Treatment of Ulcers (Vrana Pratisedha) in Ashtang Hridayam of Vaghbhat

 Treatment of Ulcers (Vrana Pratisedha) in Ashtang Hridayam of Vaghbhat

We will now expound the treatment of ulcers described by Atreya and other great sages. 

Treatment of Ulcer 

Types of ulcer: Vrana are of two kinds viz, Nija (organic) and Agantu (traumatic); and dusta (vitiated, foul ) and suddha (unvitiated, clean); nija is caused by dosas (aggravated) in the body, agantu by external causes; dusta is that in which the dosas are localised and suddha is that which is free from localisation of the dosas. 1-2a. 

Vitiated ulcer: Either contraction or expansion; hardness or softness; too much of elevation of depression; too much of warmth ( feeling of heat) or cold; too much of redness or paleness; black colouration, discharge of foul smelling pus; foul smelling muscle, veins, or tendons covering the ulcer at its top; severe pain, profound distress, burning sensation, swelling itching and other complication associating and persisting for a long time—are the feature of a dusta vrana (vitiated ulcer). 2b-5a

It (vrana) is of fifteen kinds, caused by the dosas along with rakta (blood). 5b. 

Vataja vrana: Vrana (ulcer) caused by maruta (vata ), is blue, blackish red or resembles ash or bones of th e pegion, exudes fluids which resembles water of curds, mutton wash or grain wash, thin and small in quantity; ulcer not showing (more of) muscle tissue with severe pricking and cutting-like pain, dryness and makes sound (when manipulated). 6-7a. 

Pittaja vrana: Ulcer caused by pitta, develops quickly, is yellow, blue, brown or yellowish-brown, exudes fluid resembling urine, kimsuka, solution ash and oil, warm and large in quantity; pain resembles that caused by the smearing of caustic alkali (severe burning sensation), redness, feelling of great heat and undergoes ripening / suppuration. 7b-8. 

Kaphaja vrana: Ulcer caused by kapha is pale, has itching, large quantity of white, thick exudate; thick edges, hard with network of tendons and veins and has mild pain. 9. 

Raktaja vrana: Ulcer caused by rakta (blood is red like the coral, exudes pus mixed with blood, emits smell like that of a horse’s stable and has other feature of ulcer caused by pitta. 10. 

By the mixtrue of feature, presence of two and three dosas should be understood. 11a. 

Suddha vrana (Unvitiated ulcer): The ulcer which resembles the tongue (in colour), is soft, smooth, bluish in its edges, with eruptions ( granulations), even the floor slightly elevated and not accompanied with any complications-are the featrues of a suddhavrana (ulcer unvitiated by the dosas etc.). 11b-12a. 

Asadhya vrana (incurable ulcer): The skin, muscle, vein, tendons, bony joints, bones, viscera of the trunk and vital spots-these eight places of dwelling (sites) of the ulcers are very difficult to cure in their successive order. 12b-13a. 

Susadhya vrana (Easily curable ulcer): Ulcers are easily curable which are present in persons who are strong in mind, muscle, digestive fire, age and strength; which are round, elongated with three folds and four sides in shape, present on the buttocks, rectum, penis, lips, back, interior of the mouth and cheeks. 13b-14. 

Kricchrasadhya vrana (Difficult to cure ulcer): Ulcer on the eyes, teeth, nose, outer angle of the eye, umbilicus, sutures, abodomen, ears, flanks, axillae and breasts are difficult to cure. 15.

Those which exude froth, pus and air (or gas), those having foreign body, which are elevated very much, which do not exude at all; rectal fiistula which has its mouth inside and invading the pelvic bone, ulcers of patients suffering from kustha (leprosy), visa (poison), sosa (tuberculosis), madhumeha (diabetes mellitus) and those ulcers which de velop on another (earlier) ulcer get cured with difficulty. 15-17.

Asadhya vrana (Incurable ulcer): Ulcer in patients of visarpa (herpes), fever, dierrhoea, cough, severe thirst, who do not sleep at all, who are suffering from dyspnoea and indigestion, in whom the skull is fractured or the brain is visible do not get cured. 18-19a. 

