The 30th chapter of Uttara Sthanam of Ashtanga Hridayam is named as ‘Granthi Arbuda Shlipada Apachi Nadi Pratishedham’. This chapter deals with the explanation of ‘Treatment of tumors-cancer-filariasis-scrofula-sinus ulcer’.
The topics covered in this chapter include –
- Granthi Chikitsa– Treatment of Benign tumor
- Arbuda Chikitsa– treatment of malignant tumor
- Shlipada Chikitsa– Treatment of Filariasis
- Apachi Chikitsa– Treatment of Scrofula
- Use of Kanchanara
- Nakulyadi Lepa
- Shami Bijadi Lepa
- Nimbadi Lepa
- Kakadanyadi Taila
- Langalikadi Taila
- Bhadrasriyadi Taila
- Vachadi Taila
- Use of Sharapunkha
- Uttama Karanyadi Taila
- Katu Taila and Inguda Taila
- Daha Karma – fire cauterization
- Removing the tumor
- Bhedana – excision
- Nadi Vrana Chikitsa– treatment of sinus ulcers
Pledge by the author(s)
अथातो ग्रन्थ्यर्बुदश्लीपदापचीनाडीप्रतिषेधं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘Treatment of tumors-cancer-filariasis-scrofula-sinus ulcer’. Thus, say (pledge) Atreya and other sages.
Granthi Chikitsa: Treatment of Benign Tumor
ग्रन्थिष्वामेषु कर्तव्या यथास्वं शोफवत्क्रिया ।
बृहतीचित्रकव्याघ्रीकणासिद्धेन सर्पिषा ॥ १ ॥
स्नेहयेच्छुद्धिकामं च तीक्ष्णैः शुद्धस्य लेपनम् ।
संस्वेद्य बहुशो ग्रन्थिं विमृद्नीयात्पुनः पुनः ॥ २ ॥
एष वाते विशेषेण क्रमः पित्तास्रजे पुनः ।
जलौकसो हिमं सर्वं कफजे वातिको विधिः ॥ ३ ॥
For Granthi (benign tumor) which is unripe, the treatment is like that of any Shopha (swelling). The patient requiring purificatory therapies, should be given oleation therapy first with ghee prepared with bṛhatī – Solanum indicum, citraka – Plumbago zeylanica, vyāghrī – Solanum xanthocarpum and kaṇā – Piper longum; after he gets purified, application of paste of herbs of penetrating action should be done (on the tumor); tumor should be given fomentation many times and squeezed (by the hands) again and again. This is the method of treatment especially for tumor of Vata origin; for those arising from Pitta and asrik (blood), application of leeches (to suck blood) and all cold therapies are beneficial; for Kapha origin, the treatment prescribed for that of Vata origin itself is suitable.
Granthi Chikitsa: Treatment of Benign Tumor
तथाऽप्यपक्वं छित्त्वैनं स्थिते रक्तेऽग्निना दहेत् ।
साध्वशेषं सशेषो हि पुनराप्यायते ध्रुवम् ॥ ४ ॥
That which has not become ripe, in spite of all should be cut (excised) and when bleeding stops it should be burnt by fire (thermal cautery), leaving no residue/remnant, because such a residue/ remnant is sure to develop again into a tumor.
Granthi Chikitsa: Treatment of Benign Tumor
मांसव्रणोद्भवौ ग्रन्थी यापयेदेवमेव च ।
Both Mamsa Granthi (tumor of muscle tissue) and Vrana Granthi (tumor sequel to an ulcer) should also be treated in the same (above) way.
Granthi Chikitsa: Treatment of Benign Tumor
कार्यं मेदोभवेऽप्येतत्तप्तैः फलादिभिश्च तम् ॥ ५ ॥
प्रमृद्यात्तिलदिग्धेन छन्नं द्विगुणवाससा ।
शस्त्रेण पाटयित्वा वा दहेन्मेदसि सूद्धृते ॥ ६ ॥
Even in Medoja Granthi (tumor of fat tissue), the same treatment should be done. It should be given a coating of the paste of tila – Sesamum indicum, channaṃ – covered with two layers of cloth and then touched with heated metal plates etc.; or it be cut (excised) completely using an instrument (knife), fat removed completely and burnt by fire (thermal cautery).
