व्रणास्रावविज्ञानीयाध्यायः
अथातो व्रणास्रावविज्ञानीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
"Now, I shall explain the chapter on understanding the discharge from wounds, as spoken by the revered Dhanvantari."
This shloka introduces the next chapter, which focuses on understanding the nature and types of discharge from wounds, as imparted by the great sage Dhanvantari.
त्वङ्मांससिरास्नाय्वस्थिसन्धिकोष्ठमर्माणीत्यष्टौ व्रणवस्तूनि |
अत्र सर्वव्रणसन्निवेशः ||३||
"Skin, flesh, veins, tendons, bones, joints, internal organs, and vital points – these are the eight objects of wounds. All types of wounds are localized in these."
This shloka lists the eight objects of wounds, explaining that all types of wounds can be found in these areas of the body.
तत्र, आद्यैकवस्तुसन्निवेशी त्वग्भेदी व्रणः सूपचरः, शेषाः स्वयमवदीर्यमाणा दुरुपचाराः ||४||
"Among these, the wound confined to the first object (skin) is easily treatable, while the others, if they progress on their own, become difficult to treat."
This shloka explains that wounds confined to the skin are relatively easy to treat, whereas those affecting deeper tissues and organs become difficult to manage if they progress untreated.
तत्रायतश्चतुरस्रो वृत्तस्त्रिपुटक इति व्रणाकृतिसमासः, शेषास्तु विकृताकृतयो दुरुपक्रमा भवन्ति ||५||
"Among them, elongated, square, circular, and triangular are the basic shapes of wounds, while the others, being irregularly shaped, are difficult to treat."
This shloka categorizes wounds into basic shapes and explains that irregularly shaped wounds are more challenging to treat.
सर्व एव व्रणाः क्षिप्रं संरोहन्त्यात्मवतां सुभिषग्भिश्चोपक्रान्ताः; अनात्मवतामज्ञैश्चोपक्रान्ताः प्रदुष्यन्ति, प्रवृद्धत्वाद्दोषाणाम् ||६||
"All wounds heal quickly in individuals with strong constitutions and under the care of good physicians, but in those with weak constitutions and treated by ignorant physicians, they worsen due to the aggravation of doshas."
This shloka explains the importance of the patient's constitution and the physician's knowledge in the healing process of wounds. Strong individuals and skilled physicians facilitate quick healing, while weak individuals and ignorant physicians lead to worsening conditions due to dosha aggravation.
तत्रातिसंवृतोऽतिविवृतोऽतिकठिनोऽतिमृदुरुत्सन्नोऽवसन्नोऽतिशीतोऽत्युष्णः
नगन्धात्यर्थदाहपाकरागवेदनावानिति पित्तेन, शेषाः कफेन; उन्मार्गी मुखात् मुखान्तरवान्, उत्सङ्गः कोटरः’ इति चक्रः; कृष्णरक्तपीतशुक्लादीनां वर्णानामन्यतमवर्णो भैरवः पूतिपूयमांससिरास्नायुप्रभृतिभिः पूर्णः पूतिपूयास्राव्युन्मार्ग्युत्सङ्ग्यमनोज्ञदर्शनगन्धोऽत्यर्थं वेदनावान् दाहपाकरागकण्डूशोफपिडकोपद्रुतोऽत्यर्थं दुष्टशोणितास्रावी दीर्घकालानुबन्धी चेति दुष्टव्रणलिङ्गानि |
तस्य दोषोच्छ्रायेण षट्त्वं विभज्य यथास्वं प्रतीकारे प्रयतेत ||७||
"Among these, the ones that are too closed, too open, too hard, too soft, elevated, or depressed, too cold, or too hot are caused by Pitta, while the rest are caused by Kapha. The ones with unregulated openings, spreading from one opening to another, irregular margins, and varying colors like black, red, yellow, or white, are dangerous. Filled with foul-smelling pus, flesh, veins, tendons, etc., they ooze putrid discharge, cause severe pain, burning, redness, itching, swelling, boils, and complications, and bleed excessively, persisting for a long time. These are the signs of chronic ulcers. Their management should be done according to the predominance of doshas divided into six categories."
This shloka provides detailed characteristics of chronic ulcers and their classification based on the predominant doshas, emphasizing the need for appropriate management according to the dosha involved.
