The 1st chapter of Chikitsasthana of Sushruta Samhita is named as Dvivraniya Cikitsitam Adhyaya. This chapter deals with Treatment of Two Kinds of Wounds.

अथातोद्विव्रणीय्ंचिकिस्तित्ंव्याक्हास्याम्ः॥१॥
यथोवाचभगवान्धन्वन्तरिः॥२॥ 

Now, we will expound the chapter ‘Dvivraniya Cikitsita – treatment of two kinds of wounds; as revealed by the venerable Dhanvantari.

Vrana bheda – kinds of wounds

द्वौव्रणौ  भावत्ः :- शारीर,आगन्तुश्च्।तयोःशारीर्ःपवनपित्त्कफशोणितसत्रिपातनिमित्त्ः;आगन्तुरपिपुरुष्पशुपक्षिव्यालसरीसृपप्रपतनपीडनप्रहाराग्निक्षारविषतीष्णौषधशकलकपाल्शृ-ड्गचक्केषुपशुशक्तिकुन्ताघायुधाभिघातनिमित्त्ः।तत्रतुल्येव्रण्सामान्येद्विकारणेत्थानप्रयोजनसामथ्याद् ’द्विव्रणीय’इत्युच्यते॥३॥

Vrana means wounds. It also means ulcers. Vrana is of two kinds. They are –

–    Sarira vrana – bodily / physical wounds, endogenous wounds caused by doshas

–    Agantu vrana – wounds caused by external factors, exogenous wounds

Sarira Vranas – Sarira Vranas are caused by aggravation of –

–    Vata

–    Pitta

–    Kapha

–    Rakta and

–    Sannipata – simultaneous aggravation of tridosha and rakta

Agantu vrana – Below mentioned are the causes of agantu vranas –

–    Injury or assault from human beings or animals

–    Falling down from great heights,

–    Pressing

–    Squeezing

–    Being hit / getting a blow from something

–    Fire injury

–    Alkali injury

–    Effect of poisons

–    Effect of strong penetrating drugs

–    Injury caused by wood splints, potsherd, animal horns, discs, arrow, axe, trident, mace and other such weapons

Formation of wounds is common in both kinds of vrana. In spite of that, vrana has been classified and described as of two kinds separately from the perspective of

–    different causes – they are caused by different set of causative factors,

–    different methods of treatment needed to manage them and

–    different effects they cause (symptoms and complications)

Treatment approach in agantuja vrana

सर्वस्मिन्नेवागन्तुव्रणेतक्तालमेवक्षतोष्म्ण्ःप्र्सृतस्यॊपशमाथें
पित्तवच्छीतक्रियावचारणविधिविशेष्ःसन्धानाथेंच
मधुधृतप्रयॊग‌इत्येतद्विकारणॊत्धनप्र्यॊजनम्,उत्तरकाल्ंतु
दॊषॊपप्ल्वविशेषाच्छारीरवन्प्र्तीकार्ः॥४॥

The heat of the wound / assault spreads very quickly in all kinds of Agantu Vranas.

Below mentioned special methods of treatment should be done at first in order to manage and mitigate this condition –

–    Shita Kriya – all cold treatments similar to those prescribed for aggravated pitta should be adopted

–    Madhu-Ghrta Prayoga – Application of honey and ghee for healing of the wounds

–    Doshopaplava – After these measures, the other treatments should be done in accordance with the aggravation of doshas in the vranas.

These are the benefits of classifying wounds into the above mentioned two types.

दॊषॊपत्ल्वविशेष्ःपुन्ःसमासत्ःपञ्जदशप्रकार्ः,प्र्सरणसामध्यॊतु,यथ्
ऒत्कॊव्रणप्र्श्नाधिकारे;शुद्धत्वात्षॊड्शप्र्कार‌ईत्येके॥५॥ 

The Sarira Vranas are of fifteen kinds depending upon the aggravation of doshas as explained in the 21st chapter of Sutrasthana of the same treatise (Sushruta Samhita) i.e. Vrana Prasna chapter, based on the capacity and nature of spreading of doshas. According to some other authorities, these vranas are of sixteen types which include the sixteenth type i.e. ‘state of normalcy or non-aggravation of doshas’.

Vrana laksana and nirukti – symptoms and definition of wound

तस्य्लक्षण्ंद्विविध्ं – सामान्य्ं,वौशेषिक्ंच।तत्रसामान्य्ं -रुक्।विशेषलक्षण्ंपुनर्वातादिलिड्गविशेषःव्रण्गात्रविचूर्णने,-

-व्रणयतीतिव्रण्ः॥६॥

The symptoms of the vranas are of two kinds i.e.

–    Samanya lakshanas – general symptoms and

–    Vishesha lakshanas – special symptoms

Samanya Lakshana – ‘Ruk’ – pain is the general symptom of vranas.

Vishesha Lakshana – These are the specific symptoms produced by the aggravated doshas.

Word derivation of Vrana –

Vrana, this term is derived from the verbal root word ‘Vran’. Vran means ‘splitting or tearing’ of the body.

Vrana is that which breaks the body or body parts into different pieces causing discontinuity of skin and other tissues in its vicinity.

It is called Vrana since it causes discontinuity of the body or skin.

Notes – According to Master Dalhana the meaning of ‘vran’ is discoloration of body parts.

Vrana laksana – features of wounds 

तत्रश्यवारुणाभस्तनुःशीत्ःपिच्छिलॊल्प्रस्त्रवीरुक्षश्चटचटा

यनशील्ःस्फुरणायामतॊदवेदनाबहुलॊनिर्मांसश्चेतिवातात्,

क्षिप्र्ज्ःपीतनीलाभःकिंशुकॊदकाभॊष्णस्त्रावीदाहपाकराग

विकारकारीपीतपिडकाजुष्ट्श्चेतिपित्तात्,प्रततचण्डकण्डूबहु

ल्ःस्थूलौष्ट्ःस्तब्धसिरास्नायुजालावततःकठिन:

पाण्ड्वभासॊमन्दवेद्नःशुक्लशीतसान्द्रपिच्छिलास्त्रवी

गुरुश्चेतिकफात्,प्रवालदलनिचयप्रकाश्ःकृष्ण्स्फोटपिडका

जालॊपचितस्तुरड्ग्स्थानगन्धिःसवेदनॊधूमायनशीलॊरक्तस्त्र

वीपित्तलिड्ग्श्चेतिरक्तात्,तॊददाह्धूमायनप्रयःपीतारूणाभस्त्

द्वर्णस्त्रवीचेतिवातपित्ताभ्यां,कण्डूयनशीलःसनिस्तॊदॊ

रुक्षॊगुरुर्दारुणॊमुहुर्महुःशीतपिच्छिलाल्पस्त्रवीचेति

वातश्लोष्पभ्यां,गुरुःसदाह‌उष्णःपीतापाण्डुस्त्रवीचेति

पित्तश्लेष्प्भ्यां,रुक्षस्तनुस्तॊदबहुलःसुप्त्‌इवचरक्तारुणाभस्तद्वर्णास्रावीचेतिवातशॊणिताभ्यां,घृतमण्डाभो

मीनधावनतॊयगन्धिर्मृदुर्विसर्प्युष्णकृष्णस्रावीचेतिपित्तशॊणिताभ्यां,रक्तॊगुरुःस्निग्ध्ः

पिच्घिलःकण्डूप्रायःस्यिरॊसरक्तपाण्डुस्रावीचेतिश्लेष्म्शॊणिताभ्यां,स्फुरणतॊददाहधूमायनप्रायःपीततनुरक्तस्त्रावीचेतिवातपित्तशॊणितेभ्यः,कण्डूरस्फुरणचुमचुमानप्रायःपाण्डुघनरक्तास्त्रावीचेतिवातश्लेष्म्शॊणितेभ्यः,दाहपाकरागकण्डूप्रायःपाण्डुघनरक्तास्त्रावीचेतिपित्तश्लेष्मशॊणितेभ्य्ः,त्रिविधवर्णवेदनास्त्रवविशेषॊपेतःपवनपित्तकफेभ्यः,

निर्दहननिर्मथनस्फुरणतॊददाहपाकरागकरागण्डूस्वापबहुलॊनानावर्ण्वेदनास्त्राविविशेषॊपेतःपवनपित्तकफशॊणितेभ्यः,जिह्वातलाभॊ,मृदुःस्निग्धःश्लक्ष्णॊविगतवेदनःसुव्यवस्थितॊनिरास्त्रावच्क्षेतिशुद्धोव्र्ण‌इति॥७॥

