द्वितीयोऽध्यायः । अथातः सद्योव्रणचिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the medical treatment of recent or traumatic wounds or sores (Sadyovrana-Chikitsa). 1 धन्वन्तरिर्धर्मभृतां वरिष्ठो वाग्विशारदः । विश्वामित्रात्मजमृषिं शिष्यं सुश्रुतमन्वशात् ।। २ ।।
Metrical Texts: The holy Dhanvantari, the foremost of the pious and the greatest of all discoursers, thus discoursed to his disciple Susruta, the son of Visvamitra. 2
नानाधारामुखैः शस्त्रैर्नानास्थाननिपातितैः । नानारूपा व्रणा ये स्युस्तेषां वक्ष्यामि लक्षणम् || ३ |
आयताश्चतुरस्त्राश्च त्र्यस्त्रा मण्डलिनस्तथा । अर्द्धचन्द्रप्रतीकाशा विशालाः कुटिलास्तथा ॥ ४ ॥
शरावनिम्नमध्याश्च यवमध्यास्तथाऽपरे । एवंप्रकाराकृतयो भवन्त्यागन्तवो व्रणाः।। ५।।
दोषजा वा स्वयं भिन्नाः न तु वैद्यनिमित्तजाः ।। ६ ।।
भिषग्वणाकृतिज्ञो हि न मोहमधिगच्छति । दुर्दर्शरूपेषु भृशं दुर्दर्शरूपेषु व्रणेषु विकृतेष्वपि ।। ७ ।।
Different shapes of Sores: I shall describe the shapes of the various kinds of Vrana (sores or wounds) caused by weapons of variously shaped edges in the different parts of the human body. Traumatic ulcers have a variety of shapes. Some of these are elongated, others are rectangular, or triangular, or circular, while some are crescent shaped, or extended, or have a zigzag shape, and some are hollow in the middle like a saucer, and lastly some have the shapes of a barley corn (bulged out at the middle ). An abscess or a swelling, due to the several Dosas and which spontaneously bursts out, may assume any of the aforesaid forms, while the one effected by a surgeon’s knife should never have a distorted or an improper shape. A surgeon throughly familiar with the shapes of ulcers is never puzzled at the sight of one of a terrible and distorted shape. 3-7
अनेकाकृतिरागन्तुः स भिषग्भिः पुरातनैः। समासतो लक्षणतः षड्विधः परिकीर्त्तितः ।। ८ ।।
छिन्नं भिन्नं तथा विद्धं क्षतं पिच्चितमेव च । घृष्टमाहुस्तथा षष्टं तेषां वक्ष्यामि लक्षणम् ।। ९ ।।
Physicians of sore have grouped these variously shaped traumatic ulcers under six broad sub-heads, such as the Chinna ( cut), Bhinna (punctured or perforated), Viddha (pierced), Kshata (contused), Piccita ( crushed ), and the Ghrsta (mangled or lacerated) according to their common features and I shall describe their symptoms. 8-9
तिरश्चीन ऋजुर्वाऽपि यो व्रणश्चायतो भवेत् । गात्रस्य पातनञ्चापि छिन्नमित्युपदिश्यते ।। १० ।।
कुन्तशक्त्यृष्टिखङ्गाग्रविषाणादिभिराशयः 1 हतः किञ्चित् स्रवेत् तद्धि भिन्नलक्षणमुच्यते ।। ११ ।।
स्थानान्यामाग्निपक्वानां मूत्रस्य रुधिरस्य च । हृदुण्डुकः फुप्फुसश्च कोष्ठ इत्यभिधीयते ।। १२ ।।
तस्मिन् भिन्ने रक्तपूर्ण ज्वरो दाहश्च जायते । मूत्रमार्गगुदास्येभ्यो रक्तं घ्राणाच्च गच्छति ।। १३ ।।
मूर्च्छाश्वासतृडाध्मानमभक्तच्छन्द एव च । स्वेदास्त्रावोऽक्षिरक्तता ।। १४ ।।
विण्मूत्रवातसङ्गश्च लोहगन्धित्वमास्यस्य गात्रदौर्गन्ध्यमेव च। हृच्छूलं पार्श्वयोश्चापि विशेषञ्चात्र मे शृणु ।। १५ ।।
traumatic ulcer which is oblique or straight and elongated is called a Chinna (cut) ulcer, while a complete severance of a part or member of the body is also designated by that name. A perforation of any of the cavities or receptacles of the body by the tip of a Kunta, spear. Rsti, or a sword or by a horn, attended with a little discharge, constitutes what is called a Bhinna (punctured) wound or ulcer. The Amasaya (stomach), the Pakvasaya (intestines), the Agnyasaya (gall-bladder ?), the Mutrasaya (urinary bladder), the Raktasaya (receptacle of blood), the heart, the Unduka (caecum) and the lungs constitute what is called the Kostha (viscus). A perforation (of the wall of any) of the Asayas causes it to become filled with blood which is discharged through the urethra, the anus, the mouth or the nostrils and is attended with fever, thirst, fainting fits, dyspnoea, burning sensations, tympanitis, suppression of stool, urine and flatus (Vata) with an aversion for food, perspiration, redness of the eyes, a bloody smell in the mouth, and feted one in the body and an aching pain in the heart and in the sides. Now hear me discoursing on (their) detailed symptoms. 10-15
Their definitions: A
आमाशयस्थे रुधिरे रुधिरं आध्मानमतिमात्रञ्ज छर्दयेत् पुनः । शूलञ्च भृशदारुणम् ।। १६ ।।
पक्वाशयगते चापि रुजो गौरवमेव च। शीतता चाप्यधो नाभेः खेभ्यो रक्तस्य चागमः ।। १७ ।।
अभिन्नेऽप्याशयेऽन्त्राणां खैः सूक्ष्मैरन्त्रपूरणम् । पिहितास्ये घटे यद्वल्लक्ष्यते तस्य गौरवम् ॥ १८ ॥
