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Line 781: − asthibhagnaM cyutaM sandhiM sandadhIta samaM punaH ||68|| + Line 761:
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Line 1,056: − rōgadōṣabalāpēkṣī mātrākālāgnikōvidaḥ| + Line 1,023:
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Line 1,140: − tatra ślōkau- + Line 1,097:
Line 1,146: − Two types of wounds, kinds of wounds, examination of wounds, defects, locations, odours, discharges, complications and treatment modalities are described. These topics after queries have been described in brief as well details by the sage to the wise Agnivesa in the chapter on treatment of wound (dwivraniya chikitsaadhaya). (120-121)+ + − + + Line 1,118:
Line 1,169: − + − Classification of ulcers and causes: − As said earlier, ulcers are of two types i.e. nija and agantuja, another classification is clean and infected wound.[ ] Nija vrana (endogenous ulcer) are caused by vitiation of doshas in the body or due to disease process. The term sharira desotha (ie.endogenous in origin) is used for morbid factors occurring in the body that cause nija vrana (i.e. endogenous ulcer). While agantuja vrana (exogenous ulcer) are caused by external factors (trauma or surgical intervention) like wound caused by stab injury, poisons, fire and sharp weapons or excessive tying of that organ (bandha) etc. In exogenous ulcers, vitiation of dosha occurs later. Nija vrana i.e. vataja, pittaja, kaphaja, raktaja and sannipataja, are caused due to faulty habit, mode of living and seasonal variation. These vitiated dosha, after a series of pathological processes (shada-kriyakala) get lodged at particular site resulting in the formation of vrana. − − − Samprapti (pathogenesis of vrana): based on shadakriya kala. − − − − − − Sanchaya – Accumulation of doshas at specific site. − − Prakopa – Vitiated doshas, stage of aggravation of doshas. − − Prasara – Spread of aggravated doshas in body through circulatory system. − − Sthana sansraya – Stage of localization of vitiated doshas at specific site or organ i.e. vrana shopha. − − Vyaktavastha – Stage of clinical manifestations of diseases (i.e. vidradhi-abscess) formation. − − Bhedavastha – Stage of complications of diseases (i.e. vrana upadrava) − − Clinical pictures of vrana: − The following ulcer is the case of diabetic ulcer. Clinical features include thrombing pain, swelling, redness, necrosis of involved tissue and non healing ulcer since 6 months. − − Image 1: Vata dominant ulcer − The following ulcer is the case of non healing ulcer due to boils. Clinical features include burning pain, redness, pus discharge, slough, with redness of involved tissue and non healing ulcer since 1month. − − Image 2: Pitta dominant ulcer − − The following ulcer is the case of non healing ulcer due to DCT (Deep vein thrombosis). Clinical features include pain, irregular superficial ulcer, redness, mild pus discharge, slough, with redness of involved tissue and non healing ulcer since 8 months. − − Image 3: Kapha dominant ulcer − − The following ulcer is the case of infected diabetic non healing ulcer (Diabetic foot). Clinical features include severe burning pain, black coloation of first toe with pus discharge, slough, bad smell and deformity in great toe. This is non healing ulcer since 2 months − − Image 4: Dushta vrana − The following ulcer is the case of healing traumatic ulcer at anterior part of tibia/lower leg.. Clinical features include mild pain, no discharge, and margins and thick and inflamed due to chronicicty and the granulation tissue are seen at base of ulcer. So this is a healing ulcer. − − Image 5: Shuddha vrana − Investigations and their clinical interpretation in brief: − The clinical features of ulcers are ulceration /disccontineous of skin, discharge (pus/blood/ serum), bad odor, differenct size, painful/painless ulcers. The above symptoms are described by Acharya Sushruta (Gandha, varna, sava, vedana, Akruti). On the basis of which kind of ulcer (varicose ulcer, diabetic ulcer, aterial ulcer, bedsores, leprotic ulcer, rodent ulcer, etc ) the symptoms may vary. In all types of ulcers on the basis of history and clinical examinations the following investigations play important role in diagnosis and prognosis of the Ulcer. TLC (Total leucocyte count), Hb% , Serum crestnine, BSL (Blood sugar level) swab culture, X-ray of affected part if chronic ulcer. if TLC are increase than normal range suggest the acute infection. if Hb% is low then the ulcer will heal delay due hyposia to the tissue. If serum creatnie is increased that might be due to kidney problem which hampered healing of ulcer. In diabetic patients BSL assessment is important for healing as glucose liden tissue are reluctant to heal. Swab culture of wound discharge is necessary to know the organism. Lastly s-xay is essential