Sushruta Samhita Chikitsasthana Chapter 2 Sadyovraņa Cikitsitam (Therapy of Unintentional Wounds)

 

The 2nd chapter of Chikitsasthana of Sushruta Samhita is called as Sadyovraņa Cikitsitam Adhyaya. This chapter offers with Therapy of Unintentional Wounds.

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

We are going to now expound the chapter – Sadyovrana Cikitsita- therapy of unintended wounds; as revealed by the venerable Dhañvañtari.

धन्वन्तरिर्धर्मभृतांवरिष्ठोवाग्विशारदः।।
विश्वामित्रसुतंशिष्यमृर्षिसुश्रुतमन्वशात्।।३।।

Sage Dhañvañtari thought of because the chief amongst these 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।।

On this chapter, I’ll describe –

• the options of various sorts of wounds,
• which have occurred on completely different components of the physique that are
• brought on by weapons with varied kinds of edges

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

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

Under talked about are the completely different shapes of Agantu Vrana i.e. wounds brought on by accident or trauma and likewise of Doshaja Vrana i.e. endogenous wounds brought on by the doshas which have go off all by themselves. These will not be the shapes of the injuries finished by a doctor i.e. they aren’t the shapes of surgical wounds –

• lengthy
• sq. – having 4 edges,
• triangular – having three edges,
• spherical
• semi lunar – resembles half-moon,
• broad,
• irregular / curved,
• saucer formed with melancholy on the centre,
• saucer formed with elevation on the centre

Unintentional wounds are of innumerable shapes

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

If a doctor has excellent information in regards to the completely different shapes of wounds, he won’t ever turn out to be confused when he encounters wounds which seem dreadful and irregular.

In line with the traditional physicians, the unintended wounds are of innumerable shapes. Primarily based on their options, all these wounds are categorized briefly into six varieties.

Unhappy-vidha   vrana – six sorts of wounds

छिन्नंभिन्नंतथाविद्धंक्षतंपिच्चितमेवच।।९।।
घृष्टमाहुस्तथाषष्ठंतेषांवक्ष्यामिलक्षणम्।।

The six sorts of wounds are as under talked about –

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

The options of those completely different sorts of wounds shall be described by me now.

Chinna – minimize / incised wound 

तिरश्चीनऋजुर्वाऽपियोव्रणश्चायतोभवेत्।।१०।।
गात्रस्यपातनंचापिछिन्नमित्युपदिश्यते।।

Chinna Vranas are minimize or incised wounds. They’re –

• Indirect or
• Straight or
• Broad / broad and consists of
• Falling off of a part of the physique

Bhinna – punctured wounds of viscera 

कुन्तशक्त्यृष्टिखङ्गाग्रविषाणादिभिराशयः।।११।।
हतःकिञ्चित्स्त्रवेत्तद्धिभिन्नलक्षणमुच्यते।।

Bhinna Vranas are these wounds brought on by puncture of inner organs. It contains of visceral organs of the chest and stomach (asaya) that are punctured by the tip of the under talked about –

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

These wounds additionally exude little amount of fluids.

स्थानान्यामाग्निपक्वानांमूत्रस्यरूधिरस्यच॥१२॥
हृदुण्डुकःफुप्फुसश्चकोष्ठइत्यभिधीयते॥

Kostha – viscera contained in the chest and belly cavity – contains of seats of –

• Ama – undigested meals
• Agni – digestive hearth,
• Pakva – digested meals,
• Mutra – urine,
• Rudhira – blood,
• Hrdaya – coronary heart,
• Unduka – caecum and
• Pupphusa – lungs

 Koşthabheda lakṣaṇa – options of puncture of the stomach

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

Under talked about are the signs of Kostha Bheda – puncture of kostha –

• Filling of kostha with blood
• Fever
• Burning sensation,
• Bleeding from urinary tract, anus, mouth and nostril,
• Fainting,
• Dyspnoea,
• Thirst,
• Flatulence,
• Not having want for meals,
• Non elimination of faeces, urine and fart / flatus,
• Sweating,
• Reddish colouration of the eyes,
• Odor of iron coming from the mouth,
• Physique emits unhealthy scent,
• Ache within the area of the center and flanks

