अथातः सद्योव्रणप्रतिषेधं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter Sadyovrana chikitsa – treatment of wounds which occur suddenly (traumatic wounds); Thus said atreya and other great sages.
सद्योव्रणा ये सहसा सम्भवन्त्यभिघाततः ।
अनन्तैरपि तैरङ्गमुच्यते घृष्टावकृत्तविच्छिन्नप्रविलम्बितपातितम् ।
विद्धं भिन्नं विदलितं जुष्टमष्टधा ॥ १ ॥
Sadyovrana are those which occur suddenly due to trauma/injury; though innumerable localised in defferent parts of the body, these are classified as of eight kinds viz, ghrsta, avakrtta, vicchinna, pravilambita, patita, viddha, bhinna and vidalita. 1-2a.
तत्र घृष्टं लसीकया ॥ २ ॥
रक्तलेशेन वा युक्तं सप्लोषं छेदनात् स्रवेत् । अवगाढं ततः कृत्तं, विच्छिन्नं स्यात्ततोऽपि च ॥ ३॥
प्रविलम्बि सशेषेऽस्थि, पतितं पातितं तनोः । सूक्ष्मास्यशल्यविद्धं तु विद्धं कोष्ठविवर्जितम् ॥ ४ ॥
भिन्नमन्यद्विदलितं मज्जरक्तपरिप्लुतम् ।
प्रहारपीडनोत्पेषात् सहास्था पृथुतां गतम् ॥ ५ ॥
Ghrsta is that which exudes lasika (lymph) alone or mixed with little of blood, associated with burning sensation; Avagadha is severe than ghrsta and Vicchinna still more severe than avagadha. Pravilambi is that in which only the bone remains in the place; patita is that in which the injured part has fallen off from (seperated) from the body; Viddha is a wound with small orifice caused by a foreign body any where on the body except the kostha (organs inside the trunk); such a wound occuring in the kostha is called Bhinna; Vidalita is that which occurs due to hitting ( assault), squeezing and crushing of bones, found containing marrow and blood inside and has become thick. 2b-5.
Treatment of traumatic wounds
सद्यः सद्योव्रणं सिञ्चेदथ यष्ट्याह्वसर्पिषा । तीव्रव्यथं कवोष्णेन बलातैलेन वा पुनः ॥ ६ ॥
Sadyovrana which has severe pain should be immediately bathed (washed) in warm yasti ghrta or bala taila often.
क्षतोष्मणो निग्रहार्थं तत्कालं विसृतस्य च । कषायशीतमधुरस्निग्धा लेपादयो हिताः ॥ ७ ॥ ॥७॥
In order to mitigate the heat of the wound, drugs which posess astringent taste, cold potency, sweet taste and unctuous properties should be made use of for lepa (external application of paste) etc. 7.
सद्योव्रणेष्वायतेषु सन्धानार्थं विशेषतः ।
मधुसर्पिश्च युञ्जीत पित्तघ्नीश्च हिमाः क्रियाः ॥ ८॥
In traumatic wounds which are wide, in order to promote healing, honey ghee should be specially made use of, so also treatment which mitigate pitta and are cold. 8.
ससंरम्भेषु कर्तव्यमूर्ध्वं चाधश्च शोधनम् । उपवासो हितं भुक्तं प्रततं रक्तमोक्षणम् ॥ ९ ॥
When accompanied with severe swelling, purification of the body in the upper (emesis) and lower parts (purgation) and fasting are beneficial, frequent blood letting also after consumption of food. 9.
घृष्टे विदलिते चैष सुतरामिष्यते विधिः ।
तयोर्ह्यल्पं स्त्रवत्यस्त्रं पाकस्तेनाशु जायते ॥ १० ॥ These (above) are the methods specially suited for ghrsta and vidalita kinds; in these the bleeding is less, hence 10. paka (suppuration) develops quickly.
अत्यर्थमस्त्रं स्त्रवति प्रायशोऽन्यत्र विक्षते ।
ततो रक्तक्षयाद्वायौ कुपितेऽतिरुजाकरे ॥ ११ ॥
स्नेहपानपरीषेकस्वेदलेप्रोपनाहनम्स्ने हबस्ति च कुर्वीत वातघ्नौषधसाधितम् ॥ १२ ॥
In others (avakrtta and vicchinna ) there is copious discharge of blood generally, by loss of blood vata undergoes aggravation and causes severe pain. For this condition, drinking of fats, washing the wound, fomentation, external application of paste, warm paultice and fat enema therapy all prepared from the drugs which mitigate vata should be administered. 11-12.