Granthi Chikitsa: Treatment of Benign Tumor
सिराग्रन्थौ नवे पेयं तैलं साहचरं तथा ।
उपनाहोऽनिलहरैर्बस्तिकर्म सिराव्यधः ॥ ७ ॥
In Siragranthi (tumor of veins), which is new, Sahachara Taila should be given to drink; warm poultice with herbs which mitigate Vata; enema therapy and venesection should be done.
Arbuda Chikitsa: Treatment of malignant tumor
अर्बुदे ग्रन्थिवत्कुर्यात्यथास्वं सुतरां हितम् ।
अजाशकृच्छिग्रुमूललाक्षासुरसकाञ्जिकैः वस्त्रबद्धैरुपस्वेद्य मर्दयित्वा प्रलेपयेत् ॥ ८+(१) ॥
उपोदकापत्रपिण्ड्या छदैराच्छादितं घनम् ।
निवेश्य पट्टं बध्नीयाच्छाम्यत्येवं नवार्बुदम् ॥८+(२) ॥
जीर्णे चार्कच्छदसुधासामुद्रगुडकाञ्जिकैः ।
प्रच्छाने पिण्डिका बद्धा ग्रन्थ्यर्बुदविलायनी ॥८+(३) ॥
For malignant tumors, also, the same treatment advocated for benign tumors are beneficial. Excreta of goat, root of Moringa oleifera, lākṣā – Laccifer lacca, surasa – Ocimum sanctum, kāñjikaiḥ – sour gruel should be tied in cloth and given with fomentation, rubbed and applied over the tumor and covered with thick bolus of leaves of upodakāb – Basella rubra and then bandaged with a cloth. By this, Arbuda of recent onset subsides after it ripens, arkacchada – Calotropis gigantea, sudhā – Euphorbia neriifolia, sea salt, jaggery and sour gruel; letting out the blood by making incisions on the skin, after tying at the calves for the sake of dissolving of tumors.
Shlipada Chikitsa: Treatment of Filariasis
श्लीपदेऽनिलजे विध्येत्स्निग्धस्विन्नोपनाहिते ॥ ८ ॥
सिरामुपरि गुल्फस्य द्व्यङ्गुले पाययेच्च तम् ।
मासमेरण्डजं तैलं गोमूत्रेण समन्वितम् ॥ ९ ॥
जीर्णे जीर्णान्नमश्नीयाच्छुण्ठीशृतपयोऽन्वितम् ।
त्रैवृतं वा पिबेदेवमशान्तावग्निना दहेत् ॥ १० ॥
In Shlipada caused by Vata, after administering oleation (anointing), sudation (fomentation) and poultice, the vein situated at 2 finger breadth length above the heel should be cut (and blood let out); the patient should be asked to drink castor oil along with cow urine for one month, after it is well digested, he should eat old rice boiled well along with decoction of śuṇṭhī – Zingiber officinale and milk or drink with milk the decoction of trivrit – Operculina turpethum. If by these methods the disease does not subside, then it should be burnt by fire (thermal cautery).
Shlipada Chikitsa: Treatment of Filariasis
गुल्फस्याधः सिरामोक्षः पैत्ते सर्वं च पित्तजित् ।
In Shlipada of Pitta origin, venesection below the heel and all other Pitta mitigating treatments should be done.
Shlipada Chikitsa: Treatment of Filariasis
सिरामङ्गुष्ठके विद्ध्वा कफजे शीलयेद्यवान् ॥ ११ ॥
सक्षौद्राणि कषायाणि वर्धमानास्तथाऽभयाः ।
लिम्पेत्सर्षपवार्ताकीमूलाभ्यां धन्वयाऽथवा ॥ १२ ॥
In Shlipada of Kapha origin, the vein near the big toe should be cut, use Hordeum vulgare (as food), decoction of herbs of astringent taste mixed with honey; use Terminalia chebula in daily increasing doses, apply the paste of sarṣapa – Brassica nigra and root of Solanum indicum or of Alhagi Maurorum to the leg.
