The 2nd chapter of Chikitsasthana of Sushruta Samhita is named as Sadyovraņa Cikitsitam Adhyaya. This chapter deals with Treatment of Accidental Wounds.

अथातोसद्यौव्रणचिकित्सितंव्याख्यास्यामः।।१।।
यथोवाचभगवान्धन्वन्तरिः।।२।।

We will now expound the chapter – Sadyovrana Cikitsita- treatment of accidental wounds; as revealed by the venerable Dhañvañtari.

धन्वन्तरिर्धर्मभृतांवरिष्ठोवाग्विशारदः।।
विश्वामित्रसुतंशिष्यमृर्षिसुश्रुतमन्वशात्।।३।।

Sage Dhañvañtari considered as the chief among those upholding dharma – righteousness and upholders of righteousness and a fluent vagvisharada – exponent thus instructed his disciple Sushruta, the son of Sage Visvamitra.

नानाधारामुखैःशस्त्रैर्नानास्थाननिपातितैः।।
नानारूपाव्रणायेस्युस्तेषांवक्ष्यामिलक्षणम्।।४।।

In this chapter, I will describe –

• the features of different kinds of wounds,
• which have occurred on different parts of the body which are
• caused by weapons with various types of edges

Agantu & Doshaja Vraņaākrti – shapes of wounds caused by trauma and by doshas

आयताश्चतुरस्त्राश्चत्र्यस्त्रामण्डलिनस्तथा।।
अर्धचन्द्रप्रतीकाशाविशालाःकुटिलास्तथा।।५।।
शरावनिम्नमध्याश्चयवमध्यास्तथाऽपरे।।
एवंप्रकाराकृतयोभवन्त्यागन्तवोव्रणाः।।६।।
दोषजावास्वयंभिन्ना,नतुवैद्यनिमित्तजाः।।

Below mentioned are the different shapes of Agantu Vrana i.e. wounds caused by accident or trauma and also of Doshaja Vrana i.e. endogenous wounds caused by the doshas which have burst off all by themselves. These are not the shapes of the wounds done by a physician i.e. they are not the shapes of surgical wounds –

• long
• square – having four edges,
• triangular – having three edges,
• round
• semi lunar – resembles half-moon,
• broad,
• irregular / curved,
• saucer shaped with depression at the centre,
• saucer shaped with elevation at the centre

Accidental wounds are of innumerable shapes

भिषग्व्रणाकृतिज्ञोहिनमोहमधिगच्छति।।७।।
भृशंदुर्दर्शरूपेषुव्रणेषुविकृतेष्वपि।।
अनन्ताकृतिरागन्तुःसभिषग्भिःपुरातनैः।।८।।
मासतोलक्षणतःषड्विधःपरिकीर्तितः।।

If a physician has very good knowledge about the different shapes of wounds, he will never become confused when he encounters wounds which appear dreadful and abnormal.

According to the ancient physicians, the accidental wounds are of innumerable shapes. Based on their features, all these wounds are classified briefly into six types.

Sad-vidha   vrana – six kinds of wounds

छिन्नंभिन्नंतथाविद्धंक्षतंपिच्चितमेवच।।९।।
घृष्टमाहुस्तथाषष्ठंतेषांवक्ष्यामिलक्षणम्।।

The six kinds of wounds are as below mentioned –

• Chinna (cut wounds),
• Bhinna (puncture wounds),
• Viddha (puncture wounds),
• Ksata (crushed wounds),
• Piccita (contused wounds) and
• Ghrsta (lacerated wounds)

The features of these different kinds of wounds shall be described by me now.

Chinna – cut / incised wound 

तिरश्चीनऋजुर्वाऽपियोव्रणश्चायतोभवेत्।।१०।।
गात्रस्यपातनंचापिछिन्नमित्युपदिश्यते।।

Chinna Vranas are cut or incised wounds. They are –

• Oblique or
• Straight or
• Broad / wide and includes
• Falling off of part of the body

Bhinna – punctured wounds of viscera 

कुन्तशक्त्यृष्टिखङ्गाग्रविषाणादिभिराशयः।।११।।
हतःकिञ्चित्स्त्रवेत्तद्धिभिन्नलक्षणमुच्यते।।

Bhinna Vranas are those wounds caused by puncture of internal organs. It comprises of visceral organs of the chest and abdomen (asaya) which are punctured by the tip of the below mentioned –

• Kunta – dagger,
• Sakti – spear,
• Rsti – lance,
• Khadga – sword,
• Visana – horns of animals etc.

These wounds also exude little quantity of fluids.