to know extension of wound upto bone/osteomylituis. − Complications of ulcer: If ulcer is not treated properly it may lead to local and systemic infection leading to septesemia. The tissue necrosis leads to gangrene which further need to amputation. − Causes of non-healing: − Two factors mainly affect the process of wound healing viz. local factors and systemic factors. − Local factors are infection, necrosis, foreign body, vascular insufficiency, lymphatic obstruction, continuous movement of part. Systemic causes include old age, protein deficiency, vit-c and zinc deficiency, diabetes mellitus. − Treatment of vrana (ulcers): − Purification measures: − Purificatory measures eliminate toxic material from body and improve healing process of ulcer. In case of endogenous ulcer removal of morbid matters (i.e. doshaja) emesis through upward route, purgation through downward route are advised. Other purificatory measures like oleation therapy, sudation therapy should be done prior to emesis, purgation etc. For local purification of ulcer, venesection and vrana basti should be done.Raktamokshan is an important modality (Sushruta samhita. Chi. 1/27-28) indicated predominantly in local vitiation of rakta as in dushta vrana. So along with emesis and purgation blood letting is also important treatment modalities with the help of jalauka (leech application), veinpuncture etc. − Selection of therapeutic measures is done as per condition of vrana and patient. − Thirty six treatment measures: − Thirty six types of therapeutic measures are described for the treatment of ulcer. Sixty types of treatment measures are described under the head of shashtiupakrama regarding ulcer treatment.[ ] It is not necessary that all the thirty six or sixty therapeutic measures have to be applied in treating an ulcer. I A patient at a time 1 or 4 type of procedures are essential in single case of vrana according to condition of the wound. (Su. Chi. 1/8). − In early stage of ulcer only inflammation appears. At this stage bloodletting should be done to break the further manifestation of ulcer. Purificatory measures should be performed in excessively aggravated doshas while lightning measures should be adopted if doshas are less aggravated. In the beginning of edema, therapeutic measures aimed to alleviate aggravated vata followed by other dosha viz. pitta and kapha are advised. Application of various pastes made of vijaya, madhuka, vira, bisagranthi etc. also reduce edema. Edema reducing dietary regimen like light food and food that does not cause burning sensation (avidahi) should be followed. − Indications and process of six fold surgical procedures: Six types of surgical procedures are described for treatment of ulcer such as patana (incision), vyadhana (puncturing), chhedana (excision), lekhana (scrapping), pracchana (scarification) and seevana (suturing). Patana procedure described by Charaka is same as for bhedana by Sushruta. Any similar or new procedure can be applied in wound management as per the surgeon’s freedom. [ ] − Pidana (Compression): − Widening of external opening (mouth) of ulcer or abscess along with breaking of multiple loculi to make uniform cavity, to avoid the collection of pus in multiple pockets and facilitate free drainage of pus. Pidana (compression) is also helpful to squeeze out the collected pus. For compression various pastes are applied over the ulcer of abscess except on mouth openings. − − Management of fracture and dislocation: − The basic guidelines for management of fracture and dislocation are to stablise the fractured bone or dislocated joint by application of splints. Proper alignment of bone is mandatory for healing of fractured bone.[ ] Suitable dietary regimen should be followed with avoidance of vidahi (food which causes burning sensation) food. [ ] Strenous exercise is not allowed during healing period due to risk of re-fracture and dislocation. Complications due to fracture of bone or dislocation of joint are managed as per condition. For e.g. If ulcer is due to fracture of bone then treatment of ulcer along with fracture management should be adopted. − Eshanakarma (probing): − It is used in ulcer of narrow opening with expanded base (eg.undermined ulcers). Various types of probes are used in ulcer to know the direction of tract or cavity, depth and discharge from ulcer or sinuses. Generally probing is not done if ulcer is located at vital organs (marma sthana) but in specific conditions as in fistula in ano it can be performed. As per site of ulcer various probes either hard or soft can be used. If deep seated and located at fleshy area hard probe (metallic) is used, in superficially seated ulcers soft probe is used. Probing is essential to know the depth of wound particularly in nadivrana (sinus at any part of the body) or fistula (fistula-in ano is