A perforation of the wall of the Amasaya (stomach) is marked by constant vomiting of blood, excessive tympanitis and an excruciating pain. A perforation of the Pakvasaya fills it with blood and is attended with extreme pain, a heaviness in the limbs, coldness of the subumbilical region, and bleeding through the (lower) ducts and orifices of the body. Even in the absence of any perforation, the Antras (intestines) are filled with blood through the small pores or apertures in their walls in the same manner as a pitcher with its mouth firmly covered may be filled through the pores (in its sides) and a sense of heaviness is also perceived in their inside. 16-18
सूक्ष्मास्यशल्याभिहतं यदङ्गं त्वाशयाद् विना । उत्तुण्डितं निर्गतं वा तद् विद्धमिति निर्दिशेत् ।। १९ ।।
नातिभिन्नमुभयोर्लक्षणान्वितम् । नातिच्छिन्नं विषमं व्रणमङ्गे यत् तत् क्षतं त्वभिनिर्दिशेत् ।। २० ।।
प्रहारपीडनाभ्यान्तु यदङ्गं यदङ्गं पृथुतां गतम् । सास्थि तत् पिच्चितं विद्यान्मज्जरक्तपरिप्लुतम् ।। २१ । ।
विगतत्वग् यदङ्गं हि संघर्षादन्यथाऽपि वा । उषास्त्रावान्वितं तत् तु घृष्टमित्युपदिश्यते ।। २२ ।।
A wound or an ulcer caused by any sharp pointed Salya (shaft) in any part of the body other than the aforesaid Asayas with or without that Salya being extricated is called a Viddha (pierced one). An ulcer which is neither a cut nor a perforation or puncture but partakes of the nature of both and is uneven is called a Ksata (wound). A part of the body with the local bone crushed between the folds of a door or by a blow becomes extended and covered with blood and marrow and is called a Piccita (thrashed) wound or ulcer. The skin of any part of the body suffering abrasion through friction or from any other such like causes and attended with heat and a secretion is called a Ghrsta (mangled or lacerated) wound or ulcer. 19-22
वाऽसगतिस्त्रवेत् । करोति पवनो करोति पवनो भृशम् ॥ २३ ॥
स्नेहपानं हितं तत्र तत्सेको विहितस्तथा । वेशवारैः सकृशरैः सुस्निग्धैश्चोपनाहनम् ॥ २४ ॥
धान्यस्वेदांश्च कुर्वीत स्निग्धान्यालेपनानि च । वातघ्नौषधसिद्धैश्च स्नेह्रैर्बस्तिर्विधीयते ॥ २५ ॥
पिच्चिते च विघृष्टे च नातिस्त्रवति शोणितम् । अगच्छति भृशं तस्मिन् दाहः पाकश्च जायते ॥ २६ ॥
तत्रोष्मणो निग्रहार्थं तथा दाहप्रपाकयोः । शीतमालेपनं कार्यं परिषेकश्च शीतलः ॥ २७ ॥
षट्स्वेतेषु यथोक्तेषु छिन्नादिषु समासतः । ज्ञेयं समर्पितं सर्वं सद्योव्रणचिकित्सितम् ॥ २८ ॥
छिन्ने भन्ने तथा विद्धे क्षते रक्तक्षयाद्रुजस्तत्र
Their Treatment: A part or member of the body any wise cut, perforated, pierced or wounded which is attended with excessive bleeding and with the local Vayu enraged or aggravated by the incidental bleeding, or haemorrhage will occasion excruciating pain. Potions of Sneha (oily or fatty liquids) and using the same as a washing (in a lukewarm state) should be advised in such cases. Preparation of Vesavaras and other Krsaras largely mixed with oil or clarified butter should be used as poultices and fomentations with the Masa pulse, etc., and the use of oily unguents and emulsive Bastis (enernatas) prepared with decoctions of Vayu-subduing drugs should be applied. A crushed or thrashed wound or abrasion is not attended with any excessive bleeding an absolute absence whereof, (on the contrary) gives rise to an excessive burning sensation and suppuration in the affected part. Cold washes and cooling plasters should be used in these cases for the alleviation of the burning and suppuration as well as for the cooling of the (incarcerated) heat. What has been briefly said of these six forms of ulcers, or wounds should be understood to include the treatment of all kinds of traumatic wounds or ulcers as well. 23-28
अत ऊर्ध्वं प्रवक्ष्यामि च्छिन्नानान्तु चिकित्सितम् । ये व्रणा विवृताः केचिच्छिर: पार्वावलम्बिनः ।
तान् सीव्येद् विधिनोक्तेन बध्नीयाद् गाढमेव च ।। २९ ।।
कर्णं स्थानादपहृतं स्थापयित्वा यथास्थितम् । सीव्येद् यथोक्तं तैलेन स्त्रोतश्चाप्यभितर्पयेत् ॥ ३० ॥
कृकाटिकान्ते छिन्ने तु गच्छत्यपि समीरणे । सम्यनिवेश्य बध्नीयात् सीव्येच्चापि निरन्तरम् ॥ ३१ ॥
आजेन सर्पिषा चैवं परिषेकन्तु कारयेत् । उत्तानोऽन्नं समश्नीयाच्छयीत च सुयन्त्रितः ।। ३२ ।।
Treatment of cuts or incised wounds & c: Now we shall discourse on the medical treatment of Chinna cuts. An open mouthed ulcer on the side of the head2 should be duly sutured as described before and firmly bandaged. An ear severed or lopped off should be
1. Snehapana is recommended when the ulcer is in region above the umbilicus and Basti-karma when the ulcer is in a subumbilical region.
