The 26th chapter of Uttara Sthanam of Ashtanga Hridayam is named as Sadyo Vrana Pratishedha. This chapter deals with the explanation of ‘Treatment of traumatic wounds’.

The topics covered in this chapter include –

• Definition of Sadyo Vrana and its types
• Definition of Sadyo Vrana and its types
• Cikitsa – treatment
• Treatment of Ghrista ulcers / wounds
• Treatment for injuries of the eye
• Treatment of eye gone deep inside the socket
• Treatment for displacement of ear
• Treatment for broken cricoid
• Treatment of injuries of extremities
• Treatment of injury to scrotum and testes
• Kalanusaryadi Taila
• Bandaging the cut off limbs
• Treatment of Viddha wounds
• Removal of foreign body from the head
• Treatment of elimination of brain matter
• Treatment of wound caused by foreign bodies
• Koshtabheda Lakshana – signs of injury of internal viscera
• Signs of bleeding in stomach
• Signs of bleeding in large intestine
• Filling of blood in the organs even in absence of wounds
• Conditions for rejecting the conditions of internal bleeding
• Kostha Bheda Cikitsa – treatment of visceral wounds

Pledge by the author(s)

अथात: सद्योव्रणप्रतिषेध व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘Treatment of traumatic wounds’.Thus, say (pledge) Atreya and other sages.

Definition of Sadyo Vrana and its types

सद्योव्रणा ये सहसा सम्भवन्त्यभिघाततः ।
अनन्तैरपि तैरङ्गमुच्यते जुष्टमष्टधा ॥ १ ॥
घृष्टावकृत्तविच्छिन्नप्रविलम्बितपातितम् ।
विद्धं भिन्नं विदलितं
Sadyovrana are those which occur suddenly due to trauma/injury; though innumerable localized in different parts of the body, these are classified as of eight kinds. viz Ghrista, Avakritta, Vicchinna, Pravilambita, Patita, Viddha, Bhinna and Vidalita

Sadyo Vrana and its types

तत्र घृष्टं लसीकया ॥ २ ॥
रक्तलेशेन वा युक्तं सप्लोषं छेदनात्स्रवेत् ।
अवगाढं ततः कृत्तं विच्छिन्नं स्यात्ततोऽपि च ॥३॥
प्रविलम्बि सशेषेऽस्थ्नि पतितं पातितं तनोः ।
सूक्ष्मास्यशल्यविद्धं तु विद्धं कोष्ठविवर्जितम् ॥४॥
भिन्नमन्यद्विदलितं मज्जरक्तपरिप्लुतम् ।
प्रहारपीडनोत्पेषात्सहास्थ्ना पृथुतां गतम् ॥५॥
Ghrista is that which exudes lasika (lymph) alone or mixed with little of blood when cut, associated with burning sensation; Avagadha is severe than Ghirsta and Vicchinna is 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 (separated) from the body; Viddha is a wound with small orifice caused by a foreign body anywhere on the body except the kostha (organs inside the trunk) such a wound occurring in the hitting (assault), squeezing and crushing of bones, affecting a large and deep tissue area, wound containing marrow and blood inside being split or torn.

Chikitsa: Treatment

सद्यः सद्योव्रणं सिञ्चेदथ यष्ट्याह्वसर्पिषा ।
तीव्रव्यथं कवोष्णेन बलातैलेन वा पुनः ॥ ६ ॥
Sadyovrana which has severe pain should be immediately bathed (washed) in warm Yasti ghrita – Herbal ghee prepared with Glycyrrhiza glabra or Bala taila often.

क्षतोष्मणो निग्रहार्थं तत्कालं विसृतस्य च ।
कषायशीतमधुरस्निग्धा लेपादयो हिताः ॥ ७ ॥
In order to mitigate the heat of the wound which has spread out quickly, herbs which possess astringent taste, cold potency, sweet taste and unctuous properties beneficial (should be made use of) for lepa (external application of paste) etc.

सद्योव्रणेष्वायतेषु सन्धानार्थं विशेषतः ।
मधुसर्पिश्च युञ्जीत पित्तघ्नीश्च हिमाः क्रियाः ॥८॥
In traumatic wounds which are wide, in order to promote healing, honey and ghee should be specially made use of so also, treatment which mitigate Pitta and are cold.

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 done after consumption of food.