one kind). (Su. Su.25/10). − Vrana shodhana (cleaning of ulcer): − Cleaning of ulcer is done with shodhana drugs (cleansing agents) leads to vrana ropana (wound healing) process. − If ulcer is contaminated i.e.presence of infective organisms, profuse secretion, presence of slough etc, in these conditions purificatory measures like debridement of ulcer (i.e. removal of slough), irrigation with shodhana kashaya or paste (purificatory measures) should be applied. Once ulcer becomes clean, healthy granulation tissue formation starts. To enhance and protect the granulation tissue vrana ropana drugs (healing drugs) either externally or internally or in combination are used. − Bandaging material, methods and its applicability in vrana (wound): − Bandaging of wound is very important as it stabilizes wounded part, prevents external injury, prevents contamination from external sources and enhances healing process. Bandaging should not be too tight, nor too loose. Act of bandaging may be from right or left side while others have mentioned fourteen types[ ] and fifteen types. [ ] − Diet: Wholesome and unwholesome aahar-vihar and ulcer healing promoters: − Lavana is vishyandi i. e. producing more secretions from tissues; it aggravates kapha and pitta and mitigates vata.[ ] Due to kapha and pitta vitiating properties it causes sliminess (kledana) and burning pain. Excessive lavana, amla and katu rasa will provoke vata dosha and may produce various types of pain. Vidahi food also leads to burning sensation due to srotorodha while sexual intercourse leads to dhatukshaya and aggravates vata. [ , ] Day time sleep causes srotorodha and gives rise to vitiation of kapha that leads to swelling. Elevation of depressed ulcer is very important aspect of healing process. In ayurvedic classics stanya janana (galactogogue),[ ] jeevaniya (life promoters e.g. vitamins)[ ] and brimhaniya gana (nourishing drugs) [ ] are described. All these drugs have nutritional value (dhatu poshana) that helps in ulcer healing. − Indications and contraindications of agnikarma (cauterization) in various disorders:. − Agni karma (cauterization by application of heat) is used as precaution for excessive bleeding ulcers, excision of hanging flesh, kaphaja granthi (enlarged gland due to kapha), goitre and in stiffness (associated with vata) etc. Agnikarma has ushna guna (hot property) which is opposite to vata and kapha. Due to heat, vasodilation leads to alleviation of srotorodha resulting in proper vascularity to organ or part. Dahakarma (cauterization) causes constriction of blood vessels so prevents bleeding from ulcer. [ ] Cauterization is performed with the help of many substances like unctuous or ununctous substances etc by many ways e.g. Small spot (bindu), shape of ring (valaya) etc depending on nature of disease, strength of patient and time of application. − Importance of dhupan karma (fumigation therapy) in wound sterilization healing process: − Fumigation of ulcer is done with dhupan dravyas (fumigating materials). [ , ] Purpose of fumigation is to make suitable conditions for better ulcer healing such as local sterilization, vasodilation, decreased discharge and removal of foul smell. Fumigation also relieves pain, discharge and kills microorganisms due to vata, kapha alleviating property along with antiseptic property. [ ] Various types of preparations are used to harden or soften the wounds as per condition of wound. − 1. Research studies on management of ulcers: The physician observing inflammation as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. Sushruta also indicated blood letting in initial stage of abscess or inflammatory conditions and in ischemic condition of the wound. (SU. Su. ---) [ ] − − 2. The nagrodhyadi group is indicated in wound as cooling for wounds which is found healing potential in one research. [ ] − 3. The panchavakkal (Vata (Ficus bengalensis − Linn), Udumbara (Ficus glomerata Roxb.), Ashvattha (Ficus religiosa Linn.), Parisha/Pāriśa (Thespesia populenoides L.) and Plaksha (Ficus lacor Buch Ham.),) is indicated for the healing of chronic wound. In resent studies panchavalkal has antiinflammatory, cleaning and healing potential in some research studies carried out and published in reputed journals of Ayurveda.