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

Now the particular signs are being mentioned by me, hearken to the identical –

Organ during which blood has collected	Signs
Amashaya – abdomen	Vomiting of blood, Profound flatulence, Excruciating ache
Pakvashaya – massive gut	Ache, Feeling of heaviness, Coldness of the stomach under the navel area Bleeding from orifices, primarily anus

Similar to a pot whose mouth has been closed with a lid will get full of water and turns into heavy with the water getting into into it via the small pores on its sides, there can be filling of intestines with blood regardless of these organs not being punctured and this occurs via the minute pores of the intestines.

 Viddha vrana – punctured wound 

सूक्ष्मास्यशल्याभिहतंयदङ्गंत्वाशयाद्विना।।१९।।
उण्डितंनिर्गतंवातद्विद्धमितिनिर्दिशेत्।।

A wound is known as as Viddha Vrana when any weapon or international physique injures any a part of the physique besides the hole viscera, by getting into via small openings and bulges up the physique, even after the international physique has come out.

Kșata vrana – crushed wound

नातिच्छिन्नंनातिभिन्नमुभयोर्लक्षणन्वितम्।।२०।।
विषमंव्रणमङ्गेयत्तत्क्षतंत्वभिनिर्दिशेत्।।

A wound qualifies to be known as as Ksata Vrana if it satisfies the under talked about circumstances –

• The wound has not vastly / severely minimize the physique half (doesn’t minimize the physique half into two), and
• doesn’t really puncture the physique half, however
• has the signs of each and
• the wound is irregular in form and stage

Piccita vrana – contused wound

प्रहारपीडनाभ्यांतुयदङ्गपृथुतांगतम्।।२१।।
सास्थितत्पिच्चितंविद्यान्मज्जरक्तपरिप्लुतम्।।

Piccita Vrana – contused wound is when –

• as a result of assault / assault by cane and many others or as a result of compression (pressed, squeezed),
• if any a part of the physique will get unfold out being crushed together with bone current inside it and
• is full of bone marrow and blood

Ghrsta vrana – abrasion

विगतत्वग्यदङ्गंहिसंघर्षादन्यथाऽपिवा।।२२।।
उषात्रावान्वितंतत्तुघृष्टमित्युपदिश्यते।।

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

• any a part of the physique loses its pores and skin both as a result of rubbing / friction on onerous or tough surfaces (or assault by weapon) or in any other case, and is
• accompanied with burning sensation and watery exudation

Sāmāñya cikitsā – common therapy

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

When there’s extreme bleeding in any sort of wounds i.e. chinna, bhinna, viddha or ksata, vata will get aggravated as a result of lack of blood. This aggravated vata produces extreme ache.

The under talked about therapy precept needs to be adopted to deal with this situation –

• snehana and swedana is helpful
• upanaha – heat poultices needs to be finished with vesavara or krsara added with fat,
• swedana – with baked or fried corns,
• software of unctuous pastes on the half,
• unctuous enemas with oil ready from the herbs which mitigate vata,

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

Blood doesn’t stream out vastly in case of piccita and ghrsta kinds of wounds. As a result of stasis of blood inside, there can be extreme burning sensation and suppuration (pus formation).

Therapy – Paste of herbs needs to be utilized chilly or chilly medicinal liquids needs to be poured on the affected half / components in order to mitigate the warmth of the wound. These therapies can even assist in overcoming the burning sensation and suppuration.

Thus, therapy in short for the six sorts of unintended wounds equivalent to chinna and many others. have been described.

Višeșa cikitsā – particular therapies

Chinna vrana cikitsa: Therapy of minimize wounds

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

After this, I’ll describe intimately the therapy of Chinna Vrana i.e. minimize or incised wounds.

