कृत्याकृत्यविध्यध्यायः
अथातः कृत्याकृत्यविधिमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
"Now, I shall explain the chapter on what to do and what not to do, as spoken by the revered Dhanvantari."
This shloka introduces the next chapter, which focuses on the guidelines for appropriate actions and contraindications, as imparted by the great sage Dhanvantari.
तत्र, वयःस्थानां दृढानां प्राणवतां सत्त्ववतां (आत्मवतां) च सुचिकित्स्या व्रणाः; एकस्मिन् वा पुरुषे यत्रैतद्गुणचतुष्टयं तस्य सुखसाधनीयतमाः |
तत्र, वयःस्थानां प्रत्यग्रधातुत्वादाशु व्रणा रोहन्ति; दृढानां स्थिरबहुमांसत्वाच्छस्त्रमवचार्यमाणं सिरास्नाय्वादिविशेषान्न प्राप्नोति; प्राणवतां वेदनाभिघाताहारयन्त्रणादिभिर्न ग्लानिरुत्पद्यते; सत्त्ववतां दारुणैरपि क्रियाविशेषैर्न व्यथा भवति; तस्मादेतेषां सुखसाधनीयतमाः ||३||
"Wounds are easily treatable in individuals who are young, strong, energetic, and have strong mental faculties; or in an individual who possesses all four qualities. Such wounds heal quickly. In young individuals, due to the freshness of their tissues, wounds heal rapidly. In strong individuals, due to their stability and abundant muscle tissue, the surgical instruments do not reach the vital parts like veins and tendons. In energetic individuals, they do not experience weakness due to pain, injury, diet, or restriction. In individuals with strong mental faculties, even severe treatments do not cause distress. Therefore, wounds in such individuals are the easiest to treat."
This shloka explains that wounds are more easily treatable in individuals with certain qualities, such as youth, strength, energy, and strong mental faculties. These attributes facilitate faster healing and better response to treatments.
त एव विपरीतगुणा वृद्धकृशाल्पप्राणभीरुषु द्रष्टव्याः ||४||
"In contrast, those who are elderly, emaciated, weak, and timid possess opposite qualities."
This shloka highlights that individuals who are old, frail, weak, and timid are more difficult to treat due to their opposite qualities compared to those who are young, strong, and energetic.
स्फिक्पायुप्रजननललाटगण्डौष्ठपृष्ठकर्णफलकोषोदरजत्रुमुखाभ्यन्तरसंस्थाः सुखरोपणीया व्रणाः ||५||
"Wounds located on the hips, anus, genitals, forehead, cheeks, lips, back, ears, sides, abdomen, neck, and inside the mouth are easier to heal."
This shloka explains that wounds in certain locations on the body are easier to treat and heal compared to those in other locations.
अक्षिदन्तनासापाङ्गश्रोत्रनाभिजठरसेवनीनितम्बपार्श्वकुक्षिवक्षःकक्षास्तनसन्धिभागगताः सफेनपूयरक्तानिलवाहिनोऽन्तःशल्याश्च दुश्चिकित्स्याः; अधोभागाश्चोर्ध्वभागनिर्वाहिणो , रोमान्तोपनखमर्मजङ्घास्थिसंश्रिताश्च, भगन्दरमपि चान्तर्मुखं सेवनीकुटकास्थिसंश्रितम् ||६||
कुष्ठिनां विषजुष्टानां शोषिणां मधुमेहिनाम् |
व्रणाः कृच्छ्रेण सिध्यन्ति येषां चापि व्रणे व्रणाः ||७||
"Wounds located on the eyes, teeth, nostrils, corners of the eyes, ears, navel, abdomen, perineum, hips, sides, flanks, chest, armpits, breasts, and joints, which are filled with frothy pus, blood, and air, or which have foreign bodies inside them are difficult to treat; as well as those situated below the body but affecting the upper part, involving body hair, nails, vital parts, shanks, and bones, including internal fistula in the perineum. In leprosy, those afflicted by poison, tuberculosis, diabetes, and those having multiple wounds are difficult to heal."
This shloka explains the various types of wounds that are difficult to treat, depending on their location and the conditions of the patient, emphasizing the complexity of treatment in such cases.