[ , , , , , ] − − 4. Bala (Sida cordifolia Linn.), guduchi (Tinospora cordifolia), madhuka (Glycyrrhiza glabra Linn.), prshnaparni (Uraria picta Desv), satavari (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. Some studies have highlighted the wound healing potential of honey mixed with above drugs. [ , ] − Various preparations containing following herbal drugs have wound cleaning effect in single and combination of drugs. The recent studies showed their efficacy as evidence based. Leaves of nimb (Azadirachta indica A. Juss) [ , , , ] and haridra (Curcuma longa Linn.) are mentioned as the shodhan and ropan(healing) of wound. [ , , ] The daruharidra (Berberis aristata DC) also showed antimicrobial effect. [ ] − 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. Most of the ingredients like triphala,[ ] khadira, daruharidra, nyagrodhadi group nimb, haridra, daruharidra, madhuka are the ingredients of jatyadi taila /ghrita which is well known formulation in managment of chronic wound for shodhan and ropan of wounds. [ , , , , , , ] − 5. The drugs which are helpful for healing of fresh and infected or chronic wounds are mentioned in the text. Among these drugs following drugs are having some research studies carried out for their healing effect. − − Decoction of Panchavalkal (nyagrodha, udumbara, asvattha, parish plaksha), karavira (Nerium indicum Mill.), arka (Calotropis procera R. Br.) [ ] and kutaja (Holarrhena antidysentrica Linn.) are wound healing. Candana (Santalum album Linn.), daruharidra bark, 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 candana are pounded together and used for cooking oil. 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. − − 6. The physician conversant with dose, time and agni (heat) may apply alkali in cases amenable to surgical operations.[ , , , ] − − 7. By dusting the wound with the powders of barks of kakubha (Termalia arjuna),[ ] udumbara,[ ] ashvattha, lodhra (Symplocos racemosa Roxb), jambu (Eugenia jambolana Lam) and katphala (Myrica esculenta Buch-Ham) they heals the skin quickly. Manashila (Realgar), manjistha, [ , ] lac, haridra and daruharidra used as paste with ghee and honey is an excellent cleanser of skin. − Potential areas /Scope for research: − The ingredients like bala (Sida cordifolia Linn.), kusa (Desmostachya bipinnata Stapf.), badara (Zizyphus jujube Lam.), trivrit (Operculina turpethum Linn.), karavira (Nerium indicum Mill.), kutaja (Holarrhena antidysentrica Linn.), meda (Polygonatum airrhifolium Royle), mahameda (Polygonatum airrhifolium Royle), murva (Marsdenia tenacissima W. & A.), lajjalu (Mimosa pudica Linn.), gojihva (Onosma bracteatum Wall.), dhataki, ela (Elleteria cardamomum Maton.), aguru (Aquilaria agallocha Roxb.), kakoli (Roscoca procera Wall.), ksirakakoli (Roscoca procera Wall.) are mentioned for wound healing so there is a scope to find out their clinical wound healing effect. − Caraka mentioned some formulations for shodhan (cleansing) and ropan (healing) in this chapter. Along with single drug these formulations need to be further studied for their scientific validation. − Shodhan (Cleansing) formulations:+ − 1. 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. − 2. Tila paste, salt, haridra (Curcuma longa Linn.), daruharidra (Berberis aristata DC), trivrit (Operculina turpethum Linn.) ghrita, madhuka, nimba leaves. − 3. Manahsila (Realgar), manjistha, lac, haridra and daruharidra used as paste with ghee and honey − Ropan (healing) formulations: − 1. 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- − 2. Pase of ghee prepared with Prapaundarika, jivanti, gojihva (Onosma bracteatum Wall.), dhataki, bala and sesamum − 3. Oil of 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 candana − 4. Oil prepared with equal quantity of prapaundarika, mahuka, kakoli (Roscoca procera Wall.), ksirakakoli (Roscoca procera Wall.), chandana and rakta chandana (Pterocarpus santalinus Linn.) − 5. Oil cooked with durva juice or kampillaka or paste of daruharidra bark. − 6. Powders of barks of kakubha (Termalia arjuna), udumbara, asvattha, lodhra (Symplocos racemosa Roxb), jambu (Eugenia jambolana Lam) and katphala (Myrica esculenta Buch-Ham). − Remedies for post healing complications: − 1. The paste prepared by bhasmas of iron, kasisa and triphala (haritaki,vibhitaki and amalaki) flowers provides blackness in the newly formed skin quickly. − 2. Kaliyaka (Jateorhiza palmata Miers), nata /tagara (Valeriana wallichii DC), mango seeds, nagakesara, iron and triphala powder mixed with cow-dung juice make an excellent paste for reviving normal colour in skin. − 3. Roots of dhyamaka, asvattha and nicula (Barringtonia acutangula Linn), lac, gairic(red-ochre), nagakesara and kasisa-These restores the natural colour of the skin. − 4. Lodhra, leafbuds of nyagrodha, khadira, triphala and ghrita - this combination used as paste provides looseness and softness in wounds. − The role of diet is very important in wounded patients which can be considered for further research as Charaka mentioned that wounded patients should abstain from salt, sour, pungent, hot, burning and heavy food and drinks and also sexual intercourse. − +
→Various treatment modalities of pacification of ulcer
शाल्मलीत्वग्बलामूलं तथा न्यग्रोधपल्लवाः |
शाल्मलीत्वग्बलामूलं तथा न्यग्रोधपल्लवाः |
न्यग्रोधादिकमुद्दिष्टं बलादिकमथापि वा ||६३||
न्यग्रोधादिकमुद्दिष्टं बलादिकमथापि वा ||६३||