The under talked about sorts of minimize wounds needs to be sutured within the technique described earlier in chapter 25 of Sutra Sthana Part –

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

After suturing, these wounds needs to be bandaged tightly.

कर्णस्थानादपहृतंस्थापयित्वायथास्थितम्।।
सीव्येद्यथोक्तंतैलेनस्रोतश्चाभिप्रतर्पयेत्।।३१।।

Under talked about is in short the administration of the ear which has turn out to be displaced –

• it needs to be changed to its traditional web site, and
• sutured correctly and
• anointed i.e. dressed with medicated oil and later,
• the orifice of the ear too needs to be full of oil

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

Under talked about is the administration when there’s a minimize wound on the finish (border) of Krkatika with air popping out of it –

• the krkatika needs to be restored in its traditional web site (place) correctly and
• steady suture needs to be finished adopted by –
• bandaging after which
• the realm needs to be bathed with goat’s ghee

The affected person needs to be suggested to take meals whereas mendacity along with his face up (supine) and sleep properly restrained.

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

Within the wounds occurring on the extremities, if the cuts are indirect and if there’s formation of a large hole within the minimize, the surgeon / doctor ought to push the bone and joints inside, place them of their locations after which suture the sound. After suturing, he ought to do the bandaging adopting the Vellitaka sort of bandage and bathe the place with oil. Gophana Bandha sort of bandage shall be finished utilizing leather-based or whichever is snug.

पृष्ठेव्रणोयस्यभवेदुत्तानंशाययेत्तुतम्।।
अतोऽन्यथाचोरसिजेशाययेत्पुरुषंव्रणे।।३६।।

Positioning of the affected person within the wounds of again and chest –

• if the wound is within the again, the individual needs to be positioned in supine place with the affected person dealing with upwards / ceiling
• if the wound is within the chest, he needs to be positioned in inclined place i.e. the affected person dealing with downward

छिन्नांनिःशेषतःशाखांदग्ध्वातैलेनबुद्धिमान्।।
बध्नीयात्कोशबन्धनप्राप्तंकार्यंचरोपणम्।।३७।।

When the extremity i.e. higher or decrease limb has been utterly separated from the physique, the smart doctor / surgeon ought to do the under mentioned sorts of therapy –

• first, he ought to burn the wound utilizing hearth i.e. rods heated on hearth, after which
• apply oil or gauze soaked in oil on it after which
• apply kosa sort of bandage following which
• he ought to do ropana – measures which might heal the wound

Cañdanādi taila 

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

The under talked about eight elements needs to be cooked with oil in order to organize the medicated oil i.e. Candanadi Taila within the traditional method –

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

This oil is alleged to be the very best for therapeutic the injuries.

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

The under talked about 13 elements / 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 fats, added with milk and medicated oil ready.

This oil is helpful for bathing the wound and likewise to heal it.

Bhinna vraņa cikitsā – therapy of puncture wounds

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

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

When the attention has been punctured and never doing its regular features of seeing issues, when it’s hanging free, it needs to be gently pushed again and positioned in its regular place whereas taking care that it’s siras i.e. veins / blood vessels will not be broken.

After this, the attention must be massaged with the palm of the doctor. Whereas doing so, petals of padma (lotus flower) needs to be positioned between the hand of the doctor and eye of the affected person.

After massaging, Tarpana needs to be finished to the attention by filling the attention with ghee and many others. The identical ghee needs to be used for nasya – instilled into the nostril additionally.

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

Medicated ghee needs to be ready by cooking the under talked about with cow’s ghee –

• One patra (adhaka) amount of every of goat’s ghee (ready from goat’s milk) and cow’s milk
• Madhuka
• Utpala
• Jivaka and
• Rshabhaka

Be aware – Madhuka, Utpala, Jivaka and Rshabhaka needs to be taken in equal portions.

This ghee is extremely helpful in treating all types of accidents of the eyes.