स्थानान्यामाग्निपक्वानांमूत्रस्यरूधिरस्यच॥१२॥
हृदुण्डुकःफुप्फुसश्चकोष्ठइत्यभिधीयते॥

Kostha – viscera inside the chest and abdominal cavity – comprises of seats of –

• Ama – undigested food
• Agni – digestive fire,
• Pakva – digested foods,
• Mutra – urine,
• Rudhira – blood,
• Hrdaya – heart,
• Unduka – caecum and
• Pupphusa – lungs

 Koşthabheda lakṣaṇa – features of puncture of the abdomen

तस्मिन्भिन्नेरक्तपूर्णेज्वरोदाहश्चजायते।।१३।।
मूत्रमार्गगुदास्येभ्योरक्तंघ्राणाच्चगच्छति।।
मूश्विासतृडाघ्मानमभक्तच्छन्दएवच।।१४।।
विण्मूत्रवातसङ्गश्चस्वेदास्रावोऽक्षिरक्तता।।
लोहगन्धित्वमास्यस्यगात्रदौर्गन्ध्यमेवच।।१५।।
हृच्छूलंपार्श्वयोश्चापि

Below mentioned are the symptoms of Kostha Bheda – puncture of kostha –

• Filling of kostha with blood
• Fever
• Burning sensation,
• Bleeding from urinary tract, anus, mouth and nose,
• Fainting,
• Dyspnoea,
• Thirst,
• Flatulence,
• Not having desire for food,
• Non elimination of faeces, urine and fart / flatus,
• Sweating,
• Reddish colouration of the eyes,
• Smell of iron coming from the mouth,
• Body emits bad smell,
• Pain in the region of the heart and flanks

विशेषंचात्रमेॠणु||
आमाशयस्थेरुधिरेरुधिरंछर्दयेत्पुनः।।१६।।
आध्मानमतिमात्रंचशूलंचभृशदारुणम्।।
पक्वाशयगतेचापिरुजोगौरवमेवच।।१७।।
शीतताचाप्यधोनाभेःखेभ्योरक्तस्यचागमः।।
अभिन्नेऽप्याशयेऽन्त्राणांखैःसूक्ष्मैरन्त्रपूरणम्।।१८।।
पिहितास्येघटेयद्वल्लक्ष्यतेतस्यगौरवम्।।

Now the special symptoms are being said by me, listen to the same –

Organ in which blood has accumulated	Symptoms
Amashaya – stomach	Vomiting of blood, Profound flatulence, Excruciating pain
Pakvashaya – large intestine	Pain, Feeling of heaviness, Coldness of the abdomen below the navel region Bleeding from orifices, mainly anus

Just like a pot whose mouth has been closed with a lid gets filled with water and becomes heavy with the water entering into it through the small pores on its sides, there will be filling of intestines with blood in spite of these organs not being punctured and this happens through the minute pores of the intestines.

 Viddha vrana – punctured wound 

सूक्ष्मास्यशल्याभिहतंयदङ्गंत्वाशयाद्विना।।१९।।
उण्डितंनिर्गतंवातद्विद्धमितिनिर्दिशेत्।।

A wound is called as Viddha Vrana when any weapon or foreign body injures any part of the body except the hollow viscera, by entering through small openings and bulges up the body, even after the foreign body has come out.

Kșata vrana – crushed wound

नातिच्छिन्नंनातिभिन्नमुभयोर्लक्षणन्वितम्।।२०।।
विषमंव्रणमङ्गेयत्तत्क्षतंत्वभिनिर्दिशेत्।।

A wound qualifies to be called as Ksata Vrana if it satisfies the below mentioned conditions –

• The wound has not greatly / severely cut the body part (does not cut the body part into two), and
• does not actually puncture the body part, but
• has the symptoms of both and
• the wound is irregular in shape and level

Piccita vrana – contused wound

प्रहारपीडनाभ्यांतुयदङ्गपृथुतांगतम्।।२१।।
सास्थितत्पिच्चितंविद्यान्मज्जरक्तपरिप्लुतम्।।

Piccita Vrana – contused wound is when –

• due to attack / assault by cane etc or due to compression (pressed, squeezed),
• if any part of the body gets spread out being crushed along with bone present inside it and
• is filled with bone marrow and blood

Ghrsta vrana – abrasion

विगतत्वग्यदङ्गंहिसंघर्षादन्यथाऽपिवा।।२२।।
उषात्रावान्वितंतत्तुघृष्टमित्युपदिश्यते।।

A wound is described as Ghrsta Vrana – abrasive wound when –

• any part of the body loses its skin either due to rubbing / friction on hard or rough surfaces (or assault by weapon) or otherwise, and is
• accompanied with burning sensation and watery exudation

Sāmāñya cikitsā – general treatment

छिन्नेभिन्नेतथाविद्धेक्षतेवाऽसृगतिस्त्रवेत्।।२३।।
रक्तक्षयानुजस्तत्रकरोतिपवनोभृशम्।।
स्नेहपानंहितंतत्रतत्सेकोविहितस्तथा।।२४।।
वेशवारैःसकशरैःसुस्निग्धैश्चोपनाहनम्।।
धान्यस्वेदांश्चकुर्वीतस्निग्धान्यालेपनानिच।।२५।।
वातघ्नौषधसिद्धश्चस्नेहर्बस्तिर्विधीयते।।

When there is excessive bleeding in any kind of wounds i.e. chinna, bhinna, viddha or ksata, vata will get aggravated due to loss of blood. This aggravated vata produces severe pain.

