The 16th chapter of Chikitsasthana of Sushruta Samhita is named as Vidradhi Cikitsitam Adhyaya. This chapter deals with Treatment of Abscess.
अथातोविद्रधीनांचिकित्सितंव्याख्यास्यामः।।१।।
यथोवाचभगवान्धन्वन्तरिः।।२।।
We will now propound Vidradhi Chikitsa-treatment of abscess; as revealed by the venerable Dhañvañtari.
Sadhyāsādhyata – Prognosis
उक्ताविद्रधयःषड्येतेष्वसाध्यस्तुसर्वजः।।
शेषेष्वामेषुकर्तव्यात्वरितंशोफवत्क्रिया।।३।।
Vidradhi is of six kinds and that has been already described earlier i.e. in the 9th chapter of Nidana Sthana. Among these six types of Vidradhi, Sarvaja or SannipatajaVidradhi i.e. that type which is caused by simultaneous aggravation of all three doshas is incurable. The treatment for other types of vidradhi should be on the lines of treating Sopha – inflammatory swelling. These treatments should be quickly done in their ama Avastha – unripe stage.
VātajaVidradhi Cikitsā – Treatment of abscess of vāta origin
वातघ्नमूलकल्कैस्तुघृततैलवसायुतैः।।
सुखोष्णोबहलोलेपःप्रयोज्योवातविद्रधौ।।४।।
सानूपौदकमांसस्तुकाकोल्यादिःसतर्पणः।।
स्नेहाम्लसिद्धोलवणःप्रयोज्यश्चोपनाहने।।५।।
वेशवारैःसकृशरैःपयोभिःपायसैस्तथा।।
स्वेदयेत्सततंचापिनिहरेच्चापिशोणितम्।।६।।
सचेदेवमुपक्रान्त :पाकायाभिमुखोयदि।।
तंपाचयित्वाशस्त्रेणभिन्द्याद्भिन्नंचशोधयेत्।।७।।
पञ्चमूलकषायेणप्रक्षाल्यलवणोत्तरैः।।
तैलैर्भद्रादिमधुकसंयुक्तैःप्रतिपूरयेत्।।८।।
वैरेचनिकयुक्तेनत्रैवृतेनविशोध्यच।।
पृथकूपर्यादिसिद्धेनत्रैवृतेनचरोपयेत्।।९।।
Below mentioned are the treatment principles of VatajaVidradhi –
Lepa – Vata mitigating herbs are taken and their paste is made. This paste is mixed with ghee, oil and fat and applied on the abscess formed by vata. This paste should be comfortably warm and applied thick.
Upanaha – Below mentioned ingredients should be mixed together to prepare a poultice for vatajavidradhi –
– Anupa mamsa – meat of animals living in marshy regions
– Audakamamsa – meat of aquatic animals – animals living in water,
– Kakolyadi Gana – herbs belonging to Kakolyadi Gana group
– Tarpana – corn flour
– Taila – oil
– Amla – sour things and
– Lavana – salt
Alternatively, poultice can be applied using –
– Vesavara – minced meat added with Sneha – fats, amla – sours and lavana – salt
– Krsara – rice cooked with pulses
– Paya – Milk or Payasa – sweet milk pudding
The patient should also be administered with swedana – sudation and raktamokshana – bloodletting done continuously.
In spite of treating vataja vidradhi with above said measures, if the abscess develops signs of ripening, it should be allowed to ripen quickly by use of foods and herbs used for the same purpose.
Bhedana and Shodhana – After this, the vidradhi should be punctured – cut open and cleansed.
