अथातो भङ्गप्रतिषेधं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter Bhanga pratisedha treatment of fractures; thus said Atreya and other great sages.
Bhagna Nirukti-bheda – definition- types
पातघातादिभिर्द्वधा भङ्गोऽस्थां सन्ध्यसन्धितः । प्रसारणाकुञ्चनयोरशक्तिः सन्धिमुक्तता ॥ १ ॥
इतरस्मिन् भृशं शोफः सर्वावस्थास्वतिव्यथा । अशक्तिश्चेष्टितेऽल्पेऽपि पीड्यमाने सशब्दता ॥ २ ॥
समासादिति भङ्गस्य लक्षणं, बहुधा तु तत् । भिद्यते भङ्गभेदेन
Bones get broken ( fractured ) from a fall from height, assault etc; it is of two kinds, a. sandhigata-localised in the joint and b. asandhigata-in places other then the joints; inability for expansion (extension) and contraction (flexion etc.) and dislocation of the joint are the features of the first kind; whereas in the second kind profound swelling and severe pain in all positions, inability even for slight movement, production of cracking sound on rubbing are the features of fractures in brief. It is of many kinds, based on the 1-3a. nature of fractures.
तस्य सर्वस्य साधनम् ॥ ३ ॥
यथा स्यादुपयोगाय तथा तदुपदेक्ष्यते ।
Those treatments which are common to all kinds and which are useful as a routine will be described here. 3b-4a.
Asadhya laksana
प्राज्याणुदारि यत्त्वस्थि स्पर्शे शब्दं करोति यत् ॥ ४ ॥
यत्रास्थिलेशः प्रविशेन्मध्यमस्थ्नो विदारितः ।
भग्नं यच्चाभिघातेन किञ्चदेवावशेषितम् ॥ ५ ॥
उन्नम्यमानं क्षतवद्यच्च मज्जनि मज्जति । तद्दुःसाध्यं कृशाशक्तवातलाल्पाशिनामपि ॥ ६ ॥
The bone which has been crushed into very small pieces, that which causes sound on touching, in which pieces of bones have entered into the marrow cavity, the condition where, by trauma very little portion of bone is left inside the body, that condition in which raising the fractured portion makes it sink into the marrow-all these kinds are difficult to cure; so also those found in persons who are emaciated, debilitated, having predominance of vata in their body and who consume very little food. 4b-6.
भिन्नं कपालं यत् कट्यां सन्धिमुक्तं च्युतं च यत् । जघनं
प्रति पिष्टं च भग्नं यत्तद्विवर्जयेत् ॥ ७ ॥
Fracture of the pelvic bone in its flat portion, dislocation of joints of the waist and crushing fracture of pubic bone should be refused. 7.
असंश्लिष्टकपालं भग्रं यच्च ललाटं चूर्णितं तथा । भवेच्छङ्खशिरः पृष्ठस्तनान्तरे ॥ ८ ॥
Skull bones not knit together, the forehead bone is broken to pieces and that fracture which has occured in the middlle of the temples, head, back and breasts should be rejected. 8.
सम्यग्यमितप्यस्थि दुर्न्यासाद्दुर्निबन्धनात् । सङ्क्षोभादपि यद्गच्छेद्विक्रियां तद्विवर्जयेत् ॥ ९ ॥ आदितो यच्च दुर्जातमस्थिसन्धिरथापि वा ।
That bone, which in spite of proper control (by the use of splints etc.) becomes irreregular (distorted) by improper joining, bandaging and exertion (functioning of the affected part) should be refused treatment; so also the bone and the joint which is ill-formed from the beginning itself. 9-10a.
तरुणास्थीनि भुज्यन्ते, भज्यन्ते नलकानि तु ॥ १० ॥
कपालानि विभिद्यन्ते, स्फुटन्त्यन्यानि भूयसा ।
Cartilages bend, tubular bones break, flat bones get punctured and others get cracked-most of the time; all are difficult to cure. 10b-11a.