The below mentioned treatment principle should be adopted to treat this condition –

• snehana and swedana is beneficial
• upanaha – warm poultices should be done with vesavara or krsara added with fats,
• swedana – with baked or fried corns,
• application of unctuous pastes on the part,
• unctuous enemas with oil prepared from the herbs which mitigate vata,

पिच्चितेचविघृष्टेचनातिस्रवतिशोणितम्।।२६।।
अगच्छतिभृशंतस्मिन्दाहःपाकश्चजायते।।
तत्रोष्मणोनिग्रहार्थंतथादाहप्रपाकयोः।।२७।।
शीतमालेपनंकार्यपरिषेकश्चशीतलः।।
षट्स्वेतेषुयथोक्तेषुछिन्नादिषुसमासतः।।२८।।
ज्ञेयंसमर्पितंसर्वसद्योव्रणचिकित्सितम्।।

Blood does not flow out greatly in case of piccita and ghrsta types of wounds. Due to the stasis of blood inside, there will be severe burning sensation and suppuration (pus formation).

Treatment – Paste of herbs should be applied cold or cold medicinal liquids should be poured on the affected part / parts so as to mitigate the heat of the wound. These therapies will also help in overcoming the burning sensation and suppuration.

Thus, treatment in brief for the six kinds of accidental wounds such as chinna etc. have been described.

Višeșa cikitsā – special treatments

Chinna vrana cikitsa: Treatment of cut wounds

अतऊर्ध्वप्रवक्ष्यामिछिन्नानांतुचिकित्सितम्।।२९।।
येव्रणाविवृताःकेचिच्छिरःपाविलम्बिनः।।
तान्सीव्येद्विधिनोक्तोनबध्नीयाद्गाढमेवच।।३०।।

After this, I will describe in detail the treatment of Chinna Vrana i.e. cut or incised wounds.

The below mentioned kinds of cut wounds should be sutured in the method described earlier in chapter 25 of Sutra Sthana Section –

• wounds present in head and flanks,
• wounds which have open mouths

After suturing, these wounds should be bandaged tightly.

कर्णस्थानादपहृतंस्थापयित्वायथास्थितम्।।
सीव्येद्यथोक्तंतैलेनस्रोतश्चाभिप्रतर्पयेत्।।३१।।

Below mentioned is in brief the management of the ear which has become displaced –

• it should be replaced to its usual site, and
• sutured properly and
• anointed i.e. dressed with medicated oil and later,
• the orifice of the ear too should be filled with oil

कृकाटिकान्तेछिन्नेतुगच्छत्यपिसमीरणे।।
सम्यङ्गिनिवेश्यबन्धीयात्सीव्येच्चापिनिरन्तरम्।।३२।।
आजेनसर्पिषाचैवंपरिषेकंतुकारयेत्।।
उत्तानोऽन्नंसमशीयाच्छयीतचसुयन्त्रितः।।३३।।

Below mentioned is the management when there is a cut wound at the end (border) of Krkatika with air coming out of it –

• the krkatika should be restored in its usual site (place) properly and
• continuous suture should be done followed by –
• bandaging and then
• the area should be bathed with goat’s ghee

The patient should be advised to take food while lying with his face up (supine) and sleep well restrained.

शाखासुपतितांस्तिर्यक्प्रहारान्विवृतान्भृशम्।।
सीव्येत्सम्यङ्गिवेश्याशुसन्ध्यस्थीन्यनुपूर्वशः।।३४।।
बद्ध्वावेल्लितकेनाशुततस्तैलेनसेचयेत्।।
चर्मणागोफणाबन्धःकार्योयोवाहितोभवेत्।।३५।।

In the wounds occurring on the extremities, if the cuts are oblique and if there is formation of a wide gap in the cut, the surgeon / physician should push the bone and joints inside, place them in their places and then suture the sound. After suturing, he should do the bandaging adopting the Vellitaka type of bandage and bathe the place with oil. Gophana Bandha type of bandage shall be done using leather or whichever is comfortable.

पृष्ठेव्रणोयस्यभवेदुत्तानंशाययेत्तुतम्।।
अतोऽन्यथाचोरसिजेशाययेत्पुरुषंव्रणे।।३६।।

Positioning of the patient in the wounds of back and chest –

• if the wound is in the back, the person should be placed in supine position with the patient facing upwards / ceiling
• if the wound is in the chest, he should be placed in prone position i.e. the patient facing downward

छिन्नांनिःशेषतःशाखांदग्ध्वातैलेनबुद्धिमान्।।
बध्नीयात्कोशबन्धनप्राप्तंकार्यंचरोपणम्।।३७।।

When the extremity i.e. upper or lower limb has been completely separated from the body, the wise physician / surgeon should do the below said kinds of treatment –

• first, he should burn the wound using fire i.e. rods heated on fire, and then
• apply oil or gauze soaked in oil on it and then
• apply kosa type of bandage following which
• he should do ropana – measures which would heal the wound

Cañdanādi taila 

चन्दनंपद्यकंरोधमुत्पलानिप्रियङ्गवः।।
हरिद्रामधुकंचैवपयःस्यादत्रचाष्टमम्।।३८।।
तैलमेभिर्विपक्वंतुप्रधानंव्रणरोपणम्।।

The below mentioned eight ingredients should be cooked with oil so as to prepare the medicated oil i.e. Candanadi Taila in the usual way –

• Candana
• Padmaka
• Rodhra
• Utpala
• Priyangu
• Haridra
• Madhuka and
• Milk

This oil is said to be the best for healing the wounds.