Even curable ulcers become incurable by exudation of tendons, cutting of the veins, increase of depth, devouring (destruction) by worms (bacteria etc.) fracture of bones, presence of foreign bodies and poisons, by too much of cutting (excising during surgical operation) improper bandaging, too much of anointing with fats or too much of dryness; friction by hair etc, too much of strain, impurity of the alimentary tract, too much of food, too much of debility, drinking wine, sleeping during day, copulation, keeping awake at nights and improper treatments. 19b-22a. 

Healing ulcer: An ulcer which has the colour resembling a pigeon, its interior free of exudations, static (hard, immovable) dull and flat in appearance should be understood as “healing.” 

Vrana chikitsa (Treatment of ulcer)

In the stage of swelling itself, purificatory therapy in the nearest route (either emesis or purgation) should be administered; swelling or ulcer get cured quick in the person who has been purified. 23b-24a.

During the stage of swelling, cold therapies should be resorted to continuously, the agni (fire) in the dosas is similar to fire (external fire) and gets subsided by this method immediately. 24b-25a.

In swelling and ulcer which are hard, discoloured, painful and containing poison, blood should be taken out by using leeches; with the vitiated blood going out, swelling, redness and pain subside immediately. 25b-26.

After such removal of blood often, the ulcer should be covered with nice paste of drugs which are cold in potency and applied cold and prepared on the same day macerating with milk, sugarcane juice and such other liquids; satadhauta ghrta (ghee washed a hundred times in water or decoction of bark of trees having milky sap) should be applied often, rubbing it in the direction opposite of the hairs. Bathing the ulcer and anointing should also be done, by the same drugs. 27-28

Pradeha (thick warm poultice) of the bark of nyagrodha, udumbara, asvattha; plaksa and vetasa added with more of ghee is best to relieve swelling. 29.

Ulcers which have predominance of vata, which are static, hard and very painful, swellings in which blood has been removed or ulcers of this kind, should be given fomentation with vesavara (minced meat cooked in oil) etc. of animals of marshy lands; seeds of uma and tila are fried, soaked in milk made into a paste and applied to the ulcer relieve bruning sensation and pain. 30-31. 

Swelling which are static and of dull pain should be anointed with oils which mitigate vata and kapha, exposed to the steam through the reeds of bamboo slowly, should be squeezed with the palm and the thumb to make it soft, applied with a paste of flour of yava, godhuma and mudga. 32-33.

If by this method the swelling does not become reduced, then upanaha (application of warm poultice) should be done; by that the swelling subsides if it is unripe and forms pus; if it ripen kola, tila, valla, uma, dadhyamla (sour curds), saktupindaka (paste of corn flour kinva brewing yeast), kustha and lavana made into a paste is applied warm suitable for poultice. 34-35.

If the swelling is well ripened, collected together and squeezed mildly, it is desirable to cause its bursting, in those who are fit for it and who are of tender nature. 36. 

Guggulu, atasi, godanta, svarnaksiri, excreta of pigeon, drugs which have caustic property and caustic alkalies; these bring about bursting of the ripe sweling. 37.

The swelling which is full of pus, has a narrow mouth, bulged up and located on a vital spot should be squeezed continuously with drugs of such action without the addition of fats. 38.

That swelling which is drying up should be neglected in respect of application of paste, its mouth not coated with the paste, for the dosas come out of it on their own accord. 39. 

Bark of the stem and roots of kalaya, yava, godhuma, masa, mudga, and harenu and drugs which are slimy-are good for squeezing (the swelling). 40.

In dusta vrana (vitiated ulcer) and those of diabetes and leprosy drugs of surasadi gana and aragvadhadi gana (chapter 15 of sutrasthana) should be made use of for the seven therapies such as ksalana etc, (ksalana, alepa, ghrta, taila, rasakriya, curna and varti) especially. 41.

Ksalana (washing the ulcer) can be done with the de coction of leaves of patoli and nimba when the ulcer is vitiated, and with that of the bark of drugs of nyagrodhadi gana (chapter 15 of Sutrasthana) when the ulcer is not vitiated. ?

Paste of patoli, tila, yastyahva, trivrt, danti, the two nisa, and leaves of nimba added with patu (salt) applied over, cleanses it. 43.

Ulcers which have small opening and which are located on joints and vital spots should be cleaned (cleared of their contents) by inserting a varti (cotton wick) prepared with trivrt, danti, langali, madhu (honey) and saindhava. 44.