Chikitsa of sandhigata bhanga
अथावनतमुन्नम्यमुन्नतं आञ्छेदतिक्षिप्तमधोगतं चावपीडयेत् ॥ ११ ॥
चोपरि वर्तयेत् । आञ्छनोत्पीडनोन्नामचर्मसङ्क्षेपबन्धनैः ॥१२॥
The portion of bone which is displaced down should be raised up and that which is displaced up should be pulled down; that which has moved away to other places should be pulled to its normal place, that which is displaced below should be brought up by pulling, kneading, raising, constricting the skin and bandaging. 11b-12.
सन्धीन् शरीरगान् सर्वान् चलानप्यचलानपि । इत्येतैः स्थापनोपायैः सम्यक् संस्थाप्य निश्चलम् ॥ १३ ॥
पट्टैः प्रभूतसर्पिर्भिर्वेष्टयित्वा कदम्बोदुम्बराश्वत्थसर्जार्जुनपलाशजैः सुखैस्ततः । ॥१४॥
वंशोद्भवैर्वा पृथुभिस्तनुभिः सुनिवेशितैः । सुश्लक्ष्णैः सप्रतिस्तम्भैर्वल्कलैः शकलैरपि ॥ १५ ॥
कुशाह्वयैः समं बन्धं पट्टस्योपरि योजयेत् । शिथिलेन हि बन्धेन सन्धिस्थैर्य न जायते ॥ १६ ॥ गाढेनाति रुजादाहपाकश्वयथुसम्भवः ।
All the joints of the body whether moveble or immovable should be placed in their normal position by these methods and immobalised by bands of cloth soaked in plenty of ghee. Hard, thick and smooth pieces of inner bark of kadamba, udumbara, asvattha, sarja, arjuna and palasa or even pieces of vamsa should be arranged evenly over the cloth bandage as kusa (splints) and then bandaged again. By loose bandaging stability (immobility) of the joint is not achieved and by very tight bandaging there is the possibility of pain, burning sensation, ripening, ulceration/suppuration, or swelling manifesting. 13-17a.
त्र्यहात्र्यहादूतौ घर्मे सप्ताहान्मोक्षयेद्धिमे ॥ १७ ॥ साधारणे तु पञ्चाहाद् भङ्गदोषवशेन वा ।
In summer, bandage should be removed every third day, in cold season once in seven days, in moderate seasons once in five days, or at such intervals depending on the condition of the fracture and the dosa. 17b-18a.
न्यग्रोधादिकषायेण ततः शीतेन सेचयेत् ॥ १८ ॥
तं पञ्चमूलपक्केन पयसा तु सवेदनम् ।
It (fracture) should then be bathed either with cold decoction of drugs of nyagrodhadi gana (chapter 15 of sutrasthana) and when there is pain with milk boiled with drugs of pancamula. 18b-19a.
सुखोष्णं वाऽवचार्यं स्याच्चक्रतैलं विजानता ॥ १९ ॥
विभज्य देशं कालं वातघ्नौषधसंयुतम् ।
प्रततं सेकलेपांश्च विदध्याद् भृशशीतलान् ॥ २० ॥
Or after carefully considering the nature of the land and season, cakrataila added with drugs which mitigate vata may be poured over the place comfortably warm, pouring decoctions and application of paste of drugs should be continuous both in very cold state. 19b-20.
गृष्टिक्षीरं ससर्पिष्कं मधुरौषधसाधितम् ।
प्रातः प्रातः पिबेद्भग्नः शीतलं लाक्षया युतम् ॥ २१ ॥ The patient of fracture should drink gristiksira (milk of the cow which has delevered the calf within seven days). every morning added with ghee and boiled with drugs of sweet taste and laksa and then cooled. 21.
सव्रणस्य तु भग्नस्य व्रणो मधुघृतोत्तरैः । कषायैः प्रतिसार्योऽथ शेषो भङ्गोदितः क्रमः ॥ २२ ॥
In case of fracture with a wound, the wound should be bathed with decoction of drugs of astringent taste added with more of honey and ghee. Remaining treatment is like that described for fractures. 22.