इति साप्ताहिकः प्रोक्तः सद्योव्रणहितो विधिः ।
सप्ताहाद्गतवेगे तु पूर्वोक्तं विधिमाचरेत् ॥ १३ ॥ Thus were described the method of treatment for the first seven days beneficial to traumatic wounds; after seven days when the severity has subsided, the treatments discribed previously (in previous chapter ) should be adopted. 13.
प्रायः सामान्यकर्मेदं वक्ष्यते तु पृथक्पृथक् ।
This is the general line of treatment; further on will be described treatment special to each, seperately. 14a.
घृष्टे रुजं निगृह्याशु व्रणे चूर्णानि योजयेत् ॥ १४ ॥ कल्कादीन्यवकृत्ते तु विच्छिन्नप्रविलम्बिनोः ।
सीवनं विधिनोक्तेन बन्धनं चानु पीडनम् ॥ १५ ॥
In Ghrsta kind of ulcer, the pain should be controlled first and then the wound dusted with the powder (of drugs), in Avakrtta, paste ( of drugs) etc. in Vicchina and Pravilambi suturing, bandaging and squeezing should be done one after the other, as per procerdure described previously. 14b-15.
असाध्यं स्फुटितं नेत्रमदीर्णं लम्बते तु यत् । सन्निवेश्य यथास्थानमव्याविद्धसिरं भिषक् ।। १६ ।।
पीडयेत् पाणिना पद्मपलाशान्तरितेन तत् । ततोऽस्य सेचने नस्ये तर्पणे च हितं हविः ॥ १७ ॥ विपक्वमाजं यष्ट्याह्वजीवकर्षभकोत्पलैः । सपयस्कैः परं तद्धि सर्वनेत्राभिघातजित् ॥ १८ ॥ The eye (ball) which is split ( broken ) is not treated which has come out and hanging loose (incurable); that and its vein not cut, then the physician should push it inside with the help of his palm holding a leaf of a lotus; goat’s ghee boiled with yastyahva, jivaka, rsabhaka, utpala and milk is beneficial for bathing the eye, nasal drops, and filling the eyes. This cures all the injuries of the eyes. 16-18.
गलपीडाऽवसन्नेऽक्षिण वमनोत्कासनक्षवाः ।
प्राणयामोऽथवा कार्य: क्रिया च क्षतनेत्रवत् ॥ १९ ॥
If the eye (ball) has gone deep inside, hard pressing of the throat inducing of vomitting, cough and sneeze or control of respiration should be done and also the treatments prescribed for ulceration of the eye. 19.
If the ear (pinna) is displaced, it should be sutured (at the proper place) and the ear filled with medicated oil. 20a.
कर्णे स्थानाच्युते स्यूते श्रोतस्तैलेन पूरयेत्
कृकाटिकायां छिन्नायां निर्गच्छत्यपि मारुते ॥ २० ॥
समं निवेश्य वध्नीयात् स्यूत्वा शीघ्रं निरन्तरम् । आजेन सर्पिषा चात्र परिषेकः प्रशस्यते ॥ २१ ॥
उत्तानोऽन्नानि भुञ्जीत, शयीत च सुयन्त्रितः ।
If the krkatika (cricoid eartilage in the neck) is found cut and air is coming out through it, it should be placed in the proper level, sutured without leaving any space in the middle and then bandaged. It is ideal to bathe the site with goat’s ghee, the patient should eat food lieing with his face up and sleep well restrained ( without making movement).
घातं शाखासु तिर्यक्स्थं गात्रे सम्यनिवेशिते ॥ २२ ॥ स्यूत्वा वेल्लितबन्धेन वध्नीयाद् घनवाससा। चर्मणा गोष्फणाबन्धः
If the extremities are injured and found distorted, they should be brought back to their normal position, sutured and bandaged with vellita bandha, using thick cloth. In case of wounds which are irregular (uneven) gosphana bandha should be tied using leather strap. 22b-23.
