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|title=Dwivraniya Chikitsa

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|titlemode=append

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|keywords=Vrana (ulcer), trividha pariksha, bloodletting, dahakarma (cauterization), shodhanakarma (cleansing of ulcer), ropankarma (healing of ulcer), wound management, non healing ulcers,Ayurveda, Indian system of medicine, charak samhita.

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|description=Chikitsa Sthana Chapter 25. Management of two types of Vrana (ulcers)

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=charak samhita

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|type=article

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}}

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<big>'''[[Chikitsa Sthana]] Chapter 25. Management of two types of Vrana (ulcers) </big>'''

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~~<big>''' Abstract </big>'''~~

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''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.

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

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{{Infobox

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|title = ~~Dwivarniya~~ Chikitsa

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|title = Dwivraniya Chikitsa

|label1 = Section/Chapter

|data1 = [[Chikitsa Sthana]] Chapter 25

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|label5 = Other Sections

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|data6 = Singh L.,Sharma A.,Dudhamal T.S.

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|label7 = Reviewer

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|data7 = Dudhamal T.S.

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|label8 = Editors

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|data8 = Dudhamal T.S.,Deole Y.S., Basisht G.

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.026 10.47468/CSNE.2020.e01.s06.026]

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}}

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~~|header3~~ =

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<big>''' Abstract </big>'''

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''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.

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

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</div>

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}}

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=== Introduction ===

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== Introduction ==

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The term ''vrana'' literally means destruction or rupture or discontinuation of body tissues. This chapter gives comprehensive information about endogenous and exogenous ulcers. ''Trividha pariksha'' or three different ways of examination of ulcer is done by ''darshana'' (inspection), ''prashna'' (interrogation) and ''sparshana'' (palpation). Inspection i.e. visual examination deals with general examination (whole body) and local examination (specific part or organ) to make proper diagnosis. The etiological factors, nature of pain, ability to get used to food (''satmya/asatmya''), drugs, status of digestive power etc are examined by interrogation. Palpation is the mode of direct examination done by palpating the margin, size, depth, temperature, stiffness or hardness etc. Prognosis of ulcer is determined by its location eg. skin (''tvaka''), blood vessels (''shira''), muscle tissue ([[mamsa dhatu]]), fatty tissue ([[meda dhatu]]), bone ([[asthi dhatu]]), ligament (''snayu''), vital organs (''marma'')<ref>Sushruta. Chikitsa Sthana, Cha.1 Dwivraneeya Chikitsitam Adhyaya verse 134. In: Kaviraja Ambikadutta Shastri Editors. Sushruta Samhita. reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013. pp 16.</ref>,visceras of chest and abdomen (''antarashraya'')<ref>Sushruta. Chikitsa Sthana, Cha.2 Sadyovrana Chikitsitam Adhyaya verse 12. In: Kaviraja Ambikadutta Shastri Editors. Sushruta Samhita. reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013. pp 16.</ref> [ Cha. Sa. [[Sharira Sthana]] 7/10 ]

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The term ''vrana'' literally means destruction or rupture or discontinuation of body tissues. This chapter gives comprehensive information about endogenous and exogenous ulcers. ''Trividha pariksha'' or three different ways of examination of ulcer is done by ''darshana'' (inspection), ''prashna'' (interrogation) and ''sparshana'' (palpation). Inspection i.e. visual examination deals with general examination (whole body) and local examination (specific part or organ) to make proper diagnosis. The etiological factors, nature of pain, ability to get used to food (''satmya/asatmya''), drugs, status of digestive power etc are examined by interrogation. Palpation is the mode of direct examination done by palpating the margin, size, depth, temperature, stiffness or hardness etc. Prognosis of ulcer is determined by its location eg. skin (''tvaka''), blood vessels (''shira''), muscle tissue (''mamsa''), fatty tissue (''meda''), bone (''asthi''), ligament (''snayu''), vital organs (''marma'')<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, chikitsa sthana Chap 1, shlok no.134 , Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 16.</ref>,visceras of chest and abdomen (''antarashraya'')<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, chikitsa sthana Chap 2, shlok no.12 , Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 19.</ref>,<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sharira sthana, Chap 7, shlok no. 10 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 913.</ref>.

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Various complications of ulcers like ''visarpa'' (erysipelas), ''pakshaghata'' (hemiplegia), ''shirastambha'' (constricted vessels), ''jwara'' (fever) etc. are described. Sloughing of ligaments and vessels, deep seated appearance of maggots, fracture of bone near the ulcer, presence of foreign body in the ulcer etc hamper the healing process. Treatment of ''nija vrana'' (endogenous ulcer)<ref>Vagbhata. Uttara Sthana, Cha.26 Sadyovranapratishedha Adhyaya verse 13. In: Kaviraj Atrideva Gupta, Editors. Ashtanga Hridayam. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2005.pp 26</ref> is different from ''agantuja vrana'' (exogenous ulcer) because endogenous ulcers are caused by vitiation of [[vata]]di [[dosha]]ja, and exogenous ulcers are initially caused by various type of trauma such as ''vadha'' (stab injury etc.), ''bandha'' (excessive tying), ''prapatana'' (injury due to fall), injury due to teeth and nail etc. But later on in exogenous ulcers also involvement of [[dosha]] takes place and then treatment should be adopted as ''nija vrana'' (endogenous ulcer). In endogenous ulcers, ''shodhana'' therapy should be adopted by [[vamana]] (emesis), [[virechana]] (purgation) and [[basti]] (medicated enema) and blood letting for removal of [[dosha]]ja (toxic materials) from body. [ Cha. Sa. [[Sutra Sthana]] 16/17 ] and ''agnikarma''. ''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. In exogenous ulcers, local treatment with use of ''kshara'' (alkaline substances), surgical intervention and cauterization is recommended.

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Various complications of ulcers like ''visarpa'' (erysipelas), ''pakshaghata'' (hemiplegia), ''shirastambha'' (constricted vessels), ''jwara'' (fever) etc. are described. Sloughing of ligaments and vessels, deep seated appearance of maggots, fracture of bone near the ulcer, presence of foreign body in the ulcer etc hamper the healing process. Treatment of ''nija vrana'' (endogenous ulcer)<ref>Kaviraj Atrideva Gupta, ~~Astanga Hridaya, Vidyotini Tika, Uttara tantra Chap 26, shlok no~~.~~13 ,~~ Reprint ~~2005,~~ Chaukhambha Sanskrit Sansthan~~, Varanasi,~~ pp 26</ref> is different from ''agantuja vrana'' (exogenous ulcer) because endogenous ulcers are caused by vitiation of ~~''vatadi doshaja''~~, and exogenous ulcers are initially caused by various type of trauma such as ''vadha'' (stab injury etc.), ''bandha'' (excessive tying), ''prapatana'' (injury due to fall), injury due to teeth and nail etc. But later on in exogenous ulcers also involvement of ''dosha'' takes place and then treatment should be adopted as ''nija vrana'' (endogenous ulcer). In endogenous ulcers, ''shodhana'' therapy should be adopted by ''vamana'' (emesis), ''virechana'' (purgation) and ''basti'' (medicated enema) and blood letting for removal of ~~''doshaja''~~ (toxic materials) from body~~<ref>Pandit Kashi Nath Shastri, Dr~~. ~~Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 16, shlok no~~.~~17 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 321~~.</~~ref>~~ and ''agnikarma''. ''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. In exogenous ulcers, local treatment with use of ''kshara'' (alkaline substances), surgical intervention and cauterization is recommended.

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=== Sanskrit Text, Transliteration and English Translation ===

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== Sanskrit Text, Transliteration and English Translation ==

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अथातो द्विव्रणीयचिकित्सितं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

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athātō dvivraṇīyacikitsitaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH ||2||

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</div></div>

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Now we shall expound the ~~treatment~~ of two types of ~~''vrana'' (ulcer~~).

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Now we shall expound the chapter "Dwivraniya chikitsa" (Management of two types of ulcers).Thus said Lord Atreya.[1-2]

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Thus said Lord Atreya.[1-2]

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==== Query by Agnivesha ====

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=== Query by Agnivesha ===

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परावरज्ञमात्रेयं गतमानमदव्यथम् |

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तयोर्लिङ्गं चिकित्सां च वक्तुमर्हसि शर्मद! ||४||

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parāvarajñamātrēyaṁ gatamānamadavyatham|

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tayorli~ggaM cikitsAM ca vaktumarhasi sharmada! ||4||

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</div></div>

Agnivesha, in opportune moment, respectfully submitted to his teacher Atreya, knower of the best and the worst and devoid of conceit, ego and suffering –“ O Lord ! Two types of ulcers have been mentioned earlier under enumeration of disorders; kindly describe their symptoms and treatment O conferer of happiness!”[3-4]

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==== Classification and etiology of ''vrana'' ====

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=== Classification and etiology of ''vrana'' ===

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इत्यग्निवेशस्य वचो निशम्य गुरुरब्रवीत् |

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लिङ्गैकदेशैर्निर्दिष्टा विपरीता निजैर्व्रणैः [२] ||८||

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ityagnivēśasya vacō niśamya gururabravīt|

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li~ggaikadeshairnirdiShTA viparItA nijairvraNaiH [2] ||8||

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</div></div>

After listening the request of Agnivesa the teacher said – ‘O gentle! Listen about the symptoms and treatment of the two types of ''vrana'' (ulcers) , endogenous ulcer and exogenous ulcer, as mentioned earlier.The endogenous ulcers occur from the bodily ''dosha'', whereas the exogenous ulcers are caused by external causative factors. Exogenous ulcer are caused by blowing, binding, falling down, injury with fangs, teeth or nails as well as due to poisonous contact, fire and weapons etc. Exogenous ulcers are different from the endogenous ones in respect of treatment with ''mantra'' (incantations), anti-poisonous pastes for external application etc. While endogenous ulcer bears opposite characteristic features in respect of etiology, sign symptoms and treatment. [5-8]

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==== Importance of ''dosha'' dominance in treatment ====

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=== Importance of [[dosha]] dominance in treatment ===

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व्रणानां निजहेतूनामागन्तूनामशाम्यताम् |

कुर्याद्दोषबलापेक्षी निजानामौषधं यथा ||९||

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vraṇānāṁ nijahētūnāmāgantūnāmaśāmyatām|

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kuryAddoShabalApekShI nijAnAmauShadhaM yathA ||9||

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</div></div>

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Exogenous ulcers not being pacified and having endogenous causative factors should be treated as endogenous ulcers according to predominance of ~~''doshas''~~.[9]

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Exogenous ulcers not being pacified and having endogenous causative factors should be treated as endogenous ulcers according to predominance of [[dosha]].[9]

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==== Endogenous ulcers ====

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=== Endogenous ulcers ===

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यथास्वैर्हेतुभिर्दुष्टा वातपित्तकफा नृणाम् |

बहिर्मार्गं समाश्रित्य जनयन्ति निजान् व्रणान् ||१०||

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yathāsvairhētubhirduṣṭā vātapittakaphā nr̥ṇām|

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bahirmArgaM samAshritya janayanti nijAn vraNAn ||10||

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</div></div>

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''Vata, pitta'' and ''kapha'' are vitiated by their respective causes get lodged in external passage and thus produce endogenous ulcers. [10]

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[[Vata]], [[pitta]] and [[kapha]] are vitiated by their respective causes get lodged in external passage and thus produce endogenous ulcers. [10]

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===~~= ''~~Dosha'' dominant ''vrana'' and their treatment ====

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=== [[Dosha]] dominant ''vrana'' and their treatment ===

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====~~= ''~~Vata'' dominant ''vrana'' and treatment =====

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==== [[Vata]] dominant ''vrana'' and treatment ====

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स्तब्धः कठिनसंस्पर्शो मन्दस्रावोऽतितीव्ररुक् [१] |

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प्रदेहैः परिषेकैश्च वातव्रणमुपाचरेत् ||१२||

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stabdhaḥ kaṭhinasaṁsparśō mandasrāvō'titīvraruk [1] |

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pradehaiH pariShekaishca vAtavraNamupAcaret ||12||

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</div></div>

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The ulcer caused by ''vata'' is stiff, hard to touch, with scanty exudation, excruciating and pricking pain with throbbing and blackish discoloration. ''Vatika'' ulcer should be treated with ''sampurana'' (filling of ulcer cavity), intake of unctuous substances (oleation therapy), unctuous fomentation and poultices, ointments and sprinklings.[11-12]

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The ulcer caused by [[vata]] is stiff, hard to touch, with scanty exudation, excruciating and pricking pain with throbbing and blackish discoloration. ''Vatika'' ulcer should be treated with ''sampurana'' (filling of ulcer cavity), intake of unctuous substances (oleation therapy), unctuous fomentation and poultices, ointments and sprinklings.[11-12]

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====~~= ''~~Pitta'' dominant ''vrana'' and treatment =====

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==== [[Pitta]] dominant ''vrana'' and treatment ====

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तृष्णामोहज्वरस्वे(क्ले)ददाहदुष्ट्यवदारणैः |

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सर्पिष्पानैर्विरेकैश्च पैत्तिकं शमयेद्व्रणम् ||१४||

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tr̥ṣṇāmōhajvarasvē(klē)dadāhaduṣṭyavadāraṇaiḥ|

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sarpiShpAnairvirekaishca paittikaM shamayedvraNam ||14||

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</div></div>

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~~''Pittaja''~~ ulcer is known from thirst, unconsciousness, fever, sweating, burning sensation, impurity, tearing and foul smell with discharge of pus from ulcer. One should pacify the ~~''pittaja''~~ ulcer by anointing and sprinkling with cold, intake of sweet and bitter drugs, intake of ghee and purgation. [13-14]

