Changes

== Introduction ==

== 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''), fatty tissue (''meda''), bone (''asthi''), 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 ]  

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>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 ]  

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 ''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. [ 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.

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 ''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. [ 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.