Type of Vrana	Features / Symptoms
Vataja Vrana – wound caused by aggravated vata	Bluish red colour Thin, Cold, Has scanty and slimy discharges, Dry, It makes rough sounds when touched, Associated with severe pain like – throbbing, expanding (stretching), pricking and splitting, Devoid of muscles
Pittaja Vrana – wounds caused by aggravated pitta	Quick in onset, Colour – Yellowish blue, Exudate – the fluids resemble Kimsuka Flower in colour i.e. has red colour, Associated with burning sensation, suppuration, reddish colouration, Studded with yellowish eruptions
Kaphaja Vrana – wounds caused by aggravated kapha	Constant and profound itching, Lips / edges of vrana – thick, immovable, Has network of veins and ligaments, Hard in texture, Colour – yellowish white Associated with – pain Exudates – white, cold, thick and slimy discharge, Heaviness
Raktaja Vrana – wounds caused by aggravated blood	Colour – red, resembles sprout of coral reef, Covered with – network of black blebs / vesicles which would burst open, Odour – smell of horse stable, Associated with – pain, feeling of hot air coming from inside, Exudes – blood Accompanied with – pitta aggravation symptoms
Vata-Pittaja Vrana – wounds caused by aggravated vata and pitta	Pricking pain, Burning sensation, Feeling of – hot fumes coming from inside the wounds, Colour – yellow and mild red or yellowish red Exudates – fluids of yellow and mild red colour is discharged,
Vata-Kaphaja Vrana – wounds caused by aggravated vata and kapha	Itching Constant pain, Dryness, Heaviness and dreadful, Exudation – cold and slimy fluid get repeatedly discharged in small quantities
Pitta-Sleshmaja Vrana – wounds caused by aggravated pitta and sleshma	Heavy, Burning sensation, Exudation – hot fluids, yellowish white in colour is discharged,
Vata Sonitaja (Vata Raktaja) Vrana – wounds caused by aggravated vata and rakta	Dryness, Thin, Excessive pricking pain, Loss of sensation – sleeping wound, Colour – red or pale red, Exudation – discharges are red or pale red in colour
Pitta Sonitaja (Pitta Raktaja) Vrana – wounds caused by aggravated pitta and rakta	Colour – resembles scum of ghee, Smell – similar to fish washed water, Soft in touch, Spreading in nature, Exudates – warm, black fluid is discharged
Sleshma Sonitaja (Kapha Raktaja) Vrana – wounds caused by aggravated kapha and rakta	Colour – red Heavy, Unctuous – oily and moist, Excessive itching, Immovable, Exudates – white coloured fluid mixed with blood is discharged,
Vata Pitta Sonitaja Vrana – Wounds caused by aggravated Vata, Pitta and Rakta	Severe Throbbing, pricking and burning sensation Feeling of hot fumes coming out of the wounds, Exudation – thin blood yellowish in colour is discharged
Vata, Slesma Sonitaja Vrana – wounds caused by aggravated vata, kapha and rakta	Excess of itching, throbbing and tingling sensation (mild burning sensation), Exudation – thick and whitish coloured blood is discharged
Pitta, Slesma Sonitaja Vrana – wounds caused by aggravated pitta, kapha and rakta	Excessive burning sensation, Suppuration, Redness, Itching, Exudation – discharge of thick, whitish coloured blood
Sannipataja Vrana – wounds caused by aggravated vata, pitta and kapha	Presents with colours, pains and exudates (discharges) of all the three doshas mixed together
Vata Pitta Kapha Sonitaja Vrana – wounds caused by aggravated vata, pitta, kapha and rakta	Excessive burning, churning, throbbing, pricking sensation, Suppuration, Redness, Itching, Loss of sensation, Exudation – of fluids of various colours, Pains – of different kinds
16. Suddha Vrana – wounds which are pure i.e. not vitiated by any dosha or doshas	Resembles – upper surface of the tongue, Soft, Moist, Smooth, Painless, Good looking and even, No exudation

Sasti Upakrama – sixty methods of treatment

तस्यव्रणास्यपष्टिरुपक्रमाभवन्ति।तघथा – अपतर्पणमलेपः

परिषेकोऽभ्यड्गःस्वेदोविम्लपनमुपनहःपाचनंविस्त्रावणं

स्नेहोवमनंविरेचनछेदनंभेदनंदारणंलेखनमेषणमाहरणं

व्यधनंविस्त्रावणंसीवनंसन्धानंपीडनंशॊणितास्थापनं

निर्वापणमुत्कारिकाकषायेवर्तिःकल्कःसर्पिस्तौलं

रसक्रियऽवचुर्णनंरोपणव्र्णधूपनमुत्सादनमवसादनं

मृदुकर्मदारुणकर्मक्षारकर्मग्निकर्मकृष्णकर्मपाण्डुकर्म

प्रतिसरणंरोमसञ्चननंलोमपहरणंबस्तिकर्मोत्तरबस्तिकर्म

बन्धः,पत्रदानंकृमिघ्न्ंबृंहण्ंविषघ्न्ंशिरोविरेचन्ंनस्य्ं

कवलधारण्ंधूमॊमधुसर्पिर्यन्त्रमाहारोरक्षाविधानमिति॥८॥

Methods of treatment of wounds are sixty in number, such as;

Upakrama (treatment name)	Meaning
Apatarpana	Fasting, therapeutic starvation
Alepa	Anointing, application of medicinal pastes
Pariseka	Pouring or showering liquids
Abhyanga	Massage, anointing
Sweda	Sudation, fomentation, sweating therapy
Vimlapana	Kneading, Massaging
Upanaha	Administering poultices
Pacana	Cooking, ripening (ama relieving measures)
Raktasravana	Bloodletting
Sneha	Oleation
Vamana	Emesis
Virecana	Purgation
Chedana	Cutting, incising
Bhedana	Dividing,
Darana	Bursting
Lekhana	Scraping, scarifying,
Esana	Probing, searching
Aharana	Extraction
Vyadhana	Puncturing
Visravana	Draining pus etc
Sivana	Suturing
Sandhana	Joining, Repairing,
Pidana	Squeezing
Sonita Sthapana	Preventing bleeding
Nirvapana	Sprinkling, pouring
Utkarika	Poultice
Kasaya	Washing with astringent liquids, herbal decoctions
Varti	Keeping wicks of herbs over the wound
Kalka	Application of paste of drugs
Sarpi	Ghee
Taila	Oil
Rasakriya	Thick decoction
Avacurnana	Dusting powder of herbs on wounds
Vrana Dhupana	Fumigating the wound
Utsadana	Raising the floor of the wound upwards
Avasadana	Reducing the floor of the wound downwards
Mrudu Karma	Softening
Daruna Karma	Hardening
Ksara Karma	Alkaline cautery
Agni Karma	Thermal cautery
Krsna Karma	Blackening
Pandu Karma	Whitening
Pratisarana	Applying, smearing liquids
Roma Sanjanana	Promoting growth of hair
Lomapaharana	Removing hairs
Basti Karma	Rectal enema therapy
Uttara Basti Karma	Urethral enema / douche therapy
Bandha	Bandaging
Patradana	Covering with leaves
Krimighna	Destroying worms, antibacterial
Brmhana	Stoutening, nourishing
Visaghna	Detoxification, de-poisoning
Sirovirecana	Purgation of head, errhines
Nasya	Nasal Medication
Kavala Dharana	Mouth gargles
Dhuma	Fumigation
Madhu Sarpi	Honey and ghee
Yantra	Instrumentation / controlling, disciplining
Ahara	Food and drinks
Raksa Vidhana	Protective measures

तेषुकषायोवर्तिःकल्कःसर्पिस्तौल्ंरसक्रियऽवचूर्णनमिति
शॊधनरोपणानि,तेष्वष्टौशस्त्रकृत्याः,शॊणितास्थापन्ं
क्षारॊऽग्निर्यन्त्रमाहरोरक्षाविधान्ंबन्धविधानंचोक्तानि,
स्नेहस्वेदनवमनविरेचनबस्त्युत्तरबस्तिशिरोविरेचनस्य्धूमकवल-
धारणान्यन्यत्रवक्ष्यामः,यदन्यदवशिष्टमुपक्रमजातंतदिह वक्ष्यते॥९॥

Out of these,

Upakramas	Purpose (meant for) / Context
Kasaya, Varti, Kalka Sarpi Taila Rasakriya Avacurnana	Sodhana – purification Ropana – healing
Chedana Bhedana Lekhana Esana Aharana Vedhana Visravana	Ashta Shastra Karmas – eight kinds of surgical techniques used for different surgical operations
Sonita Sthapana – methods of controlling the bleeding, Kshara Karma Agnikarma Yantra (yantrana) Ahara Raksha Vidhana Bandha Vidhana	Described earlier in different chapters of Sushruta Samhita Sutra Sthana
Snehana Swedana Vamana Virechana Basti Uttara Basti Shiro Virechana Nasya Dhuma Kavala	Will be described elsewhere, in other chapters of this section itself
The remaining methods of treatments	Will be described now, in this chapter itself

Kriya prayoga – indications of the therapies

षडिवधःप्रागुपदिष्टःशॊफः,तस्यौकादशॊपक्रमा
भवन्त्यपतर्पणादयॊविरेचनान्ताः; तेचविशेषेण
शॊथप्रतीकारेवर्तन्ते,व्रणभावमापन्नस्य
चनविरुध्यन्ते;शेषास्तुप्रायेणव्रणप्रतीकारहेतव‌एव॥१०॥

Earlier (in Sutra Sthana 17/4), it was said that Sopha – inflammatory swelling is of six kinds. The eleven methods of treatment commencing with Apatarpana – fasting and ending with Virechana – purgation are mainly beneficial for treating / mitigating Sopha – swelling. Even after the formation of wounds, these treatments can be done and are not prohibited. Apart from these eleven treatments, the remaining treatments are generally meant for vrana pratikara – treating the wounds.

