preliminary; those during manifest illness are principal; and care for what persists after the illness subsides is subsequent. These measures are not all detailed here because that would make the text unnecessarily lengthy; they will be explained under individual disorders.
Key terms
pUrvakarma (pūrvakarma)
Preparatory measures, defined differently in the commentary's three interpretations.
pradhAnakarma (pradhānakarma)
The principal treatment or procedure.
pashcAtkarma (paścātkarma)
Care following the principal procedure or the subsiding of illness.
peyA (peyā)
A thin gruel placed first in the gradual dietary sequence mentioned here.
For a physician intending to undertake any of these procedures, the text calls for supplies to be assembled beforehand: yantras, sharp instruments, kshara, fire, probes or rods, horns, leeches, gourds, the jambavaushtha implement, cotton, cloth, thread, leaves, bandaging material, honey, ghee, fat, milk, oil, tarpana preparations, decoctions, applications and pastes, a fan, cold and warm water, vessels and other necessities. It also calls for attendants who are devoted, steady and strong.
The required articles are to be brought nearby before undertaking a procedure such as excision. Jambavaushtha is described as a black-stone implement whose tip resembles a jambu fruit. Picu is cotton, prota is cloth, and patta is material for binding a wound. Tarpana includes preparations such as saktu mixed with water and milk preparations; kashaya is water in which medicinal substances have been boiled. A fan may be made of bamboo, and the vessel called kataha of iron or another material. The inclusive ending also covers pads, earthenware pieces, pots, cooking vessels, beds, seats and similar supplies. Some articles are needed for the procedure itself, while others address complications. Attendants, as well as equipment, must be prepared. They should be devoted to the person they serve, unwavering, and capable of carrying out the required tasks.
Key terms
jAmbavauShThaM (jāmbavauṣṭham)
A black-stone implement with a tip likened to a jambu fruit.
In this operative context, favourable qualities of a vrana are that it is elongated, broad, even, clearly defined and free from an unfavourable site of attachment.
The commentary preserves different accounts of these qualities. Ayata means long and vishala broad. Sama is first understood as uniformly suppurated: a lesion partly suppurated and partly not is unsuitable for easy incision. Others take vishala as square and sama as round, relating the passage to a classification of wound shapes as elongated, square, round and triangular. Another interpretation takes sama to mean straight rather than following an irregular, winding course; it then qualifies the elongated wound. Suvibhakta means distinctly delineated, with its parts clearly separated. Nirashraya means not situated in an inaccessible place such as the tongue or the junction of teeth. A further interpretation applies the entire description to an incision made by the physician: sama then means without uneven depressions or elevations, and suvibhakta means free from the defects of insufficiency and excess. Such an incision permits easier application of pastes, decoctions and similar measures. Opposite features are regarded as defects.
Key terms
samaH (samaḥ)
Even; interpreted here as uniform suppuration, roundness, a straight course, or an even surface.
suvibhaktaH (suvibhaktaḥ)
Clearly delineated; alternatively free from insufficient or excessive division.
nirAshrayaH (nirāśrayaḥ)
Not based in an unfavourable or inaccessible site in this explanation.
For operative work, the text commends a vrana that is elongated and broad, clearly defined, free from an unfavourable site, and made at the appropriate time.
The verse restates the preceding description. The repeated conjunction allows an elongated wound, a broad wound, or one possessing both features. Nirashraya is explained as not involving marmas and similar structures. Some read nirashaya, interpreted as not remaining adherent there. Appropriate timing is illustrated by restrictions on procedures using instruments, kshara or fire in children and older people; another example contrasts the cold season with summer for a lesion considered suitable for fire treatment. Some read yuktakalakrita and explain it as uniform suppuration; others as treatment performed when suppuration has properly occurred. Some textual traditions omit this verse.
Key terms
prAptakAlakRutaH (prāptakālakṛtaḥ)
Performed at an appropriate time, with different explanations preserved in the commentary.
Courage means freedom from fear: fear may prevent a physician from undertaking even a treatable, deeply rooted lesion, or lead to leaving a procedure unfinished. Prompt action means dexterity and swift performance, which the commentary links with avoiding prolonged distress for the patient. Instrument sharpness means a well-sharpened, effective edge, to which the commentary attributes avoidance of pain. An unconfused mind is explained as clear recognition of unripe and suppurated lesions and correct performance of the required action. Others understand it as remaining composed at the sight of blood and similar appearances during cutting. Some textual traditions omit this verse.
Key terms
shauryaM (śauryam)
Courage or freedom from fear during the procedure.
asammohaH (asammohaḥ)
Clear understanding or composure, according to the alternative explanations.
