The other two types of Visarpa are incurable i.e.

–        Sannipataja Visarpa and

–        Ksataja Visarpa

The curable types of Visarpa should be treated using the below mentioned methods –

–        drinking of medicated ghee,

–        taking bath with medicated decoctions and

–        applying pastes prepared using herbs which mitigate particular doshas (involved in the causation of the disease)

Vätaja visarpa

Below mentioned ingredients should be used to prepare kashaya – decoctions which can be used for bathing, pastes for external application and medicated ghee for internal usage in patients suffering from Vataja type of Visarpa –

–        Mustā,

–        Satánvā,

–        Suradāru,

–        Kustha,

–        Vārāhikanda,

–        Kustumburu,

–        Krsnagandha (sobhanjana) and

–        Pippalyadi Gana group of herbs and

–        Usna Gana i.e. herbs belonging to Bhadradarvadi and Pippalyadi Gana group of herbs

The physician should use the below mentioned herbs for providing warm poultice, bathing and for preparation of medicated oil and ghee –

–        Herbs belonging to Kantakſ Pañcamúla group,

–        Herbs belonging to Alpa (hrasva) Pañcamüla group,

–        Herbs belonging to Mahat Pancamüla group and

–        Herbs belonging to Valli Pañcamüla group

Pittaja Visarpa

कसेरुशृङ्गाटकपशगुन्द्राःसशैवलाःसोत्पलकर्दमाश्च।।
वस्त्रान्तराःपित्तकृतेविसर्पलेपाविधेयाःसघृताःसुशीताः।।६।।
हीवेरलामज्जकचन्दनानिस्रोतोजमुक्तामणिगैरिकाश्च।।
क्षीरेणपिष्टाःसघृताःसुशीतालेपाःप्रयोज्यास्तनवःसुखाय।।७।।
प्रपौण्डरीकंमधुकंपयस्यामञ्जिष्ठिकापाकचन्दनेच।।
सुगन्धिकाचेतिसुखायलेपःपैत्तेविसर्पभिषजाप्रयोज्यः।।८।।
न्यग्रोधवर्ग:परिषेचनंचघृतंचकुर्यात्स्वरसेनतस्य।।
शीतैःपयोभिश्चमधूदकैश्चसशर्करैरिक्षुरसैश्चसेकान्।।९।।

For treatment of Visarpa caused by Pitta, paste of the below mentioned should be prepared –

–        Kaseruka,

–        Karnataka,

–        Padma,

–        Gundra,

–        Saivala,

–        Utpala and

–        Kardama (slush)

This paste should be added with ghee and spread over a pad of sterile cloth. This should be applied cold on the lesion.

Paste of the below mentioned herbs should be macerated with the milk, mixed with ghee and applied cold and thin on the lesion caused by Pittaja Visarpa to provide comfort –

–        Hrībera,

–        Lämajjaka,

–        Cañdana,

–        Srotoñjana,

–        Muktä,

–        Maņi and

–        Gairika

To provide comfort to the patient of Pittaja Visarpa, the paste of the below mentioned should be applied over the lesions –

–        Prapaundarīka,

–        Madhuka,

–        Payasyä,

–        Mañjisthä,

–        Padmaka and

–        Candana and

–        Sugandhika (utpala sārivā)

Nyagrodhädi Gana group of herbs should be used for preparing water which can be used for bathing purposes.

Ghee prepared from the fresh juice of the same herbs i.e. Nyagrodhadi Gana group of herbs should be used for Seka i.e. irrigation or showering (or cold compress), with cold milk, honey water, sugar water or sugarcane juice.

Gauryadi ghrta (Haridrādi ghrta)

घृतस्यगौरीमधुकारविन्दरोधाम्बुराजादनगैरिकेषु।।
तथर्षभेपद्मकसारिवासुकाकोलिमेदाकुमुदोत्पलेषु।।१०।।
सचन्दनायांमधुशर्करायांद्राक्षास्थिरापृश्रिशताह्वयासु।।
कल्कीकृतासूदकमत्रदत्त्वान्यग्रोधवर्गस्यतथास्थिरादेः।।११।।
गणस्यबिल्वादिकपञ्चमूल्याश्चतुर्गुणंक्षीरमथापितद्वत्।।
प्रस्थंविपक्वंपरिषेचनेनपैत्तीनिहन्यात्तुविसर्पनाडीः॥१२॥
विस्फोटदुष्टव्रणशीर्षरोगान्पाकंतथाऽऽस्यस्यनिहन्तिपानात्।।
ग्रहार्दितेशोषिणिचापिबालेघृतंहिगौर्यादिकमेतदिष्टम्।।१३।।