आलेपनं निर्वपणं तद्विद्यात्तैश्च [१] सेचनम् |
आलेपनं निर्वपणं तद्विद्यात्तैश्च [१] सेचनम् |
सर्पिषा शतधौतेन पयसा मधुकाम्बुना ||६४|
सर्पिषा शतधौतेन पयसा मधुकाम्बुना ||६४|
निर्वापयेत् सुशीतेन रक्तपित्तोत्तरान् व्रणान् |६५|
निर्वापयेत् सुशीतेन रक्तपित्तोत्तरान् व्रणान् |६५|
śālmalītvagbalāmūlaṁ tathā nyagrōdhapallavāḥ|
śālmalītvagbalāmūlaṁ tathā nyagrōdhapallavāḥ|
nyagrōdhādikamuddiṣṭaṁ balādikamathāpi vā||63||
nyagrōdhādikamuddiṣṭaṁ balādikamathāpi vā||63||
ālēpanaṁ nirvapaṇaṁ tadvidyāttaiśca [1] sēcanam|
ālēpanaṁ nirvapaṇaṁ tadvidyāttaiśca [1] sēcanam|
sarpiṣā śatadhautēna payasā madhukāmbunā||64||
sarpiṣā śatadhautēna payasā madhukāmbunā||64||
nirvāpayēt suśītēna raktapittōttarān vraṇān|65|
nirvāpayēt suśītēna raktapittōttarān vraṇān|65|
shAlmalItvagbalAmUlaM tathA nyagrodhapallavAH |
shAlmalItvagbalAmUlaM tathA nyagrodhapallavAH |
nyagrodhAdikamuddiShTaM balAdikamathApi vA ||63||
nyagrodhAdikamuddiShTaM balAdikamathApi vA ||63||
AlepanaM nirvapaNaM tadvidyAttaishca [1] secanam |
AlepanaM nirvapaNaM tadvidyAttaishca [1] secanam |
sarpiShA shatadhautena payasA madhukAmbunA ||64||
sarpiShA shatadhautena payasA madhukAmbunA ||64||
nirvApayet sushItena raktapittottarAn vraNAn |65|
nirvApayet sushItena raktapittottarAn vraNAn |65|
Bark of shalmali (Salmalia malabarica Schott), bala (Sida cordifolia) root, tender leaves of nyagrodha – this group (of drugs) known as nyagrodhadi or baladi acts as cooling agent applied as paste and sprinkling. Wounds predominant in raktapitta should be cooled by applying very cold ghee washed hundred times, milk or decoction of madhuka (Madhuka indica).(63-65)
Bark of ''shalmali'' (Salmalia malabarica Schott), ''bala'' (Sida cordifolia) root, tender leaves of ''nyagrodha'' – this group (of drugs) known as ''nyagrodhadi'' or ''baladi'' acts as cooling agent applied as paste and sprinkling. Wounds predominant in ''raktapitta'' should be cooled by applying very cold ghee washed hundred times, milk or decoction of ''madhuka'' (Madhuka indica).[63-65]
लम्बानि व्रणमांसानि प्रलिप्य मधुसर्पिषा ||६५||
लम्बानि व्रणमांसानि प्रलिप्य मधुसर्पिषा ||६५||
सन्दधीत समं वैद्यो बन्धनैश्चोपपादयेत् |
सन्दधीत समं वैद्यो बन्धनैश्चोपपादयेत् |
तान्समान्सुस्थिताञ्ज्ञात्वा फलिनीलोध्रकट्फलैः ||६६||
तान्समान्सुस्थिताञ्ज्ञात्वा फलिनीलोध्रकट्फलैः ||६६||
समङ्गाधातकीयुक्तैश्चूर्णितैरवचूर्णयेत् |
समङ्गाधातकीयुक्तैश्चूर्णितैरवचूर्णयेत् |
पञ्चवल्कलचूर्णैर्वा शुक्तिचूर्णसमायुतैः ||६७||
पञ्चवल्कलचूर्णैर्वा शुक्तिचूर्णसमायुतैः ||६७||
धातकीलोध्रचूर्णैर्वा तथा रोहन्ति ते व्रणाः |६८|
धातकीलोध्रचूर्णैर्वा तथा रोहन्ति ते व्रणाः |६८|
lambāni vraṇamāṁsāni pralipya madhusarpiṣā||65||
lambāni vraṇamāṁsāni pralipya madhusarpiṣā||65||
sandadhīta samaṁ vaidyō bandhanaiścōpapādayēt|
sandadhīta samaṁ vaidyō bandhanaiścōpapādayēt|
tānsamānsusthitāñjñātvā phalinīlōdhrakaṭphalaiḥ||66||
tānsamānsusthitāñjñātvā phalinīlōdhrakaṭphalaiḥ||66||
samaṅgādhātakīyuktaiścūrṇitairavacūrṇayēt|
samaṅgādhātakīyuktaiścūrṇitairavacūrṇayēt|
pañcavalkalacūrṇairvā śukticūrṇasamāyutaiḥ||67||
pañcavalkalacūrṇairvā śukticūrṇasamāyutaiḥ||67||
dhātakīlōdhracūrṇairvā tathā rōhanti tē vraṇāḥ|68|
dhātakīlōdhracūrṇairvā tathā rōhanti tē vraṇāḥ|68|
lambAni vraNamAMsAni pralipya madhusarpiShA ||65||
lambAni vraNamAMsAni pralipya madhusarpiShA ||65||
sandadhIta samaM vaidyo bandhanaishcopapAdayet |
sandadhIta samaM vaidyo bandhanaishcopapAdayet |
tAnsamAnsusthitA~jj~jAtvA phalinIlodhrakaTphalaiH ||66||
tAnsamAnsusthitA~jj~jAtvA phalinIlodhrakaTphalaiH ||66||
sama~ggAdhAtakIyuktaishcUrNitairavacUrNayet |
sama~ggAdhAtakIyuktaishcUrNitairavacUrNayet |
pa~jcavalkalacUrNairvA shukticUrNasamAyutaiH ||67||
pa~jcavalkalacUrNairvA shukticUrNasamAyutaiH ||67||
dhAtakIlodhracUrNairvA tathA rohanti te vraNAH |68|
dhAtakIlodhracUrNairvA tathA rohanti te vraNAH |68|
Chronic wound should be pasted with honey and ghee there after bandaged leads to evenly union.When they are evenly set, powder of priyangu (Callicarpa macrophylla Vahl.), lodhra (Symplocos racemosa Roxb.), katphala (Myrica esculenta Buch-Ham.), lajjalu (Mimosa pudica Linn.) and dhataki (Woodfordia fruticosa Kurz.) should be applied thereon or the powder of panchavalkala mixed with that of sukti bhasma (pearl ash) or the powder of dhataki and lodhra should be applied. Application of above measures leads to proper wounds healing.(65-68)
Management of bone fracture and dislocation:
Chronic wound should be pasted with honey and ghee there after bandaged leads to evenly union.When they are evenly set, powder of ''priyangu'' (Callicarpa macrophylla Vahl.), ''lodhra'' (Symplocos racemosa Roxb.), ''katphala'' (Myrica esculenta Buch-Ham.), ''lajjalu'' (Mimosa pudica Linn.) and ''dhataki'' (Woodfordia fruticosa Kurz.) should be applied thereon or the powder of ''panchavalkala'' mixed with that of ''sukti bhasma'' (pearl ash) or the powder of ''dhataki'' and ''lodhra'' should be applied.
