अग्निना वा भिषक् साधु क्षारेणैवोष्ट्रकन्धरम् । नाडीरेकान्तराः कृत्वा पाटयेच्छतपोनकम् ॥ २६ ॥
Ustragriva Bhagandara should be treated with application of kshara (alkali) only by the physician. Shataponka should be cut with the knife, one sinus after the other, after healing of the earlier one,
otherwise death may occur if the rectum is greatly injured. In Parikshepi also, the same treatment explained for nadi, in addition, ksharasutra (thread soaked in alkaline juice may be used).
In case of Arshobhagandara, Arshas (piles) should be treated first; after having refused treatment, if the wound contains foreign body, that foreign body should be removed,
आहरेच्च तथा दद्यात्कृमिघ्नं लेपभोजनम् । पिण्डनाड्यादयः स्वेदाः सुस्निग्धा रुजि पूजिताः ॥ २९ ॥
then application of paste of herbs and foods which kill the worms should be adopted. Fomentation by pinda (hot balls of herbs), nadi (tubes emitting steam) etc. after lubrication are beneficial when there is pain.
सर्वत्र च बहुच्छिद्रे छेदान् आलोच्य योजयेत् । गोतीर्थसर्वतोभद्रदललाङ्गललाङ्गलान् ॥ ३० ॥
In case of multiple sinuses and openings, the appropriate type of incision should be selected after careful consideration of every aspect, such as Gotirtha, Sarvatobhadra, Dala, Ardhalangala and Langalaka.