Adhikarana 10 (11-12) · Śloka 12
ēkēna vā vraṇēnāśudhyamānē nā'ntarā buddhyā'vēkṣyāparān vraṇān kuryāt ||11||
bhavati cātra- yatō yatō gatiṁ vidyādutsaṅgō yatra yatra ca |
tatra tatra vraṇaṁ kuryādyathā dōṣō na tiṣṭhati ||12||
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एकेन वा व्रणेनाशुध्यमाने नाऽन्तरा बुद्ध्याऽवेक्ष्यापरान् व्रणान् कुर्यात् ||११||
भवति चात्र- यतो यतो गतिं विद्यादुत्सङ्गो यत्र यत्र च |
तत्र तत्र व्रणं कुर्याद्यथा दोषो न तिष्ठति ||१२||
Meaning of the śloka
If a lesion is not cleared through a single opening, the passage calls for careful assessment and further openings where needed. Wherever a tract or a recess is found, it describes making an opening so that the offending material does not remain.
Further openings are discussed when the first does not permit clearance. The commentator explicitly glosses na as 'the person' and antara as 'within'. Gati means a nadi tract. Utsanga is first explained as a depressed internal recess formed when pus remains for a long time and breaks down surrounding unripe tissue, resembling a hollow or lap. Another interpretation derives it from pus collecting above. Dosha here specifically means pus: retained pus leads to the involvement of vata and the other doshas, so the effect's name is applied to its cause.
Key terms
gatiM (gatim)
A tract, glossed as nadi.
utsa~ggaH (utsaṅgaḥ)
An internal recess retaining pus; alternatively a collection above.
doShaH (doṣaḥ)
Pus in this passage, according to the commentary.
Adhikarana 11 (13-15) · Śloka 15
tatra bhrūgaṇḍaśaṅkhalalāṭākṣipuṭauṣṭhadantavēṣṭakakṣākukṣivaṅkṣaṇēṣu tiryak chēda uktaḥ ||13||
(candramaṇḍalavacchēdān pāṇipādēṣu kārayēt |
ardhacandrākr̥tīṁścāpi gudē mēḍhrē ca buddhimān) ||14||
anyathā tu sirāsnāyucchēdanam, atimātraṁ vēdanā, cirādvraṇasaṁrōhō, māṁsakandīprādurbhāvaścēti ||15||
The text specifies transverse incisions for the eyebrows, cheeks, temples, forehead, eyelids, lips, gums, armpits, abdomen and groins. A parenthesized verse describes circular incisions on the hands and feet and semicircular ones at the anus and penis. Departing from the stated pattern is associated in the passage with injury to siras and snayus, excessive pain, delayed healing and the appearance of fleshy projections.
Although transverse incision is elsewhere listed among complications, the commentator treats these named sites as exceptions. The anatomical terms are explained as cheek, eyelid, flesh surrounding the teeth, root of the arm, abdomen and junction of the thigh. Mamsakandi means a small tuber-shaped projection of flesh. Some read 'elsewhere' instead of 'otherwise', taking the warning to concern incision at other sites. Some also read kshanana, injury, instead of chedana, cutting.
Key terms
tiryak
Transversely, describing the incision's direction.
After using the instrument, the text describes comforting the patient with cold water, applying pressure around the lesion with a finger, attending to the wound, washing it with a decoction and taking up the water with cloth. It then describes placing a medicated varti coated with sesame paste, honey and ghee, neither excessively oily nor excessively dry; covering the site with paste and a thick pad; and securing it with a cloth bandage. Fumigation and protective mantras are prescribed for relief of pain and protection from harmful beings within the text's ritual framework.
Cold water is explained as relieving distress caused by the procedure and preventing fainting and similar events. Pressure around the lesion is intended to release discharge. With the reading abhimridya, attending to the wound means manipulation to even out the operative site. Others read abhimrijya and connect it with detecting hairs, bone, tracts and recesses. The commentary specifies a decoction intended for fresh wounds during the first seven nights and, thereafter, one prepared for the relevant dosha. Water inside the wound is taken up with cloth. The varti is thickly coated with sesame paste, honey and ghee and contains cleansing medicines referred to in a later chapter. The covering paste is likewise associated with fresh-wound medicines. Kavalika is a covering pad intended to keep the medicinal liquid from escaping. One account describes bark or leaves such as palasha and udumbara; another describes soft cloth folded twice or four times; a third describes a thick pad using roasted barley meal with ghee. Fumigants for pain are exemplified by hingu and salt, and those for protection against rakshasas by vacha and related substances.