2. Several commentators explain those that are situated either on the head or on the sides. sutured in the proper way and position and oil should be poured into its cavity. A Chinna cut on the Krkatika (lying on the posterior side of the junction of the neck and the head) and even if it allow the Vayu¹ (air) to escape through its cavity should be brought together and duly sutured and bandaged in a manner (so as not to leave any intervening space between) the part thus adhesioned should be sprinkled with clarified butter prepared from goat’s milk. The patient should be made to take his food lying on his back, properly secured or fastened with straps (so that he might not move his head and advised to perform all other physical acts such as, urination, defecation etc., in that position). 29-32
शाखासु पतितांस्तिर्यक् प्रहारान् विवृतान् भृशम् । सीव्येत् सम्यङ् निवेश्याशु सन्ध्यस्थीन्यनुपूर्वशः || ३३ ||
बद्धवा वेल्लितकेनाशु ततस्तैलेन सेचयेत् । चर्मणा गोफणाबन्धः कार्यो यो वा हितो भवेत् ॥ ३४ ॥
पृष्ठे व्रणो यस्य भवेदुत्तानं शाययेत् तु तम्। अतोऽन्यथा चोरसिजे शाययेत् पुरुषं व्रणे ।। ३५ ।।
In the case of a lateral and wide-mouthed wound (sword-cut, etc.) on the extremeties, the bone-joints should be duly set and joined together as instructed before and the wound should be sutured and speedily bandaged in the manner of a Vellitaka bandage (spiral Bandage), or with a piece of skin tied in the Gophana (slig bandage ) or such other form as would seem proper and beneficial and oil should be poured over it. In the case of a wound on the back the patient should be laid on his back, while in the case of its occurring on the chest the patient should be laid on his face.2 33-35
छिन्नां नि:शेषत: शाखां दग्ध्वा तैलेन बुद्धिमान् । बध्नीयात् कोशबन्धेन प्राप्तं कार्यञ्च रोपणम् ।। ३६ ।।
1. The dictum that a hurt on any of the wind-carrying or sounding channels is pronounced to be incurable, should not be supposed to hold good in the present case.
2. For the complete elimination of the deranged Dosa i.e., pus, etc., of the wound involved in the case –Jejjata.
He who has got a wound on his back should be laid on his face and he who has got an ulcer on his breast should be laid on his back–Different Reading Gayi.