चन्दनंकर्कटाख्याचसहेमांस्याह्वयाऽमृता।।३९।।
हरेणवोमृणालंचत्रिफलापद्मकोत्पले।।त्र
योदशाङ्गंत्रिवृतमेतद्वापयसाऽन्वितम्।।४०।।
तैलंविपकंसेकार्थेहितंतुव्रणरोपणे।।

The below mentioned thirteen ingredients / herbs are taken –

• Candana,
• Karkatasringi
• Two Saha – Masaparni and Mudgaparni
• Jatamansi
• Amrta
• Harenu
• Mrnala
• Triphala – Haritaki, Bibhitaki and Amalaki
• Padmaka
• Utpala

These herbs are cooked with Trivrt Sneha i.e. oil, ghee and muscle fat, added with milk and medicated oil prepared.

This oil is useful for bathing the wound and also to heal it.

Bhinna vraņa cikitsā – treatment of puncture wounds

अतऊर्ध्वंप्रवक्ष्यामिभिन्नानांतुचिकित्सितम्।।४१।।
भिन्नंनेत्रमकर्मण्यमभिन्नंलम्बतेतुयत्।।
तन्निवेश्ययथास्थानमव्याविद्धसिरंशनैः।।४२।।
पीडयेत्पाणिनासम्यक्पद्मपत्रान्तरेणतु।।
ततोऽस्यतर्पणंकार्यनस्यंचानेनसर्पिषा।।४३।।

After this, the treatment of puncture wounds shall be described by me.

When the eye has been punctured and not doing its normal functions of seeing things, when it is hanging loose, it should be gently pushed back and placed in its normal place while taking care that it’s siras i.e. veins / blood vessels are not damaged.

After this, the eye needs to be massaged with the palm of the physician. While doing so, petals of padma (lotus flower) should be placed between the hand of the physician and eye of the patient.

After massaging, Tarpana should be done to the eye by filling the eye with ghee etc. The same ghee should be used for nasya – instilled into the nose also.

आजघृतंक्षीरपात्रंमधुकंचोत्पलानिच।।
जीवकर्षभकोचैवपिष्टवासर्पिर्विपाचयेत्।।४४।।
सर्वनेत्राभिघातेतुसर्पिरेतत्प्रशस्यते।।

Medicated ghee should be prepared by cooking the below mentioned with cow’s ghee –

• One patra (adhaka) quantity of each of goat’s ghee (prepared from goat’s milk) and cow’s milk
• Madhuka
• Utpala
• Jivaka and
• Rshabhaka

Note – Madhuka, Utpala, Jivaka and Rshabhaka should be taken in equal quantities.

This ghee is highly beneficial in treating all kinds of injuries of the eyes.

Koşthabheda cikitsā – treatment of visceral wounds

उदरान्मेदसोवर्तिर्निर्गतायस्यदेहिनः।।४५।।
कषायभस्ममृत्कीर्णाबद्ध्वासूत्रेणसूत्रवित्।।
अग्नितप्तेनशस्त्रेणछिन्द्यान्मधुसमायुतम्।।४६।।
बद्ध्वाव्रणंसुजीर्णेऽन्नेसर्पिषःपानमिष्यते।।
स्नेहपानाइतेचापिपयःपानंविधीयते।।४७।।
शर्करामधुयष्टिभ्यांलाक्षयावाश्वदंष्ट्रया।।
चित्रासमन्वितंचैवरुजादाहविनाशनम्।।४८।।
आटोपोमरणंवास्याच्छूलोवाऽच्छिद्यमानया।।
मेदोग्रन्यौतुयत्तैलंवक्ष्यतेतच्चयोजयेत्।।४९।।

When due to the puncture, the medovarti i.e. pancreas has come out of the abdomen, the physician / surgeon should smear powder of astringent herbs, ash or mud. After applying one of these, it should be tied with threads all round, cut using a heated sharp instrument like scalpel or lancet. Following this, honey is applied on it and bandaging is done over the wound.

After that, he shall be given food which has been cooked well for eating and ghee for drinking. Ghee should be given for drinking after the consumed food has been thoroughly digested. Administration of ghee shall be done even without following rules of abhyantara Sneha – internal oleation. After the patient has consumed ghee, he should be given milk for drinking. The milk needs to be mixed with Sarkara – sugar, Madhuyashti – Glyzyrrhiza glabra, Laksa – lac, Svadamshtra – Tribulus terristris and Citra – Plumbago zeylanica.