पादौ विलम्बिमुष्कस्य प्रोक्ष्य नेत्रे च वारिणा । प्रवेश्य वृषणौ सीव्येत् सेवन्या तुन्नसंज्ञयाः ॥ २४ ॥
कार्यश्चासते व्रणे ॥ २३ ॥
कार्यश्च गोष्फणाबन्धः कट्यामावेश्य पट्टकम् ।
स्नेहसेकं न कुर्वीत तत्र क्लिद्यति हि व्रणः ॥ २५ ॥
If in a person the scrotum is found hanging loose and the testes have come out (as a result of injury) the feet and eyes of such a person should be washed with water (first), then the testes should be pushed into the scrotum and sutured at the suture called tunnasevani (vesico-rectal raphae) then gosphana bandha should be tied, tieing one end of the band at the waist. Use of fats and fomentation should not be done to the site since the ulcer might become moist (exude pus). 24-25.
कालानुसार्यगुर्वेलाजातीचन्दनपर्पटैः ।
शिलादार्व्यमृतातुत्थैः सिद्धं तैलं च रोपणम् ॥ २६ ॥
Medicated oil prepared with kalanusari, aguru, ela, jati, candana, parpata, sila, darvi, amrta and tuttha is good for healing. 26.
छिन्नां निःशेषतः शाखां दग्ध्वा तैलेन युक्तितः । बध्नीयात् कोशबन्धेन ततो व्रणवदाचरेत् ॥ २७ ॥
The limb which has been completely cut off should be bandaged using kosabandha and then treated like any ulcer. 27.
कार्या शल्याहृते विद्धे भङ्गाद्विदलिते क्रिया |
In Viddha kind of wound from which the foreign body has been removed, the treatment prescribed for vidalita wound, should be done. 28a.
शिरसोऽपहृते शल्ये वालवर्ति प्रवेशयेत् ॥ २८ ॥
मस्तुलुङ्गस्स्रुतेः क्रुद्धो हन्यादेनं चलोऽन्यथा | व्रणे रोहति चैकैकं शनैरपनयेत्कचम् ॥ २९ ॥
After removing the foreign body from the head (scalp) a wick of hair should be inserted into that holes, otherwise by discharge of mastulunga ( brain mattar) cala (vata) getting aggravated may kill the person; after the wounds heal, the wick of hair should be removed one after the other.
मस्तुलुङ्गस्रुतो खादेन्मस्तिष्कानन्यजीवजान् ।
In case of elimination of brain matter, the patient should partake the brain of other animals. 30a.
शल्ये हृतेऽङ्गादन्यस्मात्स्नेहवर्तिं निधापयेत् ॥ ३० ॥
Wound caused by removal of foreign bodies should be plugged with ( cotton ) wick soaked in fats (oil or ghee), 30.
दूरावगाढा: सूक्ष्मास्या ये व्रणाः स्स्रुतशोणिताः । सेचयेच्चक्रतैलेन सूक्ष्मनेत्रार्पितेन तान् ॥ ३१ ॥
The wounds which are deep seated, with minute mouth (orifice) and exuding blood should be bathed with cakra taila (oil dribbling from the pestle of the oil mill) pushed inside through the minute tubes. 31.
Kosthabheda lakshana – signs of injury to internal viscera
भिन्ने कोष्ठेऽसृजा पूर्णे मूर्च्छाहृत्पार्श्ववेदनाः । ज्वरो दाहस्तृडाध्मानं भक्तस्यानभिनन्दनम् ॥ ३२ ॥
सङ्गो विमूत्रमरुतां श्वासः स्वेदोऽक्षिरक्तता । लोहगन्धित्वमास्यस्य स्याद् गात्रे च विगन्धता ॥ ३३ ॥
If the organs of the trunk are wounded/ injured there is accumilation of blood inside, fainting, pain in the region of the heart and flonks, fever, burning sensation, thirst, flatulance, lack of desire for food, obstruction fo faeces, urine and flatus, dyspnoea, sweating, redness of the eyes, smell of iron from the mouth and abnormal smell in body. 32-33.
आमाशयस्थे रुधिरे रुधिरं छर्दयत्यपि । आध्मानेनातिमात्रेण शूले च विशस्यते ॥ ३४ ॥
If the blood has accumilated in the stomach, there is vomiting of blood and the person dies by profound flatulence and severe pain. 34.