चन्दनं पद्मकं रोध्रमुत्पलानि हरिद्रा मधुकञ्चैव पयः स्यादत्र तैलमेभिर्विपक्वन्तु प्रधानं चन्दनं कर्कटाख्या च सहे मांसाह्वयाऽमृता । हरेणवो मृणालञ्च त्रिफला त्रयोदशाङ्गं प्रियङ्गवः । चाष्टमम् । व्रणरोपणम् ॥ ३७॥ पद्मकोत्पले । । ३८ ।। पयसाऽन्वितम् । त्रिवृतमेतद् वा तैलं विपक्वं सेकार्थे हितन्तु व्रणरोपणे ।। ३९ ।।
In the case of a hand or a leg being cut away or completely severed the wound should be cauterised with the application of hot oil and bandaged in the manner of a Kosa (sheath bandage) bandage and proper healing medicines should be applied. An oil cooked with the eight drugs Candana, Padmaka, Rodhra, Utpala, Priyangu, Haridra, Madhuka, (Yastimadhu) and milk, forms one of the most efficacious healing (Ropana) agents. A Kalka of the thirteen drugs Candana, Karkatakhya, the two kinds of Saha (Mudgparni and Masparni), Mainsi. (D. R. Masahva, Somahva). Amrta, Harenu, Mrinala Triphala. Padmaka and Utpala should be cooked in oil mixed with milk (four times that of oil) and the three other kinds of oily matter (lard, marrow and clarified butter) and this medicated oil should be used for sprinkling over a wound of this type for the purpose of healing (Ropana). 36-39
शनैः ।। ४० ।। अत ऊर्ध्वं प्रवक्ष्यामि भिन्नानान्तु चिकित्सितम् । भिन्नं नेत्रमकर्मण्यमभिन्नं लम्बते तु यत् । तन्निवेश्य यथास्थानमव्याविद्धसिरं पीडयेत् पाणिना सम्यक् पद्मपत्रान्तरेण तु । ततोऽस्य तर्पणं कार्यं नस्यञ्चानेन सर्पिषा ॥ ४१ ॥ आजं घृतं क्षीरपात्रं मधुकञ्चोत्पलानि च। जीवकर्षभकौ चैव पिष्ट्वा सर्पिर्विपाचयेत् । सर्वनेत्राभिघाते तु सर्पिरतत् प्रशस्यते ॥ ४२ ॥ ।।
Medical Treatment of Bhinna: Henceforth we shall deal with the medical treatment of Bhinna (excised) wounds. A case of an excised eye (Bhinna) should be given up as incurable. But in the case where an eye (ball) instead of being completely separated would be found to be dangling out (of its socket ) the affected organ should be reinstated in its natural cavity in a manner so as not to disturb the connected Siras (nerve arrangements) and gently pressed with the palms of the hand by first putting a lotus leaf on its (eye) surface. After that the eye should be filled (Tarpana) with the following (D. R..-Ajena in place of Anena–i.e., prepared from goat’s milk) medicated clarified butter, which should be used in the form of an errhine as well. The recipe is as follows: Clarified butter prepared from goat’s milk, Madhuka, Utpala, Jivaka and Rsabhaka taken in equal parts should be pasted together, and cooked with sixteen seers of cow’s milk and four seers of clarified butter. The use of the medicated Ghrta thus prepared should be regarded as commendable in all types of occular hurt or injury. 40-42
उदरान्मेदसो वर्त्तिर्निर्गता यस्य देहिनः । कषायभस्ममृत्कीर्णां बद्धवा सूत्रेण सूत्रवित् ।। ४३ ॥
अग्नितप्तेन शस्त्रेण छिन्द्यान्मधुसमायुतम् । बद्धवा व्रणं सुजीर्णेऽन्ने सर्पिष: स्नेहपानादृते चापि पय: पानं पानमिष्यते ॥ ४४ ॥
विधीयते । श्वदंष्ट्रया | शर्करामधुयष्टिभ्यां लाक्षया वा चित्रासमन्वितञ्चैव रुजादाहविनाशनम्।। ४५ ।।
आटोपो मरणं वा स्याच्छूलो वाऽच्छिद्यमानया । मेदोग्रन्थौ च यत् तैलं वक्ष्यते तच्च योजयेत् ।। ४६ ।।
In the case of a perforation of the abdomen marked by the discharge of lumps or rope-like Varti (fat) through the wound, the emitted or ejected fat-lump should be dusted with the burnt ashes (D. R.–powders) of astringent woods (such as Manu, Arjuna, etc.) and black clay (pounded together). A ligature of thread should then be bound round the fat-lump and the fat-lump cut off with a heated instrument. Honey should then be applied and the wound (Vrana)
1. Several authorities, however, say that equal parts of clarified butter prepared from goat’s milk and from cow’s milk should be taken and cooked with 16 seers of cow’s milk and with the four drugs as a Kalka.
But Gayi recommends only four seers of clarified butter prepared from goat’s milk cooked with 16 seers of cow’s milk and the four drugs as a Kalka. should then be duly bandaged. The patient should be caused to drink clarified butter after the full digestion of his injested food. Instead of this Ghrta, milk prepared medicinally with Yasti-madhu, Laksa and Goksura, mixed with (a proper quantity of) sugar and castor oil (as Praksepa)¹, is equally commendable for the alleviation of the pain and the burning sensation, (in the wound or ulcer). The fat-lump (pariental fat) aforesaid causes a rumbling sound with pain in the abdoment and may prove even fatal in the event of its being left uncut. The medicated oil to be mentioned hereafter in connection with Medaja-Granthi should be applied in such cases. 43-46
त्वचोऽतीत्य सिरादीनि भित्त्वा वा परिहत्य वा । कोष्ठे प्रतिष्ठितं शल्यं कुर्यादुक्तानुपद्रवान् ॥४७॥
तत्रान्तर्लोहितं पाण्डुं शीतपादकराननम् । रक्तनेत्रमानद्धञ्च विवर्जयेत् ॥ ४८ ॥ शीतोच्छ्वासं
Foreign bodies (Salya) piercing into any of the Kosthus after having run through the (seven layers of) skin, whether passing through the veins, etc., (muscles, nerves, bones or joints or not, produces the distressing symptoms as described before (Ch. III.–Sutra). The blood (of the affected chamber or receptacle) in such case lies incarcerated therein in the event of its failing to find an outlet and causes a pallor of the face and a coldness of the extremities and of the face in the patient. Respiration becomes cold, the eyes red-coloured, the bowels constipated and the abdomen distended. The manifestation of these symptoms indicates the incurable character of the disease. 47-48
आमाशयस्थे रुधिरे वमनं पथ्यमुच्यते ।
1. This explanation is given on the authority of old Vagabhata. Dalhana, however, explains the verse in a different way. He explains it to mean two different preparations of milk–one with Yasti-madhu mixed with sugar and castor oil as a Praksepa and the other with Goksura mixed with Laksa and castor oil as a Praksepa.