Notes Bhagna (fracture ) is two kinds-Savrana-with a wound (compound fracture ) and Avrana-without a wound ( simple fracture).
लम्बानि व्रणमांसानि प्रलिप्य मधुसर्पिषा ।
सन्दधीत व्रणान् वैद्यो बन्धनैश्चोपपादयेत् ॥ २३ ॥
Muscles which are hanging loose in the wound should be smeared with honey and ghee and then cut, sutured and bandaged appropriately. 23.
तान् समान् सुस्थिताञ्ज्ञात्वा फलिनीरोधकट्फलैः।
समङ्गाधातकीयुक्तैश्चूर्णितैरवचूर्णयेत् धातकीरोधचूर्णैर्वा रोहन्त्याशु तथा व्रणाः। ॥ २४ ॥
Observing that these are well adhered, fine powder of either phalini, rodhra, katphala, samanga and dhataki; or of dhataki and rodhra should be sprinkled over them; by this the wounds heal quickly. 24-25a.
इति भङ्ग उपक्रान्तः स्थिरधातोर्ऋतौ हिमे ॥ २५ ॥ मांसलस्याल्पदोष य सुसाध्यो, दारुणोऽन्यथा ।
Thus was described the treatment of bhanga; it is easily curable in those who have strong tissues, during autumn, in persons who are muscular and who have mild aggravation of dosa; the opposite of all these are either very difficult or impossible to cure. 25b-26a.
पूर्वमध्यान्तवयसामेकद्वित्रिगुणैः क्रमात् ॥ २६ ॥
मासैः स्थैर्य भवेत्सन्धेर्यथोक्तं भजतां विधिम् ।
By adopting the treatment described earlier, persons of early, middle and late ages should attain strength in the (fractured) joints in one, two and three months respectively.
कटीजङ्घोरुभग्नानां कपाटशयनं हितम् ॥ २७ ॥
यन्त्रणार्थं तथा कीलाः पञ्च कार्या निबन्धनाः । जङ्घोर्वोः पार्श्वयोद्वौं द्वौ तल एकश्च कीलकः ॥ २८ ॥
श्रोण्यां वा पृष्ठवंशे वा वक्षस्यक्षकयोस्तथा ।
For fractures of the waist, forelegs and thighs it is beneficial to lie on a hard wooden box fitted with five pegs to control (immobolise the leg) two each for the forelegs (calves) and thighs and one for the sole. In the same way (in fractures) of the pelvis, vertebral column, chest or the collar bone. 27b-29a.
विमोक्षे भग्नसन्धीनां विधिमेवं समाचरेत् ॥ २९ ॥
This method may be followed in case of fracture-dislocation of the joints. 29b.
सन्धींश्चिरविमुक्तांस्तु स्निग्धस्विन्नान् मृदूकृतान् । उक्तर्विधानैर्बुद्ध्या च यथास्वं स्थानमानयेत् ॥ ३० ॥
Dislocation of the joint which has become old, should be made soft by anointing with oil and fomentation and then placed in the normal position by the methods described above by using intellegence. 30.
असन्धिभग्ने रूढे तु विषमोल्बणसाधिते । आपोथ्य भङ्गं यमयेत्ततो भग्नवदाचरेत् ॥ ३१ ॥
A fracture which is not located in the joints and has healed improperly (malunion), should be broken up again and treated properly. 31
भग्नं नैति यथा पाकं प्रयतेत तथा भिषक् । पक्क्रमांससिरास्नायुः सन्धिः श्लेषं न गच्छति ॥ ३२ ॥
The physician should not allow ripening (suppuration) in the fracture site; since muscle, veins, tendons, joints which develop pus do not stick together. 32.