Koşthabheda cikitsā – therapy of visceral wounds

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

When because of the puncture, the medovarti i.e. pancreas has come out of the stomach, the doctor / surgeon ought to smear powder of astringent herbs, ash or mud. After making use of considered one of these, it needs to be tied with threads all spherical, minimize utilizing a heated sharp instrument like scalpel or lancet. Following this, honey is utilized on it and bandaging is completed over the wound.

After that, he shall be given meals which has been cooked properly for consuming and ghee for consuming. Ghee needs to be given for consuming after the consumed meals has been totally digested. Administration of ghee shall be finished even with out following guidelines of abhyantara Sneha – inner oleation. After the affected person has consumed ghee, he needs to be given milk for consuming. The milk must be combined with Sarkara – sugar, Madhuyashti – Glyzyrrhiza glabra, Laksa – lac, Svadamshtra – Tribulus terristris and Citra – Plumbago zeylanica.

It will relieve ache and burning sensation. Flatulence, loss of life or ache could happen if slicing isn’t finished. On this situation, the medicated oil described for treating Medogranthi i.e. fatty tumours earlier (chapter 18) shall be used.

Koșthaśalyāharaņa– eradicating international our bodies from the stomach 

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

Chopping the stomach or different strategies needs to be adopted to take away the international our bodies which have entered the stomach slicing via the pores and skin, veins and many others and lodged contained in the stomach. Later the issues enumerated earlier (chapter 26 of Sutra Sthana) needs to be handled.

The doctor / surgeon ought to reject the affected person (shouldn’t deal with) if he has developed the under talked about signs / issues –

• Inside bleeding,
• Pallor,
• Coldness of fingers, toes and face,
• Chilly breath,
• Redness of the eyes and
• Flatulence

Raktapūrņakoştha cikitsā – inner haemorrhage and its therapy

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

Therapies for haemorrhage occurring in amashaya (abdomen) –

• Vamana – emesis remedy is alleged to be the very best therapy

Therapies for haemorrhage occurring in pakvashaya (massive gut) –

• Virechana – purgation remedy
• Asthapana Vasti – decoction enemas with out including Sneha – fat and ready from purgative herbs needs to be administered heat

Meals – meals ready with yava – barley and kola – jujube needs to be served together with kulattha yusa – horse gram soup or meat soup or yavagu – thick gruel added with saindhava lavana – rock salt.

The affected person shall be given with blood of animals for consuming if he has extreme bleeding or if his organs are punctured.

स्वमार्गप्रतिपन्नास्तुयस्यविण्मूत्रमारुताः।।
व्युपद्रवःसभिन्नेऽपिकोष्ठेजीवतिमानवः।।५५।।

The individual would survive regardless of his belly organs being punctured if –

• his faeces, urine and fart / flatus are seen to be transferring in their very own channels,
• when there aren’t any issues

Nişkrāñtāñtra cikitsā – therapy 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 gut which has protruded out of the stomach and never been punctured, the doctor / surgeon shall push the gut again via the identical orifice via which it’s protruding and shouldn’t be allowed to stay outdoors for a very long time.

In line with the opinion of others, the half protruding needs to be washed with water. Grass, blood and sand adhering to it needs to be eliminated (via washing) and held tight by the heads of huge sized ants. Later they should be pushed inside gently, by the doctor / surgeon. The doctor ought to have pared his nails intently earlier than touching the gut. He must also smear his fingers with ghee. Doing so, he ought to push the gut inside. The doctor ought to squeeze the neck of the affected person along with his fingers and likewise needs to be frightened by sprinkling water on his face. As a way to make the gut get again into the stomach, sturdy individuals ought to raise the affected person up by holding his fingers and toes and shake him. When finished so, the gut displaces its personal membranes whereas getting into in.