A third interpretation would make three preparations of milk prepared separately with Yasti-madhu, Laksa and Goksura–sugar and castor oil being mixed in the first (as Praksepa) and castor oil alone in the second and third.
A fourth preparation would be to prepare the milk separately with Yastimadhu, Laksa and Goksura as in the preced case–without the addition of castor oil (as Praksepa).
पक्वाशयस्थे देयञ्च विरेचनमसंशयम् । आस्थापनञ्च निःस्नेहं कार्यमुष्णैर्विशोधनैः ॥ ४९ ॥
यवकोलकुलत्थानां निःस्नेहेन रसेन च। भुञ्जीतान्नं यवागूं वा पिबेत् सैन्धवसंयुताम् ।। ५० ।।
Emesis is beneficial in the case where the blood would be found to be confined in the Amasaya (stomach). Purgatives should unhesitatingly be prescribed where the blood would be found to have been lodged in the Pakvasaya (intestines) and Asthapana measures without oil should be employed with hot, purifying (Sodhana) substances (such as the cow-urine, etc.). The patient should be made to drink a Yavagu (gruel) with Saindhava salt and his diet should consist of boiled rice mixed with the soup of barley, Kola and Kulattha pulse divested of oil. 49-50
अतिनिःस्रुतरक्तो वा भिन्नकोष्ठः पिबेदसृक् ।। ५१ ।।
स्वमार्गप्रतिपन्नास्तु यस्य विण्मूत्रमारुताः । व्युपद्रवः स भिन्नेऽपि कोष्ठे जीवति मानवः ।। ५२ ।।
In a case of a perforation or piercing of any of the bodily Kosthas attended with excessive haemorrhage or bleeding, the patient should be caused to drink (a potion of animal) blood and such a case marked by the passage of stool, urine, etc., through their proper channels of outlet and by the absence of fever and tympanitis and other dangerous symptoms. (Upadrava) survives even though his abdomen may have burst. 51-52
अभिन्नमन्त्रं निष्क्रान्तं प्रवेश्यं नान्यथा भवेत् । पिपीलिकाशिरोग्रस्तं तदप्येके वदन्ति तु ॥ ५३॥
प्रक्षाल्य पयसा दिग्धं तृणशोणितपांशुभिः । प्रवेशयेत् कृत्तनखो घृतेनातं शनैः शनैः ॥ ५४॥
प्रवेशयेत् क्षीरसिक्तं शुष्कमन्त्रं घृताप्लुतम् ।। ५५ ।।
In a case of a perforation of the Kostha (abdomen) where the intestines have protruded or bulged out in an untorn condition, they should be gently re-introduced into the cavity and placed in their original position, and otherwise even (torn intestines) according to others, however, large black ants should be applied even to the perforated intestines in such a case and their bodies should be separated from their heads after they had firmly bitten the perforated parts with their claws. After that the intestines with the heads of the ants attached to them should be gently pushed back into the cavity and reinstated in their original situation therein. The bulged out intestines should be rinsed with grass, blood and dust, washed with milk and lubricated with clarified butter and gently re-introduced into the cavity of the abdomen with the hand with its finger nails cleanly paired. The dried intestines should be washed with milk and lubricated with clarified butter before introducing it into their former and natural place in the abdomen. 53-55
अङ्गुल्याऽभिमृशेत् कण्ठं हस्तपादेषु जलेनोद्वेजयेदपि । संगृह्य समुत्थाप्य भवत्यन्तःप्रवेशस्तु यथा निर्धुनुयुस्तथा ।
तथाऽन्त्राणि विशन्त्यन्तः स्वां कलां पीडयन्ति च ।। ५७।। महाबलाः ।। ५६।।
In a case where the intestines could be but partially introduced. the three following measures should be adopted. The interior of the throat of the patient should be gently rubbed with a finger (and the urging for vomiting thus engendered, would help the full introduction of the intestines into the abdominal cavity). As an alternative, he should be enlivened with sprays of cold water; or he should be caught hold of by his hands and feet and lifted up into the air with the help of strong attendants and shaken in a manner that would bring about a complete introduction of the intestines into the natural position in the abdominal cavity. They should be so introduced as to press upon their specific (Maladhara) Kala (facia). 56-57
व्रणाल्पत्वाद् बहुत्वाद् वा दुष्प्रवेशं भवेत् तु यत् । तदापाट्य प्रमाणेन भिषगन्त्रं प्रवेशयेत् ।। ५८ ।।
यथास्थानं निविष्टे च व्रणं सीव्येदतन्द्रितः ।। ५९ ।। स्थानादपेतमादत्ते प्राणान् गुपितमेव वा ।। ६० ।।