Application of above measures leads to proper wounds healing.[65-68]
==== Management of bone fracture and dislocation ====
अस्थिभग्नं च्युतं सन्धिं सन्दधीत समं पुनः ||६८||
अस्थिभग्नं च्युतं सन्धिं सन्दधीत समं पुनः ||६८||
समेन सममङ्गेन कृत्वाऽन्येन विचक्षणः |
समेन सममङ्गेन कृत्वाऽन्येन विचक्षणः |
स्थिरैः कवलिकाबन्धैः कुशिकाभिश्च संस्थितम् ||६९||
स्थिरैः कवलिकाबन्धैः कुशिकाभिश्च संस्थितम् ||६९||
पट्टैः प्रभूतसर्पिष्कैर्बध्नीयादचलं सुखम् |
पट्टैः प्रभूतसर्पिष्कैर्बध्नीयादचलं सुखम् |
अविदाहिभिरन्नैश्च पैष्टिकैस्तमुपाचरेत् ||७०||
अविदाहिभिरन्नैश्च पैष्टिकैस्तमुपाचरेत् ||७०||
ग्लानिर्हि न हिता तस्य सन्धिविश्लेषकारिका |
ग्लानिर्हि न हिता तस्य सन्धिविश्लेषकारिका |
विच्युताभिहताङ्गानां विसर्पादीनुपद्रवान् ||७१||
विच्युताभिहताङ्गानां विसर्पादीनुपद्रवान् ||७१||
उपाचरेद्यथाकालं [१] कालज्ञः स्वाच्चिकित्सितात् |७२| asthibhagnaṁ cyutaṁ sandhiṁ sandadhīta samaṁ punaḥ||68||
उपाचरेद्यथाकालं [१] कालज्ञः स्वाच्चिकित्सितात् |७२|
asthibhagnaṁ cyutaṁ sandhiṁ sandadhīta samaṁ punaḥ||68||
samēna samamaṅgēna kr̥tvā'nyēna vicakṣaṇaḥ|
samēna samamaṅgēna kr̥tvā'nyēna vicakṣaṇaḥ|
sthiraiḥ kavalikābandhaiḥ kuśikābhiśca saṁsthitam||69||
sthiraiḥ kavalikābandhaiḥ kuśikābhiśca saṁsthitam||69||
upācarēdyathākālaṁ [1] kālajñaḥ svāccikitsitāt|72|
upācarēdyathākālaṁ [1] kālajñaḥ svāccikitsitāt|72|
asthibhagnaM cyutaM sandhiM sandadhIta samaM punaH ||68||
samena samama~ggena kRutvA~anyena vicakShaNaH |
samena samama~ggena kRutvA~anyena vicakShaNaH |
sthiraiH kavalikAbandhaiH kushikAbhishca saMsthitam ||69||
sthiraiH kavalikAbandhaiH kushikAbhishca saMsthitam ||69||
vicyutAbhihatA~ggAnAM visarpAdInupadravAn ||71||
vicyutAbhihatA~ggAnAM visarpAdInupadravAn ||71||
upAcaredyathAkAlaM [1] kAlaj~jaH svAccikitsitAt |72|
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)
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)
Management of various conditions of vrana:
==== Management of various conditions of vrana ====
शुष्का महारुजः स्तब्धा ये व्रणा मारुतोत्तराः |
शुष्का महारुजः स्तब्धा ये व्रणा मारुतोत्तराः |
स्वेद्याः सङ्करकल्पेन ते स्युः कृशरपायसैः ||७२||
स्वेद्याः सङ्करकल्पेन ते स्युः कृशरपायसैः ||७२||
rugdāhayōḥ praśamanō vraṇēṣvēṣa vidhirhitaḥ||79||
rugdāhayōḥ praśamanō vraṇēṣvēṣa vidhirhitaḥ||79||
shuShkA mahArujaH stabdhA ye vraNA mArutottarAH |
svedyAH sa~gkarakalpena te syuH kRusharapAyasaiH ||72||
svedyAH sa~gkarakalpena te syuH kRusharapAyasaiH ||72||
grAmyabailAmbujAnUpairvaishavAraishca saMskRutaiH |
grAmyabailAmbujAnUpairvaishavAraishca saMskRutaiH |
rugdAhayoH prashamano vraNeShveSha vidhirhitaH ||79||
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)
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)
Probing:
==== Probing ====
सूक्ष्मानना बहुस्रावाः कोषवन्तश्च ये व्रणाः |
सूक्ष्मानना बहुस्रावाः कोषवन्तश्च ये व्रणाः |
न च मर्माश्रितास्तेषामेषणं हितमुच्यते ||८०||
न च मर्माश्रितास्तेषामेषणं हितमुच्यते ||८०||
eShyaM vidyAdvraNaM nAlairviparItamato bhiShak ||82||
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)
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)
Local purification of ulcers:
==== Local purification of ulcers ====
पूतिगन्धान् विवर्णांश्च बहुस्रावान्महारुजः |
पूतिगन्धान् विवर्णांश्च बहुस्रावान्महारुजः |