When the intestinal mass protruding out is huge and when the wound is small it’d get troublesome to push the gut into the stomach. Then the surgeon ought to minimize a portion of the protruding stomach, to a required size after which push it inside. The wound needs to be correctly sutured with none laxity as soon as the gut has been positioned in its correct place by pushing it in. when improperly positioned or twisted whereas inserting, the gut takes away life. After suturing, the stomach shall be wrapped with a band of leather-based or thick fabric. Ghee needs to be poured on this. Additionally, the affected person is given ghee to drink. This ghee needs to be added with oil of Citra – Eranda, Ricinus communis (castor oil) and served sizzling.

As a way to soften the faeces and assist motion of flatus downward the affected person needs to be given heat ghee combined with eranda taila (castor oil) to drink.

The under talked about oil shall be ready and used for wound therapeutic. The oil needs to be processed with barks of the under talked about timber / herbs –

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

This oil would heal the injuries. The individual ought to keep away from bodily actions, copulation and many others. and lead a life with restraint, for a interval of 1 12 months.

Nirastamuşka – prolapse of testes

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

When the scrotum will get torn as a result of assault or damage by weapons and when because of that the testes are protruding out of the scrotum partly, the doctor / surgeon ought to do the therapy as mentioned under –

• The protruding testes and the orifice via which the testes is protruding needs to be sprinkled with water and
• The testes needs to be pushed inside, close to the sevani i.e. scrotal raphae and later
• The scrotum needs to be sutured and
• Gophanika sort of bandage needs to be utilized and
• Tie it to a management / thread mounted around the waist

Anointing and pouring liquids over the place needs to be averted. Doing so could create moistness within the wound.

Medicated oil ready with under talked about herbs heals the wound –

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

Śirassalya – international our bodies within the cranium

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

After eradicating the international our bodies from the top (cranium) wicks product of hairs needs to be inserted. If the hair wick isn’t inserted into the wound, mastulunga i.e. mind matter would stream out via the wound (opening). Because of this, vata would get aggravated and ultimately kill the individual. Subsequently, it needs to be handled within the described method. The wicks of hairs which have been inserted should be eliminated one after the other after the wound has healed.

Sarira salya – international our bodies in different components

गात्रादपहतेऽन्यस्मात्स्नेहवर्तिप्रवेशयेत्।।७१।।
कृतेनिःशोणितेचापिविधिःसद्यःक्षतेहितः।।

Within the different components of the physique, when the international our bodies are discovered, they need to be eliminated and the wound needs to be cleared of blood. Later, wicks lubricated with oil or ghee needs to be inserted within the wound. Right here additionally the therapies advocated for traumatic wounds needs to be adopted beneficially.

दूरावगाढाःसूक्ष्माःस्युर्येव्रणास्तान्विशोणितान्।।७२।।
कृत्वासूक्ष्मेणनेत्रेणचक्रतैलेनतर्पयेत्।।

When the injuries are deep and have small openings, the blood in them needs to be cleared and full of Cakra taila i.e. recent oil extracted from the mill. The oil filling needs to be finished with the assistance of a nozzle of a tubular instrument used for wound washing.

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

Medicated oil ready with the under talked about herbs –

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

When used at correct time, this medicated oil helps finest in therapeutic.

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

Medicated oil is ready utilizing the under talked about herbs,

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

That is the very best oil for therapeutic the injuries.

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

क्षतेक्षतविधिकार्यःपिच्चितेभग्नवद्विधिः।।७६।।
घष्टेरुजोनिगृह्माशुचूर्णरुपचरेवणम्।।

Therapy described in chapter 23 for Ksata needs to be finished for Ksataja Vrana i.e. crushed wounds additionally.

Equally, the identical therapies advocated for Bhagna – fracture of bones shall be adopted for Piccita Vrana i.e. contused wounds.

Ache needs to be mitigated rapidly and the wound needs to be handled by dusting the powder of medicinal herbs in case of Ghrsta Vrana – lacerated wounds.