Apachi Chikitsa: Treatment of Scrofula
ऊर्ध्वाधःशोधनं पेयमपच्यां साधितं घृतम् ।
दन्तीद्रवन्तीत्रिवृताजालिनीदेवदालिभिः ॥ १३ ॥
शीलयेत्कफमेदोघ्नं धूमगण्डूषनावनम् ।
सिरयाऽपहरेद्रक्तं पिबेन्मूत्रेण तार्क्ष्यजम् ॥ १४ ॥
In apachi, purification of the body in its upper and lower routes, drinking of ghee prepared with dantī – Baliospermum montanum, dravantī – Jatropha glandulifera, trivṛtā – Operculina turpethum, jālinī – Luffa acutangular, devadālibhiḥ – Luffa echinata; should practice inhalation of smoke, holding liquids in the mouth and nasal medication which mitigate Kapha and medas (fat), blood should be let out from the vein, and drink (Rasanjana) – aqueous extract of Berberis aristate mixed with cow urine.
Use of Kanchanara
पलमर्धपलं वाऽपि कर्षं वाऽप्युष्णवारिणा ।
काञ्चनारत्वचं पीत्वा गण्डमालां व्यपोहति ॥१४+(१) ॥
Drinking the fresh juice of bark of kāñcanāra – Bauhinia variegata in doses of one pala (48 grams), or half pala (24 grams) or one karsha (12 grams) every day along with warm water, the person gets cured of Gandamala
Nakulyadi Lepa
ग्रन्थीनपक्वान् आलिम्पेन्नाकुलीपटुनागरैः ।
स्विन्नान् लवणपोटल्या कठिनाननु मर्दयेत् ॥ १५ ॥
Tumors (of gandamala) which are unripe, should be smeared with the paste of nākulī – Rauwolfia serpentina, salt, nāgaraiḥ – Zingiber officinale; fomented with salt poultice and then the hard tumors massaged softly.
Shami Bijadi Lepa
शमीमूलकशिग्रूणां बीजैः सयवसर्षपैः ।
लेपः पिष्टोऽम्लतक्रेण ग्रन्थिगण्डविलायनः ॥ १६ ॥
Seeds of śamī – Prosopis cineraria, mūlaka – Raphanus sativus, and moringa oleifera mixed with sa yava – Hordeum vulgare, sarṣapaiḥ – Brassica nigra macerated with sour buttermilk and this paste applied over the tumor makes that liquefied.
Nimbadi Lepa
क्षुण्णानि निम्बपत्राणि क्लृप्तैर्भल्लातकैः सह ।
शरावसम्पुटे दग्ध्वा सार्धं सिद्धार्थकैः समैः॥१६+(१) ॥
एतच्छागाम्बुना पिष्टं गण्डमालाप्रलेपनम् ॥ १६+(२) अब् ॥
Wet (fresh) leaves of nimba – Azadirachta indica, bhallātakaiḥ – Semecarpus anacardium cut to bits, burnt to ashes within sealed earthen saucers and mixed with half its quantity of siddhārthakaiḥ – Brassica nigra, macerated with goat urine and applied to Gandamala (is beneficial).
Apachi Chikitsa: Treatment of Scrofula
पाकोन्मुखान् स्रुतास्रस्य पित्तश्लेष्महरैर्जयेत् ।
अपक्वानेव वोद्धृत्य क्षाराग्निभ्यामुपाचरेत् ॥ १७ ॥
Those which are undergoing ripening (suppuration), should be treated with bloodletting and therapies which mitigate Pitta-Shleshma (Kapha) or the unripe ones should be removed and treated by the use of alkaline and thermal cauterization.