Paste of the below mentioned herbs is prepared –

–        Gauri (haridrā),

–        Madhuka,

–        Aravinda (padma),

–        Rodhra,

–        Ambu (välaka)

–        Rājādana,

–        Gairika,

–        Rsabhaka, Padmaka,

–        Sāriva,

–        Kākoli,

–        Meda,

–        Kumuda,

–        Utpala,

–        Candana,

–        Madhusarkara (solidified honey),

–        Drāksa,

–        Sthira (salaparni),

–        Prsniparni and

–        Satähvaya (satapuspa)

Decoction of the below mentioned should be taken in four parts each

–        Nyagrodhadi Gana group of herbs,

–        Sthiradi Gana group of herbs,

–        Bilvadi Pancamula group of herbs

Milk – taken in four parts

Ghee – is taken in one prastha i.e. 640 grams quantity

All the above mentioned ingredients are taken together and medicated ghee prepared. This ghee is known by the name Gauryadi Ghrta.

Benefits –

This Gauryadi Ghrta when used for bathing the lesion cures –

–        erysipelas caused by pitta and

–        sinus ulcers caused by pitta

It cures the below mentioned conditions / diseases when used internally –

–        eruptions of smallpox

–        septic ulcers

–        diseases of the head

–        ulcers of the mouth,

–        possession by evil spirits in children and

–        consumption

Kaphaja visarpa

अजाऽश्वगन्धासरलासकालासैकषिकाचाप्यथवाऽजशृङ्गी।।
गोमूत्रपिष्टोविहितःप्रदेहोहन्याद्विसर्पकफजसशीघ्रम्।।१४।।
कालानुसार्यागुरुचोचगुञ्जारास्रावचाशीतशिवेन्द्रपर्यः।।
पालिन्दिमुञ्जातमहीकदम्बाहिताविसर्पेषुकफात्मकेषु।।१५।।

Below mentioned ingredients are macerated in gomutra – urine of cow and their paste is prepared –

–        Aja (ajagandha),

–        Asvagandha,

–        Sarala (trivrt),

–        Kala (kāsamarda),

–        Ekaisika (śatāvarī) and

–        Ajaśrñgi

This paste applied warm cures Visarpa caused by kapha quickly.

Paste of the below mentioned herbs is beneficial for application in Visarpa of Kapha origin –

–        Kālānusārya,

–        Aguru,

–        Coca,

–        Guñjā,

–        Räsnā,

–        Vacā,

–        Sītaśiva (satapuspa bheda),

–        Indraparņi (iñdravāruņi or lāñgalaki)

–        Palinda,

–        Muñjāta and

–        Mahikadamba (bhūkadamba)

गुणस्तुयोज्योवरुणप्रवृत्तःक्रियासुसर्वासुविचक्षणेन।।

संशोधनंशोणितमोक्षणंचश्रेष्ठंविसर्पेषुचिकित्सितंहि।।१६।।

सर्वांश्चपक्वान्परिशोध्यधीमान्व्रणक्रमेणोपचरेद्यथोक्तम्।।

Use of herbs belonging to the Varunadi Gana group is said to be the best for all purposes like external application, bathing and preparing ghee etc. in the treatment of all varieties of Visarpa. Likewise, in all varieties of Visarpa, administration of purificatory therapies and bloodletting are the best.

The intelligent physician should clean the Visarpa once it has become ripe i.e. once it has formed into ulcers. Following this, he should adopt treatments advocated for ulcers.

2. 
   

     Nadi vrana – Sinus ulcers

नाडीत्रिदोषप्रभवानसिध्येच्छेषाश्चतस्त्र:खुलयलसाध्याः।।१७।।  

Sannipataja Nadi Vrana i.e. sinus ulcers produced by simultaneous aggravation of all the tridoshas together does not respond to any treatment. On the other hand, the remaining four types of Nadi Vrana i.e. Vataja, Pittaja, Kaphaja and Salyaja Nadi Vrana are curable with difficulty.