This will relieve pain and burning sensation. Flatulence, death or pain may occur if cutting is not done. In this condition, the medicated oil described for treating Medogranthi i.e. fatty tumours earlier (chapter 18) shall be used.

Koșthaśalyāharaņa– removing foreign bodies from the abdomen 

त्वचोऽतीत्यसिरादीनिभित्त्वावापरिहृत्यवा।।
कोष्ठेप्रतिष्ठितंशल्यंकुर्यादुक्तानुपद्रवान्।।५०।।
तत्रान्तर्लोहितंपाण्डुशीतपादकराननम्।।
शीतोच्छवासंरक्तनेत्रमानद्धंचविवर्जयेत्।।५१।।

Cutting the abdomen or other methods should be adopted to remove the foreign bodies which have entered the abdomen cutting through the skin, veins etc and lodged inside the abdomen. Later the complications enumerated earlier (chapter 26 of Sutra Sthana) should be treated.

The physician / surgeon should reject the patient (should not treat) if he has developed the below mentioned symptoms / complications –

• Internal bleeding,
• Pallor,
• Coldness of hands, feet and face,
• Cold breath,
• Redness of the eyes and
• Flatulence

Raktapūrņakoştha cikitsā – internal haemorrhage and its treatment

आमाशयस्थेरुधिरेवमनंपथ्यमुच्यते।।
पक्वाशयस्थेदेयंचविरेचनमसंशयम्।।२।।
आस्थापनंचनिःस्नेहंकार्यमुष्णैर्विशोधनैः।।
यवकोलकुलत्थानांनि : स्नेहेनरसेनच।।५३।।
भुञ्जीतान्नंयवागूवापिबेत्सैन्धवसंयुताम्।।
अतिनिःउतरक्तोवाभिन्नकोष्ठःपिबेदसृक्।।५४।।

Treatments for haemorrhage occurring in amashaya (stomach) –

• Vamana – emesis therapy is said to be the best treatment

Treatments for haemorrhage occurring in pakvashaya (large intestine) –

• Virechana – purgation therapy
• Asthapana Vasti – decoction enemas without adding Sneha – fats and prepared from purgative herbs should be administered warm

Foods – foods prepared with yava – barley and kola – jujube should be served along with kulattha yusa – horse gram soup or meat soup or yavagu – thick gruel added with saindhava lavana – rock salt.

The patient shall be given with blood of animals for drinking if he has severe bleeding or if his organs are punctured.

स्वमार्गप्रतिपन्नास्तुयस्यविण्मूत्रमारुताः।।
व्युपद्रवःसभिन्नेऽपिकोष्ठेजीवतिमानवः।।५५।।

The person would survive in spite of his abdominal organs being punctured if –

• his faeces, urine and fart / flatus are seen to be moving in their own channels,
• when there are no complications

Nişkrāñtāñtra cikitsā – treatment of protrusion / prolapse of intestines

अभिन्नमंत्रंनिष्क्रान्तंप्रवेश्यंनान्यथाभवेत्।।
पिपीलिकाशिरोग्रस्तंतदप्येकेवदन्तितु।।५६।।
प्रक्षाल्यपयसादिग्धंतृणशोणितपांशुभिः।।
प्रवेशयेत्कृत्तनखोघृतेनाक्तंशनैःशनैः।।५७।।
प्रवेशयेत्क्षीरसिक्तंशुष्कमन्त्रंघृताप्लुतम्।।
अङ्गल्याऽभिमृशेत्कण्ठंजलेनोद्वेजयेदपि।।५८।।
हस्तपादेषुसंगृह्यसमुत्थाप्यमहाबलाः।।
भवत्यन्तःप्रवेशस्तुयथानिथुनुयुस्तथा।।५९।।
तथाऽन्त्राणिविशन्त्यन्तःस्वांकलांपीडयन्तिच।।
व्रणाल्पत्वाद्बहुत्वाद्वादुष्प्रवेशंभवेत्तुयत्।।६०।।
तदापाट्यप्रमाणेनभिषगन्त्रंप्रवेशयेत्।।
यथास्थानंनिविष्टेचव्रणंसीव्येदतन्द्रितः।।६१।।
स्थानादपेतमादत्तेप्राणान्गुपितमेववा।।
वेष्टयित्वातुपट्टेनघृतसेकंप्रदापयेत्।।६२।।
घृतंपिबेत्सुखोष्णंचचित्रातैलसमन्वितम्।।
मृदुक्रियार्थंशकृतोवायोश्चाधःप्रवृत्तये।।६३।।
ततस्तैलमिदंकुर्याद्रोपणार्थंचिकित्सकः।।
त्वचोऽश्वकर्णधवयोर्मोचकीमेषशृङ्गयोः।।६४।।
शल्लक्यर्जुनयोश्चापिविदार्याःक्षीरिणांतथा।।
बलामूलानिचाहृत्यतैलमेतैर्विपाचयेत्।।६५।।
व्रणंसंरोपयेत्तेनवर्षमात्रंयतेतच।।

The intestine which has protruded out of the abdomen and not been punctured, the physician / surgeon shall push the intestine back through the same orifice through which it is protruding and should not be allowed to remain outside for a long time.