Kakadanyadi Taila
काकादनीलाङ्गलिकानहिकोत्तुण्डिकीफलैः ।
जीमूतबीजकर्कोटीविशालाकृतवेधनैः ॥ १८ ॥
पाठान्वितैः पलार्धांशैर्विषकर्षयुतैः पचेत् ।
प्रस्थं करञ्जतैलस्य निर्गुण्डीस्वरसाढके ॥ १९ ॥
अनेन माला गण्डानां चिरजा पूयवाहिनी ।
सिध्यत्यसाध्यकल्पाऽपि पानाभ्यञ्जननावनैः ॥ २० ॥
Medicated oil is prepared with the decoction of kākādanī – Celastrus paniculata, lāṅgalikā – Gloriosa superba, nahikā – Bombax ceiba, uttuṇḍikīphalaiḥ jīmūtabīja – seeds of Luffa echinata, karkoṭī – Luffa acutangulata, viśālā – Alstonia scholaris, kṛtavedhanaiḥ – Luffa acutangular, pāṭhānvitaiḥ – Cissampelos pareira each half pala (24 grams); visha one karsha (12 grams); karañjatailasya – Karanja taila, one prastha (768 grams) nirguṇḍī svarasa – and fresh juice of Vitex negundo, one adhaka (3.072 Kg). By the use of this oil for drinking, anointing on the tumor and nasal medication, Gandamala (scrofula) which are chronic, which exude pus, with recent incurable features all become cured.
Langalikadi Taila
तैलं लाङ्गलिकीकन्दकल्कपादं चतुर्गुणे ।
निर्गुण्डीस्वरसे पक्वं नस्याद्यैरपचीप्रणुत् ॥ २१ ॥ Medicated oil prepared with decoction of lāṅgalikī kanda – Gloriosa superba, paste of the same in one-fourth part along with four parts of fresh juice of nirguṇḍī – Vitex negundo used as nasal drops etc. cures Apachi
Bhadrasriyadi Taila
भद्रश्रीदारुमरिचद्विहरिद्रात्रिवृद्घनैः ।
मनःशिलालनलदविशालाकरवीरकैः ॥ २२ ॥
गोमूत्रपिष्टैः पलिकैर्विषस्यार्धपलेन च ।
ब्राह्मीरसार्कजक्षीरगोशकृद्रससंयुतम् ॥ २३ ॥
प्रस्थं सर्षपतैलस्य सिद्धमाशु व्यपोहति ।
पानाद्यैः शीलितं कुष्ठदुष्टनाडीव्रणापचीः ॥ २४ ॥
Medicated oil prepared with the paste of one pala (48 grams) each of bhadraśrī – Santalum album, dāru – Cedrus deodara, marica – Piper nigrum, the two Haridra-
Haridra – Curcuma longa
Daruharidra – Berberis aristata,
trivṛt – Operculina turpethum, ghanaiḥ – Cyperus rotundus, manaḥśilā – realgar, āla – arsenic trisulphidum, nalada – Nardostachys jatamamsi, viśālā – Alstonia scholaris and karavīrakaiḥ – Nerium indicum made with cow urine; viṣasya – Aconitum ferox half pala (24 grams), juice of brāhmī – Bacopa monnieri, arka Kshira (milky sap of) – Calotropis gigantea, mixed with juice of fresh cow dung and one prastha (768 ml) of sarṣapatailasya – oil of Brassica nigra; this used for drinking etc. (anointing, nasal medication) habitually cures skin disease, foul ulcers, sinus ulcers and Apachi (small tumors) in quick time.
Vachadi Taila
वचाहरीतकीलाक्षाकटुरोहिणिचन्दनैः ।
तैलं प्रसाधितं पीतं समूलामपचीं जयेत् ॥ २५ ॥
Medicated oil prepared with vacā – Acorus calamus, harītakī – Terminalia chebula, lākṣā – Laccifer lacca, kaṭurohiṇi – Picrorhiza Kurroa and candanaiḥ – and Santalum album consumed daily destroys Apachi from its root even.
Use of Sharapunkha
शरपुङ्खोद्भवं मूलं पिष्टं तण्डुलवारिणा ।
नस्याल्लेपाच्च दुष्टारुरपचीविषजन्तुजित् ॥ २६ ॥
Root of śarapuṅkha – Tephrosia purpurea macerated with rice wash and used for nasal medication and external application, cures bad ulcers, Apachi and poisonous worms.