व्रणानशुद्धान् विज्ञाय शोधनैः समुपाचरेत् ||८३||
व्रणानशुद्धान् विज्ञाय शोधनैः समुपाचरेत् ||८३||
madhukaṁ nimbapatrāṇi pralēpō vraṇaśōdhanaḥ||85||
madhukaṁ nimbapatrāṇi pralēpō vraṇaśōdhanaḥ||85||
pUtigandhAn vivarNAMshca bahusrAvAnmahArujaH |
vraNAnashuddhAn vij~jAya shodhanaiH samupAcaret ||83||
vraNAnashuddhAn vij~jAya shodhanaiH samupAcaret ||83||
triphalA khadiro dArvI nyagrodhAdirbalA [1] kushaH |
triphalA khadiro dArvI nyagrodhAdirbalA [1] kushaH |
madhukaM nimbapatrANi pralepo vraNashodhanaH ||85||
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)
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)
Ropana (healing) of ulcer:
==== Ropana (healing) of ulcer ====
नातिरक्तो नातिपाण्डुर्नातिश्यावो न चातिरुक् |
नातिरक्तो नातिपाण्डुर्नातिश्यावो न चातिरुक् |
न चोत्सन्नो न चोत्सङ्गी शुद्धो रोप्यः परं व्रणः ||८६||
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.
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)
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)
Bandage:
==== Bandage ====
कदम्बार्जुननिम्बानां पाटल्याः पिप्पलस्य च |
कदम्बार्जुननिम्बानां पाटल्याः पिप्पलस्य च |
व्रणप्रच्छादने विद्वान् पत्राण्यर्कस्य चादिशेत् ||९५||
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)
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)
Contraindications:
==== Contraindications ====
लवणाम्लकटूष्णानि विदाहीनि गुरूणि च |
लवणाम्लकटूष्णानि विदाहीनि गुरूणि च |
वर्जयेदन्नपानानि व्रणी मैथुनमेव च ||९७||
वर्जयेदन्नपानानि व्रणी मैथुनमेव च ||९७||
annapAnaM vraNahitaM hitaM cAsvapanaM divA ||98||
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)
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)
Suitable food and medicines:
==== Suitable food and medicines ====
स्तन्यानि जीवनीयानि बृंहणीयानि यानि च |
स्तन्यानि जीवनीयानि बृंहणीयानि यानि च |
उत्सादनार्थं निम्नानां व्रणानां तानि कल्पयेत् ||९९||
उत्सादनार्थं निम्नानां व्रणानां तानि कल्पयेत् ||९९||
vraNAvasAdanaM tadvat kalavi~gkakapotaviT ||100||
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)
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)
Indications and contra-inidcations of agni karma (cauterization):
==== Indications and contra-inidcations of agni karma (cauterization) ====
रुधिरेऽतिप्रवृत्ते तु च्छिन्ने च्छेद्येऽधिमांसके |
रुधिरेऽतिप्रवृत्ते तु च्छिन्ने च्छेद्येऽधिमांसके |
कफग्रन्थिषु गण्डेषु वातस्तम्भानिलार्तिषु ||१०१||
कफग्रन्थिषु गण्डेषु वातस्तम्भानिलार्तिषु ||१०१||
saviSheShu ca shalyeShu netrakuShThavraNeShu ca ||106||
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)
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)
Kshara karma (application of alkali) and dhupana(fumigation):
==== Kshara karma (application of alkali) and dhupana(fumigation) ====
रोगदोषबलापेक्षी मात्राकालाग्निकोविदः |
रोगदोषबलापेक्षी मात्राकालाग्निकोविदः |
शस्त्रकर्माग्निकृत्येषु क्षारमप्यवचारयेत् ||१०७||
शस्त्रकर्माग्निकृत्येषु क्षारमप्यवचारयेत् ||१०७||
मुद्गषष्टिकशालीनां पायसैर्वा यथाक्रमम् |
मुद्गषष्टिकशालीनां पायसैर्वा यथाक्रमम् |
सघृतैर्जीवनीयैर्वा तर्पयेत्तानभीक्ष्णशः ||११२||
सघृतैर्जीवनीयैर्वा तर्पयेत्तानभीक्ष्णशः ||११२||
rōgadōṣabalāpēkṣī mātrākālāgnikōvidaḥ|
śastrakarmāgnikr̥tyēṣu kṣāramapyavacārayēt||107||
śastrakarmāgnikr̥tyēṣu kṣāramapyavacārayēt||107||