Prakshalana etc. measures – Later, it should be washed with –
– Panchamula decoction added with more of salt and
– Filled with Bhadradarvadi Taila i.e. oil prepared with herbs of Bhadradarvadi Gana group and Madhuka and
– Cleansed by dusting the powder of virechana varga – herbs belonging to purgative group, along with Trivrt – Operculina turpethum and
– Made to heal using Prthakparnyadi Taila – oil prepared using Prthakparni and Trivrt
Pittaja Vidradhi Cikitsā
पैत्तिकंशर्करालाजामधुकैःसारिवायुतैः।।
प्रदिह्यात्क्षीरपिष्टैर्वापयस्योशीरचन्दनैः।।१०।।
पाक्यैःशीतकषायैर्वाक्षीरैरिक्षुरसैस्तथा।।
जीवनीयघृतैर्वाऽपिसेचयेच्छर्करायुतैः।।११।।
त्रिवृद्धरीतकीनांचचूर्णंलिह्यान्मधुद्रवम्।।
जलौकोभिर्हरेच्चासृक्पक्वंचापाट्यबुद्धिमान्।।१२।।
क्षीरवृक्षकषायेणप्रक्षाल्यौदकजेनवा।।
तिलैःसयष्टीमधुकैःसक्षौद्रैःसर्पिषायुतैः।।१३।।
उपदिह्यप्रतनुनावाससावेष्टयेत्व्रणम्।।
प्रपौण्डरीकमञ्जिष्ठामधुकोशीरपद्मकैः।।१४।।
सहरिद्रैःकृतंसर्पिःसक्षीरंव्रणरोपणम्।।
क्षीरशुक्लापृथक्पीसमङ्गारोनचन्दनैः।।१५।।
न्यग्रोधादिप्रवालेषुतेषांत्वक्ष्वथवाकृतम्।।
Below mentioned are the principles of treating Pittaja Vidradhi–
Pradeha – The below mentioned herbs should be macerated with milk and the prepared pastes is applied on the abscess caused by aggravated pitta –
- Sarkaradi Pradeha – paste of –
– Sarkara – sugar
– Laja –
– Madhuka – Glyzyrrhiza glabra
– Sariva – Hemidesimus indicus
- Payasyadi Pradeha – paste of –
– Payasya –
– Usira – Vetiveria zizanoides and
– Candana – Santalum album, sandalwood
Secana is pouring medicated liquids on the vidradhi. It should be done using –
– Jivaniya Gana Kashaya – decoction / infusion prepared with herbs belonging to Jivaniya Gana group or
– Milk or
– Sugarcane juice or
– Jivaniya Ghrta – ghee prepared with Jivaniya Gana group of herbs added with sugar
Trivrtadi Churna – Powder of Trivrit – Operculina tuprethum and Haritaki – Terminalia chebula should be given for licking mixed with honey.
Raktamokshana – bloodletting should be done using leeches.
Patana and Prakshalana – The wise physician should do patana – cutting open the ripe abscess. After this, he should do prakshalana– washing it with Panchavalkala Kashaya – decoction of trees which yield milky sap or audaka plants – plants growing in water.
Upadeha / Upanaha – Poultice prepared with tila – sesame seeds and yastimadhuka – Glyzyrrhiza glabra – added and mixed with ghee and honey, should be applied over the abscess which has been washed as mentioned above and then a band of thin cloth should be wrapped on the wound and tied.
