Chapter XI - Alkaline cautery

Now we shall discuss the Chapter which treats of the pharmacy of alkalis or potential cauteries (Kshara-paka-vidhi-madhyaya).

In cases that require incising, excising and scraping, alkalis or alkaline preparations are of greater importance than surgical instruments and appliances (both principal and secondary or substitutive, as they are possessed of the virtues of subduing the three deranged bodily humours (such as wind, bile and phlegm).

The etymological signification of the term Kshara (alkalis) is based on their property of corroding (the skin or the flesh of an affected part of the body), or on their peculiar quality in destroying the skin and flesh (where such an effect is desired). Since a variety of substances enter into the composition of Kshara (alkalis), they are endued with the virtue of subduing the three deranged bodily humours. Owing to their white colour, Ksharas should be included within the category of cooling substances (Saumya).

But since many drugs or substances of a hot or fiery nature (agneya) enter into their composition, Ksharas (alkalis) are endued with the properties of blistering, burning, suppurating (Pacana), opening etc., without involving any contradiction to their generic (Saumya) nature, and lienee they are included within the list of those substances which are both hot and cooling (Saumya and agneya in their virtues. They are pungent in taste, of a heat-making potency, irritant, digestive, corrosive, absorbent, liquefacient, improve unhealthy sores and granulation, and act as styptic and paralysing agents. They exercise destructive action on animal tissues. They are antitoxic, anthelmintic and possess the property of curing mucous accumulations in the intestines. They tend to reduce fat and phlegm and they have the virtue of destroying skin diseases. In large doses, alkalis) have the effect of destroying the virile potency of a man.

Kshara (caustics) may be grouped under two distinct heads according to their mode of administration), such as the Pratisaraniya (for external application) and the Pania (alkaline potions). Alkaline preparations should be externally used in such skin diseases as Kitima, Dadru, Kilas, Mandala, Fistula in ano, tumour, bad ulcer (Dushta Vrana), sinus, Carma-kila, Tilkalaka, Naccya, Vyanga, Mashaka and external abscesses and hemorrhoids. In cases of worms and poisoning as well as in the seven forms of diseases which affect the cavity of the mouth, such as Upajihva, Upakusha, Danta-Vaidarbha, and in the three types of Rohini, external applications of alkalis act like substitutive surgical instruments. Alkaline potions or any other internal use of alkalis, should be prescribed in cases of Gulma (abdominal glands), Ascites, loss of appetite, indigestion, flatulent distension of the abdomen with suppression of stool and urine, urinary calculi, stone in the bladder, internal abscesses, worms in the intestines and hemorrhoids, as well as for subduing or eliminating any sort of poison from the system.

Alkalis or alkaline potions will prove positively injurious to a patient laid up with fever or hemoptysis, to a man of bilious temperament, to an infant, or to an old man, and they will work similar mischief in a weak person, or in a patient suffering from vertigo, insensibility, syncope and Timira (darkness of vision). These preparations of Alkalis should be made in one and the same way by filtering; and we reserve the full description of this process for another occasion.

Alkalis for external application are prepared in three different potencies; the mild, middling and strong (extremely irritant. A physician wishing to prepare such an alkali, should first purify his body and mind, and observe a fast on a day in autumn marked by auspicious astral combinations. Then having ascended the brow of a hill, he should select a full grown Ashita-mushka (Ghanta parul) tree of middle age, and growing on soil recommended in the works on pharmacy and not anywise affected.

Then having formally invoked the spirit of the aforesaid tree, which bears no white flowers) the physician should fell it on the day following,—reciting the Mantra which reads as:—

“O thou possessed of mighty virtues, O thou endued with fiery potency, may thy potency never decrease or vanish. Stay here, O thou blissful one, execute my work, and after the performance thereof thou shalt be at liberty to ascend to the heavenly regions.”

