Dwivraniya Chikitsa: Difference between revisions

शाल्मलीत्वग्बलामूलं तथा न्यग्रोधपल्लवाः |  

न्यग्रोधादिकमुद्दिष्टं बलादिकमथापि वा ||६३||  

आलेपनं निर्वपणं तद्विद्यात्तैश्च [१] सेचनम् |  

सर्पिषा शतधौतेन पयसा मधुकाम्बुना ||६४|  

निर्वापयेत् सुशीतेन रक्तपित्तोत्तरान् व्रणान् |६५|

śālmalītvagbalāmūlaṁ tathā nyagrōdhapallavāḥ|  

nyagrōdhādikamuddiṣṭaṁ balādikamathāpi vā||63||  

ālēpanaṁ nirvapaṇaṁ tadvidyāttaiśca [1] sēcanam|  

sarpiṣā śatadhautēna payasā madhukāmbunā||64||  

nirvāpayēt suśītēna raktapittōttarān vraṇān|65|  

shAlmalItvagbalAmUlaM tathA nyagrodhapallavAH |  

nyagrodhAdikamuddiShTaM balAdikamathApi vA ||63||  

AlepanaM nirvapaNaM tadvidyAttaishca [1] secanam |  

sarpiShA shatadhautena payasA madhukAmbunA ||64||  

nirvApayet sushItena raktapittottarAn vraNAn |65|

लम्बानि व्रणमांसानि प्रलिप्य मधुसर्पिषा ||६५||  

सन्दधीत समं वैद्यो बन्धनैश्चोपपादयेत् |  

तान्समान्सुस्थिताञ्ज्ञात्वा फलिनीलोध्रकट्फलैः ||६६||  

समङ्गाधातकीयुक्तैश्चूर्णितैरवचूर्णयेत् |  

पञ्चवल्कलचूर्णैर्वा शुक्तिचूर्णसमायुतैः ||६७||  

धातकीलोध्रचूर्णैर्वा तथा रोहन्ति ते व्रणाः |६८|  

lambāni vraṇamāṁsāni pralipya madhusarpiṣā||65||  

sandadhīta samaṁ vaidyō bandhanaiścōpapādayēt|  

tānsamānsusthitāñjñātvā phalinīlōdhrakaṭphalaiḥ||66||  

samaṅgādhātakīyuktaiścūrṇitairavacūrṇayēt|  

dhātakīlōdhracūrṇairvā tathā rōhanti tē vraṇāḥ|68|  

lambAni vraNamAMsAni pralipya madhusarpiShA ||65||  

sandadhIta samaM vaidyo bandhanaishcopapAdayet |  

tAnsamAnsusthitA~jj~jAtvA phalinIlodhrakaTphalaiH ||66||  

sama~ggAdhAtakIyuktaishcUrNitairavacUrNayet |  

pa~jcavalkalacUrNairvA shukticUrNasamAyutaiH ||67||  

dhAtakIlodhracUrNairvA tathA rohanti te vraNAH |68|

अस्थिभग्नं च्युतं सन्धिं सन्दधीत समं पुनः ||६८||  

समेन सममङ्गेन कृत्वाऽन्येन विचक्षणः |  

स्थिरैः कवलिकाबन्धैः कुशिकाभिश्च संस्थितम् ||६९||  

पट्टैः प्रभूतसर्पिष्कैर्बध्नीयादचलं सुखम् |  

अविदाहिभिरन्नैश्च पैष्टिकैस्तमुपाचरेत् ||७०||  

ग्लानिर्हि न हिता तस्य सन्धिविश्लेषकारिका |  

विच्युताभिहताङ्गानां विसर्पादीनुपद्रवान् ||७१||  

samēna samamaṅgēna kr̥tvā'nyēna vicakṣaṇaḥ|  

sthiraiḥ kavalikābandhaiḥ kuśikābhiśca saṁsthitam||69||  

upācarēdyathākālaṁ [1] kālajñaḥ svāccikitsitāt|72|  

samena samama~ggena kRutvA~anyena vicakShaNaH |  

sthiraiH kavalikAbandhaiH kushikAbhishca saMsthitam ||69||  

vicyutAbhihatA~ggAnAM visarpAdInupadravAn ||71||  

upAcaredyathAkAlaM [1] kAlaj~jaH svAccikitsitAt |72|

Fractured bone and dislocated joints should be set correctly comparing with its counterpart. Setting with firm pad-bandages and splints, it should be immobilised without any discomfort by binding with cloth pieces dipped in plenty of ghee. The patient should be kept on non-burning foods (avidahi) made of flour. Such patients should not resort to physical exercise which may cause dislocation of joint. The physician, according to time, should treat the complications such as erysipelas etc in fracture and dislocation of bone. (68-72)