Vätaja Nādi Vrana

तत्रानिलोत्थामुपनाह्यपूर्वमशेषतःपूयगतिविदार्य।।
तिलैरपामार्गफलैश्चपिष्टवाससैन्धवैर्बन्धनमत्रकुर्यात्।।१८।।
प्रक्षालनेचापिसदाव्रणस्ययोज्यंमहद्यत्खलुपञ्चमूलम्।।
हिंस्रांहरिद्राकटुकोबलाचगोजिह्निकांचापिसबिल्वमूलाम्।।१९।।
संहृत्यतैलंविपचेद्णस्यसंशोधनपूरणरोपणंच।।

Upanaha (warm poultice fomentation) should firstly be given for Nadi Vrana produced by vata. Following this, the channel (tract) of pus should be fully cut open. The opening should be filled with paste of tila – sesame, fruits (seeds) of Apamarga and Saindhava – rock salt and bandaged. For washing the ulcer, the decoction prepared using herbs belonging to Brhat / Mahat Pancamula should always be used.

Decoction and paste should be prepared from the below mentioned herbs –

–        Himsra,

–        Haridra,

–        Katuka,

–        Bala,

–        Gojihva and

–        Root of Bilva

Medicated oil should be prepared from this decoction and paste.

This medicated oil should be used for cleansing and healing the ulcer.

Pittaja nādi vrana

पित्तात्मिकाप्रागुपनाह्यधीमानुत्कारिकाभिःसपयोघृताभिः।।२०।।
निपात्यशस्त्रंतिलनागदन्तीयष्टयाह्वकल्कैःपरिपूरयेत्ताम्।।
प्रक्षालनेचापिससोमनिम्बानिशाप्रयोज्याकुशलेननित्यम्।।२१।।

In Pittaja Nadivrana fomentation should be given first by the intelligent physician. He should do that by using utkarika (pan cake) added with milk and ghee. Following this, he should cut open the sinus with the help of a sharp instrument and clean it. In the cleaned sinus paste of tila, nagadanti and yasti should be filled.

Decoction of Soma (somalata), Nimba and Nisa should be used for washing the wound daily.

श्यामात्रिभण्डीत्रिफलासुसिद्धहरिद्रयोरोधकवृक्षयोश्च।।
पतंसदुग्धंव्रणतर्पणेनहन्याद्गतिकोष्ठगताऽपियास्यात्।।२२।।

Ghee should be prepared with the below mentioned ingredients –

–        Syāma,

–        Tribhandi (trivrt),

–        Triphalā,

–        Haridrā,

–        Rodhra and

–        Vrkşaka (kutaja) and

–        Milk

This ghee is filled into the sinus. When done, this recipe cures the ulcer though present in the abdominal viscera.

Kaphaja Nādi Vrana

नाडीकफोत्थामुपनाह्यसम्यक्कुलत्थसिद्धार्थकसक्तुकिण्वैः।।
मृदूकृतामेष्यगतिंविदित्वानिपातयेच्छस्त्रमशेषकारी।।२३।।
दद्याद्रणेनिम्बातिलान्संदन्तीन्सुराष्ट्रजासैन्धवसंप्रयुक्तान्।।
प्रक्षालनेचापिकरञ्जनिम्बजात्यक्षपीलुस्वरसाःप्रयोज्याः।।२४।।
सुवर्चिकासैन्धवचित्रकेषुनिकुम्भतालीतलरूपिकासु।।
फलेष्वपामार्गभवेषुचैवकुर्यात्समूत्रेषुहितायतैलम्।।२५।।

In Kaphaja Nadi Vrana, fomentation should be given first. It should be given with warm poultice prepared from Kulattha, Siddhartaka, Saktu (corn flour) and Kinva (yeast).

After the ulcer has been made soft thereby, it should be probed through the pus channel, fully cut open using a sharp instrument. The wound should be filled with the paste of Nimba, Tila, Danti, Surastraja (Mrittika) and Saindhava.

Fresh juice or decoction of Karanja, Nimba, Jati, Aksa and Pilu should be used daily for washing.