Then having performed the Homa ceremony with thousands of white and red flowers, the physician should cut the wood of the abovesaid tree into small pieces and put them in a place protected from the wind. Then having placed pieces of unslaked limestone over them, the physician should burn them to ashes with the lighted faggots of dried sesamum plants. Then after the fire has fairly burnt itself out, the ashes of the limestone and the Ghanta-parula wood should be separately collected and stored. Similarly the wood as well as the leaves, roots and fruits of Kutaja, Palasha, Ashvakarna, Paribhadra, Vibhitaka, aragvadha, Tilvaka, Arka, Snuhi, Apamarga, Patala, Naktamala, Vrisha, Kadali, Citraka, Putika, Indra-Vriksha, asphota, Ashvamaraka, Saptacchada, Agnimantha, Gunja, and the four species of Koshataki, should be burnt down to ashes.

Then a Drona measure of the ashes thus prepared^[1] should be dissolved and stirred up in six Drona measures of pure water or cow’s urine, and be filtered twenty-one times in succession. The (alkaline water filtered as above) should be kept in a large caldron over a fire and boiled by gently agitating it with a ladle.. It should be taken down from the fire when by gradual stirring, the saturated water would appear transparent, slimy, red and irritating. It should then be filtered through a piece of clean linen, and the dregs thrown away. After this a Kudava measure and a half (12 Palas) of the (abovesaid) saturated or alkaline water should be taken out of the caldron, and the rest should be again kept boiling over the fire. Following this, substances known as Kata-Sharkara, the ashes of the burnt limestone previously obtained, Kshirapakas (fresh water oysters) and Sankhanabhi, should be burnt red hot in equal proportions, and then immersed and pressed in the Kudaba measure of alkaline water previously set apart in an iron basin as above described.

Then having immersed eight Pala measures of the substances known as the Shankhanabhi etc., in the abovesaid alkaline water, the physician should boil it by continuous and steady stirring, care being taken not to make it of too thin nor of tod thick a consistency. Then the basin or the caldron should be taken down from the oven, and its contents poured into an iron pitcher, carefully covering its mouth after filling it. The alkali thus prepared is called the Kshara (alkali) of middling potency, which, if prepared without the subsequent addition (lit: throw-over) of the ashes of Katasharkara, etc., goes by the name of mild alkali (Mridu Kshara). Similarly, alkali prepared with the addition of the powders of the drugs known as Danti, Dravanti, Citraka, Langulaki, Putika-Pravala Talpatri, Vidha, Suvarchika, Kanaka-Kshiri, Hingu, Vaca, and Visha, or with as many of them as are available, each weighing four tolas, is called the strong Kshara (extremely irritating alkali). These alkaline preparations of different potencies, should be severally used in cases where their administrations would be clearly indicated. An alkaline preparation, any way weakened, should be strengthened by adding to it alkaline water (water saturated with an alkali) as before described.

Authoritative verses on the subject:—

The commendable features in an alkali are based on its whiteness, on its being neither too mild nor too strong, on its gloss and sliminess, on its sticking to the place of application, and on its power of secreting (Abhisyandi) the morbid fluid, and on its rapid effect. On the other hand, its defective traits consist in its being too mild, of excessive whiteness, excessive strength or irritability, of over-sliminess, excessive stickiness or thickness, insufficient boiling, and insufficiency of component ingredients.

A patient laid up with a disease amenable to an application of alkali (potential cautery or caustic) should be kept in a spacious chamber, and should not be exposed to draughts and to the hot rays of the sun, [Then the physician having secured] the necessary appliances etc, as already laid down in the Chapter V, should view the part of the patient’s body to which the alkali is to be applied. The affected part should be then^[2] rubbed or scarified^[3] with an alkali, and covered over^[4] with a piece of linen. The alkaline preparation should be applied with a rod or director^[2] and kept undisturbed for a period needed to articulate a hundred long letter (sounds).