शुष्का महारुजः स्तब्धा ये व्रणा मारुतोत्तराः |  

स्वेद्याः सङ्करकल्पेन ते स्युः कृशरपायसैः ||७२||  

rugdāhayōḥ praśamanō vraṇēṣvēṣa vidhirhitaḥ||79||  

svedyAH sa~gkarakalpena te syuH kRusharapAyasaiH ||72||  

grAmyabailAmbujAnUpairvaishavAraishca saMskRutaiH |  

rugdAhayoH prashamano vraNeShveSha vidhirhitaH ||79||

Wounds which are dry, intensly painful, stiffened and predominant in vata should be fomented by bolus fomentation with krishara and payasa (a type of dietary preparation). Similarly, they should be fomented with seasoned vesavara made of the meat of domestic, burrow-dwellers, aquatic or marshy animals or hot utkarika. Thus the patient gets relief. If the wounds predominant in vata have burning sensation and pain, they should be pasted upon with linseed and sesamum seeds roasted, then dipped in milk and again pounded with the same milk. Bala (Sida cordifolia Linn.), guduchi (Tinospora cordifolia), madhuka (Glycyrrhiza glabra Linn.), prishnaparni (Uraria picta Desv), shatavari (Asparagus racemosus Willd), jivanti (Leptadenia reticulate W. & A.), sugar, milk, oil, fish fat, ghee cooked with beewax is known as ‘sneha sarkara’, it relieves pain.The wound should be sprinkled with warm decoction of two panchamula (ie.dasamula), milk and ghee with oil. Barley powder (Hordeum vulgare Linn.), madhuka (Glycyrrhiza glabra Linn.) and tila mixed with ghee should be applied as warm paste for alleviating burning sensation and pain. Payasa prepared of mudga (Phaseolus radiates Linn.) mixed with tila should be applied as poultice to pacify pain and burning sensation. These management principles are beneficial in wounds.(72-79)

सूक्ष्मानना बहुस्रावाः कोषवन्तश्च ये व्रणाः |  

न च मर्माश्रितास्तेषामेषणं हितमुच्यते ||८०||  

eShyaM vidyAdvraNaM nAlairviparItamato bhiShak ||82||

In case of wounds with narrow opening, profuse discharge and pouch and not situated in vital parts, probing is beneficial. Probe is of two types – soft and hard, the former is made of soft stalks of plants and the latter of iron (metallic) rods. In deep and muscular parts iron rods preferred while in other parts plant stalks should be used for probing. (80-82)

पूतिगन्धान् विवर्णांश्च बहुस्रावान्महारुजः |  

व्रणानशुद्धान् विज्ञाय शोधनैः समुपाचरेत् ||८३||  

madhukaṁ nimbapatrāṇi pralēpō vraṇaśōdhanaḥ||85||  

vraNAnashuddhAn vij~jAya shodhanaiH samupAcaret ||83||  

triphalA khadiro dArvI nyagrodhAdirbalA [1] kushaH |  

madhukaM nimbapatrANi pralepo vraNashodhanaH ||85||

Wounds with foul odour, abnormal colour, profuse discharge and intense pain should be known as dusta vrana (unclean) and as such wounds should be treated with cleansing agents. Decoctions of triphala, khadira (Acasia catechu Willd), daruharidra (Berberis aristata DC), nyagrodhadi group, bala (Sida cordifolia Linn.), kusa (Desmostachya bipinnata Stapf.), leaves of nimb (Azadirachta indica A. Juss) and badara (Zizyphus jujube Lam.) are regarded as cleansing drugs. Tila paste, salt, haridra (Curcuma longa Linn.), daruharidra (Berberis aristata DC), trivrit (Operculina turpethum Linn.) ghrita, madhuka, nimba leaves – this formulation is said as wound cleanser. (83-85)

