क्षोभादशुद्धकोष्ठत्वात्सौहित्यादतिकर्शनात् । मद्यपानाद्दिवास्वप्नाद्व्यवायाद्रात्रिजागरात् ॥ २१ ॥
due to physical strain/irritation (kṣobhāt), unpurified/impure alimentary tract (aśuddha-koṣṭhatvāt), overeating (sauhityāt), extreme emaciation/debility (ati-karśanāt), drinking alcohol (madyapānāt), sleeping during the day (divāsvapnāt), sexual intercourse (vyavāyāt), or staying awake at night (rātri-jāgarāt);
and due to improper medical treatment (mithyā-upacārāc ca), even a curable ulcer (sādhyo 'pi vraṇaḥ) fails to heal (na eva sidhyati). An ulcer which has the color resembling a pigeon, its interior free of exudations,
static (hard, immovable) containing skin flakes should be understood as “healing”. In the stage of swelling itself, prefatory therapy in the nearest route (either emesis or purgation) should be administered;
योज्यं शोफो हि शुद्धानां व्रणश्चाशु प्रशाम्यति । कुर्याच्छीतोपचारं च शोफावस्थस्य सन्ततम् ॥२४॥
swelling or ulcer get cured quickly in the person who has been purified. During the stage of swelling, cold therapies should be resorted to continuously; the agni (fire)
दोषाग्निरग्निवत्तेन प्रयाति सहसा शमम् । शोफे व्रणे च कठिने विवर्णे वेदनान्विते ॥ २५ ॥
in the Doshas is similar to fire (external fire) and gets subsided by this method immediately. In swelling and ulcer which are hard, discolored, painful and