According to the opinion of others, the part protruding should be washed with water. Grass, blood and sand adhering to it should be removed (through washing) and held tight by the heads of big sized ants. Later they need to be pushed inside gently, by the physician / surgeon. The physician should have pared his nails closely before touching the intestine. He should also smear his hands with ghee. Doing so, he should push the intestine inside. The physician should squeeze the neck of the patient with his fingers and also should be frightened by sprinkling water on his face. In order to make the intestine get back into the abdomen, strong persons should lift the patient up by holding his hands and feet and shake him. When done so, the intestine displaces its own membranes while entering in.

When the intestinal mass protruding out is big and when the wound is small it might get difficult to push the intestine into the abdomen. Then the surgeon should cut a portion of the protruding abdomen, to a required length and then push it inside. The wound should be properly sutured without any laxity once the intestine has been placed in its proper position by pushing it in. when improperly placed or twisted while placing, the intestine takes away life. After suturing, the abdomen shall be wrapped with a band of leather or thick cloth. Ghee should be poured on this. Also, the patient is given ghee to drink. This ghee should be added with oil of Citra – Eranda, Ricinus communis (castor oil) and served hot.

In order to soften the faeces and help movement of flatus downward the patient should be given warm ghee mixed with eranda taila (castor oil) to drink.

The below mentioned oil shall be prepared and used for wound healing. The oil should be processed with barks of the below mentioned trees / herbs –

• Asvakarna,
• Dhava,
• Mocaki,
• Mesasringi,
• Sallaki,
• Arjuna,
• Vidari,
• Trees yielding milky sap and
• Roots of Bala

This oil would heal the wounds. The person should avoid physical activities, copulation etc. and lead a life with restraint, for a period of one year.

Nirastamuşka – prolapse of testes

पादौनिरस्तमुष्कस्यजलेनप्रोक्ष्यचाक्षिणी।।६६।।
प्रवेश्यतुन्नसेवन्यामुष्कीसीव्येत्ततःपरम्।।
कार्योगोफणिकाबन्धःकट्यामावेश्यचन्त्रकम्।।६७।।
नकुर्यात्स्नेहसेकंचतेनक्लिद्यतिहिव्रणः।।
कालानुसार्यागुर्वेलाजातीचन्दनपाकैः।।६८।।
शिलादाळमृतातुत्यैस्तैलंकुर्वीतरोपणम्।।

When the scrotum gets torn due to assault or injury by weapons and when as a result of that the testes are protruding out of the scrotum partly, the physician / surgeon should do the treatment as said below –

• The protruding testes and the orifice through which the testes is protruding should be sprinkled with water and
• The testes should be pushed inside, near the sevani i.e. scrotal raphae and later
• The scrotum should be sutured and
• Gophanika type of bandage should be applied and
• Tie it to a control / thread fastened round the waist

Anointing and pouring liquids over the place should be avoided. Doing so may create moistness in the wound.

Medicated oil prepared with below mentioned herbs heals the wound –

• Kalanusarya
• Aguru
• Ela
• Jati
• Candana
• Padmaka
• Manassila
• Darvi
• Amrta
• Tuttha and
• Taila

Śirassalya – foreign bodies in the skull

शिरसोऽपहृतेशल्येबालवर्तिर्निवेशयेत्।।६९।।
बालवामदत्तायांमस्तुलुङ्गंव्रणात्स्रवेत्।।
हन्यादेनंततोवायुस्तस्मादेवमुपाचरेत्।।७।।
व्रणेरोहतिचैकैकंशनैर्बालमपक्षिपेत्।।

After removing the foreign bodies from the head (skull) wicks made of hairs should be inserted. If the hair wick is not inserted into the wound, mastulunga i.e. brain matter would flow out through the wound (opening). As a result, vata would get aggravated and eventually kill the person. Therefore, it should be treated in the described manner. The wicks of hairs which were inserted have to be removed one by one after the wound has healed.

Sarira salya – foreign bodies in other parts

गात्रादपहतेऽन्यस्मात्स्नेहवर्तिप्रवेशयेत्।।७१।।
कृतेनिःशोणितेचापिविधिःसद्यःक्षतेहितः।।

In the other parts of the body, when the foreign bodies are found, they should be removed and the wound should be cleared of blood. Later, wicks lubricated with oil or ghee should be inserted in the wound. Here also the treatments advocated for traumatic wounds should be adopted beneficially.

दूरावगाढाःसूक्ष्माःस्युर्येव्रणास्तान्विशोणितान्।।७२।।
कृत्वासूक्ष्मेणनेत्रेणचक्रतैलेनतर्पयेत्।।

When the wounds are deep and have small openings, the blood in them should be cleared and filled with Cakra taila i.e. fresh oil extracted from the mill. The oil filling should be done with the help of a nozzle of a tubular instrument used for wound washing.