घृष्टे विदलिते चैष सुतरामिष्यते विधिः ।
तयोर्ह्यल्पं स्रवत्यस्रं पाकस्तेनाशु जायते ॥ १० ॥
These (above) are the methods specially suited for Ghrista and Vidalita kinds;in these the bleeding is less, hence Paka (suppuration) develops quickly.

Treatment for Avakruta and Vicchinna

अत्यर्थमस्रं स्रवति प्रायशोऽन्यत्र विक्षते ।
ततो रक्तक्षयाद्वायौ कुपितेऽतिरुजाकरे ॥ ११ ॥
स्नेहपानपरीषेकस्वेदलेपोपनाहनम् ।
स्नेहवस्तिं 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 poultice and fat enema therapy prepared from the herbs which mitigate Vata should be administered.

इति साप्ताहिकः प्रोक्तः सद्योव्रणहितो विधिः ।
सप्ताहाद्गतवेगे तु पूर्वोक्तं विधिमाचरेत् ॥ १३ ॥
Thus, were described the methods of treatment for the first seven days beneficial to traumatic wounds; after seven days when the severity has subsided, the treatments described previously (in previous chapter) should be adopted.

प्रायः सामान्यकर्मेदं वक्ष्यते तु पृथक् पृथक् ।
This is the general line of treatment; further on will be described treatment, special to each, separately.

Treatment of Ghrista ulcers / wounds

घृष्टे रुजं निगृह्याशु व्रणे चूर्णानि योजयेत् ॥ १४ ॥
कल्कादीन्यवकृत्ते तु विच्छिन्नप्रविलम्बिनोः ।
सीवनं विधिनोक्तेन बन्धनं चानु पीडनम् ॥ १५ ॥
In Ghrista kind of ulcer, the pain should be controlled first and then the wound dusted with the powder (of herbs); in Avakrtta, paste (of herbs) etc. should be applied. In Vicchina and Pravilambi suturing, bandaging and squeezing should be done one after the other, as per procedure described previously.

Treatment for injuries of the eye

असाध्यं स्फुटितं नेत्रमदीर्णं लम्बते तु यत् ।
सन्निवेश्य यथास्थानमव्याविद्धसिरं भिषक् ॥१६॥
पीडयेत्पाणिना 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 incurable; that which has come out and hanging loose and its vein not cut, then the physician should push it inside by pressing it back into its place, with the help of his palm holding a leaf of a lotus; palāśa – Butea monosperma separately goat ghee boiled with yaṣṭi -¬ Glycyrrhiza glabra, jīvaka – Malaxis¬ acuminata, ṛṣabhaka – Manilkara hexandra, utpalaiḥ – Nymphaea alba and with milk is beneficial for bathing the eye, nasal drops, and filling inside the eyes. This cure all the injuries of the eyes.

Treatment of eye gone deep inside the socket

गलपीडाऽवसन्नेऽक्ष्णि वमनोत्कासनक्षवाः ।
प्राणायामोऽथवा कार्यः क्रिया च क्षतनेत्रवत् ॥ १९ ॥
If the eye (ball) has gone deep inside, hard pressing of the throat, inducing of vomiting, cough and sneeze or control of respiration should be done and also the treatments prescribed for ulceration of the eye.

Treatment for displacement of ear

कर्णे स्थानाच्च्युते स्यूते श्रोतस्तैलेन पूरयेत् ।
If the ear pinna is displaced, it should be sutured at the proper place and the ear filled with medicated oil.

Treatment for broken cricoid

कृकाटिकायां छिन्नायां निर्गच्छत्यपि मारुते ॥ २० ॥
समं निवेश्य बध्नीयात्स्यूत्वा शीघ्रं निरन्तरम् ।
आजेन सर्पिषा चात्र परिषेकः प्रशस्यते ॥ २१ ॥
उत्तानोऽन्नानि भुञ्जीत शयीत च सुयन्त्रितः ।
In the Krikatika (cricoids cartilages in the neck) is found torn and air is coming out through it, should be placed in the proper level, sutured quickly, without leaving any space in the middle and then bandaged. It is ideal to bath the site with goat ghee, the patient should eat lying with his face up and sleep well restrained (without making movement).

Treatment of injuries of extremities

घातं शाखासु तिर्यक्स्थं गात्रे सम्यङ्निवेशिते ॥ २२ ॥
स्यूत्वा वेल्लितबन्धेन बध्नीयाद्घनवाससा ।
चर्मणा गोष्फणाबन्धः कार्यश्चासङ्गते व्रणे ॥ २३ ॥
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), gophana bandha should be tied using leather strap.