नातिरक्तो नातिपाण्डुर्नातिश्यावो न चातिरुक् |  

न चोत्सन्नो न चोत्सङ्गी शुद्धो रोप्यः परं व्रणः ||८६||  

Those ulcers, are not very red, pale, blackish, painful, elevated and protruded should be known as clean and appeals healing process. Decoction of nyagrodha, udumbara, asvattha, kadamba, plaksha, vetasa, karavira (Nerium indicum Mill.), arka (Calotropis procera R. Br.) and kutaja (Holarrhena antidysentrica Linn.) are wound healing. Candana (Santalum album Linn.), lotus stamens, daruharidra bark, blue water lily, meda (Polygonatum airrhifolium Royle), mahameda (Polygonatum airrhifolium Royle), murva (Marsdenia tenacissima W. & A.), lajjalu (Mimosa pudica Linn.) and madhuyasti- this formulation is wound healer. Prapaundarika, jivanti, gojihva (Onosma bracteatum Wall.), dhataki, bala and sesamum should be applied as paste with ghee for wound healing. Kampillaka (Mallotus philippinensis Muell Arg), vidanga (Embelia ribes Burm), kutaja, triphala, bala, patola (Trichosanthes dioica Roxb.), nimba, musta (Cyperus rotundus Linn.), priyangu, khadira, dhataki, sarja, ela (Elleteria cardamomum Maton.), aguru (Aquilaria agallocha Roxb.) and chandana are pounded together and oil is extracted. This oil is used as ulcer healing agent.

Similarly, oil prepared with equal quantity of prapaundarika, mahuka, kakoli (Roscoca procera Wall.), ksirakakoli (Roscoca procera Wall.), chandana and rakta chandana (Pterocarpus santalinus Linn.) is an excellent ulcer healing agent. Oil cooked with durva juice or kampillaka or paste of daruharidra bark is an important ulcer healer. By the above method ghrita should be prepared and used for healing, ulcers predominant in rakta and pitta.(86-94)

कदम्बार्जुननिम्बानां पाटल्याः पिप्पलस्य च |  

व्रणप्रच्छादने विद्वान् पत्राण्यर्कस्य चादिशेत् ||९५||  

For covering the wound, leaves of kadamba, arjuna, nimba, patala (Stereospermum suaveolens DC.), pippala (Ficus religiosa Linn.) and arka should be used. Bandage made of plant bark, deer hide or flaxen cloth is used in wounds. Bandaging of wounds are of two types ie, It can be started either from left or right side. (95-96)

   

लवणाम्लकटूष्णानि विदाहीनि गुरूणि च |  

वर्जयेदन्नपानानि व्रणी मैथुनमेव च ||९७||  

annapAnaM vraNahitaM hitaM cAsvapanaM divA ||98||  

Patients of ulcer should abstain from salt, sour, pungent, hot, burning and heavy food and drinks and also sexual intercourse. Food and drinks that are not too cold, heavy and fatty, non-burning, according to the nature of ulcerare beneficial, while day-sleep is not suitable in these patient.(97-98)

स्तन्यानि जीवनीयानि बृंहणीयानि यानि च |  

उत्सादनार्थं निम्नानां व्रणानां तानि कल्पयेत् ||९९||  

vraNAvasAdanaM tadvat kalavi~gkakapotaviT ||100||

For raising the depressed wounds galactogogues (stanyajanan), vitalisers (jeevaniya) and bulk promotings (brinhaniya) drugs should be applied. Similarly, bhurjagranthi (nodes in the tree of Butea utilis), asmakasisa (copper sulphate), purgatives, guggulu and excrements of sparrow and pigeon should be used for depressing the wounds. (99-100)

रुधिरेऽतिप्रवृत्ते तु च्छिन्ने च्छेद्येऽधिमांसके |  

कफग्रन्थिषु गण्डेषु वातस्तम्भानिलार्तिषु ||१०१||  

saviSheShu ca shalyeShu netrakuShThavraNeShu ca ||106||

Excessive haemorrhage after excision, excisable growths, kaphaja nodules, glands, stiffness and disorders due to vata, wounds with hidden pus and lymph, deep and firm; and after amputation of body part, cauterization is prescribed. The expert in cauterization should cauterize the spot with bee-wax, oil, marrow, honey, muscle-fat, ghrita or various heated metallic sticks. Wounds deep and predominant in vata and in patients rough and delicate should be cauterized with fat or bee-wax otherwise with iron stick or honey.  Cauterization should not be applied in children, debilitated, old persons, pregnants women, those suffering from internal haemorrhage, thirst, fever, weak and poisoned persons and in wounds situated at ligaments and vital parts, poisoned, foreign body, opthalmic and leprotic wounds.(101-106)