In a case where the re-introduction of the intestines into the abdominal cavity would be found to be difficult owing to the narrowness or largeness of the orifice of the wound, it should be extended or widened with a small or slight incision according to requirements, and the intestines re-introduced into their proper place. The orifice or mouth of the wound should be forthwith carefully sutured as soon as the intestines would be found to have been introduced into their right place. Intestines dislodged from their proper seat, or not introduced into their correct position, or coiled up into a lump bring on death. 58-60
वेष्टयित्वा तु पट्टेन घृतसेकं प्रदापयेत् । घृतं पिबेत् सुखोष्णञ्च चित्रातैलसमन्वितम् । मृदुक्रियार्थं शकृतो वायोश्चाधःप्रवृत्तये ।। ६१ ।।
ततस्तैलमिदं कुर्याद्रोपणार्थं चिकित्सकः । त्वचोऽश्वकर्णधवयोर्मोचकीमेषशृङ्गयोः शल्लक्यर्जुनयोश्चापि विदार्याः क्षीरिणां तथा ।
बलामूलानि चाहृत्य तैलमेतैर्विपाचयेत् । व्रणं संरोपयेत् तेन वर्षमात्रं यतेत च ।। ६३ ।। ।। ६२ ।।
Subsequent Treatment: [ After the full and correct introduction of the intestines ] the wound should be bandaged with a piece of silkcloth saturated with clarified butter, and the patient should be given a draught of tepid clarified butter (D. R. tepid milk) with castor oil for an easy passage of the stool and downward coursing of the Vayu ( spontaneous emission of the flatus). Then, for its healing up (Ropana), a medicated oil, prepared with the bark of the Asvakarna, Dhava, salmali, Mesa-srngi, Sallaki, Arjuna, Vidari, and Ksiri trees and Bala roots should be applied to the wound. For a year the patient should live a life of strictest continence and forego all kinds of physical exercise. 61-63
पादौ निरस्तमुष्कस्य जलेन प्रोक्ष्य चाक्षिणी । प्रवेश्य तुन्नसेवन्या मुष्कौ सीव्येत् ततः परम् ।। ६४ । ।
कार्यो गोफणिकाबन्धः कट्यामावेश्य यन्त्रकम् । न कुर्यात् स्नेहसेकञ्च तेन क्लिद्यति हि व्रणः ॥ ६५ ||
कालानुसार्यगुर्वेला- जातीचन्दनपद्मकैः शिलादार्व्यमृतातुत्थैस्तैलं • कुर्वीत रोपणम् ।। ६६ ।।
The legs and the eyes of the patient should be washed and sprinkled with water in the event of the bursting out of the testicles which should be introduced into their proper place within the scrotum, and swen up in the manner of a Tunna-sevani (raised seam). The scrotum should be bandaged in the shape of a Gophana-Bandha and a restraining apparatus (Ghatta-Yantra) placed round the waist of the patient (to guard it against its oscillations or hanging down). The wound should not be lubricated with any kind of oil or Ghrta inasmuch as it would make the wound moist and slimy. The wound should be got healed with a medicated oil prepared with Kalanusdri, Aguru, Ela, Jati flower, Candana, Padmaka, Manahsila, Devadaru, Amrta and sulphate of copper ( pounded together). 64-66
शिरसोऽपहृते शल्ये बालवर्त्तिं निवेशयेत् । बालवत्र्त्यामदत्तायां मस्तुलुङ्गं व्रणात् स्रवेत् ॥ ६७ ।।
हन्यादेनं वायुस्तस्मादेवमुपाचरेत् । ततो व्रणे रोहति चैकैकं शनैर्बालमपक्षिपेत् ॥ ६८ ॥
गात्रादपहृतेऽन्यस्मात् स्नेहवर्त्ति प्रवेशयेत् । कृते निःशोणिते चापि विधिः सद्यःक्षते हितः ।। ६९ ।।
A plug of hair should be inserted into a wound on the head, after having extracted the foreign matter therefrom, with a view to arrest the exuding of the brain matter (Mastulunga) which invariably proves fatal to the patient through the aggravation of the deranged Vayu in consequence thereof. The hairs of the plug should be taken out one by one as the healing process progresses granulation). An oleaginous medicated plug or lint should be inserted into a wound on any other part of the body, which should be treated with the measures and remedial agents laid down in connection with a traumatic ulcer after having first allowed the vitiated blood to escape.67-69
दूरावगाढा: सूक्ष्माः स्युर्ये व्रणास्तान् विशोणितान् । सूक्ष्मो नेत्रेण चक्रतैलेन तर्पयेत् ।। ७० ।। कृत्वा
समङ्गां रजनीं पद्मां त्रिवर्गं तुत्थमेव च। विडङ्ग कटुकां पथ्यां गुडूचीं सकरञ्जिकाम् । संहृत्य विपचेत् काले तैलं तालीशं पद्मकं मांसी
हरिद्रे पद्मबीजानि सोशीरं सोशीरं पक्वं सद्योव्रणेषूक्तं तैलं रोपणमुत्तमम् ॥ हरेण्वगुरुचन्दनम् । ।। ७१ ॥ ।।
मधुकञ्च मधुकञ्च तैः । रोपणमुत्तमम् ।। ७२ ।।