Treatment of injury to scrotum and testes

पादौ विलम्बिमुष्कस्य प्रोक्ष्य नेत्रे च वारिणा ।
प्रवेश्य वृषणौ सीव्येत्सेवन्या तुन्नसञ्ज्ञया ॥ २४ ॥
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 sprinkled with water, the testes pushed into the scrotum and sutured using a needle called tunnasevani (vesicorectal raphae); then covering the waist, should be tied a bandage with gophana bandha. Use of fats and fomentation should not be done to the site since the ulcer become moist (exude pus).

Kalanusaryadi Taila

कालानुसार्यगुर्वेलाजातीचन्दनपर्पटैः ।
शिलादार्व्यमृतातुत्थैः सिद्धं तैलं च रोपणम् ॥ २६ ॥
Medicated oil prepared with kālānusāri – Valeriana wallichi, aguru – Aquilaria agallocha¬, elā – Elettaria cardamomum, jātī – Jasminum grandiflorum, candana – Santalum album, parpaṭaiḥ – Fumaria parviflora, śilā -¬ Arsenic bi sulphide, dārvī -¬ Colocasia esculenta, amṛtā – Tinospora cordifolia and Purified Copper Sulphate is good for healing.

Bandaging the cut off limbs

छिन्नां निःशेषतः शाखां दग्ध्वा तैलेन युक्तितः ।
बध्नीयात्कोशबन्धेन ततो व्रणवदाचरेत् ॥ २७ ॥
The limb which has been completely cut off should be skilfully burnt with oil, bandaged using koshabandha and then treated like any ulcer.

Treatment of Viddha wounds

कार्या शल्याहृते विद्धे भङ्गाद्विदलिते क्रिया ।
In Viddha kind of wound, from which the foreign body has been removed, the treatments prescribed for vidalita wound, should be done.

Removal of foreign body from the head

शिरसोऽपहृते शल्ये वालवर्तिं प्रवेशयेत् ॥ २८ ॥
मस्तुलुङ्गस्रुतेः 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 brain matter Vata getting aggravated may kill person; after the wounds heal, the wick of hair should be removed one after the other gradually.

Treatment of elimination of brain matter

मस्तुलुङ्गस्रुतौ खादेन्मस्तिष्कानन्यजीवजान् ।
In case of elimination of brain matter, the patient should partake the brain of other animals.

Treatment of wound caused by foreign bodies

शल्ये हृतेऽङ्गादन्यस्मात्स्नेहवर्तिं निधापयेत् ॥ ३० ॥
Wound caused by removal of foreign bodies from the body, in some other parts, except the ones mentioned above, should be plugged with (cotton) wick soaked in fat (oil or ghee).

Chakra taila to treat the deep seated wounds

दूरावगाढाः सूक्ष्मास्या ये व्रणाः स्रुतशोणिताः ।
सेचयेच्चक्रतैलेन सूक्ष्मनेत्रार्पितेन तान् ॥ ३१ ॥
The wounds which are deep seated, with minute mouth (orifice) and exuding blood, should be bathed with Chakra Taila (oil dribbling from the pestle of the oil mill) pushed inside through the minute tubes.

Koshtabheda Lakshana: Signs of injury of internal viscera

भिन्ने कोष्ठेऽसृजा पूर्णे मूर्छाहृत्पार्श्ववेदनाः ।
ज्वरो दाहस्तृडाध्मानं भक्तस्यानभिनन्दनम् ॥ ३२ ॥
सङ्गो विण्मूत्रमरुतां श्वासः स्वेदोऽक्षिरक्तता ।
लोहगन्धित्वमास्यस्य स्याद्गात्रे च विगन्धता ॥ ३३ ॥
If the organs of the trunk are wounded / injured, there is accumulation of blood inside, fainting, pain in the region of the heart and flanks, fever, burning sensation, thirst, flatulence, lack of desire for food, obstruction of feces, urine and flatus, dyspnoea, sweating, redness of the eyes, smell of iron from the mouth and abnormal smell in the body.

Signs of bleeding in stomach

आमाशयस्थे रुधिरे रुधिरं छर्दयत्यपि ।
आध्मानेनातिमात्रेण शूलेन च विशस्यते ॥ ३४ ॥
If the blood has accumulated in the stomach, there is vomiting of blood and the person dies by profound flatulence and severe pain.