Uttama Karanyadi Taila
मूलैरुत्तमकारण्याः पीलुपर्ण्याः सहाचरात् ।
सलोध्राभययष्ट्याह्वशताह्वाद्वीपिदारुभिः ॥ २७ ॥
तैलं क्षीरसमं सिद्धं नस्येऽभ्यङ्गे च पूजितम् ।
Medicated oil prepared with the root of uttama kāraṇyāḥ – Pergularia extensa, pīluparṇyāḥ – Chonemorpha Fragrans and sahācarāt – Casearia sesculanta added with Symplocos racemosa, abhaya – Terminalia chebula, yaṣṭyāhva – Glycyrrhiza glabra, śatāhvā – Anethum sowa, dvīpi – Plumbago zeylanica and dārubhiḥ – Cedrus deodara and equal quantity of milk is best for nasal drops and anointing.
Katu Taila and Inguda Taila
गोऽव्यजाश्वखुरा दग्धाः कटुतैलेन लेपनम् ॥ २८ ॥
ऐङ्गुदेन तु कृष्णाहिर्वायसो वा स्वयं मृतः ।
Ash of the hoof of cow, sheep, goat, horse mixed with Katu taila should be applied externally or the ash of a black snake or crow which has died of its own accord mixed with Ingudi taila may be applied.
Daha Karma: Fire cauterization
इत्यशान्तौ गदस्यान्यपार्श्वजङ्घासमाश्रितम् ॥ २९ ॥
बस्तेरूर्ध्वमधस्ताद्वा मेदो हृत्वाऽग्निना दहेत् ।
If the disease does not subside by these treatments, then considering the calf muscle of the leg opposite to the side of the disease (Apachi), the medas (fat) present above and below the basti (bladder / indrabasti marma) should be taken out and the site burnt by fire.
Removing the tumor
स्थितस्योर्ध्वं पदं मित्वा तन्मानेन च पार्ष्णितः॥३०॥
तत ऊर्ध्वं हरेद्ग्रन्थीनित्याह भगवान्निमिः ॥ +1 ॥
The patient is made to stand, extending his leg, measuring the distance from the heel (up to the middle of the calf muscles), thereafter Granthi (tumour) present there should be removed. Thus, said the honourable Nimi.
Removing the tumor
पार्ष्णिं प्रति द्वादश चाङ्गुलानि मुक्त्वेन्द्रबस्तिं च गदान्यपार्श्वे |
विदार्य मत्स्याण्डनिभानि मध्याज्जालानि कर्षेदिति सुश्रुतोक्तिः ॥ ३१॥
Leaving away twelve angula (fingers breadth) from the heel and going upward, to the place of indira basti and avoiding it, on the other side of the disease, calf muscle should be torn (cut) open, the small tumor resembling eggs of the fish removed out from the network of muscles this is the saying of Sushruta.
Bhedana: Excision
आगुल्फकर्णात्सुमितस्य जन्तोस्तस्याष्टभागं खुडकाद्विभज्य ।
घ्राणार्जवेऽधः सुरराजबस्तेर्भित्त्वाऽक्षमात्रं त्वपरे वदन्ति ॥ ३२ ॥
Dividing the total length of man after proper measurement, from his heel to the ear, and keeping one eight parts of it (at the bottom and discarding the major part at the top) from the knee or measuring from the tip of the nose straight downwards to the indrabasti and taking one eight parts of it (is the site for conducing the operation) 1 aksha proportion should be cut, say some others.
Nadi Vrana Chikitsa: Treatment of sinus ulcers
उपनाह्यानिलान्नाडीं पाटितां साधु लेपयेत् ।
प्रत्यक्पुष्पीफलयुतैस्तैलैः पिष्टैः ससैन्धवैः ॥ ३३ ॥
पैत्तीं तु तिलमञ्जिष्ठानागदन्तीनिशाद्वयैः ।
श्लैष्मिकीं तिलसौराष्ट्रीनिकुम्भारिष्टसैन्धवैः ॥ ३४ ॥
Sinus ulcer caused by Vata should be fomented with warm poultice, cut open and applied with the paste of Achyranthes aspera with fruit, oil of Sesamum indicum, mixed with rock salt, in that caused by pitta with paste of tila – Sesamum indicum, mañjiṣṭhā – Rubia cordifolia, nāgadantī – Croton oblongifolius and the two Nisha – Haridra – Curcuma longa and Daruharidra – Berberis aristata; that caused by Kapha with the paste of tila – Sesamum indicum, saurāṣṭrī – Cinnamomum camphora, nikumbha – Baliospermum montanum, ariṣṭa – Azadirachta indica and rock salt.