अत ऊर्ध्वं सर्वस्रावान् वक्ष्यामः- तत्र घृष्टासु छिन्नासु वा त्वक्षु स्फोटे भिन्ने विदारिते वा सलिलप्रकाशो भवत्यास्रावः किञ्चिद्विस्रः पीतावभासश्च; मांसगतः सर्पिःप्रकाशः सान्द्रः श्वेतः पिच्छिलश्च; सिरागतः सद्यश्छिन्नासु सिरासु रक्तातिप्रवृत्तिः पक्वासु च तोयनाडीभिरिव तोयागमनं पूयस्य, आस्रावश्चात्र तनुर्विच्छिन्नः पिच्छिलोऽवलम्बी श्यावोऽवश्यायप्रतिमश्च; स्नायुगतः स्निग्धो घनः सिङ्घाणकप्रतिमः सरक्तश्च; अस्थिगतोऽस्थन्यभिहते स्फुटिते भिन्ने दोषावदारिते वा दोषभक्षितत्वादस्थि निःसारं शुक्तिधौतमिवाभाति , आस्रावश्चात्र मज्जमिश्रः सरुधिरः स्निग्धश्च; सन्धिगतः पीड्यमानो न प्रवर्तते, आकुञ्चनप्रसारणोन्नमनविनमनप्रधावनोत्कासनप्रवाहणैश्च स्रवति, आस्रावश्चात्र पिच्छिलोऽवलम्बी सरुधिरोन्मथितश्च ; कोष्ठगतोऽसृङ्मूत्रपुरीषपूयोदकानि स्रवति; मर्मगतस्त्वगादिष्ववरुद्धत्वान्नोच्यते |
तत्र त्वगादिगतानामास्रावाणां यथाक्रमं पारुष्यश्यावावश्यायदधिमस्तुक्षारोदकमांसधावनपुलाकोदकसन्निभत्वानि मारुताद्भवन्ति; पित्ताद्गोमेदकगोमूत्रभस्मशङ्खकषायोदकमाध्वीकतैलसन्निभत्वानि; पित्तवद्रक्तादतिविस्रत्वं च; कफान्नवनीतकासीसमज्जपिष्टतिलनालिकेरोदकवराहवसासन्निभत्वानि; सन्निपातान्नालिकेरोदकैर्वारुकरसकाञ्जिकप्रसादारुकोदकप्रियङ्गुफलयकृन्मुद्गयूषसवर्णत्वानीति ||८||
"Now, I shall explain all types of discharges: When the skin is abraded, cut, or torn, the discharge resembles water, is slightly odorous, and has a yellowish tint. When it affects the flesh, the discharge resembles ghee, is thick, white, and sticky. When it affects the veins, the immediate discharge is a profuse flow of blood from freshly cut veins, or in mature cases, the pus flows through multiple channels, and the discharge is thin, disjointed, sticky, dangling, and appears similar to mist. When it affects the tendons, the discharge is oily, thick, resembling nasal mucus, and mixed with blood. When it affects the bones, if the bone is struck, cracked, broken, or torn by the doshas, the bone, having been consumed by the doshas, appears hollow like a washed shell, and the discharge is mixed with marrow, blood, and is oily. When it affects the joints, the discharge does not occur when pressured, but it oozes out with movements like contraction, expansion, raising, lowering, running, sitting, or straining, and the discharge is sticky, dangling, mixed with blood, and churned. When it affects the internal organs, there is a discharge of blood, urine, feces, pus, and water. When it affects vital points, it is not described due to obstruction in the skin and other tissues. The appearance of the discharge from various affected areas, in order, is: From Vata – rough, grey, resembling curdled milk, whey, alkaline water, meat washings, and barley water. From Pitta – resembling gomedaka (onyx), cow urine, ash, conch water, honey, and oil. From blood – as in Pitta, with an excessive smell. From Kapha – resembling butter, lead oxide, marrow, paste of sesame, coconut water, and boar fat. From Sannipata (combined doshas) – resembling coconut water, cactus juice, sour gruel, the juice of aruka fruit, priyangu fruit water, mung bean soup, etc."
This shloka provides detailed descriptions of various types of discharges based on the affected tissues and the predominant doshas, helping in the diagnosis and treatment of wounds and ulcers.
श्लोकौ चात्र भवतः-
पक्वाशयादसाध्यस्तु पुलाकोदकसन्निभः |
क्षारोदकनिभः स्रावो वर्ज्यो रक्ताशयात्स्रवन् ||९||
आमाशयात् कलायाम्भोनिभश्च त्रिकसन्धिजः |
स्रावानेतान् परीक्ष्यादौ ततः कर्माचरेद्भिषक् ||१०||
"Here are the shlokas: Discharge from the colon, resembling barley water, and that from the urinary bladder, resembling alkaline water, should be considered incurable, especially when oozing from blood vessels. Discharge from the stomach, resembling the water of green grams, and that from the joints should be examined first, and then the physician should proceed with the treatment."