Apatarpana – fasting

अपतर्पणमाघ‌उपक्रमः;एषसर्वशॊफानांसामान्यःप्रधानतमक्ष्च॥११॥

Apatarpana means depleting therapies meant for making the body thin, by implementation of fasting. This is the first treatment mentioned amongst Shashti Upakrama. Apart from being the chief method of treatments, it is common treatment for all kinds of sopha – swellings i.e. to treat all kinds of swellings.

भवन्तिचात्र

Some verses here

दोषोच्छायोपशान्त्यर्थंदोषानद्धस्यदेहिनः॥
अवेक्ष्यदॊषंप्राणंचकार्यंस्यदपतर्पणम्॥१२॥
ऊर्ध्वमारुततृष‌ऋमान्वितौ:॥
नकार्यंगर्भिणीवृद्धबालदुर्बलभीरुभि:॥१३॥

Apatarpana – fasting should be administered to mitigate the severity of those aggravated doshas which have accumulated in the body and have blocked the srotas – channels therein.

Apatarpana should be done only after having considered the condition of doshas and status of prana – the life force and activities.

Apatarpana is contraindicated in –

–    Urdhwa vata – when vata is moving upwards,

–    Presence of thirst

–    Presence of hunger

–    Presence of dryness of mouth

–    To those who are fatigued

–    To pregnant women

–    To old persons

–    To children

–    To the debilitated individuals

–    To those who are frightened

Alepa — applying paste of drugs / cold poultice 

शॊफेषूत्थितमात्रेषुव्रणेषूग्ररुजेषुच॥
यथास्वौरौषधौर्लेपंप्र्त्येकश्येनकारयेत्॥१४॥
यथाप्रवज्वलितेवेश्म्न्यम्भसापरिषेचनम्॥
क्षिप्रंप्रशमयत्यग्निमेवमालेपनंरुजः॥१५॥
प्रह्लादनेरोपणोचलेपःस्यात्तुतदर्थकृत्॥१६॥ 

Alepa means applying medicinal pastes. Paste of appropriate herbs which are indicated for applying collectively or each one separately should be used for applications on –

–    Swellings which are newly arising and

–    Wounds associated with severe pain

Water is poured over the burning house so as to extinguish the fire and save the burning house. Similarly, alepa is done to quickly mitigate the pain.

Other benefits of alepa –

–    It bestows comfort,

–    Cleanses the wound,

–    Mitigates the swelling,

–    Fills the wound

–    Heals the wound

Pariseka – pouring fluids on the swelling

वातशोफेतुवेदनोपशमार्थंसर्पिस्तौलधान्याम्लमांसवातहरौष्-

धनिष्क्वाथौर्शीतौःपरिषेकन्कुर्वीत,पित्तरक्ताभिघातविषनिमित्ते-

षुक्षीरघृतमधुशर्करोकेक्षुरसधुरौषधक्षीरवृक्षनिष्क्वाथौरनुष्णौःपरिषेकन्कुर्वीत,श्लेष्मशो{एतुतौलमूत्रक्षारोदकसुराशुक्तकफघ्नौषधनिष्क्वाथौरशीतौः [अरिषेकान्कुर्वीत॥१७॥

तथाऽन्बुभिःसिच्यमानःशान्तिमग्निर्नियच्छ्ति॥दोषाग्निरेव्ंसहसापरिषेकेणशाम्यति॥१८॥

Type of Sopha – swelling	Things (medicaments) used for Pariseka – pouring liquids on the swelling	Nature of Pariseka
Vataja Sopha – swelling caused by aggravated vata	Ghee Oils Dhanyamla – sour gruel Meat soup Decoctions prepared from herbs which mitigate vata	Each of these should not be cold i.e. they need to be warm
Pittaja Sopha – swelling caused by aggravated pitta, rakta, abhighata (trauma) and visa (poison)	Milk Ghee Honey Sugar water Sugarcane juice Decoction prepared using herbs of sweet taste or Decoction of Panchavalkala – bark of trees having milky sap	Each one should be cold
Kaphaja Sopha – swelling caused by aggravated kapha	Oil Urines Solution of alkali Sura – beer Sukta – vinegar Decoction prepared with kapha mitigating herbs	Each one of these should be warm

The heat produced by the doshas gets subsided by the administration of Pariseka, just like pouring of water on the fire extinguishes it.

Abhyanga – anointing and massage / oil bath

अभ्यड्गस्तुदोषमालोक्योपयुक्तोदोषोपशमंमृदुतांचकरोति॥१९॥
स्वेदविम्लापनादीनांक्रियाणांप्राक्स‌उच्यते॥
पच्क्षात्कर्मसुचादिष्टःसचविस्त्रावणादिषु॥२०॥ 

Abhyanga – massage or oil bath done over the sopha – swollen part of the body which is conducted after considering the status of doshas and malas would mitigate aggravation of doshas. It would also bestow softness of the doshas.

Abhyanga as purvakarma – Abhyanga is done as a preparatory procedure, before conducting therapies such as swedana – sudation, vimlapana – kneading or massaging etc.

Abhyanga as pascat karma – Abhyanga is conducted as follow up therapy, after doing the therapies like visravana – draining out the fluids etc. treatments.

Svedana – fomentation

रुजावतांदारुणानांकठिनानांतथौवच॥
शॊफनांस्वेदन्ंकार्यंयेचाप्येवंविधाव्रणाः॥२१॥

Swedana – sudation should be done for sopha – swellings which are painful, rough and hard. Swedana also should be done for the vranas – wounds which have similar features (painful, rough and hard).

Vimlapana – Kneading / massaging

स्थिराणांरुजतांमन्दंकार्यंविम्लापनंभवेत्॥
अभ्यज्यस्वेदयित्वातुवेणुनाडयाततःशनौः॥
विमर्दयेद्धिषक्प्राज्ञस्त्तलेनाङ्गुष्ठकेनवा॥२२॥

Vimlapana – mild kneading of swelling – should be done in –

–    Immovable swellings and

–    Painful swellings

The intelligent physician should first administer abhyanga to these swellings and then administer sudation. The swelling should be slowly massaged later with the help of tubes of bamboo, palm or thumb.

Upanaha – warm poultice

शॊफयोरुपनाहंतुकुर्यदामविदग्धयोः॥
अविदग्धःशमंयातिविदग्धःपाकमेतिच॥२३॥

Upanaha – Warm poultices should be administered in ama sopha – unripe swellings and vidagdha sopha – ripening swellings.

By this, the unripe swelling would subside. Also, the swelling which is ripening would ripen i.e. get suppurated quickly (formation of pus takes place quickly).

Pacana – ripening

निवर्ततेनयःशोफोविरेकान्तैरुपक्रमैः॥
तस्यसंपाचनंकुर्यत्समाहृत्यौषधानितु॥२४॥
दधितक्रसुराशुक्तधान्यम्लैर्योजितानितु॥
स्त्रिग्धानिलवणीकृत्यपचेदुत्कारिकांशुभाम्॥२५॥
सैरण्डपत्रयाशोफंनाहयेदुष्णयातया॥
हितंसम्भोजनंचापिपाकयाभिमुखोयदि॥२६॥

A wise physician should administer pacana – therapies which would ripen the swellings after having collected all the essential herbs needed for this treatment. Pacana should be preferably done in the swellings which does not subside in spite of doing the therapies ending with virechana.

Materials used for preparing Utkarika – pancakes for treatment –

–    Curds,

–    Buttermilk,

–    Beer,

–    Vinegar,

–    Sour gruels etc.

After covering the swelling with eranda – castor plant leaves, slightly lubricated – utkarika should be applied hot and kept on the swelling.

Intake of foods which promote ripening of swelling are also beneficial to treat the swelling in the stage of ripening.

Rakta Visaravana – bloodletting

वेदनोपशमार्थायतथापाकशमायच॥
अचिरोत्पतितेशॊफेकुर्याच्छोणितमॊक्षणम्॥२७॥
सशॊफेकठिनेध्यामेसरक्तेवेदनावति॥
संरब्धेविषमेचापिर्वणेविस्त्रावणंहितम्॥२८॥
सविषेचविशेषेणजलौकॊभिःपदैस्तथा॥
वेदनायाःप्र्शान्त्यर्थंपाकस्याप्राप्त्येतथा॥२९॥

Rakta mokshana – bloodletting should be done in swellings of recent onset. This will mitigate pain and ripening (suppuration).

It can also be administered in wounds with below mentioned features –

–    Which are hard,

–    Which are dark red in colour,

–    Which contain blood,

–    Which are painful,

–    Which are deep seated and

–    Which are uneven

Bloodletting should also be done in swellings containing poison. It should especially be done using jalauka – leeches and or by sastrapada – incising by lancet. This would help in mitigating pain and to prevent suppuration (ripening).

