Astanga Hrudaya
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तेषु रुग्दाहकण्ड्वादीन् विद्याद्व्रणनिषेधतः । षट् कृच्छ्रसाधनास्तेषां निचयक्षतजौ त्यजेत् ॥ २१ ॥
In these (all kinds of Bhagandara), the nature of pain, burning sensation, itching etc. should be learnt from Vrana Pratishedha (chapter 25). Out of these, six (there from individual dosha and three from their combination in twos) are difficult to cure, that caused by all the doshas and that by injury should be refused;
english translation
teSu rugdAhakaNDvAdIn vidyAdvraNaniSedhataH । SaT kRcchrasAdhanAsteSAM nicayakSatajau tyajet ॥ 21 ॥
hk transliteration by Sanscriptप्रवाहिणीं वलीं प्राप्तं सेवनीं वा समाश्रितम् । अथास्य पिटिकामेव तथा यत्नादुपाचरेत् ॥ २२ ॥
so also, if the fistula is in the pravahini layer of the rectum or if it is in the sevani (vesico-rectal raphae). During the Pitika (eruption) stage only, effective treatment should be done with effort
english translation
pravAhiNIM valIM prAptaM sevanIM vA samAzritam । athAsya piTikAmeva tathA yatnAdupAcaret ॥ 22 ॥
hk transliteration by Sanscriptशुद्ध्यसृक्स्रुतिसेकाद्यैर्यथा पाकं न गच्छति । पाके पुनरुपस्निग्धं स्वेदितं चावगाहतः ॥ २३ ॥
by administering purificatory therapies, bloodletting, bathing the lesion with decoction and such others, so that it does not undergo ripening (suppuration, ulceration). If the pitaka ripens, the ulcer should be slightly anointed with oil and fomentation given by immersing the part (buttocks) in medicated warm water,
english translation
zuddhyasRksrutisekAdyairyathA pAkaM na gacchati । pAke punarupasnigdhaM sveditaM cAvagAhataH ॥ 23 ॥
hk transliteration by Sanscriptयन्त्रयित्वाऽर्शसमिव पश्येत्सम्यग्भगन्दरम् । अर्वाचीनं पराचीनमन्तर्मुखबहिर्मुखम् ॥ २४ ॥
the physician should then inspect the rectum by using the rectal speculum just like visualizing the piles, properly and note whether the fistula is nearer or farther, opening inside or opening outside.
english translation
yantrayitvA'rzasamiva pazyetsamyagbhagandaram । arvAcInaM parAcInamantarmukhabahirmukham ॥ 24 ॥
hk transliteration by Sanscriptअथान्तर्मुखमेषित्वा सम्यक् शस्त्रेण पाटयेत् । बहिर्मुखं च निःशेषं ततः क्षारेण साधयेत् ॥ २५ ॥
That fistula which opens to the interior should be explored by the probe and then cut with the knife properly; that which opens to the exterior should also be probed, cut without leaving any remnant and then treated either with kshara (caustic alkali) or agni (fire);
english translation
athAntarmukhameSitvA samyak zastreNa pATayet । bahirmukhaM ca niHzeSaM tataH kSAreNa sAdhayet ॥ 25 ॥
hk transliteration by Sanscript