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[[Pitta]]ja ulcer is known from thirst, unconsciousness, fever, sweating, burning sensation, impurity, tearing and foul smell with discharge of pus from ulcer. One should pacify the [[pitta]]ja ulcer by anointing and sprinkling with cold, intake of sweet and bitter drugs, intake of ghee and purgation. [13-14]

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====~~= ''~~Kapha'' dominant ''vrana'' and treatment =====

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==== [[Kapha]] dominant ''vrana'' and treatment ====

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बहुपिच्छो गुरुः स्निग्धः स्तिमितो मन्दवेदनः |

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कफव्रणं प्रशमयेत्तथा लङ्घनपाचनैः [३] ||१६||

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bahupicchō guruḥ snigdhaḥ stimitō mandavēdanaḥ|

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kaphavraNaM prashamayettathA la~gghanapAcanaiH [3] ||16||

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</div></div>

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~~''Kaphaja''~~ ulcer has much sliminess, heavyness, unctuousness, numbness, with mild pain, paleness in color, little slough and prolonged healing. ~~''Kaphaja''~~ ulcer is treated with anointing and sprinkling with astringent, pungent, dry and hot drugs as well as fasting and digestive measures.[15-16]

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[[Kapha]]ja ulcer has much sliminess, heavyness, unctuousness, numbness, with mild pain, paleness in color, little slough and prolonged healing. [[Kapha]]ja ulcer is treated with anointing and sprinkling with astringent, pungent, dry and hot drugs as well as fasting and digestive measures.[15-16]

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तौ द्वौ नानात्वभेदेन निरुक्ता विंशतिर्व्रणाः |

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विभज्यमानाञ्छृणु [१] मे सर्वानेतान् यथेरितान् ||१९||

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tau dvau nānātvabhēdēna niruktā viṁśatirvraṇāḥ|

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vibhajyamAnA~jchRuNu [1] me sarvAnetAn yatheritAn ||19||

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</div></div>

Above 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 ulcers are of twelve types, eight locations, fourteen types of discharges, sixteen complications, twenty four defects and thirty six therapeutic measures. Now listen about these in details. [17-19]

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==== Twenty types of ulcers ====

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=== Twenty types of ulcers ===

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कृत्योत्कृत्यस्तथा [१] दुष्टोऽदुष्टो मर्मस्थितो न च |

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इति नानात्वभेदेन निरुक्ता [२] विंशतिर्व्रणाः ||२१||

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kr̥tyōtkr̥tyastathā [1] duṣṭō'duṣṭō marmasthitō na ca|

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iti nAnAtvabhedena niruktA [2] viMshatirvraNAH ||21||

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</div></div>

Curable (can be treated with surgical intervention), incurable; infected, non-infected; situated in vital parts, not situated in vital parts; closed, open; hard, soft; discharging, non-discharging; poisonous, non-poisonous; unevenly located, evenly located; pouched, un-pouched; elevated, depressed – these are the twenty types of ulcers according to various distinguishing features.[20-21]

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==== Three fold examination ====

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=== Three fold examination ===

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दर्शनप्रश्नसंस्पर्शैः परीक्षा त्रिविधा स्मृता |

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स्पर्शान्मार्दवशैत्ये च परीक्ष्ये सविपर्यये ||२३||

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darśanapraśnasaṁsparśaiḥ parīkṣā trividhā smr̥tā|

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sparshAnmArdavashaitye ca parIkShye saviparyaye ||23||

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</div></div>

Examination of ulcer can be performed by three methods e.g. by inspection, interrogation and palpation.

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Age, complexion and color, body parts and sense organs are examined by inspection. Etiology, nature of pain, suitability and power of digestion should be known by patient’s statement. By palpation softness and coldness are known with their contraries. [22-23]

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==== Twelve types of ulcers ====

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=== Twelve types of ulcers ===

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श्वेतोऽवसन्नवर्त्माऽतिस्थूलवर्त्माऽतिपिञ्जरः [१] |

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चतुर्विंशतिरुद्दिष्टा [२] दोषाः कल्पान्तरेण वै ||२५||

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śvētō'vasannavartmā'tisthūlavartmā'tipiñjaraḥ [1] |

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caturviMshatiruddiShTA [2] doShAH kalpAntareNa vai ||25||

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</div></div>

White, with depressed margins, very thick margins, much greyish (''pinjara''), blue, blackish, surrounded with numerous boils, red, black, very fetid odor, non- healing nature and bottle-necked (narrow opening) these are twelve types of defective (''dushta'') ulcers.[24-25]

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==== Sites of vitiation ====

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=== Sites of vitiation ===

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त्वक्सिरामांसमेदोऽस्थिस्नायुमर्मान्तराश्रयाः |

व्रणस्थानानि निर्दिष्टान्यष्टावेतानि सङ्ग्रहे ||२६||

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tvaksirāmāṁsamēdō'sthisnāyumarmāntarāśrayāḥ|

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vraNasthAnAni nirdiShTAnyaShTAvetAni sa~ggrahe ||26||

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</div></div>

In the treatise, eight locations of wounds have been mentioned such as skin, blood vessels, flesh, fat, bone, ligament, vital parts and viscera.[26]

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==== Specific odors of ''vrana'' ====

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=== Specific odors of ''vrana'' ===

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सर्पिस्तैलवसापूयरक्तश्यावाम्लपूतिकाः |

व्रणानां व्रणगन्धज्ञैरष्टौ गन्धाः प्रकीर्तिताः ||२७||

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sarpistailavasāpūyaraktaśyāvāmlapūtikāḥ|

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vraNAnAM vraNagandhaj~jairaShTau gandhAH prakIrtitAH ||27||

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</div></div>

Eight types of wound odors have been defined by the experts like ghee, oil, muscle-fat, pus, blood, and cadaver, sour and fetid.[27]

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==== Fourteen types of discharges and sixteen complications ====

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=== Fourteen types of discharges and sixteen complications ===

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लसीकाजलपूयासृग्घारिद्रारुणपिञ्जराः |

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षोडशोपद्रवाः प्रोक्ता व्रणानां व्रणचिन्तकैः |३१|

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lasīkājalapūyāsr̥gghāridrāruṇapiñjarāḥ|

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ShoDashopadravAH proktA vraNAnAM vraNacintakaiH |31|

+

</div></div>

Discharges from ulcers are of fourteen types in appearance such as ''lasika'' (like lymph), water, pus, blood, color of exudation as yellow, reddish, brownish, ochre-colored, blue, green, unctuous, rough, white and black.

Line 449: Line 512:

The experts have mentioned sixteen complications of wounds such as erysipelas, paralysis, occlusion in blood vessels, tetanus, and mental confusion, and insanity, pain in wound, fever, thirst, lockjaw, cough, vomiting, diarrhea, hiccups, dyspnea and trembling.[28-31]

−

==== Causes of non-healing ulcers ====

+

=== Causes of non-healing ulcers ===

+

स्नायुक्लेदात्सिराक्लेदाद्गाम्भीर्यात्कृमिभक्षणात् [१] ||३१||

Line 468: Line 532:

व्रणानां बहुदोषाणां कृच्छ्रत्वं चोपजायते ||३५||

+

snāyuklēdātsirāklēdādgāmbhīryātkr̥mibhakṣaṇāt [1] ||31||

Line 504: Line 569:

vraNAnAM bahudoShANAM kRucchratvaM copajAyate ||35||

+

</div></div>

Defects are known to be twenty four according to etiological factors which are as follows: moistening of ligaments, excess of fluid in blood vessels, deepness, eaten by maggots, cracking of bones, presence of foreign body, presence of toxins, spreading, excessive tearing with nails or wooden piece, friction of skin, friction of body hair, faulty bandage, over-application of uncting substance, excessive emaciation due to over dose, indigestion, over-eating, intake of incompatible food items, unsuitable food, grief, anger, day-sleep, physical exercise, sexual intercourse and inactivity.These factors lead to delay in the healing process. Ulcers having much impurity become difficult to be cured due to presence of excessive discharges, odors, defects and complications.[31-35]

−

==== Factors affecting prognosis ====

+

=== Factors affecting prognosis ===

+

त्वङ्मांसजः सुखे देशे तरुणस्यानुपद्रवः |

Line 516: Line 583:

सर्वैर्विहीनो विज्ञेयस्त्वसाध्यो निरुपक्रमः [१] ||३७||

+

tvaṅmāṁsajaḥ sukhē dēśē taruṇasyānupadravaḥ|

Line 532: Line 600:

sarvairvihIno vij~jeyastvasAdhyo nirupakramaH [1] ||37||

+

</div></div>

Wound is easily curable if it is located in skin and muscles, easy places, youthful age, without complication, in a wise patient and of recent origin. If it is devoid of some of these qualities it is curable with difficulty and when it is devoid of all the qualities it is incurable and thus not to be treated.[36-37]

−

==== Principles of management ====

+

=== Principles of management ===

+

व्रणानामादितः कार्यं यथासन्नं विशोधनम् |

Line 542: Line 612:

सद्यः शुद्धशरीराणां प्रशमं यान्ति हि व्रणाः |३९|

+

vraṇānāmāditaḥ kāryaṁ yathāsannaṁ viśōdhanam|

Line 555: Line 626:

sadyaH shuddhasharIrANAM prashamaM yAnti hi vraNAH |39|

−

In cases of wound, first of all, purification with therapeutic emesis, purgation, ''shastra karma'' (surgical intervention) and ''basti'' (medicated enema) should be done after assessment of condition because the wounds get healed quickly in those with cleansed body.[38-39]

+

</div></div>

+

In cases of wound, first of all, purification with therapeutic emesis, purgation, ''shastra karma'' (surgical intervention) and [[basti]] (medicated enema) should be done after assessment of condition because the wounds get healed quickly in those with cleansed body.[38-39]

−

==== Procedures for management of ulcers ====

+

=== Procedures for management of ulcers ===

+

यथाक्रममतश्चोर्ध्वं शृणु सर्वानुपक्रमान् ||३९||

Line 576: Line 649:

इति षट्त्रिंशदुद्दिष्टा व्रणानां समुपक्रमाः ||४३||

+

yathākramamataścōrdhvaṁ śr̥ṇu sarvānupakramān||39||

Line 612: Line 686:

iti ShaTtriMshaduddiShTA vraNAnAM samupakramAH ||43||

+

</div></div>

Hereafter listen about all the measures of treatment in order such as – measures for pacification of swelling, six types of surgical operations, pressing, cooling?, 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, repilatory- these are the thirty six measures of treatment of wounds.[39-43]

−

==== Guidelines for management of ulcers ====

+

=== Guidelines for management of ulcers ===

+

पूर्वरूपं भिषग्बुद्ध्वा व्रणानां शोफमादितः |

Line 636: Line 712:

अविदाहीनि चान्नानि शोफे भेषजमुत्तमम् ||४८||

+

pūrvarūpaṁ bhiṣagbuddhvā vraṇānāṁ śōphamāditaḥ|

Line 676: Line 753:

avidAhIni cAnnAni shophe bheShajamuttamam ||48||

+

</div></div>

−

The physician observing ''shopha'' (swelling) as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. One should evacuate the persons with plenty of impurity and lighten those with little impurity. He should overcome the wound predominant in ''vata'' first with decoctions and ghritas. Paste of ''nyogrodha'' bark (Ficus bengalensis Linn.), ''udumbara'' (Ficus glomerata Roxb.), ''ashwattha'' (Ficus religiosa Linn.), ''plaksha'' (Ficus lacor Buch.Ham.) and ''vetasa'' (Salix caprea Linn.) are mixed with ghee is an excellent cooling for inflammation, other local applications prescribed are (1) ''vijaya'' (Terminalia chebula Retz.), ''madhuka'' (Glycyrrhiza glabra Linn.), ''vira , bisagranthi, shatavari'' (Asparagus racemosus Willd.), ''nilotpala'' (Nymphea stellata Willd.), ''nagapuspa'' (Mesua ferrea Linn.) and ''sandal'' (Santalum album Linn.). (2) Parched grain flour, ''madhuka, sarkara'' and ghee. ''Avidahi'' (non-burning) food is the best remedy for inflammation.[44-48]

+

The physician observing ''shopha'' (swelling) as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. One should evacuate the persons with plenty of impurity and lighten those with little impurity. He should overcome the wound predominant in [[vata]] first with decoctions and ghritas. Paste of ''nyogrodha'' bark (Ficus bengalensis Linn.), ''udumbara'' (Ficus glomerata Roxb.), ''ashwattha'' (Ficus religiosa Linn.), ''plaksha'' (Ficus lacor Buch.Ham.) and ''vetasa'' (Salix caprea Linn.) are mixed with ghee is an excellent cooling for inflammation, other local applications prescribed are (1) ''vijaya'' (Terminalia chebula Retz.), ''madhuka'' (Glycyrrhiza glabra Linn.), ''vira , bisagranthi, shatavari'' (Asparagus racemosus Willd.), ''nilotpala'' (Nymphea stellata Willd.), ''nagapuspa'' (Mesua ferrea Linn.) and ''sandal'' (Santalum album Linn.). (2) Parched grain flour, ''madhuka, sarkara'' and ghee. ''Avidahi'' (non-burning) food is the best remedy for inflammation.[44-48]

−

==== ''Patana'' (incision) and ''upanaha'' (poultice) ====

+

=== ''Patana'' (incision) and ''upanaha'' (poultice) ===

+

स चेदेवमुपक्रान्तः शोफो न प्रशमं व्रजेत् |

Line 704: Line 783:

सुकुमारस्य, कृच्छ्रस्य शस्त्रं तु परमुच्यते ||५४||

+

sa cēdēvamupakrāntaḥ śōphō na praśamaṁ vrajēt|

Line 752: Line 832:

sukumArasya, kRucchrasya shastraM tu paramucyate ||54||

+

</div></div>

If swelling of ulcers treated in this way does not subside, poultice should be applied and when ripened should be incised. Warm poultice of the bolus of parched grain flour mixed with oil or ghee or both is useful for ripening of inflammation. The bolus of parched grain flour mixed with ''tila'' (Sesamum indicum Linn.), linseeds (Linum usitatissimum Linn.), sour curd, yeast, ''kustha'' (Saussurea lappa C. B. Clarke) and salt is recommended as poultice.