kaṭhinatvaṁ vraṇā yānti gandhaiḥ sāraiśca dhūpitāḥ|
kaṭhinatvaṁ vraṇā yānti gandhaiḥ sāraiśca dhūpitāḥ|
mudgaṣaṣṭikaśālīnāṁ pāyasairvā yathākramam|
mudgaṣaṣṭikaśālīnāṁ pāyasairvā yathākramam|
saghr̥tairjīvanīyairvā tarpayēttānabhīkṣṇaśaḥ||112||
saghr̥tairjīvanīyairvā tarpayēttānabhīkṣṇaśaḥ||112||
rogadoShabalApekShI mAtrAkAlAgnikovidaH |
shastrakarmAgnikRutyeShu kShAramapyavacArayet ||107||
shastrakarmAgnikRutyeShu kShAramapyavacArayet ||107||
kaThinatvaM vraNA yAnti gandhaiH sAraishca dhUpitAH |
kaThinatvaM vraNA yAnti gandhaiH sAraishca dhUpitAH |
saghRutairjIvanIyairvA tarpayettAnabhIkShNashaH ||112||
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)
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)
==== External applications ====
ककुभोदुम्बराश्वत्थलोध्रजाम्बवकट्फलैः |
ककुभोदुम्बराश्वत्थलोध्रजाम्बवकट्फलैः |
त्वचमाश्वेव गृह्णन्ति त्वक्चूर्णैश्चूर्णिता व्रणाः ||११३||
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.
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)
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)
Summary:
==== Summary ====
तत्र श्लोकौ-
तत्र श्लोकौ-
द्वौ व्रणौ व्रणभेदाश्च परीक्षा दुष्टिरेव च |
द्वौ व्रणौ व्रणभेदाश्च परीक्षा दुष्टिरेव च |
व्रणाधिकारे सप्रश्नमेतन्नवकमुक्तवान् |
व्रणाधिकारे सप्रश्नमेतन्नवकमुक्तवान् |
मुनिर्व्याससमासाभ्यामग्निवेशाय धीमते ||१२१||
मुनिर्व्याससमासाभ्यामग्निवेशाय धीमते ||१२१||
tatra ślōkau-
dvau vraṇau vraṇabhēdāśca parīkṣā duṣṭirēva ca|
dvau vraṇau vraṇabhēdāśca parīkṣā duṣṭirēva ca|
sthānāni gandhāḥ srāvāśca sōpasargāḥ kriyāśca yāḥ||120||
sthānāni gandhāḥ srāvāśca sōpasargāḥ kriyāśca yāḥ||120||
munirvyāsasamāsābhyāmagnivēśāya dhīmatē||121||
munirvyāsasamāsābhyāmagnivēśāya dhīmatē||121||
Now the summing up verses –
Now the summing up verses –
Two types of wounds, kinds of wounds, examination of wounds, defects, locations, odours, discharges, complications and treatment modalities are described. These topics after queries have been described in brief as well details by the sage to the wise Agnivesa in the chapter on treatment of wound (dwivraniya chikitsaadhaya). (120-121)
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते दृढबलसम्पूरिते चिकित्सास्थाने द्विव्रणीयचिकित्सितं नाम पञ्चविंशोऽध्यायः ||२५|| ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē dr̥ḍhabalasampūritē cikitsāsthānē dvivraṇīyacikitsitaṁ nāmapañcaviṁśō'dhyāyaḥ||25||
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||
ityagniveshakRute tantre carakapratisaMskRute dRuDhabalasampUrite cikitsAsthAne dvivraNIyacikitsitaM nAma pa~jcaviMsho~adhyAyaH ||25||
Tattva:
=== ''Tattva Vimarsha'' ===
• Vrana (ulcers) are broadly classified into two types viz. nija (endogenous) and agantu (exogenous).
• 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.
• 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.
• 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.
Vidhi vimarsha:
=== Vidhi Vimarsha ===
Work in Progress
Glossary of technical terms:
=== Glossary ===
1. Liṅgaṁ (li~ggaM : र्लिङ्गं -) – Causative factors, sign and Symptoms.
1. Liṅgaṁ (li~ggaM : र्लिङ्गं -) – Causative factors, sign and Symptoms.
2. Prapatan ( Prapatan ; प्रपतन) – Falling down.
2. Prapatan ( Prapatan ; प्रपतन) – Falling down.