The medicated oil known as the Cakra-taila¹ should be poured (frequently applied) by means of a slender pipe into an ulcer (wound which is deep-seated but narrow-mouthed, after first letting out the vitiated blood. An oil duly prepared and boiled with Samanga (manjistha), Haridra, Padma, Trivarga³ Tuttha, Vidanga, Katuka, Pathya, Guduci and Karanja acts as a good healing (Ropana) agent (in these cases). The use of an oil prepared with Talisa, Padmaka, Mansi, Harenu, Aguru, Candana, and the two kinds of Haridra, Padma-bija, Usira and Yasti-madhu acts as a good healing remedy in cases of traumatic ulcers. 70-72
घृष्टे रुजो निगृह्याशु चूर्णैरुपचरेद् व्रणम् ॥ ७४ ॥
A cut wound (Ksata) should be treated with its own specific measures and remedies, while a bruised one (Piccita) should be treated (to all intents and purposes) as a case of Bhagna (bone-fracture). The first treatment of a mangled or contused wound (Ghrsta) is to extinguish pain, after which it should be dusted with the powder of proper medicinal drugs (such as Sala, Sarja, Arjuna, etc.). 73-74
विश्लिष्टदेहं पतितं मथितं हतमेव च। वासयेत् तैलपूर्णायां द्रोण्यां मांसरसाशनम् । अयमेव विधिः कार्यः क्षीणे मर्महते तथा ॥ ७५ ॥
In the case of a dislocation of any part of the body, caused by a fall (from a tree), or in the event of having been run over or trampled down (Mathita–by a carriage or by a beast), or of being wounded (by a blow, etc.), the patient should be kept immeersed in a large tank (Droni) of oil and the diet should consist of the soup or essence (Rasa) of meat. A man fatigued (from the labours of a journey), or hurt at any of the Marmas, should be likewise treated with the preceding measures. 75
रोपणे सपरीषेके पाने च व्रणिनां सदा ।
तैलं घृतं वा संयोज्यं शरीरतूनवेक्ष्य हि ॥ ७६ ॥
1. The oil just pressed out of an old oil-mill or squeezed out of the chips of wood belonging to an old one, in the manner of the Anu-taila to be described hereafter, is called the Cakra-taila.
2. The vitiated blood should first be let out for fear of putrefaction of the ulcer. 3. Triphala, Trikatu and Trimada are called Trivarga.
घृतानि यानि वक्ष्यामि यत्नतः पित्तविद्रधौ । सद्योव्रणेषु देयानि तानि वैद्येन जानता ।। ७७॥
सद्यःक्षतव्रणं वैद्यः सशूलं परिषेचयेत् । सर्पिषा नातिशीतेन बलातैलेन वा पुनः ।। ७८ ।।
Oil or clarified butter should be always administered as drinks, washes or external healing applications for an ulcer-patient with a due regard to his temperament and the nature of the season. Medicated Ghrtas, yet to be mentioned in connection with the medical treatment of a Pittaja abscess, should be used as well in the case of a traumatic ulcer (according to its respective indications). A physician should wash a traumatic ulcer attended with an aching pain either with a Balaoil or tepid clarified butter (according to the nature of the season and the temperament of the patient).’ 76-78
समङ्गां रजनीं पद्मां पथ्यां तुत्थं पद्मकं मधुकं रोध्रं विडङ्गानि तालीशपत्रं नलदं चन्दनं सुवर्चलाम् । हरेणुकाम् ॥ ७९ ॥
पद्मकेशरम् । मञ्जिष्ठोशीरलाक्षाश्च क्षीरिणाञ्चापि पल्लवान् ।। ८० ।।
प्रियालबीजं तिन्दुक्यास्तरुणानि फलानि च । यथालाभं समाहत्य तैलमेभिर्विपाचयेत् । रोपणम् ।। ८१ ।।
सद्योव्रणानां सर्वेषामदुष्टानान्तु कपायमधुराः शीताः क्रियाः स्निग्धाश्च योजयेत् । सद्योव्रणानां सप्ताह पश्चात् पूर्वोक्तमाचरेत् ।। ८२ ।।
An oil cooked with Samanga, Rajani, Padma (Bhargi), Pathya, sulphate of copper Suvarcala, Padmaka, Rodhra, Yasti-madhuka, Vidanga, Harenuka, Talisa-patra, Nalada (Jatamansi), (red) Candana, Padma-kesara, Manjistha, Usira, Laksa, and the tender leaves of Ksiri trees, Priyala seeds, raw and tender Tinduka fruit, or with as many of them as would be available, should be regarded as a good healing remedy in respect of all non-malignant traumatic sores or ulcers. Applications of astringent, sweet, cooling and oily medicines should be used for a week in a case of a traumatic ulcer (Sadyo-vrana) after which those mentioned before, in the Chapter of Divraniya, should be adopted. 79-82
1. With oil in autumn and in the case of a patient of Rakta-pitta temperament, and with Bala-oil in winter and in the case of one a Vata-kapha temperament.