Line 757: Line 838:

Swelling is known as ''vidagdha'' (under ripening) by the symptoms such as pain, burning sensation, redness and piercing pain. The same should be known as ripened when it is like water-bag on palpation and rises on pressure. Linseed, ''guggulu'' (Commiphora mukul), latex of ''snuhi'' (Euphorbia neriifolia Linn.), feces of chicken and pigeon, alkali of ''palasha'' (Butea monosperma Linn.), ''svarnakhsiri'' (Argemone mexicana Linn.) and ''mukulaka'' (Pistacia vera Linn.). This is the group of drugs which helps in the tearing of ripened inflammation in delicate patients otherwise it should be operated upon surgically.[49-54]

−

==== Six types of surgical procedures ====

+

=== Six types of surgical procedures ===

+

पाटनं व्यधनं चैव छेदनं लेपनं तथा |

प्रच्छनं सीवनं चैव षङ्विधं शस्त्रकर्म तत् ||५५||

+

pāṭanaṁ vyadhanaṁ caiva chēdanaṁ lēpanaṁ tathā|

Line 770: Line 853:

pracchanaM sIvanaM caiva Sha~gvidhaM shastrakarma tat ||55||

+

</div></div>

Surgical treatment is of six types such as – incision, puncturing, excision, scrapping, scarification and suturing.[55]

−

==== Indications of various surgical procedures ====

+

=== Indications of various surgical procedures ===

+

नाडीव्रणाः पक्वशोथास्तथा क्षतगुदोदरम् |

Line 796: Line 881:

इति षड्विधमुद्दिष्टं शस्त्रकर्म मनीषिभिः |६१|

+

nāḍīvraṇāḥ pakvaśōthāstathā kṣatagudōdaram|

Line 840: Line 926:

iti ShaDvidhamuddiShTaM shastrakarma manIShibhiH |61|

+

</div></div>

−

Sinuses, ripened inflammations (i.e.suppurated ulcer or abscess), intestinal perforation, intestinal obstruction, having foreign body within and other similar conditions are incisable. Ascites, suppurated tumor and ~~''raktaja~~ gulma'' (uterine tumor), blood disorders such as erysipelas, boils etc, are treated by puncturing. Wounds protruded with thick margins, elevated, hard, piles etc and other growths should be excised.The wise physician should scrape leucoderma, skin diseases and other such disorders which need scraping. The physician should perform scarification over ''vatarakta'' (nodular swelling), ''granthi'' (cysts) pimples, urticarial rashes, red patches, skin diseases, injured parts and swellings. Suturing should be done in pelvic, abdominal surgeries (i.e., laparotomy) etc.Thus the scholars have mentioned six types of surgical treatments.[56-61]

+

Sinuses, ripened inflammations (i.e.suppurated ulcer or abscess), intestinal perforation, intestinal obstruction, having foreign body within and other similar conditions are incisable. Ascites, suppurated tumor and [[rakta]]ja gulma (uterine tumor), blood disorders such as erysipelas, boils etc, are treated by puncturing. Wounds protruded with thick margins, elevated, hard, piles etc and other growths should be excised.The wise physician should scrape leucoderma, skin diseases and other such disorders which need scraping. The physician should perform scarification over vatarakta(nodular swelling), ''granthi'' (cysts) pimples, urticarial rashes, red patches, skin diseases, injured parts and swellings. Suturing should be done in pelvic, abdominal surgeries (i.e., laparotomy) etc.Thus the scholars have mentioned six types of surgical treatments.[56-61]

−

==== ''Vrana pidana''(pressing of wound) ====

+

=== ''Vrana pidana''(pressing of wound) ===

+

सूक्ष्माननाः कोषवन्तो ये व्रणास्तान्प्रपीडयेत् ||६१||

Line 850: Line 938:

कल्कीकृताः प्रशस्यन्ते निःस्नेहा व्रणपीडने ||६२||

+

sūkṣmānanāḥ kōṣavantō yē vraṇāstānprapīḍayēt||61||

Line 862: Line 951:

kalkIkRutAH prashasyante niHsnehA vraNapIDane ||62||

+

</div></div>

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 for pacification of ulcer ====

+

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

+

शाल्मलीत्वग्बलामूलं तथा न्यग्रोधपल्लवाः |

Line 876: Line 967:

निर्वापयेत् सुशीतेन रक्तपित्तोत्तरान् व्रणान् |६५|

+

śālmalītvagbalāmūlaṁ tathā nyagrōdhapallavāḥ|

Line 896: Line 988:

nirvApayet sushItena raktapittottarAn vraNAn |65|

+

</div></div>

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||

Line 910: Line 1,004:

धातकीलोध्रचूर्णैर्वा तथा रोहन्ति ते व्रणाः |६८|

+

lambāni vraṇamāṁsāni pralipya madhusarpiṣā||65||

Line 934: Line 1,029:

dhAtakIlodhracUrNairvA tathA rohanti te vraNAH |68|

+

</div></div>

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.

Line 939: Line 1,035:

Application of above measures leads to proper wounds healing.[65-68]

−

==== Management of bone fracture and dislocation ====

+

=== Management of bone fracture and dislocation ===

+

अस्थिभग्नं च्युतं सन्धिं सन्दधीत समं पुनः ||६८||

Line 956: Line 1,053:

उपाचरेद्यथाकालं [१] कालज्ञः स्वाच्चिकित्सितात् |७२|

+

asthibhagnaṁ cyutaṁ sandhiṁ sandadhīta samaṁ punaḥ||68||

Line 988: Line 1,086:

upAcaredyathAkAlaM [1] kAlaj~jaH svAccikitsitAt |72|

+

</div></div>

Fractured bone and dislocated joints should be set correctly comparing with its counterpart. Setting with firm pad-bandages and splints, it should be immobilized 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 |

Line 1,024: Line 1,124:

रुग्दाहयोः प्रशमनो व्रणेष्वेष विधिर्हितः ||७९||

+

śuṣkā mahārujaḥ stabdhā yē vraṇā mārutōttarāḥ|

Line 1,088: Line 1,189:

rugdAhayoH prashamano vraNeShveSha vidhirhitaH ||79||

+

</div></div>

−

Wounds which are dry, intensely 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 beeswax is known as ''sneha sarkara'', it relieves pain.The wound should be sprinkled with warm decoction of two ''panchamula'' (ie.''dashamula''), milk and ghee with oil.

+

Wounds which are dry, intensely 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 beeswax is known as ''sneha sarkara'', it relieves pain.The wound should be sprinkled with warm decoction of two ''panchamula'' (ie.''dashamula''), 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]

−

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

+

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

+

−

सूक्ष्मानना बहुस्रावाः कोषवन्तश्च ये व्रणाः |

+

सूक्ष्मानना बहुस्रावाः कोषवन्तश्च ये व्रणाः | <br />

−

न च मर्माश्रितास्तेषामेषणं हितमुच्यते ||८०||

+

न च मर्माश्रितास्तेषामेषणं हितमुच्यते ||८०|| <br />

−

द्विविधामेषणीं विद्यान्मृद्वीं च कठिनामपि |

+

द्विविधामेषणीं विद्यान्मृद्वीं च कठिनामपि | <br />

−

औद्भिदैर्मृदुभिर्नालैर्लोहानां वा शलाकया ||८१||

+

औद्भिदैर्मृदुभिर्नालैर्लोहानां वा शलाकया ||८१|| <br />

−

गम्भीरे मांसले देशे पाट्यं लौहशलाकया |

+

गम्भीरे मांसले देशे पाट्यं लौहशलाकया | <br />

−

एष्यं विद्याद्व्रणं नालैर्विपरीतमतो भिषक् ||८२||

+

एष्यं विद्याद्व्रणं नालैर्विपरीतमतो भिषक् ||८२|| <br />

+

−

sūkṣmānanā bahusrāvāḥ kōṣavantaśca yē vraṇāḥ|

+

sūkṣmānanā bahusrāvāḥ kōṣavantaśca yē vraṇāḥ| <br />

−

na ca marmāśritāstēṣāmēṣaṇaṁ hitamucyatē||80||

+

na ca marmāśritāstēṣāmēṣaṇaṁ hitamucyatē||80|| <br />

−

dvividhāmēṣaṇīṁ vidyānmr̥dvīṁ ca kaṭhināmapi|

+

dvividhāmēṣaṇīṁ vidyānmr̥dvīṁ ca kaṭhināmapi| <br />

−

audbhidairmr̥dubhirnālairlōhānāṁ vā śalākayā||81||

+

audbhidairmr̥dubhirnālairlōhānāṁ vā śalākayā||81|| <br />

−

gambhīrē māṁsalē dēśē pāṭyaṁ lauhaśalākayā|

+

gambhīrē māṁsalē dēśē pāṭyaṁ lauhaśalākayā| <br />

−

ēṣyaṁ vidyādvraṇaṁ nālairviparītamatō bhiṣak||82||

+

ēṣyaṁ vidyādvraṇaṁ nālairviparītamatō bhiṣak||82||<br />

−

sUkShmAnanA bahusrAvAH koShavantashca ye vraNAH |

+

sUkShmAnanA bahusrAvAH koShavantashca ye vraNAH | <br />

−

na ca marmAshritAsteShAmeShaNaM hitamucyate ||80||

+

na ca marmAshritAsteShAmeShaNaM hitamucyate ||80|| <br />

−

dvividhAmeShaNIM vidyAnmRudvIM ca kaThinAmapi |

+

dvividhAmeShaNIM vidyAnmRudvIM ca kaThinAmapi | <br />

−

audbhidairmRudubhirnAlairlohAnAM vA shalAkayA ||81||

+

audbhidairmRudubhirnAlairlohAnAM vA shalAkayA ||81|| <br />

−

gambhIre mAMsale deshe pATyaM lauhashalAkayA |

+

gambhIre mAMsale deshe pATyaM lauhashalAkayA | <br />

−

eShyaM vidyAdvraNaM nAlairviparItamato bhiShak ||82||

+

eShyaM vidyAdvraNaM nAlairviparItamato bhiShak ||82||<br />

+

</div></div>

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]

−

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

+

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

+

−

पूतिगन्धान् विवर्णांश्च बहुस्रावान्महारुजः |

+

पूतिगन्धान् विवर्णांश्च बहुस्रावान्महारुजः | <br />

−

व्रणानशुद्धान् विज्ञाय शोधनैः समुपाचरेत् ||८३||

+

व्रणानशुद्धान् विज्ञाय शोधनैः समुपाचरेत् ||८३|| <br />

−

त्रिफला खदिरो दार्वी न्यग्रोधादिर्बला [१] कुशः |

+

त्रिफला खदिरो दार्वी न्यग्रोधादिर्बला [१] कुशः | <br />

−

निम्बकोलकपत्राणि कषायाः शोधना मताः ||८४||

+

निम्बकोलकपत्राणि कषायाः शोधना मताः ||८४|| <br />

−

तिलकल्कः सलवणो द्वे हरिद्रे त्रिवृद्धृतम् |

+

तिलकल्कः सलवणो द्वे हरिद्रे त्रिवृद्धृतम् | <br />

−

मधुकं निम्बपत्राणि प्रलेपो व्रणशोधनः ||८५||

+

मधुकं निम्बपत्राणि प्रलेपो व्रणशोधनः ||८५|| <br />

+

−

pūtigandhān vivarṇāṁśca bahusrāvānmahārujaḥ|

+

pūtigandhān vivarṇāṁśca bahusrāvānmahārujaḥ| <br />

−

vraṇānaśuddhān vijñāya śōdhanaiḥ samupācarēt||83||

+

vraṇānaśuddhān vijñāya śōdhanaiḥ samupācarēt||83|| <br />

−

triphalā khadirō dārvī nyagrōdhādirbalā [1] kuśaḥ|

+

triphalā khadirō dārvī nyagrōdhādirbalā [1] kuśaḥ| <br />

−

nimbakōlakapatrāṇi kaṣāyāḥ śōdhanā matāḥ||84||

+

nimbakōlakapatrāṇi kaṣāyāḥ śōdhanā matāḥ||84|| <br />

−

tilakalkaḥ salavaṇō dvē haridrē trivr̥ddhr̥tam|

+

tilakalkaḥ salavaṇō dvē haridrē trivr̥ddhr̥tam| <br />

−

madhukaṁ nimbapatrāṇi pralēpō vraṇaśōdhanaḥ||85||

+

madhukaṁ nimbapatrāṇi pralēpō vraṇaśōdhanaḥ||85|| <br />

−

pUtigandhAn vivarNAMshca bahusrAvAnmahArujaH |

+

pUtigandhAn vivarNAMshca bahusrAvAnmahArujaH | <br />

−

vraNAnashuddhAn vij~jAya shodhanaiH samupAcaret ||83||

+

vraNAnashuddhAn vij~jAya shodhanaiH samupAcaret ||83|| <br />

−

triphalA khadiro dArvI nyagrodhAdirbalA [1] kushaH |

+

triphalA khadiro dArvI nyagrodhAdirbalA [1] kushaH | <br />

−

nimbakolakapatrANi kaShAyAH shodhanA matAH ||84||

+

nimbakolakapatrANi kaShAyAH shodhanA matAH ||84|| <br />

−

tilakalkaH salavaNo dve haridre trivRuddhRutam |

+

tilakalkaH salavaNo dve haridre trivRuddhRutam | <br />

−

madhukaM nimbapatrANi pralepo vraNashodhanaH ||85||

+

madhukaM nimbapatrANi pralepo vraNashodhanaH ||85||<br />

+

</div></div>

Wounds with foul odor, abnormal color, profuse discharge and intense pain should be known as ''dushta 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 ''nimba'' (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 | <br />