Medicated oil should be prepared with the below mentioned ingredients –

–        Suvarcikā,

–        Saiñdhava,

–        Citraka,

–        Nikumbha,

–        Tälītala (root of musalī),

–        Rūpikā (svetärka) and

–        Apāmārga phala along with goműtra and tila taila

This oil is used for healing.

Salyaja nädi vrana

नाडीतुशल्यप्रभवांविदार्यनिहत्यशल्यंप्रविशोध्यमार्गम्।।
संशोधयेत्क्षौद्रघृतप्रगाढस्तिलैस्ततोरोपणमाशुकुर्यात्।।२६।।
कुम्भीकखजूंरकपित्थबिल्ववनस्पतीनांचशलाटुवर्गः।।
कृत्वाकषायंविपचेत्तुतैलमावाप्यमुस्तासरलाप्रियङ्गः।।२७।।
सुगन्धिकामोचरसाहिपुष्यंरोधंविदध्यादपिधातकीच।।
एतेनशल्यप्रभवातुनाडीरोहेदद्रणोवासुखमाशुचैव।।२८।।

Firstly, the Nadi Vrana caused by Salya (foreign body) should be cut open. The foreign body inside it should be removed and the sinus is cleaned. Cleaning should be done using the paste of tila added with more honey and ghee and then made to heal quickly.

Decoction is prepared using the tender fruits of the below said –

–        Kumbhika,

–        Kharjura,

–        Kapittha,

–        Bilva and

–        Vanaspati Varga (Pancavalkala)

Paste should be prepared with the below mentioned herbs –

–        Musta,

–        Sarala,

–        Priyangu,

–        Sugandhika (Utpala Sariva),

–        Mocarasa,

–        Ahipuspa (Nagakesara),

–        Rodhra and

–        Dhataki

Medicated oil is prepared by processing the oil with the decoction and paste explained above.

The sinus ulcers caused by salya – foreign bodies heal quickly and easily by using this oil.

Kşāra sūtra prayoga – use of alkali thread

कशदुर्बलभीरूणांनाडीमर्माश्रिताचया।।
क्षारसूत्रेणतांच्छिन्द्यान्नतुशस्त्रेणबुद्धिमान्।।२९।।
एषण्यागतिमन्विष्यक्षारसूत्रानुसारिणीम्।।
सूचीनिदध्याद्गत्यन्तेतथोन्नम्याशुनिहरेत।।३०।।
सूत्रस्यान्तंसमानीयगाढंबन्धंसमाचरेत्।।
ततःक्षारबलंवीक्ष्यसूत्रमन्यत्प्रवेशयेत्।।३१।।
क्षाराक्तंमतिमान्वैद्योयावन्नछिद्यतेगतिः।।
भगन्दरेऽप्येषविधिःकार्योवैद्येनजानता।।३२।।
अर्बुदादिषुचोत्क्षिप्यमूलेसूत्रंनिधापयेत्।।
सूचीभिर्यववक्राभिराचितान्वासमन्ततः।।
मूलेसूत्रेणबन्धीयाच्छिन्नेचोपचरेद्रणम्।।३३।।

The wise physician / surgeon should cut open the sinus using Ksara Sutra (threads soaked in caustic alkalies) and not by using sharp instruments in the below mentioned conditions –

–        in persons who are emaciated,

–        in persons who are weak,

–        in persons who are frightened and

–        in ulcers present in vital organs

With the help of a probe, the physician / surgeon should probe the sinus. Then he should introduce a blunt needle having an alkali thread till the needle reaches the end of the sinus.

Then the needle is lifted up following which the front tip (end) of the thread is pulled out and a tight knot is tied. Another ksara sutra may be inserted after having removed the first thread by the physician after having considered the strength of the alkali, until the sinus gets cut.

The intelligent physician should adopt the same procedure of doing ksara sutra in conditions like bhagandara (fistula in ano), arbuda (malignant tumour) etc.

A ksara sutra may be wound around the base of the arbuda and tied, after lifting it from its base. The thread may be passed through the needle which has a hole in the front, inserted at the base of the arbuda and then tied. After the tumour cuts off, the resulting ulcer may be treated like any other wound.