Snehapana – oleation

सॊपद्रवाणांरुक्षाणांकृशानांव्र्णशॊषिणाम्॥
यथास्वमौषधौःसिद्धंस्नेहपानंविधियते॥३०॥

Snehapana should be administered with oil or ghee medicated with herbs appropriate to the doshas for –

–    Those who have developed complications

–    Persons who are dry,

–    Those emaciated,

–    Those who are suffering from vrana sosha – consumption or emaciation due to wounds

Vamana – emesis

उत्सन्नमांसशॊफेतुकफजुष्टेविशेषतः॥
संक्लिष्टश्या(ध्या) मरुधिरेव्र्णेप्र्च्छर्दनंहितम्॥३१॥

Vamana / Prachardana – emesis therapy in great measure is beneficial in below mentioned kinds of swellings –

–    Swellings having utsanna mamsa – elevation of muscles (muscle like mass),

–    Swellings having aggravation of kapha especially and

–    In wounds wherein blood is clotted and has become slightly black

Virecana – purgation

वातपित्तप्रदुष्टेषुदीर्घकालानुबन्धिषु॥
विरेचन्ंप्रशंसन्तिव्रणेषु व्र्णकोविदाः॥३३॥

According to experts in wound management, virechana – purgation therapy is beneficial in –

–    Wounds which have been greatly vitiated by aggravated vata and pitta and

–    In wounds which are chronic (persisting for long time)

Chedana — excising

अपाकेषुतुरॊगेषुकठिनेषुच॥
स्नायुकॊथादिषुतथाच्छेदनंप्राप्त्मुच्यते॥३३॥ 

Chedana – excision and removal of dead tissues etc. is ideal to be done in –

–    Wounds which are unripe, hard and static

–    Suppuration of ligaments etc.

Bhedana – splitting by cutting

अन्तःपूयेष्ववक्रेषुतथैवॊत्सङ्गवत्स्वपि॥
गतिमत्सुचरोगेषुभेदनंप्राप्तमुच्यते॥३४॥ 

Bhedana – is a procedure wherein splitting and draining the accumulated pus is done. It is ideal to be done in –

–    Wounds having pus inside them and

–    Not having an opening and

–    In those which have bulged up and

–    Those having sinuses inside them

Darana — bursting

बालवृद्धासहक्षीणभीरुणांयोषितामपि॥३५॥
मर्मपरिचजातेषुरोगेषूक्तेषुदारणम्॥
सुपक्वेपिण्डितेशोफेपीडनैरुपपीडिते॥३६॥
पाकोदूवृत्तेषुदोषेषुतत्तुकार्यंविजानता॥
सुपिष्टौर्दारणद्रव्यैर्युक्तैःक्षारेणवापुन॥३७॥      

Darana means promoting bursting by local application of medicines. It is ideal to be done in wounds of –

–    Children

–    Aged individuals,

–    Intolerant individuals,

–    Emaciated persons,

–    Frightened individuals,

–    Women and

–    Those located in marmas – vital / fatal spots

Application of herbs which cause mild squeezing of swelling is beneficial to be administered in –

–    Swellings which are well ripened and

–    Elevated with swelling i.e. swelling with knots

This therapy shall be done carefully when the doshas are ripened and are trying to come out of the wound. Herbs which are meant to cause bursting of swelling should be properly macerated and applied. Alternatively, alkali may be applied.

Lekhana — scraping

कठिनान्स्थूलवृत्तौष्ठान्दीर्यमाणान्पुनःपुनः॥
कठिनॊत्सन्नमांसांश्चलेखनेनाचरेद्धिषक्॥३८॥
सम्ंलिखेत्सुलिखितंलिखेन्निरवशेषतः॥
वर्त्मनांतुप्रमाणेनसमंशस्त्रेणनिर्लिखेत्॥३९॥ 

The physician should conduct lekhana karma i.e. scraping in wounds –

–    which are hard

–    having thick and round lips / edges,

–    which burst open often,

–    having elevated muscles

Scraping should be done evenly using a sharp instrument like a scalpel or lancet. It should be done without leaving any remnants, over the thickness of the eyelids i.e. edges should be scraped to the level of the floor of the wound.

क्षौमंप्लोतंपिचुंफेनंयावशूकंससैन्धवम्॥
कर्कशानिचपत्राणिलेखनार्थेप्रदापयेत्॥४०॥

Below mentioned things shall be used for lekhana karma i.e. scraping –

–    coarse (linen) cloth

–    thick cotton cloth,

–    rough cloth,

–    sea foam,

–    alkali / ash of barley spikes mixed with rock salt or

–    rough leaves of the plants

Esana – probing

नाडीव्रणाञ्शल्यगर्भानुन्मार्ग्युत्सङ्गिनःशनैः॥
करीरबालाङ्गुलिभिरेषण्यावैषयेद्धिषक्॥४२॥
नेन्नवर्त्मगुदाभ्यासनाड्यॊऽवक्राःसशॊणिताः॥
चुच्चूपोदकजैःश्लक्ष्णैःकरीरैरेषयेत्तुताः॥४२॥    

The surgeon should do esana – probing in the wounds –

–    having straight sinuses,

–    having foreign bodies,

–    having curved sinuses and

–    which bulge up slowly

Esana should be done by using shoots of karira, hairs, finger or metal probes.

Smooth sprouts of cuccu, upodike and karira should be used for probing the sinuses –

–    of the eyelids,

–    located near the anal opening,

–    which do not have an opening and

–    filled with blood

Aharana – extracting

संवृतासंवृतास्येषुव्रणेषुमतिमान्भिषक्॥
यथॊक्तमाहरेच्छल्य्प्राप्तॊद्धरणलक्षणम्॥४६॥

The intelligent physician or surgeon should extract the salya – foreign body from the wounds having their mouth either closed or open (not closed), when features suitable for such removal have appeared.

Vyadhana – visravana — puncturing and draining

रोगेव्यधनसाध्येतुयथोद्देशंप्रमाणतः॥
शस्त्रंनिदध्यादोषंचस्रावयेत्कीर्तितंयथा॥४४॥

Vyadhana – puncturing should be done in wounds which are treatable with vyadhana. For this, sharp instruments should be used, the wounds punctured and the accumulated dosas (pus etc.) should be subjected to visravana (draining) and drained out as previously described.

Sivana — sandhana — suturing and repairing

अपाकोपद्रुतायेचमांसस्थाविवृताश्चये॥
यथोक्तंसीवनंतेषुकार्यंसन्धानमेवच॥४५॥

Sivana – suturing should be done in wounds –

–    which do not have any complications of suppuration,

–    localized in muscles and

–    having wide opening

The suture should be done as described earlier in the 25th chapter of Sutra Sthana, edges of the wound joined appropriately and the wound repaired.

Pidana – Pradeha — squeezing poultices

पूयगर्भानणुद्वारान्व्रणान्मर्मगतानपि॥
यथोक्तैःपीडनद्रव्यैःसमन्तात्परिपीडयेत्॥४६॥
शुष्यमाणमुपेक्षेतप्रदेहंपीडनंप्रति॥
नचाभिमुखमालिम्पेत्तथादोषःप्रसिच्यते॥४७॥ 

The wounds should be squeezed by applying warm poultices prepared from herbs possessing pidana – squeezing properties. Pidana – squeezing of wounds should be done in wounds –

–    having pus inside them,

–    having small opening and

–    situated on marma – vital / fatal wounds

The pradeha – poultice which is becoming dry should be ignored i.e. allowed to remain in place. It should not be applied in front of the wound since the pus etc. doshas are expelled by that route.

Sonita Sthapana — controlling bleeding

तैस्तैर्निमित्तैर्बहुधाशोणितेप्रस्तुतेभृशम्॥
कार्ययथोक्तंवैद्येनशोणितास्थापनंभवेत्॥४८॥ 

Appropriate methods to control the bleeding should be adopted by the surgeons / physicians when too much bleeding takes place by the mentioned causes i.e. as a result of many therapies described until now.

Nirvapana — mitigation of pain

दाहपाकज्वरवतांव्रणानांपित्तकोपतः॥
रक्तेनचाभिभूतानांकार्यंनिर्वापणंभवेत्॥४९॥
यथोक्तैःशीतलद्रव्यैःक्षीरपिष्टैघृताप्लुतैः ||
दिह्यादबहलान्सेकान्सुशीतांश्चावचारयेत्॥५०॥

Therapies to mitigate pain should be done in wounds

–    which are accompanied with burning sensation, suppuration and fever and

–    covered with blood because of aggravation of pitta

Shitala Dravya i.e. herbs possessing cold properties (potency) should be macerated with milk and added with ghee and should be made into paste. Thin layer of this paste should be applied on the area. Alternatively cold liquids shall be poured in streams over the wounds.

Svedana – fomentation

व्रणेषुक्षीणमासेषुतनुस्राविष्वपाकिषु॥
तोदकाठिन्यपारुष्यशूलवेपथुमत्सुच॥५१॥
वातघ्नवर्गेऽम्लगणेकाकोल्यादिगणेतथा॥
स्नैहिकेषुचबीजेषुपचेदुत्कारिकाशुभाम्॥५२॥
तेषांचस्वेदनंकार्यंस्थिराणांवेदनावताम्॥

Swedana should be done for wounds –

–    having emaciated muscles,

–    exuding thin fluids,

–    not undergoing suppuration,

–    having pricking pain, hardness, roughness / dryness, pain and throbbing

Swedana should be done by placing Utkarika – a pancake prepared from herbs mitigating vata or sour taste or herbs of Kakolyadi Gana group of herbs or oil yielding seeds.