−

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

+

न चोत्सन्नो न चोत्सङ्गी शुद्धो रोप्यः परं व्रणः ||८६|| <br />

−

न्यग्रोधोदुम्बराश्वत्थकदम्बप्लक्षवेतसाः |

+

न्यग्रोधोदुम्बराश्वत्थकदम्बप्लक्षवेतसाः | <br />

−

करवीरार्ककुटजाः कषाया व्रणरोपणाः ||८७||

+

करवीरार्ककुटजाः कषाया व्रणरोपणाः ||८७|| <br />

−

चन्दनं पद्मकिञ्जल्कं दार्वीत्वङ्नीलमुत्पलम् |

+

चन्दनं पद्मकिञ्जल्कं दार्वीत्वङ्नीलमुत्पलम् | <br />

−

मेदे मूर्वा समङ्गा च यष्ट्याह्वं व्रणरोपणम् ||८८||

+

मेदे मूर्वा समङ्गा च यष्ट्याह्वं व्रणरोपणम् ||८८|| <br />

−

प्रपौण्डरीकं जीवन्ती गोजिह्वा धातकी बला |

+

प्रपौण्डरीकं जीवन्ती गोजिह्वा धातकी बला | <br />

−

रोपणं सतिलं दद्यात् प्रलेपं सघृतं व्रणे ||८९||

+

रोपणं सतिलं दद्यात् प्रलेपं सघृतं व्रणे ||८९|| <br />

−

कम्पिल्लकं विडङ्गानि वत्सकं त्रिफलां बलाम् |

+

कम्पिल्लकं विडङ्गानि वत्सकं त्रिफलां बलाम् | <br />

−

पटोलं पिचुमर्दं च लोध्रं मुस्तं प्रियङ्गुकम् ||९०||

+

पटोलं पिचुमर्दं च लोध्रं मुस्तं प्रियङ्गुकम् ||९०|| <br />

−

खदिरं धातकीं सर्जमेलामगुरुचन्दने |

+

खदिरं धातकीं सर्जमेलामगुरुचन्दने | <br />

−

पिष्ट्वा साध्यं भवेत्तैलं तत् परं व्रणरोपणम् ||९१||

+

पिष्ट्वा साध्यं भवेत्तैलं तत् परं व्रणरोपणम् ||९१|| <br />

−

प्रपौण्डरीकं मधुकं काकोल्यौ द्वे च चन्दने |

+

प्रपौण्डरीकं मधुकं काकोल्यौ द्वे च चन्दने | <br />

−

सिद्धमेतैः समैस्तैलं परं स्याद्व्रणरोपणम् ||९२||

+

सिद्धमेतैः समैस्तैलं परं स्याद्व्रणरोपणम् ||९२|| <br />

−

दूर्वास्वरससिद्धं वा तैलं कम्पिल्लकेन वा |

+

दूर्वास्वरससिद्धं वा तैलं कम्पिल्लकेन वा | <br />

−

दार्वीत्वचश्च कल्केन प्रधानं व्रणरोपणम् ||९३||

+

दार्वीत्वचश्च कल्केन प्रधानं व्रणरोपणम् ||९३|| <br />

−

येनैव विधिना तैलं घृतं तेनैव साधयेत् |

+

येनैव विधिना तैलं घृतं तेनैव साधयेत् | <br />

−

रक्तपित्तोत्तरं दृष्ट्वा रोपणीयं व्रणं भिषक् ||९४|

+

रक्तपित्तोत्तरं दृष्ट्वा रोपणीयं व्रणं भिषक् ||९४| <br />

+

−

nātiraktō nātipāṇḍurnātiśyāvō na cātiruk|

+

nātiraktō nātipāṇḍurnātiśyāvō na cātiruk| <br />

−

na cōtsannō na cōtsaṅgī śuddhō rōpyaḥ paraṁ vraṇaḥ||86||

+

na cōtsannō na cōtsaṅgī śuddhō rōpyaḥ paraṁ vraṇaḥ||86|| <br />

−

nyagrōdhōdumbarāśvatthakadambaplakṣavētasāḥ|

+

nyagrōdhōdumbarāśvatthakadambaplakṣavētasāḥ| <br />

−

karavīrārkakuṭajāḥ kaṣāyā vraṇarōpaṇāḥ||87||

+

karavīrārkakuṭajāḥ kaṣāyā vraṇarōpaṇāḥ||87|| <br />

−

candanaṁ padmakiñjalkaṁ dārvītvaṅnīlamutpalam|

+

candanaṁ padmakiñjalkaṁ dārvītvaṅnīlamutpalam| <br />

−

mēdē mūrvā samaṅgā ca yaṣṭyāhvaṁ vraṇarōpaṇam||88||

+

mēdē mūrvā samaṅgā ca yaṣṭyāhvaṁ vraṇarōpaṇam||88|| <br />

−

prapauṇḍarīkaṁ jīvantī gōjihvā dhātakī balā|

+

prapauṇḍarīkaṁ jīvantī gōjihvā dhātakī balā| <br />

−

rōpaṇaṁ satilaṁ dadyāt pralēpaṁ saghr̥taṁ vraṇē||89||

+

rōpaṇaṁ satilaṁ dadyāt pralēpaṁ saghr̥taṁ vraṇē||89|| <br />

−

kampillakaṁ viḍaṅgāni vatsakaṁ triphalāṁ balām|

+

kampillakaṁ viḍaṅgāni vatsakaṁ triphalāṁ balām| <br />

−

paṭōlaṁ picumardaṁ ca lōdhraṁ mustaṁ priyaṅgukam||90||

+

paṭōlaṁ picumardaṁ ca lōdhraṁ mustaṁ priyaṅgukam||90|| <br />

−

khadiraṁ dhātakīṁ sarjamēlāmagurucandanē|

+

khadiraṁ dhātakīṁ sarjamēlāmagurucandanē| <br />

−

piṣṭvā sādhyaṁ bhavēttailaṁ tat paraṁ vraṇarōpaṇam||91||

+

piṣṭvā sādhyaṁ bhavēttailaṁ tat paraṁ vraṇarōpaṇam||91|| <br />

−

prapauṇḍarīkaṁ madhukaṁ kākōlyau dvē ca candanē|

+

prapauṇḍarīkaṁ madhukaṁ kākōlyau dvē ca candanē| <br />

−

siddhamētaiḥ samaistailaṁ paraṁ syādvraṇarōpaṇam||92||

+

siddhamētaiḥ samaistailaṁ paraṁ syādvraṇarōpaṇam||92|| <br />

−

dūrvāsvarasasiddhaṁ vā tailaṁ kampillakēna vā|

+

dūrvāsvarasasiddhaṁ vā tailaṁ kampillakēna vā| <br />

−

dārvītvacaśca kalkēna pradhānaṁ vraṇarōpaṇam||93||

+

dārvītvacaśca kalkēna pradhānaṁ vraṇarōpaṇam||93|| <br />

−

yēnaiva vidhinā tailaṁ ghr̥taṁ tēnaiva sādhayēt|

+

yēnaiva vidhinā tailaṁ ghr̥taṁ tēnaiva sādhayēt| <br />

−

raktapittōttaraṁ dr̥ṣṭvā rōpaṇīyaṁ vraṇaṁ bhiṣak||94||

+

raktapittōttaraṁ dr̥ṣṭvā rōpaṇīyaṁ vraṇaṁ bhiṣak||94|| <br />

−

| nAtirakto nAtipANDurnAtishyAvo na cAtiruk |

+

| nAtirakto nAtipANDurnAtishyAvo na cAtiruk | <br />

−

na cotsanno na cotsa~ggI shuddho ropyaH paraM vraNaH ||86||

+

na cotsanno na cotsa~ggI shuddho ropyaH paraM vraNaH ||86|| <br />

−

nyagrodhodumbarAshvatthakadambaplakShavetasAH |

+

nyagrodhodumbarAshvatthakadambaplakShavetasAH | <br />

−

karavIrArkakuTajAH kaShAyA vraNaropaNAH ||87||

+

karavIrArkakuTajAH kaShAyA vraNaropaNAH ||87|| <br />

−

candanaM padmaki~jjalkaM dArvItva~gnIlamutpalam |

+

candanaM padmaki~jjalkaM dArvItva~gnIlamutpalam | <br />

−

mede mUrvA sama~ggA ca yaShTyAhvaM vraNaropaNam ||88||

+

mede mUrvA sama~ggA ca yaShTyAhvaM vraNaropaNam ||88|| <br />

−

prapauNDarIkaM jIvantI gojihvA dhAtakI balA |

+

prapauNDarIkaM jIvantI gojihvA dhAtakI balA | <br />

−

ropaNaM satilaM dadyAt pralepaM saghRutaM vraNe ||89||

+

ropaNaM satilaM dadyAt pralepaM saghRutaM vraNe ||89|| <br />

−

kampillakaM viDa~ggAni vatsakaM triphalAM balAm |

+

kampillakaM viDa~ggAni vatsakaM triphalAM balAm | <br />

−

paTolaM picumardaM ca lodhraM mustaM priya~ggukam ||90||

+

paTolaM picumardaM ca lodhraM mustaM priya~ggukam ||90|| <br />

−

khadiraM dhAtakIM sarjamelAmagurucandane |

+

khadiraM dhAtakIM sarjamelAmagurucandane | <br />

−

piShTvA sAdhyaM bhavettailaM tat paraM vraNaropaNam ||91||

+

piShTvA sAdhyaM bhavettailaM tat paraM vraNaropaNam ||91|| <br />

−

prapauNDarIkaM madhukaM kAkolyau dve ca candane |

+

prapauNDarIkaM madhukaM kAkolyau dve ca candane | <br />

−

siddhametaiH samaistailaM paraM syAdvraNaropaNam ||92||

+

siddhametaiH samaistailaM paraM syAdvraNaropaNam ||92|| <br />

−

dUrvAsvarasasiddhaM vA tailaM kampillakena vA |

+

dUrvAsvarasasiddhaM vA tailaM kampillakena vA | <br />

−

dArvItvacashca kalkena pradhAnaM vraNaropaNam ||93||

+

dArvItvacashca kalkena pradhAnaM vraNaropaNam ||93|| <br />

−

yenaiva vidhinA tailaM ghRutaM tenaiva sAdhayet |

+

yenaiva vidhinA tailaM ghRutaM tenaiva sAdhayet | <br />

−

raktapittottaraM dRuShTvA ropaNIyaM vraNaM bhiShak ||94||

+

raktapittottaraM dRuShTvA ropaNIyaM vraNaM bhiShak ||94||<br />

+

</div></div>

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. ''Chandana'' (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.), ''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]

−

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

+

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

+

−

कदम्बार्जुननिम्बानां पाटल्याः पिप्पलस्य च |

+

कदम्बार्जुननिम्बानां पाटल्याः पिप्पलस्य च | <br />

−

व्रणप्रच्छादने विद्वान् पत्राण्यर्कस्य चादिशेत् ||९५||

+

व्रणप्रच्छादने विद्वान् पत्राण्यर्कस्य चादिशेत् ||९५|| <br />

−

वार्क्षोऽथवाऽऽजिनः क्षौमः पट्टो व्रणहितः स्मृतः |

+

वार्क्षोऽथवाऽऽजिनः क्षौमः पट्टो व्रणहितः स्मृतः | <br />

−

बन्धश्च द्विविधः शस्तो व्रणानां सव्यदक्षिणः ||९६||

+

बन्धश्च द्विविधः शस्तो व्रणानां सव्यदक्षिणः ||९६|| <br />

+

−

kadambārjunanimbānāṁ pāṭalyāḥ pippalasya ca|

+

kadambārjunanimbānāṁ pāṭalyāḥ pippalasya ca| <br />

−

vraṇapracchādanē vidvān patrāṇyarkasya cādiśēt||95||

+

vraṇapracchādanē vidvān patrāṇyarkasya cādiśēt||95|| <br />

−

vārkṣō'thavā''jinaḥ kṣaumaḥ paṭṭō vraṇahitaḥ smr̥taḥ|

+

vārkṣō'thavā''jinaḥ kṣaumaḥ paṭṭō vraṇahitaḥ smr̥taḥ| <br />

−

bandhaśca dvividhaḥ śastō vraṇānāṁ savyadakṣiṇaḥ||96||

+

bandhaśca dvividhaḥ śastō vraṇānāṁ savyadakṣiṇaḥ||96|| <br />

−

kadambArjunanimbAnAM pATalyAH pippalasya ca |

+

kadambArjunanimbAnAM pATalyAH pippalasya ca | <br />

−

vraNapracchAdane vidvAn patrANyarkasya cAdishet ||95||

+

vraNapracchAdane vidvAn patrANyarkasya cAdishet ||95|| <br />

−

vArkSho~athavA~a~ajinaH kShaumaH paTTo vraNahitaH smRutaH |

+

vArkSho~athavA~a~ajinaH kShaumaH paTTo vraNahitaH smRutaH | <br />

−

bandhashca dvividhaH shasto vraNAnAM savyadakShiNaH ||96||

+

bandhashca dvividhaH shasto vraNAnAM savyadakShiNaH ||96||<br />

+

</div></div>

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 i.e, It can be started either from left or right side. [95-96]