Dronīvāsa – inserting in tub

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

Under talked about individuals needs to be made to lie for some days in a bath of oil and be served with meals together with meat soup –

• These having displacement of physique components,
• Those that have fallen from peak,
• Those that have been twisted of their physique components and
• Those that have been hit on their marmas i.e. very important or deadly spots,

Comparable therapy needs to be finished for individuals who are emaciated and those that have been hit on very important / deadly spots.

रोपणेसपरीषेकेपानेचव्रणिनांसदा।।
तैलंघृतंवासंयोज्यंशरीरतूंनवेक्ष्यहि।।७९।।

For the aim of therapeutic the injuries and for pouring on them, medicated oil or ghee needs to be made use of. This needs to be finished after having thought of the situation of the physique and the season. This could at all times be adopted whereas treating the wounded individuals.

घृतानियानिवक्ष्यामियत्नतःपित्तविद्रधौ।।
सद्योव्रणेषुदेयानितानिवैद्येनजानता।।८।।

A smart doctor ought to make use of the medicated ghee that I’m going to explain within the therapy of Pittaja Vidradhi (in chapter 16) in treating the unintended wounds additionally.

सद्यःक्षतव्रणंवैद्यःसशूलंपरिषेचयेत्।।
सर्पिषानातिशीतेनबलातैलेनवापुनः।।८१।।

For unintended wounds that are painful, the doctor ought to do pariseka – i.e. pour heat medicated liquids in streams over the injuries. It needs to be finished both with ghee or utilizing Bala Taila after making them barely heat.

Samañgādi Taila

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

The under talked about herbs, as many as out there, are collected and used for making ready medicated oil –

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

This medicated oil is alleged to be the very best to heal all types of non-vitiated unintended wounds.

कषायमधुराःशीताःक्रियाःस्निग्धाश्चयोजयेत्।।८५।।
सद्योव्रणानांसप्ताहंपश्चात्पूर्वोक्तमाचरेत्।।

Under talked about are the ideas of treating unintended wounds –

• They need to be handled with astringent and candy tasting herbs and with
• Chilly and unctuous measures and later,
• Therapies described earlier in chapter 1 needs to be adopted

Dustavrana Cikitsa – therapy of septic wounds

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

Dushta Vrana i.e. septic wounds needs to be firstly handled with –

• Upward and downward purification strategies i.e. vamana and virechana
• Meals which trigger thinning of physique and
• Bloodletting

The injuries needs to be washed with the Kashaya of herbs belonging to both Rajavriksadi Gana group of herbs or Surasadi Gana group of herbs.

Oil ready with the identical herbs needs to be used for cleaning the wound.

Ksara – oil or oil ready with Ksara needs to be used for the aim.

Dravañtyādi Taila 

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

The under talked about herbs, as many as out there shall be collected and medicated oil or ghee ready –

• 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 identical herbs can also be utilized. All these are thought of nearly as good for Sodhana – cleaning the wound.

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

Wounds with	Drugs
Signs of Vata	Paste of Saindhava, Trivrt and Eranda patra
Signs of Pitta	Paste of Trivrt, Haridra and Madhuka
Signs of Kapha	Paste of Tila, Tejohva, Danti, Svarjika and Citraka
Attributable to diabetes and pores and skin ailments	Therapy prescribed for Dusta Vrana – septic wounds

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

There are solely six sorts of Sadyovrana – unintended wounds, as described by me to this point and nothing or no different sort could be added to this by any discriminating individual.

Some individuals can have immense pleasure and declare themselves as discovered and consequently, by including both suffixes or prefixes to those phrases, could describe some extra sorts of wounds. Lots of these varieties talked about by them would even be included beneath these six sorts of Sadyovrana solely similar to the Visesa (peculiars, specials) merge with the Samanya (generals). Thus, the classification into six sorts is the very best classification and ultimate one too.

इतिसुश्रुतसंहितायांचिकित्सास्थानेसद्योव्रणचिकित्सितं नामद्वितीयोऽध्यायः।।२।।

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