Treatment of an Abscess
An abscess is a localised collection of pus. In Ayurveda, it is termed as ‘Vidhradhi’.
त्वग्रक्तमांसमेदांसि प्रदूश्यास्थिसमाश्रिताः |
दोषा: शोफं शनैर्घोरं जनयन्त्युच्छ्रिता भृशम् ||
महामूलं रुजावन्तं वृतं चाप्यथवायतम् |
तमाहुर्विद्धधिं धीरा…|| (Ref : Su. Ni. Ch. 9/4-5)
According to Sushruta (School of Ayurvedic Surgery), when Vata, Pitta and Kapha doshas getting aggravated, it vitiates the skin, blood, muscle, fat and bone tissues and becoming localised at some place and produce a troublesome swelling which is bulging up rapidly, deep rooted, painful, round or wide, such type of swelling is known as ‘Vidhradhi’.
Types of abscess:
- Pyogenic abscess: It is the commonest form of an abscess. Subcutaneous, deep or it can occur within the viscera such as liver or kidney etc.
- Pyaemic abscess: It occurs due to circulation of pyaemic emboli in the blood (pyaemia).
- Cold abscess: Usually refers to tubercular abscess due to involvement of lymph nodes or involvement of spine.
Pyogenic abscess: (The commonest one): In this article, we will discuss the commonest variety of abscess.
Causative organisms (bacteria) of an abscess:
- Staphylococcus aureus
- Streptococcus pyogenes
- Gram negative bacteria (E. coli, Pseudomonas, klebsiella)
Symptoms of abscess:
- Fever often with chills and rigors
- Localised swelling which is smooth, soft and fluctuant
- Visible (pointing) pus
- Throbbing pain and pointing tenderness
- Brawny indurations around
- Redness and warmth with restricted movement around a joint
- Rubor (Redness); Dolor (Pain); Calor (Warmness); Tumour (Swelling) and Functiolaesa (loss of function of adjacent tissue) are quiet obvious
Sites of abscess:
a) External sites:
- Fingers and hand
- Ischiorectal and perianal region
- Abdominal wall
- Dental abscess, tonsillar abscess and other abscesses in the oral cavity
b) Internal sites:
- Abdominal, pelvic, paracolic, amoebic liver abscess, pyogenic abscess of liver, splenic abscess, pancreatic abscess
- Perinephric abscess
- Retroperitonial abscess
- Lung abscess
- Brain abscess
- Retropharyngeal abscess
Investigations of abscess:
- Total WBC count is increased
- Urine sugar and blood sugar is done to rule out diabetes
- USG (Ultrasonography) of the part or abdomen or other region is done when required.
- Chest X-ray in case of lung abscess.
- Gallium isotope scan is very useful
- CT Scan or MRI is done in cases of brain and thoracic abscess
- Investigations, relevant to specific types: Liver function tests, blood culture etc.
Complications of an Abscess:
- Bacteraemia, septicaemia and pyaemia
- Multiple abscess formation
- Metastatic abscess
- Destruction of tissues
- Antibioma formation. Once abscess forms, thick fibrous tissue develops around abscess cavity because of antibiotics.
- Sinus and fistula formation
- Large abscess may erode into adjacent vessels and can cause life-threatening torrential haemorrhage, e.g. as in pancreatic abscess.
- Some of the specific complications of internal abscess, e.g. Liver abscess can cause hepatic failure, rupture and jaundice.
Ayurvedic Treatment of an abscess:
- According to Ayurveda, in the very beginning stage of an abscess, always try to subside the swelling.
- Give hot fomentation to the patient around the area of an abscess.
- Do Ayurvedic bloodletting (Siravyadha Treatment) procedure near the affected area.
- Advice the patient to do fast for 24-48 hours or should give him light diet.
- One should apply the ‘Ayurvedic herbal paste’ having anti inflammatory properties on the affected area, e.g. Dashang lepa, Doshagna lepa etc.
- Advice patient to take Ayurvedic medicines having anti inflammatory properties, e.g. Triphala Kwath, Varunaadi Kwath, Punarnavaadi Kwath, Shigru Kwath, Tab. Shilajit, Tab. Pathyadi ghanvati, Tab. Dashang guggulu, Tab. Yograj guggulu etc.
- By using these above appropriate measure, if the swelling is not getting subsided and become larger and larger, then go for the next step, and try to ripe the swelling fast. For achieving it, apply the ‘Ayurvedic herbal paste’ which can ripe, mild squeeze and burst the swelling, e.g. Lepa ghuti lepa, Apamarg kshara lepa, Yav kshara lepa etc.
- Incision and drainage of the abscess would the last treatment choice.
- Incision and drainage (I & D): It is done under local, spinal or general anaesthesia. A stab incision is made over the most prominent part of an abscess. The pus which comes out is collected and sent for culture and sensitivity. A sinus forceps or a finger is introduced within the abscess cavity and all the loculi are broken down. Fresh bleeding is an indication of completeness of the procedure. The abscess cavity is irrigated with mild antiseptic agents like iodine solution or hydrogen peroxide solution.
- Modified Hilton’s method for I & D is followed where an abscess is situated in the vicinity of important anatomical structures like vessels or nerves.