−

==== Contraindications ====

+

=== Contraindications ===

+

−

लवणाम्लकटूष्णानि विदाहीनि गुरूणि च |

+

लवणाम्लकटूष्णानि विदाहीनि गुरूणि च | <br />

−

वर्जयेदन्नपानानि व्रणी मैथुनमेव च ||९७||

+

वर्जयेदन्नपानानि व्रणी मैथुनमेव च ||९७|| <br />

−

नातिशीतगुरुस्निग्धमविदाहि यथाव्रणम् |

+

नातिशीतगुरुस्निग्धमविदाहि यथाव्रणम् | <br />

−

अन्नपानं व्रणहितं हितं चास्वपनं दिवा ||९८||

+

अन्नपानं व्रणहितं हितं चास्वपनं दिवा ||९८|| <br />

+

−

lavaṇāmlakaṭūṣṇāni vidāhīni gurūṇi ca|

+

lavaṇāmlakaṭūṣṇāni vidāhīni gurūṇi ca| <br />

−

varjayēdannapānāni vraṇī maithunamēva ca||97||

+

varjayēdannapānāni vraṇī maithunamēva ca||97|| <br />

−

nātiśītagurusnigdhamavidāhi yathāvraṇam|

+

nātiśītagurusnigdhamavidāhi yathāvraṇam| <br />

−

annapānaṁ vraṇahitaṁ hitaṁ cāsvapanaṁ divā||98||

+

annapānaṁ vraṇahitaṁ hitaṁ cāsvapanaṁ divā||98|| <br />

−

lavaNAmlakaTUShNAni vidAhIni gurUNi ca |

+

lavaNAmlakaTUShNAni vidAhIni gurUNi ca | <br />

−

varjayedannapAnAni vraNI maithunameva ca ||97||

+

varjayedannapAnAni vraNI maithunameva ca ||97|| <br />

−

nAtishItagurusnigdhamavidAhi yathAvraNam |

+

nAtishItagurusnigdhamavidAhi yathAvraNam | <br />

−

annapAnaM vraNahitaM hitaM cAsvapanaM divA ||98||

+

annapAnaM vraNahitaM hitaM cAsvapanaM divA ||98|| <br />

+

</div></div>

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 ulcer are 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 | <br />

−

उत्सादनार्थं निम्नानां व्रणानां तानि कल्पयेत् ||९९||

+

उत्सादनार्थं निम्नानां व्रणानां तानि कल्पयेत् ||९९|| <br />

−

भूर्जग्रन्थ्यश्मकासीसमधोभागानि गुग्गुलुः |

+

भूर्जग्रन्थ्यश्मकासीसमधोभागानि गुग्गुलुः | <br />

−

व्रणावसादनं तद्वत् कलविङ्ककपोतविट् ||१००||

+

व्रणावसादनं तद्वत् कलविङ्ककपोतविट् ||१००||<br />

+

−

stanyāni jīvanīyāni br̥ṁhaṇīyāni yāni ca|

+

stanyāni jīvanīyāni br̥ṁhaṇīyāni yāni ca|<br />

−

utsādanārthaṁ nimnānāṁ vraṇānāṁ tāni kalpayēt||99||

+

utsādanārthaṁ nimnānāṁ vraṇānāṁ tāni kalpayēt||99|| <br />

−

bhūrjagranthyaśmakāsīsamadhōbhāgāni gugguluḥ|

+

bhūrjagranthyaśmakāsīsamadhōbhāgāni gugguluḥ| <br />

−

vraṇāvasādanaṁ tadvat kalaviṅkakapōtaviṭ||100||

+

vraṇāvasādanaṁ tadvat kalaviṅkakapōtaviṭ||100|| <br />

−

stanyAni jIvanIyAni bRuMhaNIyAni yAni ca |

+

stanyAni jIvanIyAni bRuMhaNIyAni yAni ca | <br />

−

utsAdanArthaM nimnAnAM vraNAnAM tAni kalpayet ||99||

+

utsAdanArthaM nimnAnAM vraNAnAM tAni kalpayet ||99|| <br />

−

bhUrjagranthyashmakAsIsamadhobhAgAni gugguluH |

+

bhUrjagranthyashmakAsIsamadhobhAgAni gugguluH | <br />

−

vraNAvasAdanaM tadvat kalavi~gkakapotaviT ||100||

+

vraNAvasAdanaM tadvat kalavi~gkakapotaviT ||100||<br />

+

</div></div>

For raising the depressed wounds galactogogues (''stanyajanana''), vitalizers (''jeevaniya'') and bulk promotives (''brinhaniya'') drugs should be applied. Similarly, ''bhurjagranthi'' (nodes in the tree of Butea utilis), ''asmakasisa'' (copper sulphate), purgatives, ''guggulu'' and excrement of sparrow and pigeon should be used for depressing the wounds. [99-100]

−

==== Indications and contraindications of ''agni karma'' (cauterization) ====

+

=== Indications and contraindications of ''agni karma'' (cauterization) ===

+

−

रुधिरेऽतिप्रवृत्ते तु च्छिन्ने च्छेद्येऽधिमांसके |

+

रुधिरेऽतिप्रवृत्ते तु च्छिन्ने च्छेद्येऽधिमांसके | <br />

−

कफग्रन्थिषु गण्डेषु वातस्तम्भानिलार्तिषु ||१०१||

+

कफग्रन्थिषु गण्डेषु वातस्तम्भानिलार्तिषु ||१०१|| <br />

−

गूढपूयलसीकेषु गम्भीरेषु स्थिरेषु च |

+

गूढपूयलसीकेषु गम्भीरेषु स्थिरेषु च | <br />

−

कलाप्तेषु [१] चाङ्गदेशेषु कर्माग्नेः सम्प्रशस्यते ||१०२||

+

कलाप्तेषु [१] चाङ्गदेशेषु कर्माग्नेः सम्प्रशस्यते ||१०२|| <br />

−

मधूच्छिष्टेन तैलेन मज्जक्षौद्रवसाघृतैः |

+

मधूच्छिष्टेन तैलेन मज्जक्षौद्रवसाघृतैः | <br />

−

तप्तैर्वा विविधैर्लोहैर्दहेद्दाहविशेषवित् ||१०३||

+

तप्तैर्वा विविधैर्लोहैर्दहेद्दाहविशेषवित् ||१०३|| <br />

−

रूक्षाणां सुकुमाराणां गम्भीरान्मारुतोत्तरान् |

+

रूक्षाणां सुकुमाराणां गम्भीरान्मारुतोत्तरान् | <br />

−

दहेत् स्नेहमधूच्छिष्टैर्लोहैः क्षौद्रैस्ततोऽन्यथा ||१०४||

+

दहेत् स्नेहमधूच्छिष्टैर्लोहैः क्षौद्रैस्ततोऽन्यथा ||१०४|| <br />

−

बालदुर्बलवृद्धानां गर्भिण्या रक्तपित्तिनाम् |

+

बालदुर्बलवृद्धानां गर्भिण्या रक्तपित्तिनाम् | <br />

−

तृष्णाज्वरपरीतानामबलानां विषादिनाम् ||१०५||

+

तृष्णाज्वरपरीतानामबलानां विषादिनाम् ||१०५|| <br />

−

नाग्निकर्मोपदेष्टव्यं स्नायुमर्मव्रणेषु च |

+

नाग्निकर्मोपदेष्टव्यं स्नायुमर्मव्रणेषु च | <br />

−

सविषेषु च शल्येषु नेत्रकुष्ठव्रणेषु च ||१०६||

+

सविषेषु च शल्येषु नेत्रकुष्ठव्रणेषु च ||१०६|| <br />

+

−

rudhirē'tipravr̥ttē tu cchinnē cchēdyē'dhimāṁsakē|

+

rudhirē'tipravr̥ttē tu cchinnē cchēdyē'dhimāṁsakē| <br />

−

kaphagranthiṣu gaṇḍēṣu vātastambhānilārtiṣu||101||

+

kaphagranthiṣu gaṇḍēṣu vātastambhānilārtiṣu||101|| <br />

−

gūḍhapūyalasīkēṣu gambhīrēṣu sthirēṣu ca|

+

gūḍhapūyalasīkēṣu gambhīrēṣu sthirēṣu ca| <br />

−

kl̥ptēṣu [1] cāṅgadēśēṣu karmāgnēḥ sampraśasyatē||102||

+

kl̥ptēṣu [1] cāṅgadēśēṣu karmāgnēḥ sampraśasyatē||102|| <br />

−

madhūcchiṣṭēna tailēna majjakṣaudravasāghr̥taiḥ|

+

madhūcchiṣṭēna tailēna majjakṣaudravasāghr̥taiḥ| <br />

−

taptairvā vividhairlōhairdahēddāhaviśēṣavit||103||

+

taptairvā vividhairlōhairdahēddāhaviśēṣavit||103|| <br />

−

rūkṣāṇāṁ sukumārāṇāṁ gambhīrānmārutōttarān|

+

rūkṣāṇāṁ sukumārāṇāṁ gambhīrānmārutōttarān| <br />

−

dahēt snēhamadhūcchiṣṭairlōhaiḥ kṣaudraistatō'nyathā||104||

+

dahēt snēhamadhūcchiṣṭairlōhaiḥ kṣaudraistatō'nyathā||104|| <br />

−

bāladurbalavr̥ddhānāṁ garbhiṇyā raktapittinām|

+

bāladurbalavr̥ddhānāṁ garbhiṇyā raktapittinām| <br />

−

tr̥ṣṇājvaraparītānāmabalānāṁ viṣādinām||105||

+

tr̥ṣṇājvaraparītānāmabalānāṁ viṣādinām||105|| <br />

−

nāgnikarmōpadēṣṭavyaṁ snāyumarmavraṇēṣu ca|

+

nāgnikarmōpadēṣṭavyaṁ snāyumarmavraṇēṣu ca| <br />

−

saviṣēṣu ca śalyēṣu nētrakuṣṭhavraṇēṣu ca||106||

+

saviṣēṣu ca śalyēṣu nētrakuṣṭhavraṇēṣu ca||106|| <br />

−

rudhire~atipravRutte tu cchinne cchedye~adhimAMsake |

+

rudhire~atipravRutte tu cchinne cchedye~adhimAMsake | <br />

−

kaphagranthiShu gaNDeShu vAtastambhAnilArtiShu ||101||

+

kaphagranthiShu gaNDeShu vAtastambhAnilArtiShu ||101|| <br />

−

gUDhapUyalasIkeShu gambhIreShu sthireShu ca |

+

gUDhapUyalasIkeShu gambhIreShu sthireShu ca | <br />

−

kLLipteShu [1] cA~ggadesheShu karmAgneH samprashasyate ||102||

+

kLLipteShu [1] cA~ggadesheShu karmAgneH samprashasyate ||102|| <br />

−

madhUcchiShTena tailena majjakShaudravasAghRutaiH |

+

madhUcchiShTena tailena majjakShaudravasAghRutaiH | <br />

−

taptairvA vividhairlohairdaheddAhavisheShavit ||103||

+

taptairvA vividhairlohairdaheddAhavisheShavit ||103|| <br />

−

rUkShANAM sukumArANAM gambhIrAnmArutottarAn |

+

rUkShANAM sukumArANAM gambhIrAnmArutottarAn | <br />

−

dahet snehamadhUcchiShTairlohaiH kShaudraistato~anyathA ||104||

+

dahet snehamadhUcchiShTairlohaiH kShaudraistato~anyathA ||104|| <br />

−

bAladurbalavRuddhAnAM garbhiNyA raktapittinAm |

+

bAladurbalavRuddhAnAM garbhiNyA raktapittinAm | <br />

−

tRuShNAjvaraparItAnAmabalAnAM viShAdinAm ||105||

+

tRuShNAjvaraparItAnAmabalAnAM viShAdinAm ||105|| <br />

−

nAgnikarmopadeShTavyaM snAyumarmavraNeShu ca |

+

nAgnikarmopadeShTavyaM snAyumarmavraNeShu ca | <br />

−

saviSheShu ca shalyeShu netrakuShThavraNeShu ca ||106||

+

saviSheShu ca shalyeShu netrakuShThavraNeShu ca ||106||<br />

+

</div></div>

−

Excessive hemorrhage 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 beeswax, 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 beeswax otherwise with iron stick or honey. Cauterization should not be applied in children, debilitated, old persons, pregnant women, those suffering from internal hemorrhage, thirst, fever, weak and poisoned persons and in wounds situated at ligaments and vital parts, poisoned, foreign body, ophthalmic and leprotic wounds.[101-106]

+

Excessive hemorrhage after excision, excisable growths, [[kapha]]ja 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 beeswax, 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 beeswax otherwise with iron stick or honey. Cauterization should not be applied in children, debilitated, old persons, pregnant women, those suffering from internal hemorrhage, thirst, fever, weak and poisoned persons and in wounds situated at ligaments and vital parts, poisoned, foreign body, ophthalmic 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 | <br />