Ghrta – Ghee prepared with the below mentioned herbs help in healing the wound –
Prapaundarikadi Ghrta – ghee prepared with –
– Prapaundarika
– Manjistha
– Ushita
– Padmaka
– Haridra and
– Milk
Ksirasukladi Ghrta – ghee prepared with –
– Ksirasukla,
– Prthakparni
– Samanga
– Rodhra
– Candana and
– Leaf buds of Nyagrodha etc. (Panchavalkala)
Karañjādi Ghrta
नक्तमालस्यपत्राणितरुणानिफलानिच।।१६।।
सुमनायाश्चपत्राणिपटोलारिष्टयोस्तथा।।
द्वेहरिद्रेमधूच्छिष्टंमधुकंतिक्तरोहिणी।।१७।।
प्रियङ्गःकुशमूलंचनिचुलस्यत्वगेवच।।
मञ्जिष्ठाचन्दनोशीरमुत्पलंसारिवेत्रिवृत्।।१८।।
एतेषांकार्षिकैर्भागैघृतप्रस्थंविपाचयेत्।।
दुष्टव्रणप्रशमनंनाडीव्रणविशोधनम्।।१९।।
सद्यश्छिन्नव्रणानांचकरञ्जाद्यमिदंशुभम्।।
दुष्टव्रणाश्चयेकेचिद्येचोत्सृष्टक्रियाव्रणाः।।२०।।
नाड्योगम्भीरिकायाश्चसद्यश्छिन्नास्तथैवच।।
अग्निक्षारकृताश्चैवयेव्रणादारुणाअपि।।२१।।
करञ्जाद्येनहविषाप्रशाम्यन्तिनसंशयः।।
The below mentioned ingredients are cooked in one prastha – 640 grams of ghee and medicated ghee prepared, in the usual method of preparing the ghee –
One karsa – 10 grams each of –
– Naktamala – Karanja – Pongamia pinnata,
– Leaves of Sumana, Patola and Arista,
– Haridra – Curcuma longa and Daruharidra – Berberis aristata,
– Madhuchista – bee wax,
– Madhuka – Glyzyrrhiza glabra,
– Tiktarohini – Picrorrhiza kurroa,
– Priyangu – Callicarpa macrophylla,
– Root of Kusa
– Bark of Nicula – Vetasa,
– Manjistha – Rubia cordifolia,
– Candana – Santalum album – sandalwood,
– Usira – Vetiveria zizanoides,
– Utpala –
– Two types of Sariva – Hemidesmus indicus and
– Trivrit – Operculina turpethum,
This ghee is called Karanjadi Ghrta.
Benefits – This ghee is useful in –
– Mitigating bad (septic) ulcers,
– Cleanses sinus ulcers and freshly cut wounds,
– Cures deep sinus ulcers and recent wounds
– Cures burns caused by fire and alkali are cured undoubtedly in spite of they being severe kinds of burns
Kapha Vidradhi Cikitsā
इष्टकासिकतालोष्टगोशकृत्तुषपांशुभिः।।२२।।
मूत्रैरुष्णैश्चसततंस्वेदयेच्छ्लेष्मविद्रधिम्।।
कषायपानैर्वमनैरालेपैरुपनाहनैः।।२३।।
हरेदोषानभीक्ष्णंचाप्यलाब्वाऽसृक्तथैवच।।
आरग्वधकषायेणपक्वंचापाट्यधावयेत्।।२४।।
हरिद्रात्रिवृताशक्तुतिलैर्मधुसमायुतैः।।
पूरयित्वाव्रणंसम्यग्बध्नीयात्कीर्तितंयथा।।२५।।
ततःकुलत्थिकादन्तीत्रिवृच्छ्यामार्कतिल्वकैः।।
कुर्यात्तैलंसगोमूत्रंहितंतत्रससैन्धवम्।।२६।।
Below mentioned are the principles of treating Kaphaja Vidradhi –
Swedana – sudation should be done by one of the below mentioned things made hot –
– Brick,
– Sand
– Stone
– Cow dung
– Husk
– Dust – mud
– Urines of animals and others
Kashaya pana–Decoctions prepared with kapha mitigating herbs should be given for drinking so as to mitigate / eliminate aggravated kapha.
Vamana –Therapeutic emesis should be administered to expel severely aggravated doshas.
Alepa and Upanaha–Application of pastes and poultices prepared with kapha mitigating medicines / herbs.
Raktamokshana – bloodletting should be done using alabu – gourd.
Patana – the ripe abscess should be cut open. Later it should be washed with Aragwadha – Cassia fistula decoction.