Varti prayoga – inserting medicinal wicks

याद्विव्रणीयेऽभिहितास्तुवर्त्यस्ताःसर्वनाडीषुभिषग्विदध्यात्।।
घोण्टाफलत्वग्लवणानिलाक्षापूगीफलंचालवणंचपत्रम्।।३४।।
स्नुह्यर्कदुग्धेनतुकल्कएषवीकृतोहन्त्यचिरेणनाडीः।।

In all varieties of sinus ulcers, the physician / surgeon should make use of the vartis i.e. medicinal wicks as described in Dvivraniya Adhyaya (chapter 1).

Paste of the below mentioned ingredients should be prepared –

–        Bark of Ghonta phala (badari phala),

–        Lavanas (all salts),

–        Laksa,

–        Pugiphala,

–        Leaves of alavana (kākamardanikā)

The paste is prepared by macerating the above said ingredients in the milky sap of Snuhi and Arka. Threads should be made from this. Alternatively, strong cotton threads should be soaked in the mixture of the above said ingredients and made into wicks.

When used, these vartis i.e. wicks cures the sinus ulcers quickly.

विभीतकाम्रास्थिवटप्रवालाहरेणुकाशङ्खिनिबीजमस्यः।।३५।।
वाराहिकन्दश्चतथाप्रदेयोनाडीषुतैलेनचमिश्रयित्वा।।३६।।

Ash should be prepared from the below mentioned ingredients –

–        Vibhitaka,

–        Amra seed kernel,

–        Tender leaves of Vata,

–        Harenuka,

–        Sankhini seeds and

–        Varahikanda

The resultant ash should be mixed with oil and used to cure the sinus ulcers.

धत्तूरजंमदनकोद्रवजंचबीजंकोशातकीशुकनसामृगभोजिनीच।।
अङ्कोटबीजकुसुमंगतिषुप्रयोज्यंलाक्षोदकाहृतमलासुविकृत्यचूर्णम्।।३७।।

Powder of the below mentioned ingredients is prepared –

–        Seeds of Dhattūra,

–        Madana,

–        Kodrava,

–        Kośātakī,

–        Sukanāsā,

–        Mrgabhojini (iñdravāruni)

–        Flower and seeds of Añkoțaki

The sinus should be cleansed with decoction / solution of laksa. After cleaning the sinus, the above mentioned powder may be used.

तथाचगोमांसमसीहितायकोष्ठाश्रितस्यादरतोदिशन्ति।।
वर्तीकृतंमाक्षिकसंप्रयुक्तंनाडीनमुक्तंलवणोत्तमंवा।।३८।।

Ash of cow meat is prepared. It is added with honey and lavanottama / saindhava lavana (rock salt) and made into wicks. These wicks may be used for treating the sinuses present in the kostha – abdominal organs.

दुष्टवणेयद्विहितंचतैलंतत्सर्वनाडीषुभिषग्विदध्यात्।।
चूर्णीकृतैरथविमिश्रितमेभिरेवतैलंप्रयुक्तमचिरेणगतिंनिहन्ति।।३९।।
एष्वेवमूत्रसहितेषुविधायतैलंतत्साधितंगतिमपोहतिसप्तरात्रात्।।

In all varieties of nadi varana i.e. sinus ulcers, the medicated oils which have been described in the context of treating dusta vrana i.e. septic ulcers (chapter 2/89) should be used.

Alternatively, powder of the herbs mentioned therein (in the above said context) should be used after adding honey, saindhava – rock salt and oil. This powder cures the sinus ulcers quickly.

Also, oil cooked with the same herbs mentioned above should be used after adding gomutra – urine of cow. This recipe cures the sinus within a week.

पिण्डीतकस्यतुवराहविभावितस्यमूलेषुकन्दशकलेषुचसौवहेषु।।४०।।
तैलंकृतंगतिमपोहतिशीघ्रमेतत्कन्देषुचामरवरायुधसाह्वयेषु।। 

Oil is cooked with Pinditaka and roots and tubers of Varahi. When used, this oil cures sinus ulcers.

Alternatively, the medicated oil prepared with tubers of Sauvaha (gandhanakuli) should also be used in the treatment of nadi vrana. This oil also cures the sinus ulcers quickly.

Sinus ulcers are also cured by using the medicated oil prepared with amaravara ayudha sahvaya i.e. Vajrakanda.