For wounds which are static / immovable and painful, swedana should be done.

Sodhana — purification

दुर्गन्धानांक्लेदवतांपिच्छिलानांविशेषतः॥५३॥
कषायैःशोधनंकार्यंशोधनैःप्रागुदीरितैः॥

Sodhana – cleansing / purification of wounds should be done for wounds –

–    which emit bad smell and

–    exude slimy fluids

Shodhana should be done using decoction of herbs having sodhana property enumerated previously in chapter 37 of Sutra Sthana of the same treatise (Sushruta Samhita).

Varti – wick of drugs

अन्तःशल्ययानणुमुखान्गम्भीरान्मांससंश्रितान्॥५४॥
शोधनद्रव्ययुक्ताभिर्वर्तिभिस्तान्यथाक्रमम्॥
पूतिमांसप्रतिच्छन्नान्महादोषांश्चशोधयेत्॥५५॥
कल्कीकृतैर्यथालाभंवर्तिद्रव्यैःपुरोदितैः॥

Medicated Varti (wick of cotton cloth) should be placed in the wounds –

–    having foreign body inside them,

–    having minute openings

–    which are deeply located and

–    localized in the muscles

The varti should have been smeared with a paste of sodhana herbs.

Cleansing should be done by placing paste of as many sodhana herbs as available (as enumerated earlier), in the wounds –

–    which are covered with foul smelling muscles and

–    which have great aggravation of doshas

Sarpi – use of medicated ghee

पित्तप्रदुष्टान्गम्भीरान्दाहपाकप्रपीडितान्॥५६॥
कार्पासीफलमिश्रेणजयेच्छोधनसर्पिषा॥

Ghee should be used to treat the wounds –

–    vitiated by pitta,

–    deep located and

–    having burning sensation and suppuration

Ghee medicated with herbs having sodhana properties prepared with fruits of Karpasa should be applied on these wounds.

Taila – use of medicated oil

उत्सन्नमांसानस्निग्धानल्पस्नावान्व्रणांस्तथा॥५७॥
सर्षपस्नेहयुक्तेनधीमांस्तैलेनशोघयेत्॥

The wise physician should administer / apply oil to wounds –

–    which have elevated muscles (muscular growths)

–    which are not unctuous / moist and

–    having less exudation

This oil should be medicated with the addition of more quantity of Sarsapa Taila (mustard oil) and should be applied to cleanse the wound.

Rasakriya – use of thick decoction

तैलेनाशुध्यमानानांशोघनीयांरसक्रियाम्॥५८॥
व्रणानांस्थिरमांसानांकुर्यादद्रव्यैरुदीरितै
कषायेविधिवत्तेषांकृतेचाधिश्रयेत्पुनः॥५९॥
सुराष्ट्रजांसकासीसांदद्याच्चापिमनःशिलाम्॥
हरितालंचमतिमांस्ततस्तामवचारयेत्॥६०॥
मातुलुङ्गरसोपेतांसक्षौद्रामतिमर्दिताम्॥
ब्रणेषुदत्त्वातांतिष्ठेत्रींस्त्रींश्चदिवसान्परम्॥६१॥ 

Rasakriya (thickened solid decoction) should be applied to wounds –

which do not get purified by medicated oil and

which still require purification and

which are have immovable muscles

This rasakriya should be prepared from the decoction of sodhana herbs boiled repeatedly and hence made thick, adding powders of Surastraja, Kasisa, Manassila and Haratala and then removed from the oven. The paste is made very soft by adding to it the juice of Matulunga and honey. This Rasakriya should be put into the wound and kept in place for three days only, at a time.

आवचुर्नन  उसे ओफ़् दुस्तिन्ग् पोव्देर्

मेदोजुष्टानगम्भीरान्टुर्गन्धांश्चूर्णशोधनैः॥

उपाचरेत्भिषक्प्राज्ञःश्लक्ष्णैःशोधनवर्तिजैः॥६२॥

Avacurnana – medicated powder should be dusted / sprinkled on wounds –

which are vitiated with fat,

which are not deep and

which emit bad smell

These wounds should be cleansed by dusting the fine powder of sodhana herbs. The same herbs enumerated for preparing varti – cleansing wicks above should be used here also.

Ropana – healing

शुद्धलक्षणयुक्तानांकषायंरोपणंहितम्॥
तत्रकार्यंयथोद्दिष्टैर्द्रव्यैवैद्येनजानता॥६३॥

Decoctions of herbs mentioned earlier which have been prepared by the physician with his knowledge are beneficial for healing the wounds which have developed signs of cleansing.

अवेदनानांशुद्धानांगम्भीराणांतथैवच॥
हितारोपणवर्त्यङ्गकृतारोपणवर्तयः॥६४॥

Ropana Varti – healing wicks prepared from herbs of healing properties is ideal for curing the wounds which are –

painless,

pure / clean and

deep seated

अपेतपूतिमांसानांमांसस्थानामरोहताम्॥
कल्कःसंरोहणःकार्यस्तिलजोमधुसंयुतः॥६५॥
समाधुर्यात्तथौष्ण्याच्चस्नेहाच्चानिलनाशनः॥
कषायभावान्माधुर्यात्तिक्तत्वाच्चापिपित्तहृत्॥६६॥
औष्ण्यात्कषायभावाच्चतिक्तत्वाच्चकफेहितः॥
शोधयेद्रोपयेच्चापियुक्तःशोधनरोपणैः॥६७॥
निम्बपत्रमधुभ्यांतुयुक्तःसंशोधनःस्मृतः॥
पूर्वाभ्यांसर्पिषाचापियुक्तश्चाप्युपरोपणः॥६८॥
तिलवधवकल्कंतुकेचिदाहुर्मनीषिणः॥
शमयेदविदग्धंचविदग्धमपिपाचयेत्॥६९॥
पक्वंभिनत्तिभिन्नंचशोधयेद्रोपयेत्तथा॥

Paste of tila – sesame seeds mixed with honey should be healing for curing wounds –

devoid of bad smelling muscles,

located in muscles and

which are not healing

This recipe mitigates vata by –

its sweetness (sweet taste),

hot potency and

unctuousness,

It mitigates pitta by the virtue of its –

astringency / astringent taste,

sweet taste and

bitterness – bitter taste

It is beneficial for kapha also owing to its hot potency.

Other benefits of this recipe –

cleanses and heals the wound

purifies the wound and also heals it in the best possible way when leaves of Nimba – Azadirachta indica (Neem) and honey are added and mixed with it

Use of Yava – According to wise physicians, paste of yava – barley is similar to paste of tila – sesame seeds in action.

It also –

mitigates the swelling if it is unripe,

ripens the swelling if it is partially ripened,

causes opening of swelling if it is ripe and

cleanses the swelling and heals it

पित्तरक्तविषागन्तून्गम्भीरानपिचव्रणान्॥७०॥
रोपयेद्रोपणीयेनक्षीरसिद्धेनसर्पिषा॥

Ghee prepared with ropana dravyas i.e. herbs used for healing the wounds and milk should be used to heal the wounds –

caused by pitta

caused by rakta

caused by visa – poisons and

those which are agantu – caused by extraneous objects

and deep seated

कफवाताभिभूतानांव्रणानांमतिमान्भिषक्॥७१॥
कारयेद्रोपणंतैलंभेषजैस्तद्यथोदितैः॥

Oils prepared with ropana dravyas as said earlier should be used by intelligent physicians for healing wounds predominant with kapha and vata.

अबन्ध्यानांचलस्थानांशुद्धानांचप्रदुष्यताम्॥७२॥
द्विहरिद्रायुतांकुर्याद्रोपणार्थीरसक्रियाम्॥

Rasakriya – thick solid decoction (solidified decoction) prepared with ropana dravyas – herbs used for healing purpose, added with Haridra – Curcuma longa and Daruharidra – Berberis aristata – should be used to help healing of wounds –

which cannot be bandaged,

situated on parts of the body which have movements,

which are either pure or vitiated

समानांस्थिरमांसानांत्वक्स्थानांरोपणंभिषक्॥७३॥
चूर्णंविदध्यान्मतिमान्प्राक्स्थानोक्तोविधिर्यथा॥

The wise physician should use ropana churna – powder prepared with healing herbs as enumerated in chapter 37 of Sutra Sthana for wounds –

which are even,

have fixed / hard – unmovable muscles and

localized in the skin

शोधनोरोपणश्चैवविधिर्योऽयंप्रकीर्तितः॥७४॥
सर्वव्रणानांसामान्येनोक्तोदोषाविशेषतः॥
एष‌आगमसिद्धत्वात्तथैवफलदर्शनात्॥७५॥
मन्त्रवत्संप्रयोक्तव्योनमीमांस्यःकथञ्चन॥

The procedures of sodhana – cleansing and ropana – healing of wounds which have been described so far are common to all kinds of wounds in accordance with doshas.