रोगदोषबलापेक्षी मात्राकालाग्निकोविदः |  

शस्त्रकर्माग्निकृत्येषु क्षारमप्यवचारयेत् ||१०७||  

मुद्गषष्टिकशालीनां पायसैर्वा यथाक्रमम् |  

सघृतैर्जीवनीयैर्वा तर्पयेत्तानभीक्ष्णशः ||११२||

śastrakarmāgnikr̥tyēṣu kṣāramapyavacārayēt||107||  

kaṭhinatvaṁ vraṇā yānti gandhaiḥ sāraiśca dhūpitāḥ|  

mudgaṣaṣṭikaśālīnāṁ pāyasairvā yathākramam|  

saghr̥tairjīvanīyairvā tarpayēttānabhīkṣṇaśaḥ||112||  

shastrakarmAgnikRutyeShu kShAramapyavacArayet ||107||  

kaThinatvaM vraNA yAnti gandhaiH sAraishca dhUpitAH |  

saghRutairjIvanIyairvA tarpayettAnabhIkShNashaH ||112||

The physician conversant with dose, time and agni (heat) may apply alkali in cases amenable to surgical treatment and cauterization according to severity of disease and morbidity. Wounds attain hardness by being fumigated with aromatic substances and heartwoods. The wounds get softened if fumigated with ghrita, marrow or muscle-fat. Through fumigation pain, discharges, odours, maggots, hardness and softness of wounds are removed. Lodhra, leafbuds of nyagrodha, khadira, triphala and ghrita - this combination used as paste provides looseness and softness in wounds. The wounds which are painful, hard, stiff and without discharge should be pasted frequently with barley powder mixed with ghrita. Wounds may be saturated by applying frequently the paste of payasa (cereals cooked with milk) made of mudga, shashtika and sali rice or jivaniya drugs mixed with ghrita.(110-112)

ककुभोदुम्बराश्वत्थलोध्रजाम्बवकट्फलैः |  

त्वचमाश्वेव गृह्णन्ति त्वक्चूर्णैश्चूर्णिता व्रणाः ||११३||  

Roots of dhyamaka, ashvattha and nichula (Barringtonia acutangula Linn), lac, gairic(red-ochre), nagakeshara and kasisa – These restore the natural colour of the skin.

The hairless spots are smeared with oil and  dusting with the ash of skin, hair, hoof, horns and bone of quadrupeds, reproduces hairs.The treatment of sixteen complications of wounds has been mentioned in their respective contexts.(113-119)

तत्र श्लोकौ-  

द्वौ व्रणौ व्रणभेदाश्च परीक्षा दुष्टिरेव च |  

व्रणाधिकारे सप्रश्नमेतन्नवकमुक्तवान् |  

मुनिर्व्याससमासाभ्यामग्निवेशाय धीमते ||१२१||

dvau vraṇau vraṇabhēdāśca parīkṣā duṣṭirēva ca|  

sthānāni gandhāḥ srāvāśca sōpasargāḥ kriyāśca yāḥ||120||  

munirvyāsasamāsābhyāmagnivēśāya dhīmatē||121||  

Now the summing up verses –

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते दृढबलसम्पूरिते चिकित्सास्थाने द्विव्रणीयचिकित्सितं नाम पञ्चविंशोऽध्यायः ||२५|| ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē dr̥ḍhabalasampūritē cikitsāsthānē dvivraṇīyacikitsitaṁ nāmapañcaviṁśō'dhyāyaḥ||25||

ityagniveshakRute tantre carakapratisaMskRute dRuDhabalasampUrite cikitsAsthAne dvivraNIyacikitsitaM nAma pa~jcaviMsho~adhyAyaH ||25||

• Vrana (ulcers) are broadly classified into two types viz. nija (endogenous) and agantu (exogenous).  

• The treatment of both types of ulcers is based upon the dosha dominance.  

• Fractured bone and dislocated joints should be set correctly comparing with its counterpart. Setting with firm pad-bandages and splints, it should be immobilised without any discomfort by binding with cloth pieces dipped in plenty of ghee.

1. Liṅgaṁ (li~ggaM : र्लिङ्गं -) – Causative factors, sign and Symptoms.  

2. Prapatan ( Prapatan ; प्रपतन) – Falling down.