पक्काशयस्थे रुधिरे सशूलं गौरवं भवेत् । नाभेरधस्ताच्छीतत्वं खेभ्यो रक्तस्य चागमः ॥ ३५ ॥
If the blood has accumilated in the large intestines, there is pain, heaviness below the umbilius, coldness and blood comes out through the orifices (of faeces etc.). 35.
अभिन्नोऽप्याशयः सूक्ष्मैः स्त्रोतोभिरभिपूर्यते । असृजा स्यन्दमानेन पार्श्वे मूत्रेण बस्तिव्त ॥ ३६ ॥
The organs even though not wounded (visibly) gets filled with blood from minute channels from all the sides just like the urinary bladder from the urine. 36.
तत्रान्तर्लोहितं शीतपादोच्छ्वासकराननम् ।
रक्ताक्षं पाण्डुबदनमानद्धं च विवर्जयेत् ॥ ३७ ॥
The person who has accumilation of blood inside, whose feet, expired air, hands and face are cold, eyes are red, face is pale and abdomen bloated should be rejected. 37.
Kosthabheda chikitsa – treatment of visceral wounds
आमाशयस्थे वमनं हितं, पक्काशयाश्रिते।
विरेचनं निरूहं च निःस्नेहोष्णैर्विशोधनैः ॥ ३८ ॥
If accumilation of blood is in the stomach emesis is beneficial and if it is in the large intestine, purgation and decoction enema without addition of fats; with drugs of hot potency and of purgative properties. 38.
यवकोलुकलत्थानां रसैः स्नेविवर्जितैः ।
भञ्जीतान्नं यवागूं वा पिबेत्सैन्धवसंयुताम् ॥ ३९ ॥
He should partake his food with the soup of yava, kola or kulattha without adding fats or drink yavagu (gruel) added with saindhava. 39.
अतिनिःस्रुतरक्तस्तु भिन्नकोष्ठः पिबेदसृक् ।
The patient wounded in the viscera who has lost much blood should drink blood ( of animals).
40a.
क्लिष्टच्छिन्नान्त्रभेदेन कोष्ठेभेदो द्विधा स्मृतः ॥ ४० ॥
मूर्च्छादयोऽल्पाः प्रथमे, द्वितीये त्वति बाधकाः । क्लिष्टान्त्रः संशयी दही छिन्नान्त्रो नैव जीवति ॥ ४१ ॥
Kosthabheda is of two kinds viz klistantra and chidrantra, in the first fainting etc. are mild and in the second they are very troublesome; in klistantra life of the person is doubtful (may survive or may not survive) but in 40-41. chidrantra, the person does not survive at all.
यथास्वं मार्गमापन्ना यस्य विण्मूत्रमारुताः | व्युपद्रवः स भिन्नेऽपि कोष्ठे जीवत्यसंशयम् ॥ ४२ ॥
The person though wounded in the internal organs surely survives when the faeces, urine and flatus begun to come out in their normal passages and when other complications get relieved. 42.
अभिन्नमन्त्रं निष्क्रान्तं प्रवेश्यं न त्वतोऽन्यथा | उत्पङ्गिलशिरोग्रस्तं तदप्येके वदन्ति तु ॥ ४३ ॥
The intestine which is not wounded and which has come out should be pushed inside but not otherwise (if it is wounded); that should be pushed inside only after it is held ight by the head of the big ants – thus say some others. 43.
प्रक्षाल्य पयसा दिग्धं तृणशोणितपांसुभिः ।
प्रवेशयेत्क्लृप्तनखो घृतेनातं शनैः शनैः ॥ ४४ ॥
The intesine contaminated with grass, blood, sand etc. should be washed well with water and the physician with his hands smeared with ghee and nails pared, should push the intestine slowly. 44.
क्षीरेणाकृतं शुष्कं भूरिसर्पिः परिप्लुतम् । अङ्गुल्या प्रमृशेत्कण्ठं तथाऽन्त्राणि विशन्त्यन्तस्तत्कालं पीडयन्ति च ।
व्रणसौक्ष्म्याद्वहुत्वाद्वा तत्प्रमाणेन जठरं पाटयित्वा प्रवेशयेत् । जलेनोद्वेजयेदपि ॥ ४५ ॥ कोष्ठमन्त्रमनाविशत् ॥ ४६ ॥
The intestine which is dry should be moistened with milk and more of ghee, then with his fingers the physician should squeeze the throat and stimulate him with water. Soon the intestine enters into the abdomen by these methods. If the intestines do not get in, then the abdomen should be cut open to the required size and the intestine pushed in 45-47a.