Purana – The wound should be filled with the paste of the below mentioned herbs mixed with honey and later bandaged suitably as described previously –
– Haridra – Curcuma longa
– Trivrit – Operculina turpethum
– Saktu – corn flour
– Tila – sesame seeds
Taila – Medicated oil prepared from the below mentioned ingredients should be used –
– Kulathika –
– Danti – Baliospermum montanum
– Trivrt – Operculina turpethum
– Syama
– Arka – Caltropis gigantea and
– Tilvaka
– Gomutra – urine of cow
– Saindhava – rock salt
Rakta Vidradhi Chikitsa
पित्तविद्रधिवत्सर्वाःक्रियानिरवशेषतः।।
विद्रध्योःकुशलःकुर्याद्रक्तागन्तुनिमित्तयोः।।२७।।
वरुणादिगणक्वाथमपक्वेऽभ्यन्तरोत्थिते।।
ऊषकादिप्रतीवापंपिबेत्सुखकरंनरः।।२८।।
अनयोर्वर्गयोःसिद्धंसर्पिवैरेचनेनच।।
अचिराद्विद्रधिंहन्तिप्रातःप्रातर्निषेवितम्।।२९।।
एभिरेवगणैश्चापिसंसिद्धंस्नेहसंयुतम्।।
कार्यमास्थापनंक्षिप्रंतथैवाप्यनुवासनम्।।३०।।
पानालेपनभोज्येषुमधुशिगुगुमोऽपिवा।।
दत्तावापोयथादोषमपक्वंहन्तिविद्रधिम्।।३१।।
तोयधान्याम्लामूत्रैस्तुपेयोवाऽपिसुरादिभिः।।
यथादोषगणक्वाथैःपिबेद्वाऽपिशिलाजतु।।३२।।
प्रधानंगुग्गुलंचापिशुण्ठीचसुरदारुच।।
स्नेहोपनाहौकुर्याच्चसदाचाप्यनुलोमनम्।।३३।।
Below mentioned are the principles of treating Raktaja Vidradhi –
Pittaja Vidradhi Treatment – In Raktaja Vidradhi – abscesses caused by aggravated blood and Agantuja Vidradhi – abscesses caused by external agents / factors – treatments prescribed for Pittaja Vidradhi should be adopted.
Kashaya pana – In the unripe abscess and also in internal abscesses one should drink the decoction prepared with Varunadi Gana group of herbs added with herbs of Usakadi Gana. This recipe gives comfort to the patient.
Ghrta – Ghee should be processed and prepared using the herbs belonging to Varunadi Gana and Virecana Gana. This ghee, when used cures raktaja vidradhi.
Niruha Vasti and Anuvasana Vasti – Decoction of Varunadi Gana and Virecana Gana group of herbs added with oil should be used for administering decoction enema. In the same way, oil enema too should be quickly done.
Use of Madhusigru – Decoction prepared with Madhusigru should be used after adding suitable herbs, for drinking purpose, external application and also with food. It may also be used with water, Dhanyamla, urine of animals or sura etc.
Shilajatu – Shilajatu is consumed along with decoctions prepared with herbs which mitigate doshas.
Use of Guggulu etc – Guggulu – Commiphora mukul, Sunthi – Zingiber officinale and Suradaru – Cedrus deodara should be used in treating RaktajaVidradhi.
Other measures –Snehana – unctuous therapies, Upanaha – poultices and Anulomana – purgation should always be done.
यथोद्दिष्टांसिरांविध्येत्कफजेविद्रधौभिषक्।।
रक्तपित्तानिलोत्थेषुकेचिद्वाहीवदन्तितु।।३४।।
As indicated in chapter 8 of Sarira Sthana, the physician / surgeon should conduct siravedha – vein puncture of veins indicated in Kaphaja Vidradhi.
Sira Vyadha should be done in the arms of Raktaja, Pittaja and Vataja Vidradhi, according to the opinion of some scholars.