They have been declared as efficient by the texts. Their effects are also actually seen. Therefore, they should be followed strictly like one believes and follows sacred hymns. They should never be debated or doubted.

स्वबुद्ध्याचापिविभजेत्कषायादिषुसप्तसु॥७६॥
भेषजानियथायोगंयान्युक्तानिपुरामया॥

As enumerated by me earlier, the physician should by his own intellect decide herbs which are suitable for the seven recipes such as Kashaya etc, says Acharya.

आद्येद्वेपञ्चमूल्यौतुगणोयश्चानिलापहः॥७७॥
सवातदुष्टेदातव्यःकषायादिषुसप्तसु॥
न्यग्रोधादिर्गणोयस्तुकाकोल्यादिश्चयःस्मृतः॥७८॥
तौपित्तदुष्टेदातव्यौकषायादिषुसप्तसु॥
आरग्वधादिस्तुगणोयश्चोष्णःपरिकीर्तितः॥७९॥
तौदेयौकफदुष्टेतु,संसृष्टेसंयुतागणाः॥

Vitiation of wound	Herbs or recipes used for preparing Kashaya etc. seven recipes
By aggravated vata	Herbs of the first two Pancamula (Mahat Pancamula and Laghu Pancamula) and Herbs of Vatahara Gana – group of herbs meant for mitigating vata
By aggravated pitta	Herbs of Nyagrodhadi Gana and Kakolyadi Gana
By aggravated kapha	Herbs of Aragwadhadi Gana – which are of hot potency
By all three doshas together	Herbs may be selected from appropriate group of herbs mentioned above (in case of vata, pitta and kapha aggravation)

ढपन  फ़ुमिगतिओन्
वातात्मकानुग्ररुजान्सास्त्रावानपिचव्रणान्॥८०॥
सक्षौमयवसर्पिर्भिधूपनाङ्गैश्चधूपयेत्॥

Dhupana – fumigation should be given with smoke of Ksauma – linen, Yava – barley and Ghrta – ghee, along with other dhupana herbs mentioned in chapter 37 of Sutra Sthana in wounds –

–    having predominance of vata

–    having severe pain and

–    exudation

Utsadana — elevating the wound

परिशुष्काल्पमांसानांगम्भीराणांतथैवच॥८१॥
कुर्यादुत्सादनीयानिसीष्यालेपनानिच॥
मांसाशिनांचमांसानिभक्षयेद्विधिवन्नरः॥८२॥
विशुद्धमनसस्तस्यमांसंमांसेनवर्धते॥

Utsadana – Elevation – i.e. making to grow upwards of wounds should be done by smearing ghee processed with herbs promoting growth of muscles in wounds –

–    which are dry

–    having less muscles in and around it and

–    deep seated

Meat of carnivorous animals should be given to persons who are habituated to taking meat. Consumption of meat helps in growth of muscles in persons having pure mind i.e. devoid of bad emotions.

Avasadana — depressing the level of wound

उत्सन्नमृदुमांसानांव्रणानामवसादनम्॥८३॥
कुर्याद्व्यैर्यथोद्दिष्टैचूर्णितैर्मधुनासह॥

Avasadana i.e. depressing the (level of) wounds to a lower level should be done using the herbs mentioned for that purpose powdered well and mixed with honey, in wounds –

–    which are elevated i.e. grown upwards and

–    have soft muscles in and around them

Mrdu Karma — softening

कठिनानाममांसानांदुष्टानांमातरिश्वना॥८४॥
मृद्वीक्रियाविधातव्याशोणितंचापिमोक्षयेत्॥
वातघ्नौषधसंयुक्तान्स्नेहान्सेकांश्चकारयेत्॥८५॥
मृदुत्वमाशुरोहंचगाढोबन्धःकरोतिहि॥

Mrdu Karma – methods of softening the wound should be planned and executed in wounds –

–    which are hard,

–    which have no muscles and

–    vitiated by vata

In these conditions, even bloodletting should be done.

Snehana – anointing of wounds should be done with oils prepared with vata mitigating herbs.

Seka – bathing of wounds should be done with liquids prepared with vata mitigating herbs.

Following this, tight bandage shall be applied which helps in softening of wounds and healing of wounds in quick time.

Darunakarama — hardening

व्रणेषुमृदुमांसेषुदारुणीकरणंहितम्॥
धवप्रियङ्ग्वशोकानांरोहिण्याश्चत्वचस्तथा॥८६॥
त्रिफलाधातकीपुष्परोधसर्जरसान्समान्॥
कृत्वासूक्ष्माणिचूर्णानिव्रणंतैरवचूर्णयेत्॥८७॥ 

Darunakarma i.e. hardening of wounds should be done in wounds which have soft muscles.

Barks of the below mentioned herbs are taken in equal quantity

–    Dhava –

–    Priyangu

–    Asoka and

–    Rohini

–    Triphala

–    Dhataki pushpa

–    Rodhra and

–    Sarjarasa

Fine powder of the above said herbs is prepared. This powder is dusted into the wound.

Ksara karma — alkali cauterisation

उत्सन्नमांसान्कठिनान्कण्डूयुक्तांश्चिरोत्थितान्॥
तथैवखलुदुःशोध्यान्शोधयेत्क्षारकर्मणा॥८८॥

Application of Ksara – alkali should be done to purify the wounds –

–    having muscular growth which is elevated

–    which are hard,

–    which has itching,

–    which persists for long time and

–    which are difficult to be purified / cleansed

Agnikarma — thermal cauterisation

स्त्रवतोऽश्मभवान्मूत्रंयेचान्येरक्तवाहिनः॥
निःशेषच्छिन्नसन्धींश्चसाधयेदग्निकर्मणा॥८९॥

Agnikarma – branding by fire or thermal cautery should be used to treat the wounds –

–    of urinary bladder caused by urinary calculus consequently leading to exudation of urine,

–    of blood vessels

–    of joints in which the portion below the joint is totally cut off,

Krsnakarma – producing black colour

दुरूढत्वात्तुशुक्लानांकृष्णकर्महितंभवेत्॥
भल्लातकान्वासयेत्तुक्षीरेप्राङ्मूत्रभावितान्॥
ततोद्विधाच्छेदयित्वालौहेकुम्भेनिधापयेत्॥९०॥
कुम्भेऽन्यस्मिन्निखातेतुतंकुम्भमथयोजयेत्॥
मुखंमुखेनसन्धायगोमयैर्दाहयेत्ततः॥९१॥
यःस्नेहश्च्यवतेतस्माद्ग्राहयेत्तंशनैभिषक्॥
ग्राम्यानूपशफान्दग्ध्वासूक्ष्मचूर्णनिकारयेत्॥१२॥
तैलेनानेनसंसृष्टंशुक्लमालेपयेद्रणम्॥
भल्लातकविधानेनसारस्नेहांस्तुकारयेत्॥९३॥
येचकेचित्फलस्नेहाविधानंतेषुपूर्ववत्॥

Krshnikarana i.e. making the skin of that area black is beneficial and hence have to be administered in (skin of the) wounds which have become white.

Firstly, the seeds of Bhallataka should be soaked in cow’s urine (for a time period of seven days as per Acharya Dalhana). Later it should be soaked in cow’s milk. After this, the seeds should be filled in an iron pot after cutting them into two (each seed is cut into two parts).

Another mud pot should be taken. It should be buried inside the ground up to its neck. Now the pot containing seeds of Bhallataka should be placed over this pot. The junction of the mouths of both pots shall be joined and sealed properly using mud plaster.

The Bhallataka seeds are then cooked by using fire created by burning heaps of cow dung placed around the iron pot. Due to the heat, oil comes out of the seeds. This oil dropped from the seeds gets collected inside the pot placed below. This oil is slowly taken out.

The hoofs of domestic animals and animals living in marshy places are burnt and later powdered nicely. This oil is now mixed with the oil extracted from seeds of Bhallataka. Now this oil should be applied on the skin which has turned white, for changing its colours into black.

Sarasneha i.e. oil of drugs belonging to Salasaradi gana group of drugs too shall be extracted following the same method explained in Bhallataka Vidhana (method of extraction of oil of Bhallataka) explained above.

Pandu karma — producing white colour

दुरूढत्वात्तुकृष्णानांपाण्डुकर्महितंभवेत्॥९४॥
सप्तरात्रंस्थितंक्षीरेछागलेरोहिणीफलम्॥
तेनैवपिष्टंसुश्लक्ष्णंसवर्णकरणंहितम्॥९५॥
नवंकपालिकाचूर्णंवैदुलंसर्जनामच॥
कासीसंमधुकंचैवक्षौद्रयुक्तंप्रलेपयेत्॥९६॥
कपित्थमुद्धतेमांसेमूत्रेणाजेनपूरयेत्॥
कासीसंरोचनांतुत्थंहरितालंमनःशिलाम्॥९७॥
वेणुनिर्लेखनंचापिप्रपुन्नाडरसाञ्जनम्॥
अधस्तादर्जुनस्यैतन्मासंभूमौनिधापयेत्॥९८॥
मासादूर्ध्वंततस्तेनकृष्णमालेपयेवणम्॥

Pandu Karma i.e. producing white colour or whitening of the skin is beneficial and hence implemented for wounds which have made the skin or particular area of the skin where there is wound black. This blackening of skin is caused due to improper healing of the wound.