−

शस्त्रकर्माग्निकृत्येषु क्षारमप्यवचारयेत् ||१०७||

+

शस्त्रकर्माग्निकृत्येषु क्षारमप्यवचारयेत् ||१०७|| <br />

−

कठिनत्वं व्रणा यान्ति गन्धैः सारैश्च धूपिताः |

+

कठिनत्वं व्रणा यान्ति गन्धैः सारैश्च धूपिताः | <br />

−

सर्पिर्मज्जवसाधूपैः शैथिल्यं यान्ति हि व्रणाः ||१०८||

+

सर्पिर्मज्जवसाधूपैः शैथिल्यं यान्ति हि व्रणाः ||१०८|| <br />

−

रुजः स्रावाश्च गन्धाश्च कृमयश्च व्रणाश्रिताः |

+

रुजः स्रावाश्च गन्धाश्च कृमयश्च व्रणाश्रिताः | <br />

−

शैथिल्यं मार्दवं चापि धूपनेनोपशाम्यति ||१०९||

+

शैथिल्यं मार्दवं चापि धूपनेनोपशाम्यति ||१०९||<br />

−

लोध्रन्यग्रोधशुङ्गानि खदिरस्त्रिफला घृतम् |

+

लोध्रन्यग्रोधशुङ्गानि खदिरस्त्रिफला घृतम् | <br />

−

प्रलेपो व्रणशैथिल्यसौकुमार्यप्रसाधनः ||११०||

+

प्रलेपो व्रणशैथिल्यसौकुमार्यप्रसाधनः ||११०|| <br />

−

सरुजः कठिनाः स्तब्धा निरास्रावाश्च ये व्रणाः |

+

सरुजः कठिनाः स्तब्धा निरास्रावाश्च ये व्रणाः | <br />

−

यवचूर्णैः ससर्पिष्कैर्बहुशस्तान् प्रलेपयेत् ||१११||

+

यवचूर्णैः ससर्पिष्कैर्बहुशस्तान् प्रलेपयेत् ||१११|| <br />

−

मुद्गषष्टिकशालीनां पायसैर्वा यथाक्रमम् |

+

मुद्गषष्टिकशालीनां पायसैर्वा यथाक्रमम् | <br />

−

सघृतैर्जीवनीयैर्वा तर्पयेत्तानभीक्ष्णशः ||११२||

+

सघृतैर्जीवनीयैर्वा तर्पयेत्तानभीक्ष्णशः ||११२||<br />

+

−

rōgadōṣabalāpēkṣī mātrākālāgnikōvidaḥ|

+

rōgadōṣabalāpēkṣī mātrākālāgnikōvidaḥ| <br />

−

śastrakarmāgnikr̥tyēṣu kṣāramapyavacārayēt||107||

+

śastrakarmāgnikr̥tyēṣu kṣāramapyavacārayēt||107|| <br />

−

kaṭhinatvaṁ vraṇā yānti gandhaiḥ sāraiśca dhūpitāḥ|

+

kaṭhinatvaṁ vraṇā yānti gandhaiḥ sāraiśca dhūpitāḥ| <br />

−

sarpirmajjavasādhūpaiḥ śaithilyaṁ yānti hi vraṇāḥ||108||

+

sarpirmajjavasādhūpaiḥ śaithilyaṁ yānti hi vraṇāḥ||108|| <br />

−

rujaḥ srāvāśca gandhāśca kr̥mayaśca vraṇāśritāḥ|

+

rujaḥ srāvāśca gandhāśca kr̥mayaśca vraṇāśritāḥ| <br />

−

śaithilyaṁ mārdavaṁ cāpi dhūpanēnōpaśāmyati||109||

+

śaithilyaṁ mārdavaṁ cāpi dhūpanēnōpaśāmyati||109|| <br />

−

lōdhranyagrōdhaśuṅgāni khadirastriphalā ghr̥tam|

+

lōdhranyagrōdhaśuṅgāni khadirastriphalā ghr̥tam| <br />

−

pralēpō vraṇaśaithilyasaukumāryaprasādhanaḥ||110||

+

pralēpō vraṇaśaithilyasaukumāryaprasādhanaḥ||110|| <br />

−

sarujaḥ kaṭhināḥ stabdhā nirāsrāvāśca yē vraṇāḥ|

+

sarujaḥ kaṭhināḥ stabdhā nirāsrāvāśca yē vraṇāḥ| <br />

−

yavacūrṇaiḥ sasarpiṣkairbahuśastān pralēpayēt||111||

+

yavacūrṇaiḥ sasarpiṣkairbahuśastān pralēpayēt||111|| <br />

−

mudgaṣaṣṭikaśālīnāṁ pāyasairvā yathākramam|

+

mudgaṣaṣṭikaśālīnāṁ pāyasairvā yathākramam| <br />

−

saghr̥tairjīvanīyairvā tarpayēttānabhīkṣṇaśaḥ||112||

+

saghr̥tairjīvanīyairvā tarpayēttānabhīkṣṇaśaḥ||112|| <br />

−

rogadoShabalApekShI mAtrAkAlAgnikovidaH |

+

rogadoShabalApekShI mAtrAkAlAgnikovidaH | <br />

−

shastrakarmAgnikRutyeShu kShAramapyavacArayet ||107||

+

shastrakarmAgnikRutyeShu kShAramapyavacArayet ||107|| <br />

−

kaThinatvaM vraNA yAnti gandhaiH sAraishca dhUpitAH |

+

kaThinatvaM vraNA yAnti gandhaiH sAraishca dhUpitAH | <br />

−

sarpirmajjavasAdhUpaiH shaithilyaM yAnti hi vraNAH ||108||

+

sarpirmajjavasAdhUpaiH shaithilyaM yAnti hi vraNAH ||108|| <br />

−

rujaH srAvAshca gandhAshca kRumayashca vraNAshritAH |

+

rujaH srAvAshca gandhAshca kRumayashca vraNAshritAH | <br />

−

shaithilyaM mArdavaM cApi dhUpanenopashAmyati ||109||

+

shaithilyaM mArdavaM cApi dhUpanenopashAmyati ||109||<br />

−

lodhranyagrodhashu~ggAni khadirastriphalA ghRutam |

+

lodhranyagrodhashu~ggAni khadirastriphalA ghRutam | <br />

−

pralepo vraNashaithilyasaukumAryaprasAdhanaH ||110||

+

pralepo vraNashaithilyasaukumAryaprasAdhanaH ||110|| <br />

−

sarujaH kaThinAH stabdhA nirAsrAvAshca ye vraNAH |

+

sarujaH kaThinAH stabdhA nirAsrAvAshca ye vraNAH | <br />

−

yavacUrNaiH sasarpiShkairbahushastAn pralepayet ||111||

+

yavacUrNaiH sasarpiShkairbahushastAn pralepayet ||111|| <br />

−

mudgaShaShTikashAlInAM pAyasairvA yathAkramam |

+

mudgaShaShTikashAlInAM pAyasairvA yathAkramam | <br />

−

saghRutairjIvanIyairvA tarpayettAnabhIkShNashaH ||112||

+

saghRutairjIvanIyairvA tarpayettAnabhIkShNashaH ||112||<br />

+

</div></div>

−

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 heartwood. The wounds get softened if fumigated with ''ghrita'', marrow or muscle-fat. Through fumigation pain, discharges, odors, maggots, hardness and softness of wounds are removed. ''Lodhra,'' leaf-buds 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 ''shali'' 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 heartwood. The wounds get softened if fumigated with ''ghrita'', marrow or muscle-fat. Through fumigation pain, discharges, odors, maggots, hardness and softness of wounds are removed. ''Lodhra,'' leaf-buds 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 ''shali'' rice or ''jivaniya'' drugs mixed with ''ghrita''.[110-112]

−

==== External applications ====

+

=== External applications ===

+

−

ककुभोदुम्बराश्वत्थलोध्रजाम्बवकट्फलैः |

+

ककुभोदुम्बराश्वत्थलोध्रजाम्बवकट्फलैः | <br />

−

त्वचमाश्वेव गृह्णन्ति त्वक्चूर्णैश्चूर्णिता व्रणाः ||११३||

+

त्वचमाश्वेव गृह्णन्ति त्वक्चूर्णैश्चूर्णिता व्रणाः ||११३|| <br />

−

मनःशिलैला [१] मञ्जिष्ठा लाक्षा च रजनीद्वयम् |

+

मनःशिलैला [१] मञ्जिष्ठा लाक्षा च रजनीद्वयम् | <br />

−

प्रलेपः सघृतक्षौद्रस्त्वग्विशुद्धिकरः परः ||११४||

+

प्रलेपः सघृतक्षौद्रस्त्वग्विशुद्धिकरः परः ||११४|| <br />

−

अयोरजः सकासीसं त्रिफलाकुसुमानि च |

+

अयोरजः सकासीसं त्रिफलाकुसुमानि च | <br />

−

करोति लेपः कृष्णत्वं [२] सद्य एव नवत्वचि ||११५||

+

करोति लेपः कृष्णत्वं [२] सद्य एव नवत्वचि ||११५||<br />

−

कालीयकनताम्रास्थिहेमकान्तारसोत्तमैः [३] |

+

कालीयकनताम्रास्थिहेमकान्तारसोत्तमैः [३] | <br />

−

लेपः सगोमयरसः सवर्णीकरणः परः ||११६||

+

लेपः सगोमयरसः सवर्णीकरणः परः ||११६||<br />

−

ध्यामकाश्वत्थनिचुलमूलं लाक्षा सगैरिका |

+

ध्यामकाश्वत्थनिचुलमूलं लाक्षा सगैरिका | <br />

−

सहेमश्चामृतासङ्गः कासीसं चेति वर्णकृत् ||११७||

+

सहेमश्चामृतासङ्गः कासीसं चेति वर्णकृत् ||११७||<br />

−

चतुष्पदानां त्वग्लोमखुरशृङ्गास्थिभस्मना |

+

चतुष्पदानां त्वग्लोमखुरशृङ्गास्थिभस्मना | <br />

−

तैलाक्ता चूर्णिता भूमिर्भवेल्लोमवती पुनः ||११८||

+

तैलाक्ता चूर्णिता भूमिर्भवेल्लोमवती पुनः ||११८|| <br />

−

षोडशोपद्रवा ये च व्रणानां परिकीर्तिताः |

+

षोडशोपद्रवा ये च व्रणानां परिकीर्तिताः | <br />

−

तेषां चिकित्सा निर्दिष्टा यथास्वं स्वे चिकित्सिते ||११९||

+

तेषां चिकित्सा निर्दिष्टा यथास्वं स्वे चिकित्सिते ||११९|| <br />

+

−

kakubhōdumbarāśvatthalōdhrajāmbavakaṭphalaiḥ|

+

kakubhōdumbarāśvatthalōdhrajāmbavakaṭphalaiḥ| <br />

−

tvacamāśvēva gr̥hṇanti tvakcūrṇaiścūrṇitā vraṇāḥ||113||

+

tvacamāśvēva gr̥hṇanti tvakcūrṇaiścūrṇitā vraṇāḥ||113|| <br />

−

manaḥśilailā [1] mañjiṣṭhā lākṣā ca rajanīdvayam|

+

manaḥśilailā [1] mañjiṣṭhā lākṣā ca rajanīdvayam| <br />

−

pralēpaḥ saghr̥takṣaudrastvagviśuddhikaraḥ paraḥ||114||

+

pralēpaḥ saghr̥takṣaudrastvagviśuddhikaraḥ paraḥ||114|| <br />

−

ayōrajaḥ sakāsīsaṁ triphalākusumāni ca|

+

ayōrajaḥ sakāsīsaṁ triphalākusumāni ca| <br />

−

karōti lēpaḥ kr̥ṣṇatvaṁ [2] sadya ēva navatvaci||115||

+

karōti lēpaḥ kr̥ṣṇatvaṁ [2] sadya ēva navatvaci||115|| <br />

−

kālīyakanatāmrāsthihēmakāntārasōttamaiḥ [3] |

+

kālīyakanatāmrāsthihēmakāntārasōttamaiḥ [3] | <br />

−

lēpaḥ sagōmayarasaḥ savarṇīkaraṇaḥ paraḥ||116||

+

lēpaḥ sagōmayarasaḥ savarṇīkaraṇaḥ paraḥ||116|| <br />

−

dhyāmakāśvatthaniculamūlaṁ lākṣā sagairikā|

+

dhyāmakāśvatthaniculamūlaṁ lākṣā sagairikā| <br />

−

sahēmaścāmr̥tāsaṅgaḥ kāsīsaṁ cēti varṇakr̥t||117||

+

sahēmaścāmr̥tāsaṅgaḥ kāsīsaṁ cēti varṇakr̥t||117|| <br />

−

catuṣpadānāṁ tvaglōmakhuraśr̥ṅgāsthibhasmanā|

+

catuṣpadānāṁ tvaglōmakhuraśr̥ṅgāsthibhasmanā| <br />

−

tailāktā cūrṇitā bhūmirbhavēllōmavatī punaḥ||118||

+

tailāktā cūrṇitā bhūmirbhavēllōmavatī punaḥ||118|| <br />

−

ṣōḍaśōpadravā yē ca vraṇānāṁ parikīrtitāḥ|

+

ṣōḍaśōpadravā yē ca vraṇānāṁ parikīrtitāḥ| <br />

−

tēṣāṁ cikitsā nirdiṣṭā yathāsvaṁ svē cikitsitē||119||

+

tēṣāṁ cikitsā nirdiṣṭā yathāsvaṁ svē cikitsitē||119|| <br />

−

kakubhodumbarAshvatthalodhrajAmbavakaTphalaiH |

+

kakubhodumbarAshvatthalodhrajAmbavakaTphalaiH | <br />

−

tvacamAshveva gRuhNanti tvakcUrNaishcUrNitA vraNAH ||113||

+

tvacamAshveva gRuhNanti tvakcUrNaishcUrNitA vraNAH ||113|| <br />

−

manaHshilailA [1] ma~jjiShThA lAkShA ca rajanIdvayam |

+

manaHshilailA [1] ma~jjiShThA lAkShA ca rajanIdvayam | <br />

−

pralepaH saghRutakShaudrastvagvishuddhikaraH paraH ||114||

+

pralepaH saghRutakShaudrastvagvishuddhikaraH paraH ||114|| <br />

−

ayorajaH sakAsIsaM triphalAkusumAni ca |

+

ayorajaH sakAsIsaM triphalAkusumAni ca | <br />

−

karoti lepaH kRuShNatvaM [2] sadya eva navatvaci ||115||

+

karoti lepaH kRuShNatvaM [2] sadya eva navatvaci ||115|| <br />

−

kAlIyakanatAmrAsthihemakAntArasottamaiH [3] |

+

kAlIyakanatAmrAsthihemakAntArasottamaiH [3] | <br />

−

lepaH sagomayarasaH savarNIkaraNaH paraH ||116||

+

lepaH sagomayarasaH savarNIkaraNaH paraH ||116|| <br />

−

dhyAmakAshvatthaniculamUlaM lAkShA sagairikA |

+

dhyAmakAshvatthaniculamUlaM lAkShA sagairikA | <br />

−

sahemashcAmRutAsa~ggaH kAsIsaM ceti varNakRut ||117||

+

sahemashcAmRutAsa~ggaH kAsIsaM ceti varNakRut ||117|| <br />

−

catuShpadAnAM tvaglomakhurashRu~ggAsthibhasmanA |

+

catuShpadAnAM tvaglomakhurashRu~ggAsthibhasmanA | <br />

−

tailAktA cUrNitA bhUmirbhavellomavatI punaH ||118||

+

tailAktA cUrNitA bhUmirbhavellomavatI punaH ||118|| <br />

−

ShoDashopadravA ye ca vraNAnAM parikIrtitAH |

+

ShoDashopadravA ye ca vraNAnAM parikIrtitAH | <br />

−

teShAM cikitsA nirdiShTA yathAsvaM sve cikitsite ||119||

+

teShAM cikitsA nirdiShTA yathAsvaM sve cikitsite ||119||<br />

+

</div></div>

By dusting the wounds with the powders of barks of ''kakubha'' (Termalia arjuna), ''udumbara, asvattha, lodhra'' (Symplocos racemosa Roxb), ''jambu'' (Eugenia jambolana Lam) and ''katphala'' (Myrica esculenta Buch-Ham) they heals the skin quickly.

