Changes

}}

}}

==([[Chikitsa Sthana]] Chapter 25, Chapter on the Management of two types of ulcers) ==

==[[Chikitsa Sthana]] Chapter 25, Chapter on the Management of two types of ''Vrana'' (ulcers) ==

=== Abstract ===

=== Abstract ===

''Vrana'' (ulcers) are of two types, ''nija vrana'' (endogenous ulcers) and ''agantuka vrana'' (exogenous ulcers). This classification is based on etiology and mode of treatments. Endogenous ulcers are caused by vitiation of ''vatadi dosha'' from initial stage while exogenous ulcers are caused initially by various types of trauma and later ''dosha'' vitiation occurs. Complications of ulcers like ''visarpa'' (erysipelas), ''sirastambha'' (constricted vessels), ''jwara'' (fever) etc. have been described. Importance of bloodletting is described during the stage of ''vrana shopha'' (i.e.inflammatory phase), alleviation of impure blood from body reduces toxic chemicals and pacifies dosha. Description of fracture, its complications and management is elaborated. ''Dahakarma'' (cauterization) causes constriction of blood vessels to prevent bleeding from ulcer. Application of alkaline substances (''kshara'') on ulcer can be done along with surgical intervention and cauterization. Prognosis of ulcer can be described on the basis of type of ulcer and its various locations.  

''Vrana'' (ulcers) are of two types, ''nija vrana'' (endogenous ulcers) and ''agantuka vrana'' (exogenous ulcers). This classification is based on etiology and mode of treatments. Endogenous ulcers are caused by vitiation of ''vata etc. dosha'' from initial stage while exogenous ulcers are caused initially by various types of trauma and later ''dosha'' vitiation occurs. Complications of ulcers like ''visarpa'' (erysipelas), ''sirastambha'' (constricted vessels), ''jwara'' (fever) etc. have been described. Importance of bloodletting is described during the stage of ''vrana shopha'' (i.e.inflammatory phase), alleviation of impure blood from body reduces toxic chemicals and pacifies dosha. Description of fracture, its complications and management is elaborated. ''Dahakarma'' (cauterization) causes constriction of blood vessels to prevent bleeding from ulcer. Application of alkaline substances (''kshara'') on ulcer can be done along with surgical intervention and cauterization. Prognosis of ulcer can be described on the basis of type of ulcer and its various locations.  

'''Keywords''': ''Vrana'' (ulcer), ''trividha pariksha,'' bloodletting, ''dahakarma'' (cauterization), ''shodhanakarma'' (cleansing of ulcer), ''ropankarma'' (healing of ulcer), wound management, non healing ulcers.

'''Keywords''': ''Vrana'' (ulcer), ''trividha pariksha,'' bloodletting, ''dahakarma'' (cauterization), ''shodhanakarma'' (cleansing of ulcer), ''ropankarma'' (healing of ulcer), wound management, non healing ulcers.

Wounds with narrow opening and multiple loculi should be pressed on. ''Kalaya'' (Pisum sativum Linn.), ''masura'' (Lens culinaris Medic.), wheat (Triticum sativum Lam.) and peas pounded and applied as paste without mixing any fat are useful for pressing the wound.[61-62]

Wounds with narrow opening and multiple loculi should be pressed on. ''Kalaya'' (Pisum sativum Linn.), ''masura'' (Lens culinaris Medic.), wheat (Triticum sativum Lam.) and peas pounded and applied as paste without mixing any fat are useful for pressing the wound.[61-62]

==== Various treatment modalities of pacification of ulcer ====

==== Various treatment modalities for pacification of ulcer ====

शाल्मलीत्वग्बलामूलं तथा न्यग्रोधपल्लवाः |  

शाल्मलीत्वग्बलामूलं तथा न्यग्रोधपल्लवाः |  

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]

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 ====

==== ''Eshana'' (Probing) ====

सूक्ष्मानना बहुस्रावाः कोषवन्तश्च ये व्रणाः |  

सूक्ष्मानना बहुस्रावाः कोषवन्तश्च ये व्रणाः |  

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 ====

==== ''Vrana shodhana'' (local purification of ulcers) ====

पूतिगन्धान् विवर्णांश्च बहुस्रावान्महारुजः |  

पूतिगन्धान् विवर्णांश्च बहुस्रावान्महारुजः |  

Similarly, oil prepared with equal quantity of ''prapaundarika, mahuka, kakoli'' (Roscoca procera Wall.), ''kshirakakoli'' (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.), ''kshirakakoli'' (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 ====

==== ''Patta bandhana'' (bandage) ====

कदम्बार्जुननिम्बानां पाटल्याः पिप्पलस्य च |  

कदम्बार्जुननिम्बानां पाटल्याः पिप्पलस्य च |  

*The two types of ulcers are further divided into twenty types on the basis of distinctive features. Their examination can be done by three ways, signs of excess vitiation at site of ulcer are of twelve types, eight locations, fourteen types of discharges, sixteen complications, twenty four defects and thirty six therapeutic measures.

*The two types of ulcers are further divided into twenty types on the basis of distinctive features. Their examination can be done by three ways, signs of excess vitiation at site of ulcer are of twelve types, eight locations, fourteen types of discharges, sixteen complications, twenty four defects and thirty six therapeutic measures.

*Skin, blood vessels, flesh, fat, bone, ligament, vital parts and viscera are involved in the pathogenesis of ulcer.

*Skin, blood vessels, flesh, fat, bone, ligament, vital parts and viscera are involved in the pathogenesis of ulcer.

*The treatment of ulcer is done in two ways viz.1. systemic treatment (internal administration)  and 2. Local treatment of ulcer.  

*The treatment of ulcer is done in two ways viz.1. systemic treatment (internal administration of medicine)  and 2. Local treatment of ulcer. The treatment is done with drugs that promote healing, purify body and local site of ulcer.   

 

The treatment is done with drugs that promote healing, purify body and local site of ulcer.   

*The first principle of management of ulcer is body purification through therapeutic emesis, purgation, ''shastra karma'' (surgical intervention) or ''basti'' (medicated enema) after assessment of condition because the ulcers get healed quickly in those with cleansed body.

*The first principle of management of ulcer is body purification through therapeutic emesis, purgation, ''shastra karma'' (surgical intervention) or ''basti'' (medicated enema) after assessment of condition because the ulcers get healed quickly in those with cleansed body.

*The thirty six measures for treatments of ulcers are those for pacification of swelling, six types of surgical operations, pressing, refrigerating, uniting, fomentation, pacification, probing, cleansing, healing, cleaning paste, healing paste, cleaning oil, healing oil, two types of covering with leaf, two types of bandaging, diet, elevation, two types of cauterization, depression, hardening fumigation, softening fumigation, hardening paste, softening paste, powdering, colorization, healing, repillatory.  

*The thirty six measures for treatments of ulcers are those for pacification of swelling, six types of surgical operations, pressing, refrigerating, uniting, fomentation, pacification, probing, cleansing, healing, cleaning paste, healing paste, cleaning oil, healing oil, two types of covering with leaf, two types of bandaging, diet, elevation, two types of cauterization, depression, hardening fumigation, softening fumigation, hardening paste, softening paste, powdering, colorization, healing, repillatory.