Paste of Rohini Phala – fruit of Rohini is made after having soaked it in goat’s milk for seven days. This paste is the best one for producing white colour.

Alternatively, the below said ingredients are mixed together to make a paste and it is applied for the same purpose –

–    nava kapala – new earthen saucer,

–    vaidula (bamboo root),

–    sarja,

–    kasisa,

–    madhuka and

–    honey

From the fruit of Kapitta fruit, its pulp is removed. The fruit is now filled with goat’s urine.

The powder of the below said is added to this –

–    kasisa

–    rochana

–    tuttha

–    haratala

–    manassila

–    bark of venu

–    prapunnata

–    rasanjana and

–    arjuna

Now, these shells are buried in the ground underneath the roots of Arjuna – Terminalia arjuna tree for a period of one month. They are later taken out after one month. The paste inside them is collected and applied on the area of the wound which has become black, so as to change the black colour of the skin into white colour.

Pratisarana / savarnakarana — Restoring normal colour

कुक्कुटाण्डकपालानिकतकंमधुकंसमम्॥९९॥
तथासमुद्रमण्डूकीमणिचूर्णंचदापयेत्॥
गुटिकामूत्रपिष्टास्ताव्रणानांप्रतिसारणम्॥१००॥

Equal parts of the below mentioned ingredients are powdered nicely and macerated in the urine of cow for some days –

–    Kukkutanda Kapala – shell of hen’s egg

–    Kataka

–    Madhuka

–    Samudramanduki – oyster shell and

–    Mani curna – powder or ash of precious stones

Next, tablets are made from this paste. These tablets are used to apply / mildly rub on the wound so as to restore normal colour of the skin.

Roma sanjanana — causing hair growth

हस्तिदन्तमसींकृत्वामुख्यंचैवरसाञ्जनम्॥
रोमाण्येतेनजायन्तेलेपात्पाणितलेष्वपि॥१०१॥
चतुष्पदानांत्वग्रोमखुरशृङ्गास्थिभस्मना||
तैलाक्ताचूर्णिताभूमिर्भवेद्रोमवतीपुनः॥१०२॥
कासीसंनक्तमालस्यपल्लवांश्चैवसंहरेत्॥
कपित्थरसपिष्टानिरोमसञ्जननंपरम्॥१०३॥

Hastidanta Masi i.e. ash of elephant’s tusk and Rasanjana are mixed together. Application of this paste even makes the hairs grow on the palms (so it definitely would make them grow in the site of wound wherein there is loss of hairs).

Ash of the below mentioned ingredients should be mixed with oil and applied –

–    skin / leather

–    hairs,

–    hoof,

–    horn,

–    bones of quadruped animals

This makes the hairs grow once again.

Also, paste of Kasisa and tender leaves of Naktamala macerated in the juice of Kapittha, when applied is considered to be the best to cause growth of hairs.

Romapaharna — removing hair growth

रोमाकीर्णोव्रणोयस्तुनसम्यगुपरोहति॥
क्षुरकर्तरिसन्दंशैस्तस्यरोमाणिनिर्हरेत्॥१०४॥
शङ्खचूर्णस्यभागौद्वौहरितालंचभागिकम्॥
शुक्तेनसहपिष्टानिलोमशातनमुत्तमम्॥१०५॥
तैलंभल्लातकस्याथस्नुहीक्षीरंतथैवच॥
प्रगृहँकत्रमतिमान्रोमशातनमुत्तमम्॥१०६॥
कदलीदीर्घवृन्ताभ्यांभस्मालंलवणंशमी- ॥
बीजंशीतोदपिष्टंवारोमशातनमाचरेत्॥१०७॥
आगारगोधिकापुच्छंरम्भाऽऽलंबीजमैङ्गुदम्॥
दग्धवातद्भस्मतैलाम्बुसूर्यपक्वंकचान्तकृत्॥१०८॥

The wounds will not heal properly when they are surrounded by hairs all around. Therefore, these hairs have to be removed using razor, scissors or forceps. To make the hairs to fall, the below mentioned ingredients macerated in vinegar should be applied on the area chosen to remove the hairs –

–    two parts of the ash of sankha – conch

–    one part of haritala

Similarly, oil of Bhallataka should be applied along with milky sap of Snuhi. It is also the best one to remove hairs.

Other recipe to remove the hairs –

–    ash of Kadali and Dirghavrnta

–    Haratala

–    Saindhava Lavana and

–    Seeds of Shami

The above mentioned are mixed with cold water, made into paste and applied on the area chosen to remove hairs.

Below mentioned ingredients are burnt together so as to prepare their ash –

–    Tail of Agaragodhika – house lizard

–    Rambha – kadali – plantain

–    Ala – Haritala

–    Seeds of Ingudi

The ash should be mixed with oil and water and cooked in sunlight. Application of this would remove the hairs.

Basti prayoga — enema therapy

वातादुष्टोव्रणोयस्तुरूक्षश्चात्यर्थवेदनः॥
अध : कायेविशेषेणतत्रबस्तिर्विधीयते॥१०९॥

Enema should be administered for wounds –

–    having more aggravation of vata,

–    which are dry,

–    associated with severe pain and

–    situated in the lower portion of the body especially

Uttarbasti prayoga — urethral enema therapy

मूत्राघातेमूत्रदोषेशुक्रदोषेऽश्मरीव्रणे॥
तथैवार्तवदोषेचबस्तिरप्युत्तरोहितः॥११०॥

Uttara Basti i.e. enema administered through urethral and vaginal route (douche) is beneficial and hence should be administered in wounds –

–    caused due to retention of urine,

–    disorders of urine

–    disorders of semen,

–    wounds or ulcers caused by urinary calculus and

–    disorders of menstrual blood

Bandha — bandaging

यस्माच्छुध्यतिबन्धेनव्रणोयातिचमार्दवम्॥
रोहत्यपिचनिःशङ्कस्तस्माद्वन्धोविधीयते॥१११॥

Below mentioned are the benefits of bandaging –

–    purified wounds,

–    softens the wounds and

–    heals the wounds without doubt

Hence, bandaging should be done.

Patradana — placing leaves on the wound

स्थिराणामल्पमांसानांरौक्ष्यादनुपरोहताम्॥
पत्रदानंभवेत्कार्यंयथादोषंयथर्तुच॥११२॥
एरण्डभूर्जपूतीकहरिद्राणांतुवातजे॥
पत्रमाश्वबलंयच्चकाश्मरीपत्रमेवच॥११३॥
पत्राणिक्षीरवृक्षाणामौदकानितथैवच॥
दूषितेरक्तपित्ताभ्यांव्रणेदद्याद्विचक्षणः॥११४॥
पाठामूर्वागुडूचीनांकाकमाचीहरिद्रयोः॥
पत्रंचशुकनासायायोजयेत्कफजेव्रणे॥११५॥
अकर्कशमविच्छिन्नमजीर्णंसुकुमारकम्॥
अजन्तुजग्धंमृदुचपत्रंगुणवदुच्यते॥११६॥
स्नेहमौषधसारंचपट्टःपत्रान्तरीकृतः॥
नादत्तेयत्ततःपत्रंलेपस्योपरिदापयेत्॥११७॥
शैत्योष्ण्यजननार्थायस्नेहसंग्रहणायच॥
दत्तौषधेषुदातव्यंपत्रंवैद्येनजानता॥११८॥

Patradana means covering the wound with fresh leaves. It should be done with leaves appropriate to the season and aggravated dosha. Patradana should be done in wounds –

–    which are static / immovable,

–    having less of muscles and

–    not healing due to dryness

–    Dosha causing the wound	Leaves to be used for Patradana
Vata	Eranda, Bhurja, Putika and Haridra
Rakta and Pitta	Asvabala Kasmari Ksiri Vrksha – trees with milky sap Audaka Vrksha – plants growing in water
Kapha	Patha Murva Guduci Kakamachi Haridra Sukanasa

 

Leaves with below mentioned features should be selected for Patradana –

–    not rough,

–    not cut,

–    not very old,

–    tender,

–    not eaten by moth

–    soft

Leaves with the above said features are said to be superior in quality and suitable to be used for Patradana. These leaves, fats i.e. medicated oil or ghee and essence of herbs shall be placed on the layer of paste of herbs. The physician should place the leaves on the paste of indicated herbs knowing their utility, in order to produce cold or heat and also to preserve unctuousness.