Line 1,501: Line 1,630:

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-

−

द्वौ व्रणौ व्रणभेदाश्च परीक्षा दुष्टिरेव च |

+

द्वौ व्रणौ व्रणभेदाश्च परीक्षा दुष्टिरेव च | <br />

−

स्थानानि गन्धाः स्रावाश्च सोपसर्गाः क्रियाश्च याः ||१२०||

+

स्थानानि गन्धाः स्रावाश्च सोपसर्गाः क्रियाश्च याः ||१२०|| <br />

−

व्रणाधिकारे सप्रश्नमेतन्नवकमुक्तवान् |

+

व्रणाधिकारे सप्रश्नमेतन्नवकमुक्तवान् | <br />

−

मुनिर्व्याससमासाभ्यामग्निवेशाय धीमते ||१२१||

+

मुनिर्व्याससमासाभ्यामग्निवेशाय धीमते ||१२१||<br />

+

tatra ślōkau-

−

dvau vraṇau vraṇabhēdāśca parīkṣā duṣṭirēva ca|

+

dvau vraṇau vraṇabhēdāśca parīkṣā duṣṭirēva ca| <br />

−

sthānāni gandhāḥ srāvāśca sōpasargāḥ kriyāśca yāḥ||120||

+

sthānāni gandhāḥ srāvāśca sōpasargāḥ kriyāśca yāḥ||120|| <br />

−

vraṇādhikārē sapraśnamētannavakamuktavān|

+

vraṇādhikārē sapraśnamētannavakamuktavān| <br />

−

munirvyāsasamāsābhyāmagnivēśāya dhīmatē||121||

+

munirvyāsasamāsābhyāmagnivēśāya dhīmatē||121|| <br />

+

</div></div>

Now the summing up verses –

Two types of wounds, kinds of wounds, examination of wounds, defects, locations, odors, 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 Agnivesha in the chapter on treatment of wound ([[Dwivraniya Chikitsa]]). [120-121]

+

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||

+

</div></div>

−

==~~= ''~~Tattva Vimarsha~~'' /~~ Fundamental Principles===

+

== Tattva Vimarsha (Fundamental Principles) ==

*''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.

−

*Endogenous ulcers are caused due to vitiation of ''dosha'' located in external pathways.

+

*Endogenous ulcers are caused due to vitiation of [[dosha]] located in external pathways.

−

*The clinical features of ''vata'' dominance in ulcer are stiffness, hardness on touch, scanty exudation, excruciating and pricking pain with throbbing and blackish discoloration. It should be treated with ''sampurana'' (filling of ulcer cavity), intake of unctuous substances (oleation therapy), unctuous fomentation and poultices, ointments and sprinklings.

+

*The clinical features of [[vata]] dominance in ulcer are stiffness, hardness on touch, scanty exudation, excruciating and pricking pain with throbbing and blackish discoloration. It should be treated with ''sampurana'' (filling of ulcer cavity), intake of unctuous substances (oleation therapy), unctuous fomentation and poultices, ointments and sprinklings.

−

*The clinical features of ''pitta'' dominant ulcer are excessive thirst, unconsciousness, fever, sweating, burning sensation, impurities at the site of ulcer, tearing and foul smell with discharge pus from ulcer. The treatment includes anointing and sprinkling with cold drugs, intake of sweet and bitter drugs, intake of ghee and purgation.

+

*The clinical features of [[pitta]] dominant ulcer are excessive thirst, unconsciousness, fever, sweating, burning sensation, impurities at the site of ulcer, tearing and foul smell with discharge pus from ulcer. The treatment includes anointing and sprinkling with cold drugs, intake of sweet and bitter drugs, intake of ghee and purgation.

−

*The clinical features of ''kapha'' dominance in ulcer are sliminess, heaviness, unctuousness, numbness, with mild pain, paleness in color, little slough and prolonged healing. It is treated with anointing and sprinkling with astringent, pungent, dry and hot drugs as well as fasting and digestive measures.

+

*The clinical features of [[kapha]] dominance in ulcer are sliminess, heaviness, unctuousness, numbness, with mild pain, paleness in color, little slough and prolonged healing. It is treated with anointing and sprinkling with astringent, pungent, dry and hot drugs as well as fasting and digestive 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.

*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 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.

*At first, bloodletting therapy is done first to reduce swelling in ulcer. ''Upanaha'' (hot poultice) and ''patana'' (incision) are done according to stage of ulcer.

Line 1,547: Line 1,682:

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

−

==~~= ''~~Vidhi Vimarsha~~'' /~~ Applied Inferences===

+

== Vidhi Vimarsha (Applied Inferences ) ==

−

==== Classification of ulcers and causes ====

+

=== 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''.

+

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 [[dosha]] 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. [[vata]]ja, [[pitta]]ja, [[kapha]]ja, [[rakta]]ja 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'' ====

+

=== ''Samprapti'' (pathogenesis of ''vrana''): based on ''shadakriya kala'' ===

[[File:Dwivraniya1.png|500px]]

−

==== Clinical pictures of ''vrana'' ====

+

=== Clinical pictures of ''vrana'' ===

The following ulcer is the case of diabetic ulcer. Clinical features include throbbing pain, swelling, redness, necrosis of involved tissue and non healing ulcer since 6 months.

−

[[File:DwivImage1.jpg|~~500px~~|Image 1: ''Vata'' dominant ulcer]]

+

[[File:DwivImage1.jpg|400px|Image 1: [[Vata]] dominant ulcer]]

−

'''Image 1: ''Vata'' dominant ulcer'''

+

'''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.

−

[[File:DwivImage2.jpg|~~500px~~|Image 2: ''Pitta'' dominant ulcer]]

+

[[File:DwivImage2.jpg|400px|Image 2: [[Pitta]] dominant ulcer]]

−

'''Image 2: Pitta dominant ulcer'''

+

'''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.

−

[[File:DwivImage3.jpg|~~500px~~|Image 3: ''Kapha'' dominant ulcer ]]

+

[[File:DwivImage3.jpg|400px|Image 3: [[Kapha]] dominant ulcer ]]

'''Image 3: Kapha dominant ulcer'''

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The following ulcer is the case of infected diabetic non healing ulcer (Diabetic foot). Clinical features include severe burning pain, black coloration of first toe with pus discharge, slough, bad smell and deformity in great toe. This is non healing ulcer since 2 months.

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[[File:DwivImage4.jpg|~~500px~~|Image 4: ''Dushta vrana'']]

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[[File:DwivImage4.jpg|400px|Image 4: ''Dushta vrana'']]

'''Image 4: ''Dushta vrana'''''

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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 their chronic nature and the granulation tissue are seen at base of ulcer. So this is a healing ulcer.

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[[File:DwivImage5.jpg|~~500px~~|Image 5: ''Shuddha vrana'']]

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[[File:DwivImage5.jpg|400px|Image 5: ''Shuddha vrana'']]

'''Image 5: ''Shuddha vrana'''''

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==== Investigations and their clinical interpretation in brief ====

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=== 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, arterial 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 creatinine 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.

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===== Complications of ulcer =====

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==== Complications of ulcer ====

If ulcer is not treated properly it may lead to local and systemic infection leading to septicemia. The tissue necrosis leads to gangrene which further need to amputation.

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===== Causes of non-healing =====

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==== Causes of non-healing ====

Two factors mainly affect the process of wound healing viz. local factors and systemic factors.

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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.

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==== Treatment of ''vrana'' (ulcers) ====

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=== Treatment of ''vrana'' (ulcers) ===

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===== Purification measures =====

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==== Purification measures ====

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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.''Raktamokshana'' 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.

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Purificatory measures eliminate toxic material from body and improve healing process of ulcer. In case of endogenous ulcer removal of morbid matters (i.e. [[dosha]]ja) 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.[[Raktamokshana]] is an important modality<ref>Sushruta. Chikitsa Sthana, Cha.1 Dwivraniya Chikitsitam Adhyaya verse 27-18. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1. </ref> 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.

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Selection of therapeutic measures is done as per condition of ''vrana'' and patient.

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Selection of therapeutic measures is done as per condition of ''vrana'' and patient.

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===== Thirty six treatment measures =====

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==== Thirty six treatment measures ====

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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.<ref>~~Kaviraja Ambikadutta Shastri,~~ Sushruta ~~Samhita~~, ~~Ist part, chikitsa sthana Chap~~ 1, ~~shlok no~~.~~8 ,Reprint 2013,~~ Chaukhambha ~~Sanskrit Sansthan, Varanasi, pp 5~~</ref> 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).~~

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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.<ref name =su>Sushruta. Chikitsa Sthana, Cha.1 Dwivraneeya Chikitsitam Adhyaya verse 8. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref> 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.<ref name=su/>

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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.

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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 [[dosha]] 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.

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==== Indications and process of six fold surgical procedures ====

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=== Indications and process of six fold surgical procedures ===

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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 Charak is same as for ''bhedana'' by Sushruta. Any similar or new procedure can be applied in wound management as per the surgeon’s freedom. <ref>K. H. Krishnamurthy, ~~editor~~ Prof. P.V. Sharma, ~~Bhela Samhita~~, ~~Chikitsa sthana~~, ~~Chap.27, Shloka 14-15~~, pp 468~~, Reprint 2008, Chaukhambha Visvabharati, Varanasi~~.</ref>

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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 Charak is same as for ''bhedana'' by Sushruta. Any similar or new procedure can be applied in wound management as per the surgeon’s freedom. <ref>Bhela, Chikitsa sthana, Chap.27, Verse 14-15 . In:K. H. Krishnamurthy,Prof. P.V. Sharma Editors, reprint edition, Varanasi; Chaukhambha Visvabharati, 2008, pp 468. </ref>

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===== ''Pidana'' (Compression) =====

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==== ''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.

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===== Management of fracture and dislocation =====

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==== Management of fracture and dislocation ====

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The basic guidelines for management of fracture and dislocation are to stabilize the fractured bone or dislocated joint by application of splints. Proper alignment of bone is mandatory for healing of fractured bones.<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita~~, Ist part, chikitsa sthana Chap 3, shlok no~~.~~18-19,~~ Reprint ~~2013,~~ Chaukhambha Sanskrit Sansthan~~, Varanasi,~~ pp 28</ref> Suitable dietary regimen should be followed with avoidance of ''vidahi'' (food which causes burning sensation) food.<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita~~, Ist part, chikitsa sthana Chap 3, shlok no~~.~~4-5 ,~~ Reprint ~~2013,~~ Chaukhambha Sanskrit Sansthan~~, Varanasi,~~ pp 27</ref> Strenuous 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.

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The basic guidelines for management of fracture and dislocation are to stabilize the fractured bone or dislocated joint by application of splints. Proper alignment of bone is mandatory for healing of fractured bones.<ref>Sushruta. Chikitsa Sthana, Cha.3 Bhagnachikisitam Adhyaya verse 18-19. In: Kaviraja Ambikadutta Shastri Aacharya, Editors. Sushruta Samhita. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013. pp 28.</ref> Suitable dietary regimen should be followed with avoidance of ''vidahi'' (food which causes burning sensation) food.<ref>Sushruta. Chikitsa Sthana, Cha.3 Bhagnachikisitam Adhyaya verse 4-5. In: Kaviraja Ambikadutta Shastri Aacharya, Editors. Sushruta Samhita. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013. pp 28.</ref> Strenuous 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.

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===== ''Eshanakarma'' (probing) =====

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==== ''Eshanakarma'' (probing) ====

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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).

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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).<ref>Sushruta. Sutra Sthana, Cha.25 Ashtavidashastrakarmeeya Adhyaya verse 10. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>

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===== ''Vrana shodhana'' (cleaning of ulcer) =====

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==== ''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 infection causing vectors, 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.