समङ्गांरजनीपद्मांत्रिवर्गतुत्थमेवच।।७३।।
विडङ्गकटुकोपथ्यागुडूचींसकरञ्जिकाम्।।
संहृत्यविपचेत्कालेतैलंरोपणमुत्तमम्।।७४।।

Medicated oil prepared with the below mentioned herbs –

• Samanga,
• Rajani,
• Padma,
• Trivarga (Triphala),
• Tuttha
• Vidanga
• Katuka
• Pathya
• Guduchi and
• Karanjaka

When used at proper time, this medicated oil helps best in healing.

तालीशंपद्मकंमांसीहरेण्वगुरुचन्दनम् ||
हरिद्रेपद्मबीजानिसोशीरंमधुकंचतैः।।७५।।
पक्वंसद्योव्रणेषूक्तंतैलंरोपणमुत्तमम्।।

Medicated oil is prepared using the below mentioned herbs,

• Talisa
• Padmaka
• Mamsi
• Harenu
• Aguru
• Candana
• Haridra and Daruharidra
• Seeds of Padma,
• Usira and
• Madhuka

This is the best oil for healing the wounds.

Kşata, piccita and ghrsta vrana cikitsā – treatment of crushed, contused and lacerated wounds

क्षतेक्षतविधिकार्यःपिच्चितेभग्नवद्विधिः।।७६।।
घष्टेरुजोनिगृह्माशुचूर्णरुपचरेवणम्।।

Treatment described in chapter 23 for Ksata should be done for Ksataja Vrana i.e. crushed wounds also.

Similarly, the same treatments advocated for Bhagna – fracture of bones shall be adopted for Piccita Vrana i.e. contused wounds.

Pain should be mitigated quickly and the wound should be treated by dusting the powder of medicinal herbs in case of Ghrsta Vrana – lacerated wounds.

Dronīvāsa – placing in tub

विश्लिष्टदेहंपतितंमथितंहतमेवच।।७७।।
वासयेत्तैलपूर्णायांद्रोण्यांमांसरसाशनम्।।
अयमेवविधि : कार्यःक्षीणेमर्महतेतथा।।७८।।

Below mentioned persons should be made to lie for some days in a tub of oil and be served with food along with meat soup –

• Those having displacement of body parts,
• Those who have fallen from height,
• Those who have been twisted in their body parts and
• Those who have been hit on their marmas i.e. vital or fatal spots,

Similar treatment should be done for those who are emaciated and those who have been hit on vital / fatal spots.

रोपणेसपरीषेकेपानेचव्रणिनांसदा।।
तैलंघृतंवासंयोज्यंशरीरतूंनवेक्ष्यहि।।७९।।

For the purpose of healing the wounds and for pouring on them, medicated oil or ghee should be made use of. This should be done after having considered the condition of the body and the season. This should always be followed while treating the wounded persons.

घृतानियानिवक्ष्यामियत्नतःपित्तविद्रधौ।।
सद्योव्रणेषुदेयानितानिवैद्येनजानता।।८।।

A wise physician should make use of the medicated ghee that I am going to describe in the treatment of Pittaja Vidradhi (in chapter 16) in treating the accidental wounds also.

सद्यःक्षतव्रणंवैद्यःसशूलंपरिषेचयेत्।।
सर्पिषानातिशीतेनबलातैलेनवापुनः।।८१।।

For accidental wounds which are painful, the physician should do pariseka – i.e. pour warm medicated liquids in streams over the wounds. It should be done either with ghee or using Bala Taila after making them slightly warm.

Samañgādi Taila

समङ्गांरजनीपद्मांपथ्यांतुत्थंसुवर्चलाम्।।
पद्मकंरोघ्रमधुकंविडङ्गानिहरेणुकाम्।।८२।।
तालीशपत्रंनलदंचन्दनंपद्मकेशरम्।।
मञ्जिष्ठोशीरलाक्षाश्चक्षीरिणांचापिपल्लवान्।।८३।।
प्रियालबीजंतिन्दुक्यास्तरुणानिफलानिच।।
यथालाभंसमाहृत्यतैलमेभिर्विपाचयेत्।।८४।।
सद्योव्रणानांसर्वेषामदुष्टानांतुरोपणम्।।

The below mentioned herbs, as many as available, are collected and used for preparing medicated oil –

• Samanga,
• Rajani
• Padma
• Pathya
• Tuttha
• Suvarchala
• Padmaka
• Rodhra
• Madhuka
• Vidanga
• Harenuka
• Talisapatra
• Nalada
• Candana
• Padmakesara
• Manjistha
• Usira
• Laksa
• Young leaves of Panchavalkala
• Priyala Bija
• Unripe fruits of Tinduki

This medicated oil is said to be the best to heal all kinds of non-vitiated accidental wounds.