Krimighna — destruction of worms

मक्षिकाव्रणमागत्यनिःक्षिपन्तियदाकृमीन्॥
श्वयथुर्भक्षितेतैस्तुजायतेभृशदारुणः॥११९॥
तीव्रारुजोविचित्राश्चरक्तास्त्रावश्चजायते॥
सुरसादिर्हितस्तत्रधावनेपूरणेतथा॥१२०॥
सप्तपर्णकरञ्जार्कनिम्बराजादनत्वचः॥
हितागोमूत्रपिष्टाश्चसेकःक्षारोदकेनवा॥१२१॥
प्रच्छाद्यमांसपेश्यावाकृमीनपहरेद्व्रणात्॥
विंशतिंकृमिजातीस्तुवक्ष्याम्युपरिभागशः॥१२२॥

Use of herbs of Surasadi Gana group is beneficial for washing and filling the wounds –

–    when the flies sitting on these wounds deposit worms etc. in the wounds,

–    when there is great increase of bad smell in the wounds,

–    when they are accompanied with severe pain of different kinds and

–    when they bleed

Barks of the below mentioned herbs should be macerated in cow’s urine or alkali solution –

–    Saptaparna,

–    Karanja,

–    Arka,

–    Nimba and

–    Rajadana

This solution is beneficial for washing the wounds.

In order to remove the worms etc. layers of muscles should be spread on the wound. Later on, twenty species of krimi – worms shall be described.

Brmhana — stoutening therapy

दीर्घकालातुराणांतुकृशानांव्रणशोषिणाम्॥
बृंहणीयोविधिःसर्वःकायाग्निपरिरक्षता॥१२३॥

All types of Brmhana – stoutening (nourishing) therapies should be administered, safeguarding the agni – digestive fire, in wounds –

–    Which exist from long time,

–    Occurring in emaciated persons and

–    Which have caused emaciation (vrana sosha)

Brmhana therapy should be done while protecting the kayagni – digestive fire.

Visaghna — removing poison

विषुजुष्टस्यविज्ञानंविषनिश्चयमेवच॥
चिकित्सितंचवक्ष्यामिकल्पेषुप्रतिभागशः॥१२४॥

The knowledge of the features of vrana caused by visha – poisons, methods of identifying the poisons and their treatment shall be described in detail in Kalpa Sthana – section 5 of Sushruta Samhita.

Shiro Virechana – purgation to the head

कण्डूमन्तःसशोफाश्चयेचजत्रूपरिव्रणाः॥
शिरोविरेचनंतेषुविदध्यात्कुशलोभिषक्॥१२५॥

Shiro Virechana should be administered by the intelligent physician in case of wounds –

–    Which are situated in places of the body above the shoulders (head and neck),

–    Which have itching and

–    Swelling

Nasya — nasal medication

रुजावन्तोऽनिलाविष्टारूक्षायेचोर्ध्वजत्रुजाः॥
व्रणेषुतेषुकर्तव्यंनस्यंवैद्येनजानता॥१२६॥

Nasya should be administered suitably in case of wounds –

–    Situated above the level of shoulders (head and neck),

–    Having pain and

–    Vitiation of Vata

Kavala Graha — mouth gargles

दोषप्रच्यावनार्थायरुजादाहक्षयायच॥
जिह्वादन्तसमुत्थस्यहरणार्थंमलस्यच॥१२७॥
शोधनोरोपणश्चैवव्रणस्यमुखजस्यवै||
उष्णोवायदिवाशीतःकवलग्रह‌इष्यते॥१२८॥

Kavala – mouth gargles should be administered either warm or cold in wounds occurring in the mouth.

Benefits –

–    Eliminate the doshas in the wounds occurring in the mouth,

–    Mitigates pain and burning sensation

–    Removes dirt accumulating on tongue and teeth

–    Promotes cleansing and healing

Dhumapana — smoke inhalation

ऊर्ध्वजत्रुगतान्रोगान्व्रणांश्चकफवातजान्॥
शोफस्रावरुजायुक्तान्धूमपानैरुपाचरेत्॥१२९॥

Dhumapana – inhalation of medicated smoke is administered in diseases and wounds –

–    Affecting the parts of the body above the level of shoulders – head and neck,

–    Produced by kapha and vata,

–    Accompanied with swelling, exudation and pain

Ksaudra Sarpi – applying mixture of honey and ghee

क्षतोष्मणोनिग्रहार्थंसन्धानार्थंतथैवच॥
सद्योव्रणेष्वायतेषुक्षौद्रसर्पिविधीयते॥१३०॥

Ksaudra Sarpi i.e. applying and filling the wound with mixture of honey and ghee should be done in wounds –

–    To control the heat of the wound,

–    To join the separated parts,

–    Accidental wounds which are wide

Yantropayoga — instrumentation

अवगाढास्त्वणुमुखायेव्रणाःशल्यपीडिताः॥
निवृत्तहस्तोद्धरणायन्त्रंतेषुविधीयते॥१३१॥

Yantra Upayoga i.e. use of surgical instruments should be done (to pull out the foreign bodies) in wounds –

–    Having foreign bodies in them,

–    Which are deep,

–    Which have minute openings,

–    When the foreign body impacted in them cannot be pulled out by hand

Ahara — suitable foods

लघुमात्रोलघुश्चैवस्निग्ध‌उष्णोऽग्निदीपनः॥
सर्वव्रणिभ्योदेयस्तुसदाऽऽहारोविजानता॥१३२॥

Foods for all wounded persons should be –

–    Less in quantity,

–    Easily digestible,

–    Unctuous,

–    Warm and

–    Increasing digestive fire

निशाचरेभ्योरक्ष्यस्तुनित्यमेवक्षतातुरः॥
रक्षाविधानैरुद्दिष्टैर्यमैःसनियमैस्तथा॥१३३॥

The wounded person should follow protective measures described earlier and also adopt restraints regarding foods and activities and also discipline measures in all the activities he is involved in, so as to protect himself from demons, evil spirits, insects and other nishacharas – night prowlers.

षण्मूलोऽष्टपरिग्राहीपञ्चलक्षणलक्षितः॥
षष्ट्याविधानैर्निर्दिष्टैश्चतुर्भिःसाध्यतेव्रणः॥१३४॥

Wounds / ulcers have

–    six causes,

–    eight seats,

–    five types of symptoms, and

–    sixty kinds of treatments enumerated so far, with

–    the four limbs of treatment

According to Acharya Dalhana –

Particular about Vrana	Details
Shat mula – six causes	Vata, Pitta, Kapha, Rakta, Sannipata and Agantu
Ashta Parigrahi – eight seats	Twak (skin), Mamsa (muscles), Sira (veins), Snayu (ligaments), Sandhi (joints), Asthi (bones), Kostha (viscera) and Marma (vital / fatal spots)
Pancha Lakshana – five symptoms	Gandha (smell), Varna (colour), Srava (discharges), Vedana (pain) and Akrti (shape)
Shashti Vidhana – sixty kinds of treatments with which vranas will be treated	As explained above
Chatushpada – four limbs who will make the treatment successful	Bhishak – physician, Rogi – patient, Dravya – medicine, Upasthata – attendant

योऽल्पौषधकृतोयोगोबहुग्रन्थभयान्मया॥
द्रव्याणांतत्समानानांतत्रावापोनदुष्यति॥१३५॥

Acharya says ‘I have not described formulas having a smaller number of herbs and also many herbs having similar properties. I have not done this due to the fear of increasing the content of the text. Including new herbs into the formulae described so far will not vitiate the formulae’.

प्रसङ्गाभिहितोयोवाबहुदुर्लभमेषजः॥
यथोपपत्तितत्रापिकार्यमेवचिकित्सितम्॥१३६॥

A physician should treat the diseases using the herbs appropriate to the condition. He should do that by selecting the best herbs from amongst the many herbs difficult to obtain and also using the herbs which are available at that point of time, which are available when needed.

गणोक्तमपियद्वव्यंभवेह्याधावयौगिकम्॥
तदुद्धरेद्यौगिकंतुप्रक्षिपेदप्यकीर्तितम्॥१३७॥

Such herbs, in spite of them being mentioned in the groups of herbs and recipes but are found unsuitable to the diseases, should be deleted from the recipe. Similarly, those herbs which are appropriate to the disease (useful in treating the diseases) should be included in the recipe, in spite of them not being mentioned in the texts.

उपद्रवास्तुविविधाव्रणस्यव्रणितस्यच॥|
तत्रगन्धादयःपञ्चव्रणस्योपद्रवाःस्मृताः॥१३८॥
ज्वरातिसारौमूर्छाचहिक्काच्छर्दिररोचकः॥
श्वासकासाविपाकाश्चतृष्णाचव्रणितस्यतु॥१३९॥

There are many complications of the wounds and also those of the wounded persons. Complications of the wounds are five i.e. abnormal smell etc.

Below mentioned are the complications of the wounded persons –

fever

diarrhoea,

fainting,

hiccup,

vomiting,

loss of taste / appetite,

dyspnoea,

cough,

indigestion and

thirst 

व्रणक्रियास्वेवमासुव्यासेनोक्तास्वपिक्रियाम्॥
भूयोऽप्यूपरिवक्ष्यामिसद्योव्रणचिकित्सते॥१४०॥ 

So far, I have described in detail the treatment of wounds. In spite of that, I shall describe some more details in the next chapter, about the treatment of accidental wounds.

इतिसुश्रुतसंहितायांचिकित्सास्थानेद्विवणीयचिकित्सितंप्रथमोऽध्यायः॥१॥

Thus ends the first chapter by name Dvivraniya Cikitsita in Chikitsa Sthana of Susruta Samhita.