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==== Bandaging material, methods and its applicability in ''vrana'' (wound) ====

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=== Bandaging material, methods and its applicability in ''vrana'' (wound) ===

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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<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita~~, Ist part, Sutra sthana Chap 18, shlok no~~.~~17 ,~~ Reprint ~~2013,~~ Chaukhambha Sanskrit Sansthan~~, Varanasi,~~ pp 98</ref> and fifteen types. <ref>~~Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika,~~ Sutra ~~sthana Chap 29~~, ~~shlok no~~.59-60, ~~Reprint 2005,~~ Chaukhambha Sanskrit Sansthan,~~Varanasi,~~ pp 161</ref>

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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<ref>Sushruta. Sutra Sthana, Cha.18 Vranalepanabandhavidhi Adhyaya verse 17. In: Kaviraja Ambikadutta Shastri, Editors. Sushruta Samhita. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013. pp 98</ref>and fifteen types. <ref>Vagbhata. Sutra Sthana, Cha.29 Shastrakarmavidhi Adhyaya verse 59-60. In: Kaviraj Atrideva Gupta, Editors. Ashtanga Hridayam. reprint ed. Varanasi:Chaukhambha Sanskrit Sansthan,2005.p.4.pp 161</ref>

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==== Diet: Wholesome and unwholesome aahar-vihar and ulcer healing promoters ====

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=== Diet: Wholesome and unwholesome aahar-vihar and ulcer healing promoters ===

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''Lavana'' is ''vishyandi'' i. e. producing more secretions from tissues; it aggravates ''kapha'' and ''pitta'' and mitigates ''vata~~''.~~<ref>~~Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika,~~ Sutra ~~sthana Chap 6~~, ~~shlok no~~.143~~, Reprint 2005, Chaukhambha Sanskrit Sansthan,Varanasi, pp 64</ref> 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''~~. ~~<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Chikitsa sthana, Chap 28, shlok no.59 ,~~Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 788</ref>, <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Vimana sthana, Chap 5, shlok no.24 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 714</ref>. 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),<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 4, shlok no.~~17 ,Reprint 2005, Chaukhambha Bharati Academy,~~ Varanasi~~, pp 83</ref> ''jeevaniya'' (life promoters e.g. vitamins)<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 4, shlok no.1 ,Reprint 2005,~~ Chaukhambha Bharati Academy, Varanasi, pp 71.</ref> and ''brimhaniya gana'' (nourishing drugs)<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 4, shlok no.2 ,Reprint 2005~~, Chaukhambha Bharati Academy, Varanasi,~~ pp 72.</ref> ~~are described. All these drugs have nutritional value (''dhatu poshana'') that helps in ulcer healing.~~

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''Lavana'' is ''vishyandi'' i. e. producing more secretions from tissues; it aggravates [[kapha]] and [[pitta]] and mitigates [[vata]]<ref>Vagbhata. Sutra Sthana, Cha.6 Annaswarupavijnaneeyam Adhyaya verse 143. In: Kaviraj Atrideva Gupta, Editors. Ashtanga Hridayam. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2005 pp 64.</ref>

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~~==== Indications~~ and ~~contraindications of agnikarma~~ (~~cauterization~~) in various ~~disorders ====~~

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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 [[dhatu]]kshaya and aggravates [[vata].] [ Cha. Sa. [[Chikitsa Sthana]] 28/59 ], [ Cha. Sa. [[Vimana Sthana]] 5/24].

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''~~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~~.~~<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part,~~ Sutra ~~sthana Chap 14, shlok no.40 ,Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 72<~~/~~ref> 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~~.

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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),[Cha. Sa. [[Sutra Sthana]] 4/17 ] ''jeevaniya'' (life promoters e.g. vitamins) [ Cha. Sa. [[Sutra Sthana]] 4/1 ] and ''brimhaniya gana'' (nourishing drugs) [ Cha. Sa. [[Sutra Sthana]] 4/2] are described. All these drugs have nutritional value ([[dhatu]] poshana) that helps in ulcer healing.

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===~~= Importance~~ of ~~''dhupana karma''~~ (~~fumigation therapy~~) in ~~wound sterilization healing process =~~===

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=== Indications and contraindications of agnikarma (cauterization) in various disorders ===

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~~Fumigation~~ of ~~ulcer~~ is ~~done~~ with ''~~dhupana dravyas~~'' (~~fumigating materials~~).<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita~~, Ist part, Sutra sthana Chap 5, shlok no~~.~~17 ,~~Reprint ~~2013,~~ Chaukhambha Sanskrit Sansthan~~, Varanasi,~~ pp 24</ref>~~, <ref>Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika, Uttara tantra Chap 25, shlok no~~.45, ~~Reprint 2005~~, ~~Chaukhambha Sanskrit Sansthan,Varanasi, pp 542.</ref>. Purpose~~ of ~~fumigation is to make suitable conditions for better ulcer healing such as local sterilization, vasodilation, decreased discharge~~ and ~~removal~~ of ~~foul smell~~.

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''Agni karma'' (cauterization by application of heat) is used as precaution for excessive bleeding ulcers, excision of hanging flesh, [[kapha]]ja 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.<ref>Sushruta. Sutra Sthana, Cha.14 Shonitavarnaneeya Adhyaya verse 40. In: Kaviraja Ambikadutta Shastri, Editors. Sushruta Samhita. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013. pp 72</ref>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.

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~~Fumigation also relieves pain, discharge and kills microorganisms due to~~ ''~~vata, kapha~~'' alleviating property along with antiseptic property.<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Chikitsa sthana Chap 1, shlok no.80, Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 12</ref> Various types of preparations are used to harden or soften the wounds as per condition of wound.

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=== Importance of ''dhupana karma'' (fumigation therapy) in wound sterilization healing process ===

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#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. ---)~~<ref>Dwivedi SP, Shukla DV. Role of Jalaukavacharana (leech therapy) in the management of ankle sprain: a pilot study. International journal of [[Ayurveda]] & Alternative Medicine. 2014; 2 (4): 92-95.</ref>,<ref>Pandey BB, Kumar A, Singh N, Bhatia. Efficacy of Jalaukavcharana (Leech Application) in Ischemic Ulcer with Pre-Gangrenous Changes - A Case Report, Journal of [[Ayurveda]] 2012 Jul-Sep ; 4 (3) :103-107.</ref>

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Fumigation of ulcer is done with ''dhupana dravyas'' (fumigating materials).<ref>Sushruta. Sutra Sthana, Cha.5 Agropaharaneeya Adhyaya verse 17. In: Kaviraja Ambikadutta Shastri, Editors. Sushruta Samhita. Reprint ed. Varanasi:Chaukhambha Sanskrit Sansthan ;2013. pp 24.</ref>,

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<ref>Vagbhata. Uttara Sthana, Cha.25 Vranapratishedha Adhyaya verse 45. In: Kaviraj Atrideva Gupta,Editors. Ashtanga Hridayam. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2005.pp 542.</ref>. Purpose of fumigation is to make suitable conditions for better ulcer healing such as local sterilization, vasodilation, decreased discharge and removal of foul smell.

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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.

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#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.<ref>Dwivedi SP, Shukla DV. Role of Jalaukavacharana (leech therapy) in the management of ankle sprain: a pilot study. International journal of [[Ayurveda]] & Alternative Medicine. 2014; 2 (4): 92-95.</ref>,<ref>Pandey BB, Kumar A, Singh N, Bhatia. Efficacy of Jalaukavcharana (Leech Application) in Ischemic Ulcer with Pre-Gangrenous Changes - A Case Report, Journal of [[Ayurveda]] 2012 Jul-Sep ; 4 (3) :103-107.</ref>

#The ''nagrodhyadi'' group is indicated in wound as cooling for wounds which is found healing potential in one research.<ref>Lad M, Bandgar S. Management of non healing wound with nyagrodhadi kwatha and jatyadi ghruta (classical ayurvedic preparations). Global Journal of Research on Medicinal Plants & Indigenous Medicine (GJRMI). 2012; 1 (7): 301-308.</ref>

#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 anti-inflammatory, cleaning and healing potential in some research studies carried out and published in reputed journals of [[Ayurveda]].<ref>Meena RK, Dudhamal T, Gupta SK, Mahanta V. Wound healing potential of Pañcavalkala formulations in a postfistulectomy wound. Ancient Sci Life (ASL) 2015;35 (2):118-21</ref>,<ref>Bhat KS, Vishwesh BN, Sahu M, Shukla VK. A clinical study on the efficacy of panchavalkala cream in vrana shodhana w.s.r to its action on microbial load and wound infection. AYU. 2014;35(2):135-140</ref>,<ref>K. Shobha Bhat, M. Sahu, V.K. Shukla. Efficacy of pancavalkala cream in the management of chronic non-healing wounds, Aryavaidyan 2013 May-July ; (26) :224-228</ref>, <ref>Khadkutkar DK, Prof. Kanthi Veena. Therapeutic uses of Panchvalkala in different forms-a review. Ayurlog; National Journal of Research in [[Ayurveda]] Science. 2014; 2(1): 1-5</ref>, <ref>Khadkutkar DK, Prof. Kanthi Veena G. A Brief Review of Research Studies Conducted on Panchavalkal. Indian Journal of Ancient Medicine and Yoga. 2015;8(2): 87-94</ref>,<ref>Khadkutkar DK, Kanthi VG, Dudhamal TS. Antimicrobial activity of Panchavalkal powder and ointment. International Journal of Medicinal Plants and Natural Products (IJMPNP). 2015; 1(3): 9-15</ref>

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#By dusting the wound with the powders of barks of kakubha (Termalia arjuna),<ref>Narayana A, Swamy RK . A medico-historical review of Arjuna (Terminalia arjuna, w. & a.). Bulletin of the Indian Institute of History of Medicine. 1998; 26(1-2): 1-10</ref> udumbara,<ref>Vinaya Kumar, P.V. Tiwari. Post-Cautery Effect of Udumbar Ointment on Cervical Erosion, Ancient Science of Life 1993 July ; 13 (1-2) :97-101</ref> ashvattha, lodhra (Symplocos racemosa Roxb), jambu (Eugenia jambolana Lam) and katphala (Myrica esculenta Buch-Ham) they heals the skin quickly. Manashila (Realgar), manjistha,<ref>Baria J, Gupta SK, Bhuyan C. Clinical Study of Manjishthadi Ghrita in Vrana Ropana. AYU. 2011; 32 (1): 95-99.</ref>,<ref>Singh AK, Srivastava PK, Shukla VK. Evaluation of Nimba taila and Manjistha churna in non healing ulcer. International Research Journal of Pharmacy. 2011; 2(5):201-210</ref> lac, haridra and daruharidra used as paste with ghee and honey is an excellent cleanser of skin.

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==== Potential areas /Scope for research ====

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=== 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.

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Charak 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.

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==== ''Shodhana'' (Cleansing) formulations ====

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=== ''Shodhana'' (Cleansing) formulations ===

#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.

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##Powders of barks of kakubha (Termalia arjuna), udumbara, asvattha, lodhra (Symplocos racemosa Roxb), jambu (Eugenia jambolana Lam) and katphala (Myrica esculenta Buch-Ham).

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==== Remedies for post healing complications ====

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=== Remedies for post healing complications ===

#The paste prepared by bhasmas of iron, kasisa and triphala (haritaki,vibhitaki and amalaki) flowers provides blackness in the newly formed skin quickly.

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The role of diet is very important in wounded patients which can be considered for further research as Charak mentioned that wounded patients should abstain from salt, sour, pungent, hot, burning and heavy food and drinks and also sexual intercourse.

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~~=== Glossary ===~~

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== References ==

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

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~~#Prapatan ( Prapatan ; प्रपतन) – Falling down.~~

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~~#Pralēpā ( pralepA ; प्रलेपा) – Application of paste or ointments.~~

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~~#Stabdhaḥ (stabdhaH; स्तब्धः) – Stiffness of ulcer.~~

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~~#Sphurati (sphurati ; स्फुरति) – Throbbing pain.~~

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~~#Pradēhaiḥ (pradehaiH ; प्रदेहैः ) – Application of paste or ointments.~~

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~~#Pariṣēkaiśca (pariShekaishca ; परिषेकैश्च) – Affusion of cold liquids.~~

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~~#Stimitō (stimito ; स्तिमितो) – Numbness.~~

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~~#Bahupicchō (bahupiccho; बहुपिच्छो)- Excessively slimy exudation.~~

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~~#Saṁvr̥tō (saMvRuto ; संवृतो) – Constricted ulcer~~

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~~#Dāruṇaḥ (dAruNaH ; दारुणः) - Hard ulcers.~~

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~~#Viṣamasthitaḥ (viShamasthitaH विषमस्थितः): Ulcers having irregular borders.~~

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~~#Avasanna (~avasanna ; ऽवसन्न ) –Depressed ulcers .~~

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~~#Piñjaraḥ (pi~jjaraH ; पिञ्जरः) – Red and yellow mixed colouration of ulcer.~~

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~~#Kumbhīmukha (kumbhImukha ; कुम्भीमुख ) – Ulcer having narrow opening with expanded base eg.Undermined ulcer.~~

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~~#Divāsvapn (divAsvapnA ; द्दिवास्वप्न ) – Day sleeping.~~

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~~#Rōpaṇīya (ropaNIya ; रोपणी) – Have healing property.~~

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~~#Mārdava (mArdava ; मार्दव ) – Softening of excessive hard tissues of ulcer.~~

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~~#Nirvāpaṇaḥ (nirvApaNaH ; निर्वापणः) –Sprinkling of cooling decoction or liquids for alleviating burning sensation and heat of ulcers.~~

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~~#Kōṣavantō (koShavanto ; कोषवन्तो ) – Pouch like.~~

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~~#Sandadhīta (sandadhIta ; सन्दधीत ) – Restoration of muscles,ligaments,fractured bone etc in the location of ulcer.~~

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~~#Vidāhīni (vidAhIni ; विदाहीनि) – Hot substance~~

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=== References ===

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