कषायमधुराःशीताःक्रियाःस्निग्धाश्चयोजयेत्।।८५।।
सद्योव्रणानांसप्ताहंपश्चात्पूर्वोक्तमाचरेत्।।

Below mentioned are the principles of treating accidental wounds –

• They should be treated with astringent and sweet tasting herbs and with
• Cold and unctuous measures and later,
• Treatments described earlier in chapter 1 should be adopted

Dustavrana Cikitsa – treatment of septic wounds

दुष्टव्रणेषुकर्तव्यमूर्ध्वंचाधश्चशोधनम्।।८६।।
विशोषणंतथाऽऽहारःशोणितस्यमोक्षणम्।।
कषायंराजवृक्षादौसुरसादौचधावनम्।।८७।।
तयोरेवकषायेणतैलंशोधनमिष्यते।।
क्षारकल्पेनवातैलंक्षारद्रव्येषुसाधितम्।।८८।।

Dushta Vrana i.e. septic wounds should be firstly treated with –

• Upward and downward purification methods i.e. vamana and virechana
• Foods which cause thinning of body and
• Bloodletting

The wounds should be washed with the Kashaya of herbs belonging to either Rajavriksadi Gana group of herbs or Surasadi Gana group of herbs.

Oil prepared with the same herbs should be used for cleansing the wound.

Ksara – oil or oil prepared with Ksara should be used for the purpose.

Dravañtyādi Taila 

द्रवन्तीचिरबिल्वश्चदन्तीचित्रकमेवच।।
पृथ्वीकानिम्बपत्राणिकासीसंतुत्थमेवच।।८९।।.
त्रिवृत्तेजोवतीनीलीहरिद्रेसैन्धवंतिलाः।।
भूमिकदम्बःसुवहाशुकाख्यालाङ्गलाह्वया।।९०।।
नैपालीजालिनीचैवमदयन्तीमृगादनी।।
सुधामूर्वार्ककीटारिहरितालकरञ्जिकाः।।९१।।
यथोपपत्तिकर्तव्यंतैलमेतैस्तुशोधनम्।।
घृतंवायदिवाप्राप्तकल्काःसंशोधनास्तथा।।९२।।

The below mentioned herbs, as many as available shall be collected and medicated oil or ghee prepared –

• Dravanti,
• Cirabilva,
• Danti,
• Citraka
• Prthvika
• Nimbapatra,
• Kasisa
• Tuttha
• Trivrt
• Tejovati
• Nili
• Haridra
• Daruharidra
• Saindhava
• Tila
• Bhumikadamba
• Suvaha
• Sukavrksa
• Langalaka
• Nepali (Manassila)
• Jalini
• Madayanti
• Mrgadani
• Sudha
• Murva
• Arka
• Kitari (Vidanga)
• Haritala and
• Karanjika

The paste of the same herbs may also be applied. All these are considered as good for Sodhana – cleansing the wound.

सैन्धवत्रिवृदेरण्डपत्रकल्कस्तुवातिके।।
त्रिवृद्धरिद्रामधुककल्कःपैत्तेतिलैयुतः।।९३।।
कफजेतिलतेजोह्वादन्तीस्वर्जिकचित्रकाः।।
दुष्टव्रणविधिःकार्योमेहकुष्ठव्रणेष्वपि।।९४।।

Wounds with	Medicine
Symptoms of Vata	Paste of Saindhava, Trivrt and Eranda patra
Symptoms of Pitta	Paste of Trivrt, Haridra and Madhuka
Symptoms of Kapha	Paste of Tila, Tejohva, Danti, Svarjika and Citraka
Due to diabetes and skin diseases	Treatment prescribed for Dusta Vrana – septic wounds

षड्विधःप्राक्प्रदिष्टोयःसद्योव्रणविनिश्चयः।।
नातःशक्यंपरंवक्तुमपिनिश्चितवादिभिः।।९५।।
उपसगैर्निपातैश्चतत्तुपण्डितमानिनः।।
केचित्संयोज्यभाषन्तेबहुधामानगर्विताः।।९६।।
बहुतद्भाषितंतेषांषट्स्वेष्वेवावतिष्ठते।।
विशेषाइवसामान्येषट्त्वंतुपरमंमतम्।।९७।।

There are only six kinds of Sadyovrana – accidental wounds, as described by me so far and nothing or no other type can be added to this by any discriminating person.

Some persons can have immense pride and declare themselves as learned and as a result, by adding either suffixes or prefixes to these terms, may describe some more kinds of wounds. Many of those types mentioned by them would also be included under these six kinds of Sadyovrana only just like the Visesa (peculiars, specials) merge with the Samanya (generals). Thus, the classification into six kinds is the best classification and final one too.

इतिसुश्रुतसंहितायांचिकित्सास्थानेसद्योव्रणचिकित्सितं नामद्वितीयोऽध्यायः।।२।।

Thus ends the second chapter by name Sadyovrana Cikitsita in Cikitsā Sthāna of Suśruta Samhita.