पक्वंवाबहिरुन्नद्धंभित्त्वाव्रणवदाचरेत्।।
स्रुतेषूर्ध्वमधोवाऽपिमैरेयाम्लसुरासवैः।।३५।।
पेयोवरुणकादिस्तुमधुशिमुद्रुमोऽपिवा।।
शिनुमूलजलेसिद्धंससिद्धार्थकमोदनम्।।३६।।
यवकोलकुलत्थानांयूषैर्भुञ्जीतमानवः।।
प्रातःप्रातश्चसेवेतमात्रयातैल्वकंघृतम्।।३७।।
त्रिवृतादिगणक्वाथसिद्धंवाऽप्युपशान्तये।।
The vidradhi should be punctured and cut open when it is ripened and bulged up. Later it should be treated like a vrana – wound.
Varunakadi Kashaya – decoction prepared with herbs belonging to Varunakadi Gana or decoction of Madhusigru tree should be consumed when there is exudation of pus, blood etc. in upward or downward direction, in cases of vidradhi. These decoctions should be given mixed with Maireya (fermented gruel), amla sura – sour beer, or asava – fermented drink.
Diet – Rice should be prepared with decoction of Sigru – Moringa oliefera (drumstick). The patient should take this rice with Siddharthaka or with Yusa – soup prepared with Yava – barley, Kola – jujube and Kulattha – horse gram.
Medicated Ghee – Every morning, the patient should consume one of these Ghrtas – ghee –
– Tilvaka Ghrta
– Ghrta prepared with herbs belonging to Trivrtadi Gana
नोपगच्छेद्यथापाकंप्रयतेततथाभिषक्।।३८।।
पर्यागतेविद्रधौतुसिद्धिकान्तिकीस्मृता।।
The physician should put all efforts to prevent the vidradhi from getting ripened. If he fails in doing so and if the abscess gets ripened, getting success in treatment of vidradhi will be doubtful.
प्रत्याख्यायतुकुर्वीतमज्जजातेतुविद्रधौ।।३९।।
स्नेहस्वेदोपपन्नानांकुर्याद्रक्तावसेचनम्।।
विद्रध्युक्तांक्रियांकुर्यात्पक्वेवाऽस्थितुभेदयेत्।।४०।।
निःशल्यमथविज्ञायकर्तव्यंप्रणशोधनम्।।
धावेत्तिक्तकषायेणतिक्तंसर्पिस्तथाहितम्।।४१।।
यदिमज्जपरिस्रावोननिवर्तेतदेहिनः।।
कुर्यात्संशोधनीयानिकषायादीनिबुद्धिमान्।।४२।।
प्रियङ्गुधातकीरोधकट्फलंतिनिसैन्धवम्।।
एतैस्तैलंविपक्तव्यंविद्रधिव्रणरोपणम्।।४३।।
MajjagataVidradhi – Before commencing the treatment, the physician should intimate the patient and his attendants about the incurability, when the vidradhi – abscess is localized in majja – bone marrow. In this condition, the below mentioned treatments should be adopted –
– Snehana – oleation
– Swedana – sudation,
– Raktamoksana – bloodletting / removal of blood and
– Other treatments which are advocated for pakva vidradhi – ripened abscess should be adopted
Asthi Vidradhi – The bone may be punctured and cleansed when the abscess is located in the bone.
The wound should be washed thoroughly with Tikta Kashaya i.e. decoction prepared with bitter tasting herbs and administered for oral consumption after determining that the vidradhi does not have any foreign / harmful materials in them.
Tiktaghrta is also beneficial in treating this condition.
Sodhana Kashaya – Decoctions prepared with herbs which are purgative in action should be given by the wise physician to the patient for drinking when the flow of majja – bone marrow does not cease.
Priyangvadi Taila – Oil prepared with the below mentioned herbs is beneficial for healing the wound of the abscess –
– Priyangu – Calicarpa macrophylla
– Dhataki – Woodfordia fruticosa,
– Rodhra – Cissampelos pareira
– Katphala
– Tini and
– Saindhava – rock salt
इतिसुश्रुतसंहितायांचिकित्सास्थानेविद्रधिचिकित्सितंनाम षोडशोऽध्यायः।।१६।।
Thus ends the sixteenth chapter by name Vidradhi Cikitsita in Cikitsā Sthāna of Suśruta Samhita.