वातव्याधिविनिर्दिष्टान् स्नेहान् भग्नस्य योजयेत् । चतुष्प्रयोगान् बल्यांश्च बस्तिकर्म च शीलयेत् ॥ ३३ ॥
Medicated fats described in the treament of vata vyadhi (chapter 21 of cikitsa sthana) should be made use of for the four therapies ( drinking, nasal drops, anointing and enema), recipes which give strength to the body and enema therapy should be adopted. 33.
शाल्याज्यरसदुग्धाद्यैः मात्रयोपचरेद्भग्नं पौष्टिकैरविदाहिभिः । सन्धिसंश्लेषकारिभिः ॥ ३४ ॥
The patient of fracture should consume in proper quantities foods such as rice, ghee, juice of meat, milk etc. which are nourishing the body which do not cause heartburnt and which bestow sturdiness to the joints. 34.
ग्लानिर्न शस्यते तस्य, सन्धिविश्लेषकृद्धि सा ।
लवणं कटुकं क्षारमम्लं मैथुनमातपम् । व्यायामं च न सेवेत भग्नो रूक्षं च भोजनम् ॥ ३५ ॥
Exertion (over activity of the fractured part) is not good for him; for, it will produce dislocation of the joint. The patient of fracture should not indulge in things which are salty, pungent, alkaline and sour; copulation, exposure to sunlight, exercise and dry (non-fatty) foods. 35.
Krsna tila, well cleaned is tied into a bundle with a thick cloth and allowed to stay in flowing water for seven days. Then it is soaked in milk and decoction of madhuka daily and dried in the shade. ( this continued for seven days); once again it is soked in milk, removed of its husk and powdered, it is then mixed with the fine powder of nalada, valaka, lohitayastika, nakha, misi, plava, kustha, balatraya, aguru, kumkuma, candana, sariva, sarala, sarjarasa, amaradaru and the drugs of padmakadi gana, all drugs of fragrant smell (eladigana) and macerated with milk; medicated oil should then be cooked with the above drugs, added with the paste of saileya, rasna, amsumati, kaseru, kalanusari, nata, patra, rodhra, ksirasukla and durva, milk and oil. This oil known as Gandha taila
कृष्णांस्तिलान् विरजसो दृढवस्त्रबद्धान्स प्त क्षपा वहति वारिणि वासयेत ।
संशोषयेदनुदिनं प्रविसार्य चैतान्क्षी रे तथैव मधुकक्कथिते च तोये ॥ ३६ ॥
पुनरपि पीतपयस्कांस्तान् पूर्ववदेव शोषितान् बाढम् । विगततुषानरजस्कान् सञ्चूर्ण्य सुचूर्णितैर्युञ्यात् ॥ ३७॥
नलदवालकलोहितयष्टिकानखमिशिप्लवकुष्ठबलात्रयैः । अगुरुकुङ्कुमचन्दनसारिवासरलसर्जरसामरदारुभिः ॥ ३८ ॥
पद्मकादिगणोपेतैस्तिलपिष्टं समस्तगन्धभैषज्यसिद्धदुग्धेन
शैलेयरास्नांशुमतीकसेरुकालानुसारीनतपत्ररोधैः सक्षीरशुक्लैः सपयः सर्वैस्तैलं पचेत्तन्नलदादिभिश्च ॥ ४० ॥
गन्धतैलमिदमुत्तममस्थिस्थैर्यकृज्जयति चाशु विकारान् । वातपित्तजनितानतिवीर्यान् व्यापिनोऽपि विविधैरुपयोगैः ॥ ४१ ॥
ततश्च तत् । पीडयेत् ॥ ३९ ॥
Gandha taila is good to bestow sturdiness to the bones, cure diseases produced by vata and pitta though powerful and spread all over the body by using it in different methods therapies. 36-41.
इति श्रीवैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने भङ्गप्रतिषेधो नाम सप्तविंशोऽध्यायः ॥ २७ ॥
Thus ends the chapter-Bhanga pratisedha-the twenty in Uttarasthana of Astanga hrdaya samhita, composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