Signs of bleeding in large intestine

पक्वाशयस्थे रुधिरे सशूलं गौरवं भवेत् ।
नाभेरधस्ताच्छीतत्वं खेभ्यो रक्तस्य चागमः ॥ ३५ ॥
If the blood has accumulated in the large intestines, there is pain, heaviness below the umbilicus, coldness and blood comes out through the orifices (of faces etc.).

Filling of blood in the organs even in absence of wounds

अभिन्नोऽप्याशयः सूक्ष्मैः स्रोतोभिरभिपूर्यते ।
असृजा स्यन्दमानेन पार्श्वे मूत्रेण वस्तिवत् ॥ ३६ ॥
The organs even though not wounded (visibly), get filled with blood from minute channels from all the sides just like the urinary bladder from the urine.

Conditions for rejecting the conditions of internal bleeding

तत्रान्तर्लोहितं शीतपादोच्छ्वासकराननम् ।
रक्ताक्षं पाण्डुवदनमानद्धं च विवर्जयेत् ॥ ३७ ॥
The person who has accumulation of blood inside, whose feet, expired air, hands and face are cold, eyes are red, face is pale and abdomen bloated should be rejected.

Kostha Bheda Chikitsa: Treatment of visceral wounds

आमाशयस्थे वमनं हितं पक्वाशयाश्रिते ।
विरेचनं निरूहं च निःस्नेहोष्णैर्विशोधनैः ॥ ३८ ॥
If accumulation 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 herbs of hot potency and of purgative properties.

Kostha Bheda Chikitsa: Treatment of visceral wounds

यवकोलकुलत्थानां रसैः स्नेहविवर्जितैः ।
भुञ्जीतान्नं यवागूं वा पिबेत्सैन्धवसंयुताम् ॥ ३९ ॥
He should partake his food with the soup of yava – Hordeum vulgare, kola – Ziziphus mauritiana, kulatthānāṃ – or Macrotyloma uniflorum, without adding fats or drink gruel added with rock salt.

अतिनिःस्रुतरक्तस्तु भिन्नकोष्ठः पिबेदसृक् ।
The patient wounded in the viscera, who has lost much blood should drink blood (of animals).

क्लिष्टच्छिन्नान्त्रभेदेन कोष्ठभेदो द्विधा स्मृतः॥४०॥
मूर्छादयोऽल्पाः प्रथमे द्वितीये त्वतिबाधकाः ।
क्लिष्टान्त्रः संशयी देही 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 Chinnantra, 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 feces, urine and flatus begun to come out in their normal passages and when other complications get relieved.

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 tight by the head of the big ants thus, say some others.

प्रक्षाल्य पयसा दिग्धं तृणशोणितपांसुभिः ।
प्रवेशयेत्क्लृप्तनखो घृतेनाक्तं शनैः शनैः ॥ ४४ ॥
The intestine 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.

क्षीरेणार्द्रीकृतं शुष्कं भूरिसर्पिःपरिप्लुतम् ।
अङ्गुल्या प्रमृशेत्कण्ठं जलेनोद्वेजयेदपि ॥ ४५ ॥
तथाऽन्त्राणि विशन्त्यन्तस्तत्कालं पीडयन्ति च ।
व्रणसौक्ष्म्याद्बहुत्वाद्वा कोष्ठमन्त्रमनाविशत् ॥ ४६ ॥
तत्प्रमाणेन जठरं पाटयित्वा प्रवेशयेत् ।
The dried intestine should be made wet with milk and the throat pressed (delicately) with fingers anointed with plenty of ghee and the patient should be agitated (shocked) by (sprinkling) water, then the intestines gets placed inside and immediately pressed; wound being small and the intestine (protruding out) being large cannot be pushed (easily) into the abdominal cavity, therefore the abdomen should be incised (cut) to its (intestine) size and pushed in.