दुष्टव्रणेषु कर्तव्यमूर्ध्वञ्चाधश्च शोधनम् । विशोषणं तथाऽऽहार: शोणितस्य च मोक्षणम् ॥ ८३ ॥
कषायं राजवृक्षादौ सुरसादौ च धावनम् । तयोरेव कषायेण तैलं शोधनमिष्यते । क्षारकल्पेन वा तैलं क्षारद्रव्येषु साधितम् ।। ८४ ।।
Treatment of Dusta-Vrana : In the case of a malignant ulcer (Dusta Vrana) emetics, errhines, purgatives, Asthapana, fasting, specific sorts of diet (composed of bitter, pungent and astringent things) and blood-letting, should be prescribed (according to the requirement of each case). The ulcer or sore should be washed with the decoctions of the drugs of both the Aragvadhadi and the Surasadi ganas, and an oil cooked with a decoction of the said drugs should be applied to the wound for the purficiation (Sodhana) thereof. As an alternative, an oil boiled and prepared in an alkaline water or solution (four times that of oil) with a Kalka of alkaline substances (such as Ghantaparuli, Palasa, etc.) should be used for that end. 83-84
द्रवन्ती चिरबिल्वश्च दन्ती चित्रकमेव च। पृथ्वीका निम्बपत्राणि कासीसं तुत्थमेव च ।। ८५ ।।
त्रिवृत् तेजोवती नीली हरिद्रे सैन्धवं तिलाः । भूमिकदम्ब: सुबहा शुकाख्या लाङ्गलाह्वया ।। ८६ ।।
नैपाली जालिनी चैव मदयन्ती मृगादनी । ।।८७।।
सुधामूर्वार्ककीटारि-हरितालकरञ्जिकाः कर्तव्यं यथोपपत्ति तैलमेतैस्तु शोधनम् । घृतं वा यदि वा प्राप्तं कल्काः संशोधनास्तथा ।। ८८ ।।
Oil cooked with Dravanti (Satamuli, according to certain authorities, Musika-parini according to others), Cirabilva, Danti, Citraka, Prthvika Nimba-leaves, Kasisa, Tuttha, Trivrt, Tejovati, Nili (indigo), the two kinds of Haridra, Saindhava salt, Tila, BhumiKadamba, Suvaha, Suka-khya, Langalahva, Naipali, Jalini, Madayanti, Mrgadani, Sudha, Murva, Arka, Kitari, Haritala, and Karanja, or with as many of them as would be available, should be used for the purification (of a malignant sore or ulcer). If found applicable, a medicated Ghrta prepared and cooked with the foregoing drugs and substances as Kalka should be used for the same purpose. 85-88
सैन्धवत्रिवृदेरण्ड – पत्रकल्कस्तु वातिके । त्रिवृद्धरिद्रामधुक-कल्कः पैत्ते तिलैर्युतः । कफजे तिलतेजोह्वा दन्तीस्वर्जिकचित्रकाः ।। ८९ ।। दुष्टव्रणविधिः कार्यो मेहकुष्ठव्रणेष्वपि ।। ९० । ।
In the case of a malignant ulcer, due to the aggravated Vayu, the purifying remedy should consist of a Kalka of Saindhava salt, Trivrt and castor leaves. In the case of a (malignant) Pittaja, sore, the remedy should consist of a Kalka of Trivrt, Haridra, Yasti-madhu and Tila. In the case of a malignant ulcer, caused by the aggravated Kapha, the purifying remedial agent should consist of Tila, Tejohva, Danti, Svarjika and Citraka roots. An ulcer brought on owing to the presence of the virus of Meha or Kustha in the system, measures and remedies mentioned under the treatment of Dusta-vrana should be adopted and used. 89-90
षड्विधः प्राक् प्रदिष्टो यः सद्योव्रणविनिश्चयः । नातः शक्यं परं वक्तुमपि उपसर्गैर्निपातैश्च निश्चितवादिभिः ।। ९१ ।।
पण्डितमानिनः । तत्तु केचित् संयोज्य भाषन्ते बहुधा मानगर्विताः । । ९२ ।।
बहु तद् भाषितं तेषां षट्स्वेष्वेवावतिष्ठते । विशेषा इव सामान्ये षट्त्वन्तु परमं मतम् । । ९३ ।।
The recognised school of physicians, which recognises these six types of traumatic sores, does not add to the list, herein mentioned, other types of ulcers, whereas vain pedagogues try to swell it with a larger number of types by adding connotative prefixes and suffixes to the names of the aforesaid six. It is mere vain-gloriousness on their part to say so, since all the other types that they can devise are but single instances and can be made to fall under one of these six general heads. Hence there should be only six kinds (of traumatic sores) and not more. 91-93
इति सुश्रुतसंहितायां चिकित्सितस्थाने सद्योव्रणचिकित्सितं नाम द्वितीयोऽध्यायः ॥ २ ॥
Thus ends the second Chapter of the Chikitsa Sthana of the Susruta Samhita which deals with the treatment of Sadyo-vrana (traumatic sores).