Nadi Vrana Chikitsa: Treatment of sinus ulcers
शल्यजां तिलमध्वाज्यैर्लेपयेच्छिन्नशोधिताम् ।
That due to foreign body should be cut open, cleaned and applied with the paste of tila – Sesamum indicum, honey and ghee.
Nadi Vrana Chikitsa: Treatment of sinus ulcers
अशस्त्रकृत्यामेषिण्या भित्त्वाऽन्ते सम्यगेषिताम् ॥३५॥
क्षारपीतेन सूत्रेण बहुशो दारयेद्गतिम् ।
That which cannot be cut by the knife, should be split with the help of a probe properly, the passage cleared and a thread soaked in solution of alkali inserted into it many times, making the channel clear and wide.
Nadi Vrana Chikitsa: Treatment of sinus ulcers
व्रणेषु दुष्टसूक्ष्मास्यगम्भीरादिषु साधनम् ॥ ३६ ॥
या वर्त्यो यानि तैलानि तन्नाडीष्वपि शस्यते ।
The treatments advocated for ulcers which have bad (exudation) and small mouth(opening) and are deep seated, the same treatments, the same medicinal wicks and oils are also beneficial even in sinus ulcers.
Nadi Vrana Chikitsa: Treatment of sinus ulcers
पिष्टं चञ्चुफलं लेपान्नाडीव्रणहरं परम् ॥ ३७ ॥
Paste of chanchuphala is best for application for cure of Sinus ulcer.
Nadi Vrana Chikitsa: Treatment of sinus ulcers
घोण्टाफलत्वक् लवणं सलाक्षं बूकस्य पत्रं वनितापयश्च ।
स्नुगर्कदुग्धान्वित एष कल्को वर्तीकृतो हन्त्यचिरेण नाडीम् ॥ ३८ ॥
Bark of Areca catechu, salt, lākṣaṃ – Laccifer lacca, būkasya patraṃ – Sesbania grandiflora women’s milk, sap of Snuk -Euphorbia neriifolia and of Arka – Calotropis gigantea made into a paste and then into a wick, cures sinus ulcer very soon.
Nadi Vrana Chikitsa: Treatment of sinus ulcers
सामुद्रसौवर्चलसिन्धुजन्मसुपक्वघोण्टाफलवेश्मधूमाः ।
आम्रातगायत्रिजपल्लवाश्च कटङ्कटेर्यावथ चेतकी च ॥ ३९ ॥
कल्केऽभ्यङ्गे चूर्णे वर्त्यां चैतेषु शील्यमानेषु ।
अगतिरिव नश्यति गतिश्चपला चपलेषु भूतिरिव॥४०॥
Sea salt, black salt, rock salt, bark of well ripe fruit of Ghonta – Areca catechu, (Angara dhuma) Kitchen soot, āmrāta – Spondias pinnata, tender leaves of Acacia catechu, kaṭaṅkaṭeryau – Berberis aristata and (Kanguni) – Celastrus paniculatus or Callicarpa macrophylla these together made use of in the form of paste, for bathing, powder, medicinal wick etc. These make for disappearance of the sinus ulcers just like wealth in a helpless man of unsteady nature.
इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने ग्रन्थ्यर्बुदश्लीपदापचीनाडीप्रतिषेधा नाम त्रिंशोऽध्याय: ॥ ३० ॥
Thus, ends the chapter Granthi- Arbuda-Shlipada-Apachi Nadi Pratishedha- the thirtieth in Uttarasthana of Astanga Hridaya Samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