Metrical texts:—

The perfect burning (blistering should be inferred from the black colour of the skin of the affected part. Madhuka and the substances included within the Amla-varga (group of acid drugs) pasted with clarified butter, should be applied to allay the incidental burning (sensation). A plaster composed of the shreds of Amla-Kanjika, sesamum and Madhuka taken in equal parts, and pasted together, should be applied to the part burnt with an alkali; in the event of the latter having failed to produce the desired effect owing to the disease being deeply seated. Madhuka and the Kalka paste of sesamum mixed with clarified butter would cause such an (incidental) ulcer to heal.

Now you may ask the question how can an acid substance, which is fiery in its virtue and heat-making in its potency, tend to subdue the effects of an alkali which is possessed of similar virtues and properties, instead of augmenting them, as can naturally be apprehended? Well my child, the question can be fairly answered by stating, that substances of all tastes enter into the composition of an alkali except the acid one. The pungent (Katu) taste is the principal taste of an alkali, while the saline (Lavana) forms its minor or accessory flavour (Anurasa). Now this saline taste in conjunction with the acid one renounces its extremely sharp or irritating property and is thus transformed into one of sweetness or of soothing virtue. Hence it is that an acid taste tends to allay the burning incidental to an application of alkali (potential caustic) in the same way as water tends to put out fire.

An operation of perfect cauterisation with an alkaline application brings about an amelioration of the disease, or the disease is entirely subdued, accompanied by lightness of the limbs and absence of secretion from the affected part; while an insufficient burning [of the part] is generally attended by symptoms of aggravation of the malady and also gives rise to local pain, itching and numbness. [On the other hand], excessive burning [of the part] with an alkaline preparation may have a fatal termination, and is attended by such symptoms as burning, suppuration, redness, secretion in and from the seat of affection. A feeling of languor and fatigue comes upon the patient accompanied with thirst, swooning and an aching sensation. An ulcer incidental to a burn by an alkali should be treated with a special eye to the nature of the disease and the deranged bodily humour specifically involved in the case.

A weak person, an infant, an aged person, a man of timid disposition, a patient suffering from abdominal dropsy with general anasarca or from hemoptysis, a pregnant woman, a woman in her menses, a person suffering from an attack of high fever or urethral discharges, or emaciated with chronic inflammation of the lungs, or a person subjected to fits of fainting or abnormal thirst, or a person suffering from virile impotencey, or whose testes have become deranged either upwards or downwards, or a woman suffering from retroversion or introversion of the uterus or prolapsus of the vagina, should be deemed unfit for being cauterised with alkalis. Moreover their application is not to be sanctioned over the veins, nerves, joints, gristles or tender bones or cartilages, sutures, arteries, throat, umbilicus, genitals, regions of Srotas (external channels), parts covered over with a thin layer of flesh, inside the nails and other vulnerable parts of the body, nor in diseases of the eyes, excepting those which affect the eyelids.

Alkalis fail to produce any beneficial effect in a patient suffering from edema of the limbs, or suffering from bone-ache, or laid up with a disease affecting the joints or the heart, or in a person of impaired appetite who has lost all relish for food, even when their use is otherwise indicated.

Authoritative verse on the subject:—

An Alkali administered by an ignorant physician is to be dreaded more than poison, fire, blows with a weapon, thunder-bolts, or death itself; while in the hand of an intelligent physician it is potent enough to speedily subdue all serious diseases in which its use is indicated.

 

Thus ends the eleventh Chapter of the Sutrasthana in the Sushruta Samhita which treats of the Pharmacy of Alkalis.

Footnotes and references:

[1]:

Two parts of the burnt ashes of Ghanta-parula and one part of the ashes of Kutaja, etc.

[2]:

In a case brought about by (Pitta) ascendency of the deranged bile.

[3]:

It should be scraped with the alkali where the skin would appear hard and benumbed owing to the action of the deranged vital winds (Vayu).

[4]:

In a case of deranged phlegm (Kapha) the affected part being marked by itching and swelling.