भल्लातकार्कमरिचैलवणोत्तमेनसिद्धंविडङ्गरजनीद्वयचित्रकैश्च।।४१।।
स्यान्मार्कवस्यचरसेननिहन्तितैलंनाडीकफानिलकृतामपचीव्रणांश्च।।

Oil should be prepared with the below mentioned ingredients –

–        Bhallātaka,

–        Arka,

–        Marica,

–        Lavaņottama (saindhava),

–        Vidañga,

–        The two Rajanī (haridrā),

–        Citraka and

–        Mārkava (bhrñgarāja) juice

This medicated oil when used cures the sinus ulcers, apaci (goitre, lymphadenitis) and wounds produced by kapha and vata.

3. 
   

     Stana roga – diseases of the breast

Stañya dusti – vitiation of breast milk

स्तन्येगतेविकृतिमाशुभिषक्तुधात्रींपीतांघृतंपरिणतेऽहनिवामयेत्तु।।४२।।
निम्बोदकेनमधुमागधिकायुतेनवान्तागतेऽहनिचमुद्गरसाशनास्यात्।।
एवंत्र्यहंचतुरहंषडहंवमेद्वासर्पिःपिबेत्रिफलयासहसंयुतंवा।।४।।
भार्गीबचामतिविषांसुरदारुपाठांमुस्तादिकंमधुरसांकटुरोहिणींच।।
धात्रीपिबेत्तुपयसःपरिशोधनार्थमारग्वधादिषुवरंमधुनाकषायम्।।४४।।
सामान्यमेतदुपदिष्टमतोविशेषाहोषान्पयोनिपतितान्शमयेद्यथास्वम्।।

The physician should conduct the below mentioned treatments when the stanya – breast milk has become abnormal (vitiated by the doshas) –

–        the mother should firstly be made to drink ghee at night

–        the next morning she should be made to vomit by drinking the decoction of Nimba added with honey and powder of Magadhi (pippali – long pepper)

–        she should be allowed to take food along with soup of mudga – green gram after she has properly vomited

The vomiting is induced in this manner for three, four or six days continuously.

She may be asked to drink the ghee boiled and prepared with the below mentioned ingredients in order to purify the milk –

–        Triphala,

–        Bharangi,

–        Vaca,

–        Ativisa,

–        Suradaru,

–        Patha,

–        Mustadi Gana group of herbs and

–        Katurohini

Alternatively, she may drink the decoction of ‘Aragvadhadi Gana’ group of herbs added with milk.

This is the general method of treatment. After this, specific (special) methods of treatment should be adopted to mitigate the vitiation of specific doshas.

Stana vidradhi – abscess of the breast

रोगंस्तनोत्थितमवेक्ष्यभिषग्विदध्याद्यद्विद्रधावभिहितंबहुशोविधानम्।।५।।
संपच्यमानमपितंतुविनोपनाहै:संभोजनेनखलुपाचयितुंयतेत।।
शीघ्रंस्तनोहिमृदुमांसतयोपनद्धःसर्वंप्रकोथमुपयात्यवदीर्यतेच।।४६।।

The physician / surgeon should adopt different methods of treatments described in treatment of Vidradhi i.e. abscesses in Vidradhi Chikitsa chapter after carefully diagnosing the breast abscess.

In spite of the abscess undergoing paka i.e. suppuration, it should be treated without using upanaha i.e. warm poultices. It should in fact be treated with only foods which promote suppuration. This should be done because the breasts are composed of soft muscles and hence putrefaction quickly develops in them, destroying and tearing them.

पक्वेतुदुग्धहरिणीःपरिहृत्यनाडीःकृष्णंचचूचुकयुगंविदधीतशस्त्रम्।।
आमेविदाहिनितथैवगतेचपाकंधात्र्याःस्तनौसततमेवचनिर्दुहीत।।४७।।

The abscess should be opened with a sharp instrument after it becomes ripe. It should be done while carefully protecting the dugdha harini i.e. lactiferous ducts and the black nipples from injury.

The milk should be taken out from the breasts of the mother or wet nurse constantly during ama (unripe), vidahi (ripening) and pakva (ripe) stages.

इतिसुश्रुतसंहितायांचिकित्सास्थानेविसर्पनाडीस्तनरोगचिकित्सितंनामसप्तदशोऽध्यायः।।१७।।

Thus ends the seventeenth chapter by name Visarpa-Nādi-Sthana roga cikitsita in cikitsā sthāna of Suśruta samhita.