These shlokas provide guidelines for physicians on assessing different types of discharges and their respective prognoses. The descriptions emphasize the importance of careful examination before proceeding with treatment.
अत ऊर्ध्वं सर्वव्रणवेदना वक्ष्यामः- तोदनभेदनताडनच्छेदनायामनमन्थनविक्षेपणचुमुचुमायननिर्दहनावभञ्जनस्फोटन विदारणोत्पाटनकम्पनविविधशूलविश्लेषणविकिरणस्तम्भनपूरणस्वप्नाकुञ्जनाङ्कु शिकाः सम्भवन्ति, अनिमित्तविविधवेदनाप्रादुर्भावो वा मुहुर्मुहुर्यत्रागच्छन्ति वेदनाविशेषास्तं वातिकमिति विद्यात्; ओषचोषपरिदाहधूमायनानि यत्र गात्रमङ्गारावकीर्णमिव पच्यते यत्र चोष्माभिवृद्धिः क्षते क्षारावसिक्तवच्च वेदनाविशेषास्तं पैत्तिकमिति विद्यात्; पित्तवद्रक्तसमुत्थं जानीयात्; कण्डूर्गुरुत्वं सुप्तत्वमुपदेहोऽल्पवेदनत्वं स्तम्भः शैत्यं च यत्र तं श्लैष्मिकमिति विद्यात्; यत्र सर्वासां वेदनानामुत्पत्तिस्तं सान्निपातिकमिति विद्यात् ||११||
"Now, I shall describe all types of wound pains: piercing, splitting, beating, cutting, stretching, churning, throwing, pricking, burning, smashing, bursting, tearing, pulling, shaking, various types of pain, loosening, spreading, stiffening, filling, feeling sleepy, and contracting are types of pain. Randomly occurring diverse pains or repeatedly occurring special pains indicate Vata dosha. Where there is burning, dryness, heat, and sensation of smoke, where the body feels like it is being cooked by embers, and where the heat increases in the wound like it is sprinkled with alkaline, these special pains indicate Pitta dosha. Pains similar to Pitta but arising from blood should be recognized. Itching, heaviness, numbness, stickiness, slight pain, stiffness, and coldness indicate Kapha dosha. Where all types of pains arise, it should be recognized as Sannipata (combined doshas)."
This shloka explains the various types of wound pains and their correlation with the doshas. Recognizing these pains helps in diagnosing the predominant dosha involved and aids in appropriate treatment.
अत ऊर्ध्वं व्रणवर्णान् वक्ष्यामः- भस्मकपोतास्थिवर्णः परुषोऽरुणः कृष्ण इति मारुतजस्यः नीलः पीतो हरितः श्यावः कृष्णो रक्तः पिङ्गलः कपिल इति रक्तपित्तसमुत्थयोः; श्वेतः स्निग्धः पाण्डुरिति श्लेष्मजस्य; सर्ववर्णोपेतः सान्निपातिक इति ||१२||
"Now, I shall describe the colors of wounds: Ashy, pigeon-colored, bony, rough, reddish, and black are due to Vata dosha. Blue, yellow, green, grey, black, red, coppery, and brown are due to Rakta and Pitta doshas. White, smooth, and pale are due to Kapha dosha. Multicolored are due to Sannipata (combined doshas)."
This shloka explains the various colors of wounds and their correlation with the different doshas. Recognizing these colors helps in diagnosing the predominant dosha involved and aids in appropriate treatment.
भवति चात्र-
न केवलं व्रणेषूक्तो वेदनावर्णसङ्ग्रहः |
सर्वशोफविकारेषु व्रणवल्लक्षयेद्भिषक् ||१३||
"Moreover, The compilation of pain and color described for wounds, should be observed by the physician in all swellings and other conditions as well."
This shloka emphasizes that the signs of pain and color described for wounds should also be considered by the physician in diagnosing and treating all kinds of swellings and related conditions.
इति सुश्रुतसंहितायां सूत्रस्थाने व्रणास्रावविज्ञानीयो नाम द्वाविंशतितमोऽध्यायः ||२२||
"Thus ends the twenty-second chapter named 'Vrana Asrava Vijnaniyo' (Understanding the Discharge from Wounds) in the Sutra Sthana of the Sushruta Samhita."
This shloka marks the conclusion of the twenty-second chapter of the Sushruta Samhita, emphasizing the importance of understanding the various types of discharges from wounds as detailed in this chapter.