यथास्थानं स्थिते सम्यगन्त्रे सीव्येदनु व्रणम् ॥ ४७ ॥
स्थानादपेतमादत्ते जीवितं कुपितं च तत् । वेष्टयित्वाऽनु पट्टेन घृतेन परिषेचयेत् ॥ ४८ ॥
पाययेत ततः कोष्णं चित्रातैलयुतं पयः । मृदुक्रियार्थं शकृतो वायोश्चाधः प्रवृत्तये ॥ ४९ ॥
अनुवर्तेत वर्षं च यथोक्ता व्रणयन्त्रणाम् ।
When the intestine occupies its proper place the wound should be sutured; if displaced again it the away may take life, by aggravation. A band of cloth should be wound round the abdomen and soaked daily with ghee. He should drink warm milk added with citra taila (castor oil) in order to make the faeces soft and flatus to move down. This procedure should be continued for one year along with other therapies prescribed in the treatment of ulcers. 47b-50a.
उदरान्मेदसो वर्ति निर्गतां भस्मना मृदा ॥ ५० ॥
अवकीर्य कषायैर्वा श्लक्ष्णैर्मूलैस्ततः समम् । दृढं बध्वा च सूत्रेण वर्द्धयेत्कुशलो भिषक् ॥ ५१॥
तीक्ष्णेनाग्निप्रतप्तेन शस्त्रेण सकृदेव तु। स्यादन्यथा रुगाटोपो मृत्युर्वा छिद्यमानया ॥ ५२ ॥
सक्षौद्रे च व्रणे बद्धे सुजीर्णेऽन्ने घृतं पिबेत् । क्षीरं वा शर्कराचित्रालाक्षागोक्षुरकैः शृतम् ॥ ५३ ॥
रुग्दाहजित्सयष्ट्याह्ववैः परं पूर्वोदितो विधिः । मेदोग्रन्थ्युदितं तत्र तैलमभ्यञ्जने हितम् ॥ ५४॥
If the medas varti ( wick of fat / pancreas) has come out, it should be cleaned with soft ash or decoction of astrigent drugs or fine powder of roots of trees, then made straight, tied firm with thread and cut, then after buched with red hot iron; if not done so, it may lead to pain, gurglings or death. Next the wound should be bathed with honey or milk boiled with sarkara, citra, laksa, goksura and yastyahva, this is best to relieve pain and burning sensation. Medicated oil prescribed for medoja granthi previously (vide chapter 31 of ) should also be adopted for anointing in this condition also. 50-54.
तालीसं पद्मकं मांसीहरेण्वगुरुचन्दनम् । हरिद्रे पद्मबीजानि सोशीरं मधुकं च तैः ॥ ५५ ॥
पक्कं सद्योव्रणेषूक्तं तैलं रोपणमुत्तमम् ।
mamsi, Medicated oil prepared with talisa, padmaka, herenu, aguru, candana, the two haridra, seed of padma, usira and madhuka, is good for healing of ulcers. 55-56a.
गूढप्रहाराभिहते पतिते विषमोच्चकैः॥ ५६॥ कार्यं वातास्त्रजित् तृप्तिमर्दनाभ्यञ्जनादिकम् ।
In wound which are caused by concealed blow, in which parts of the body have got displaced, which are irregular and greatly elevated, treatments such as tarpana (nourishment), mardana (massage), abhyanjana (oil anointing), etc. which are prescribed for vatasra ( gout) should be done. 56b-57a.
विश्लिष्टदेहं मथितं क्षीणं मर्माहतं हतम् ॥ ५७ ।। वासयेत्तैलपूर्णायां द्रोण्यां मांसरसाशिनम् ॥ ५७॥
The person whose body is badly wounded, churned, emaciated, injured in the vital organs and badly damaged should be kept in bath-tub filled with medicated oil and the patient consuming juice of meat as food. 57b-572.
इति श्रीवैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने सद्योव्रणप्रतिषेधो नाम षड्विशोऽध्यायः ॥ २६ ॥
Thus ends the chapter Sadyovrana pratisedha-the twenty sixth in Uttarasthana of Astanahrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