Key terms
vartiM (vartim)
The medicated wick or insert described for the wound.
kavalikA (kavalikā)
A covering pad, with several materials proposed in the commentary.
The text next describes fumigation using powders of guggulu, aguru, sarjarasa, vacha and white mustard, combined with salt, neem leaves and ghee. It then prescribes anointing the patient's vital sites with the remaining ghee.
The commentator extends fumigation to the bed and related articles, as well as the wound, explaining its purposes as removing wound odour and keeping away blue flies and similar insects. The arrival of these flies is connected with the appearance of krimis in the wound. The remaining ghee means what is left from the ghee mixed with the fumigation materials. Pranas here denotes sites such as the heart because they are regarded as seats of the vital principles. Anointing them is described as nourishing those principles.
Key terms
AjyasheSheNa (ājyaśeṣeṇa)
With the ghee remaining from the preparation described.
prANAn (prāṇān)
Vital sites such as the heart, according to this commentary.
Adhikarana 17 (35) · Śloka 35
tatastr̥tīyē'hani vimucyaivamēva badhnīyādvastrapaṭṭēna; na cainaṁ tvaramāṇō'parēdyurmōkṣayēt ||35||
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ततस्तृतीयेऽहनि विमुच्यैवमेव बध्नीयाद्वस्त्रपट्टेन; न चैनं त्वरमाणोऽपरेद्युर्मोक्षयेत् ||३५||
Meaning of the śloka
The text next specifies removing the dressing on the third day and bandaging again with cloth in the same manner. It cautions against hurriedly opening it on the following day.
The 'following day' is explicitly identified as the second day. An alternative reading adds washing with a decoction after opening the dressing on the third day. That decoction is explained as one made from the substances described for fresh wounds, and the bandaging is performed as before.
Key terms
aparedyuH (aparedyuḥ)
On the following day, here explained as the second day.
Vigrathita is glossed as granthita, knotted. An alternative replaces the prefix vi with hi and reads the wording as a reason: because the wound becomes knotted and has not properly developed healing tissue, it does not heal readily and becomes intensely painful.
Key terms
vigrathitaH (vigrathitaḥ)
Knotted or indurated, as explained through granthita.
Adhikarana 19 (37) · Śloka 37
ata ūrdhvaṁ dōṣakālabalādīnavēkṣya kaṣāyālēpanabandhāhārācārān vidadhyāt ||37||
After this, decoctions, external applications, bandaging, diet and conduct are to be selected with consideration of dosha, season, strength and other relevant factors.
The first explanation understands 'after this' as after the third day. Doshas are vata and the others; seasons begin with hemanta; strength is low, moderate or high. Age, suitability through habituation and similar factors are also included. These are assessed while treatment continues until healing. Another reading shortens the list to 'decoctions and so on' and understands the time as the fourth bandaging, after the third. In that reading, the inclusive phrase also covers pastes and unctuous substances.
Key terms
sAtmya (sātmya)
Suitability or accustomed tolerance considered when choosing the regimen.
Therefore the text calls for healing a wound only when it is thoroughly clear both internally and externally. Even after closure, it prescribes avoiding indigestion, exertion, sexual activity and related disturbances, as well as excitement, anger and fear, until the healed site has become firm.
Internal clearance is indicated by the disappearance of pain associated with vata and the other doshas. External clearance is described through four features: appropriate colour, rasa, condition or site, and smell. Some textual traditions omit the words beginning with excitement, anger and fear, but include these through the earlier phrase 'sexual activity and so on'.
Key terms
sushuddham (suśuddham)
Thoroughly clear, both internally and externally, in the stated wound assessment.
The verse describes opening the dressing after three days in hemanta, shishira and vasanta, and after two days in sharad, grishma and varsha, with knowledgeable judgment.
The commentary links the longer interval in the first group of seasons to cold and the absence of concern about rapid suppuration, and the shorter interval in the latter group to warmth and quicker suppuration. It then limits any rigid application of this rule. For a paittika wound, the interval in hemanta and shishira is adjusted as appropriate. In vasanta, the heat of Vaishakha may justify the two-day interval for any wound, and the commentary also allows twice-daily bandaging for a paittika wound. In summer, a paittika wound may likewise require bandaging twice in a day. Another reading replaces shishira with pravrit, the onset of rains; the commentator rejects it because it was criticized in the Panjika. Finally, the seasons are not identical in their intensity: the intervals of three and two days are not absolute, and the degree of seasonal conditions must be assessed.
Key terms
paittika
Associated with pitta, qualifying the wound in the exceptions discussed.
mokShayet (mokṣayet)
Should release or open the dressing in this passage.