यथास्थानं स्थिते सम्यगन्त्रे सीव्येदनु व्रणम् ॥ ४७ ॥
स्थानादपेतमादत्ते जीवितं कुपितं च तत् ।
वेष्टयित्वाऽनु पट्टेन घृतेन परिषेचयेत् ॥ ४८ ॥
पाययेत ततः कोष्णं चित्रातैलयुतं पयः ।
मृदुक्रियार्थं शकृतो वायोश्चाधःप्रवृत्तये ॥ ४९ ॥
अनुवर्तेत वर्षं च यथोक्तं व्रणयन्त्रणाम् ।
When the intestine occupies its proper place the wound should be sutured; if displaced again it may take away the life, by aggravation. A band of cloth should be tied around the abdomen and soaked daily with ghee. He should drink warm milk added with chitra taila (castor oil) in order to make the feces soft and flatus to move down. This procedure should be continued for one year along with other therapies prescribed in the treatment of ulcers.

उदरान्मेदसो वर्तिं निर्गतां भस्मना मृदा ॥ ५० ॥
अवकीर्य कषायैर्वा श्लक्ष्णैर्मूलैस्ततः समम् ।
दृढं बद्ध्वा च सूत्रेण वर्धयेत्कुशलो भिषक् ॥ ५१ ॥
तीक्ष्णेनाग्निप्रतप्तेन शस्त्रेण सकृदेव तु ।
स्यादन्यथा रुगाटोपो मृत्युर्वा छिद्यमानया ॥ ५२ ॥
सक्षौद्रे च व्रणे बद्धे सुजीर्णेऽन्ने घृतं पिबेत् ।
क्षीरं वा शर्कराचित्रालाक्षागोक्षुरकैः शृतम् ॥ ५३ ॥
रुग्दाहजित्सयष्ट्याह्वैः परं पूर्वोदितो विधिः ।
मेदोग्रन्थ्युदितं तत्र तैलमभ्यञ्जने हितम् ॥ ५४ ॥
If the medasvarti (wick of fat/ pancreas) has come out of the abdomen, it should be cleaned with soft ash or decoction of astringent herbs or fine powder of roots of trees, then made straight, tied firm with threads and cut by wise physician, then after touched with red hot iron; if not done so, it may lead to pain, gurgling or death because of being torn. Next the wound, with honey should be bandaged (bathed), and after the digestion of food should drink ghee and consume milk boiled with (or milk and ghee boiled with) sugar, citrā – Ricinus communis, lākṣā – Laccifer lacca, gokṣurakaiḥ – Tribulus terrestris and yaṣṭi -Glycyrrhiza glabra, this is best to relieve pain and burning sensation. Medicated oil prescribed for medojagranthi previously (vide chapter 31 of uttara sthana) should also adopted for anointing in this condition also.

तालीशं पद्मकं मांसी हरेण्वगुरुचन्दनम् ।
हरिद्रे पद्मबीजानि सोशीरं मधुकं च तैः ॥ ५५ ॥
पक्वं सद्योव्रणेषूक्तं तैलं रोपणमुत्तमम् ।
Medicated oil prepared with tālīśaṃ – Abies webbiana¬, padmakaṃ – Prunus cerasoides, māṃsī – Nardostachys jatamansi, hareṇu – Pisum sativum, aguru – Aquilaria agallocha, candanam – Santalum album, haridre – the two haridra- Haridra – Curcuma longa, Daruharidra – Berberis aristata, padmabījāni – seed of¬ Nelumbo nucifera, Usira – Vetiveria zizanioides and Madhuka – Glycyrrhiza glabra, is good for healing of ulcers.

गूढप्रहाराभिहते पतिते विषमोच्चकैः ॥ ५६ ॥
कार्यं वातास्रजित्तृप्तिमर्दनाभ्यञ्जनादिकम् ।
In wounds which are caused by concealed blow, in which parts of the body have got displaced, which are irregular and greatly elevated, treatment such as nourishment, massage, oil anointing etc. which are prescribed for Vatasra (gout) should be done.

विश्लिष्टदेहं मथितं क्षीणं मर्माहतं हतम् ॥ ५७ ॥
वासयेत्तैलपूर्णायां द्रोण्यां मांसरसाशिनम् ॥ ५७½ ॥
The person whose body is badly wounded, churned, emaciated, injured in the vital organs and badly damaged should be kept in a bath-tub filled with medicated oil and the patient consuming juice of meat as food.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने सद्योव्रणप्रतिषेधो नाम षड्विंशोऽध्याय: ॥ २६ ॥
Thus, ends the chapter Sadyovrana Pratishedha the twenty sixth in Uttarasthana of Astanga Hridaya Samhita composed by Srimad Vagbhata, son of Vaidyapati Simhagupta.