Ulcers which have been vitiated by vata, which have exudation and severe pain should be fumigated with yava, bhurja, madana, Srivestha and surahva mixed with ghee. 45.

Those which are predominant with pitta, rakta (blood) and visa (poison) should be bathed with cold things (decoction, oils etc). 46a.

In those ulcers which have very little of dried-out muscle tissue, and the ulcer if deep seated, it is beneficial to elevate it, make it grow up by massaging with paste of drugs of nyagrodhadi gana and of padmakadi gana (chapter 15 of Sutrasthana), asvagandha, bala and tila; the patient should eat meat of carnivorous animals prepared in the proper manner; muscle grows / develops by ingestion of meat especially of carnivorous animals and by pure (pleasant) mind. 46b-48a.

Overgrowth of soft muscle tissue should be reduced by the use of paste of buds of jati, kasisa, manohva, pura and agnika; muscle which is elevated and ulcers in those who are difficult to be purified should be cleaned by ksarakarma alkaline cautery. 48b-50a.

Ulcers caused by asmari (renal calculii) which exude urine through them and others which exude blood, those ulcers located on the bony joints and have caused tearing, those ulcers which do not get cleaned by the usual methods of cleaning-all these should be cleaned by agnikarmathermal cautery. 50b-51. 

For the healing of the ulcers the same drugs mentioned for massaging and raising up (vide verse no. 46b-48a) should be used. 52a.

Paste of asvagandha, ruha (vrksaruha), rodhra, katphala, madhuyasti, samanga and dhatakipuspa are best for healing the ulcer. 52b-53a.

The purified and foul smelling muscle tissue having been removed, if new muscle tissue is not seen growing in that place, then the paste of tila added with honey should be kept in that place which helps muscle growth. This being unctuous, hot, bitter, sweet, astringent, it cures all trobles; added with honey and leaves of nimba is a good pruifier, with these and ghee it heals the ulcers quickly. 53b-55. 

Some that paste of say yava also acts like that of tila. Ulcers which are caused by blood, pitta, poison, external causes and which are deep seated should be made to heal by bathing it with lukewarm ghee boiled with milk and healing drugs; those which are caused by kapha and vata by oil boiled with milk and healing drugs. 56-57.

Kacchi (saurastra mrttika), rodhra, abhaya, sarja, sindura, anjana and tutthaka-powdered, mixed with oil and bees wax is good for healing ulcers. 58.

For healing of ulcers which are even, with firm muscles and localised in the skin, powders (of healing drugs) are desirable; powder of bark of kakubha, udumbara, asvattha, jambu, katphala and rodhra dusted into the ulcers on the skin cures them quickly. 59-60a.

Application of cold paste of laksa manohva, manjistha, haritala and two nisa, added with ghee and honey is best to purify the skin. 60b-61a.

Application of paste of kaliyaka, lata, amrasthi, hema (padmaka), kala (manjistha), rasottama (mercury) added with juice of fresh cowdung is best to bring up the normal colour of the skin. 61b-62a.

Tooth ot an elephant, burnt to ash in the internal method (putapaka method) oil and rasanjana is an application best for promoting growth of hair; similarly so the paste of ash of nails, hair, bones, skin, horn and hoof of quadrupeds added with oil. 62b-63.

The do’s and dont’s prescribed for a person who has undergone surgical operation apply to the patient of ulcer also. 64a.

In ulcers of vata origin, the drugs of the two pancamulas and those that mitigate vata are suitable. For that of pitta origin, drugs of nyagrodhadi and padmakadi gana (chapter 15 of Sutrasthana) and for that of kapha origin, the drugs of aragvadha gana and in ulcer of mixed origin with mixture of drugs. 64b-65.

These drugs should be made use of for praksalana (washing), lepa (application of paste), ghrta, taila, rasakriya (preparing medicated ghee, oil, solidified decoction) curna (powder) and varti (wick smeared with paste of drugs) in the treatment of an ulcer appropriately. 66.

Medicated ghee prepared with leaves of jati, nimba and patola, katuka, darvi, nisa, sariva, manjistha, abbaya, siktha, tuttha, madhuka and seeds of naktahva, cleanses and heals the ulcers which have small openings, situated on vital spots, which have exudation, deep seated, painful and having sinuses. 67.