अवपाटिकानिरुद्धप्रकशसन्निरुद्धगुदजठराणि, ग्रन्थिक्षतक्रिमयः प्रतिश्यायजाः कोष्ठजाश्च त्वग्दोषिणां प्रमेहिणां वा ये परिक्षतेषु दृश्यन्ते, शर्करा सिकतामेहो वातकुण्डलिकाऽष्ठीला दन्तशर्करोपकुशः कण्ठशालूकं निष्कोषणदूषिताश्च दन्तवेष्टा विसर्पास्थिक्षतोरःक्षतव्रणग्रन्थिप्रभृतयश्च याप्याः ||८||
"Wounds in the anus and abdomen with inverted and obstructed nature, those caused by lumps, worms, sinusitis, and abdominal disorders in individuals with skin disorders or diabetes, wounds seen with gravel, sand-like urine, wind colic, stones, dental diseases like tartar and pyorrhea, conditions like tonsillitis and impacted teeth, spreading sores, bone injuries, chest injuries, and glandular swellings are deemed to be chronic."
This shloka describes various types of chronic wounds and conditions that are difficult to treat, emphasizing the complexity and challenges in managing these cases.
साध्या याप्यत्वमायान्ति याप्याश्चासाध्यतां तथा |
घ्नन्ति प्राणानसाध्यास्तु नराणामक्रियावताम् ||९||
"Curable conditions may become manageable, and manageable ones may turn incurable. Incurable conditions can take lives if not treated properly."
This shloka emphasizes the dynamic nature of diseases and the importance of timely and appropriate treatment. It suggests that even curable conditions can become difficult to manage if neglected, and incurable conditions can be life-threatening if not addressed properly.
यापनीयं विजानीयात् क्रिया धारयते तु यम् |
क्रियायां तु निवृत्तायां सद्य एव विनश्यति ||१०||
प्राप्ता क्रियां धारयति याप्यव्याधितमातुरम् |
प्रपतिष्यदिवागारं विष्कम्भः साधुयोजितः ||११||
"A condition that is manageable should be recognized as such; it is maintained with appropriate treatment, but if treatment stops, it worsens immediately. Proper treatment maintains a manageable condition in a patient, like a well-placed pillar supports a collapsing house."
These shlokas emphasize the importance of continuous and appropriate treatment in managing chronic conditions. Just as a pillar supports a collapsing house, proper and sustained treatment is crucial to maintaining health in manageable conditions.
अत ऊर्ध्वमसाध्यान् वक्ष्यामः- मांसपिण्डवदुद्गताः प्रसेकिनोऽन्तःपूयवेदनावन्तोऽश्वापानवदुद्वृत्तौष्ठाः , केचित् कठिना गोशृङ्गवदुद्गतमृदुमांसप्ररोहाः, अपरे दुष्टरुधिरास्राविणस्तनुशीतपिच्छिलास्राविणो वा मध्योन्नताः, केचिदवसन्नशुषिरपर्यन्ताः शणतूलवत् स्नायुजालवन्तो दुर्दर्शनाः, वसामेदोमज्जमस्तुलुङ्गस्राविणश्च दोषसमुत्थाः, पीतासितमूत्रपुरीषवातवाहिनश्च कोष्ठस्थाः, त एवोभयतोभागव्रणमुखेषु पूयरक्तनिर्वाहिणः, (क्षीणमांसानां च ) सर्वतोगतयश्चाणुमुखा मांसबुद्बुदवन्तः, सशब्दवातवाहिनश्च शिरःकण्ठस्थाः, क्षीणमांसानां च पूयरक्तनिर्वाहिणोऽरोचकाविपाककासश्वासोपद्रवयुक्ताः, भिन्ने वा शिरःकपाले यत्र मस्तुलुङ्गदर्शनं त्रिदोषलिङ्गप्रादुर्भावः कासश्वासौ वा यस्येति ||१२||
"Now, I shall describe the incurable conditions: Those rising like a lump of flesh, filled with pus and pain inside, resembling a horse's hoof, some hard like a cow's horn with soft flesh growth, others discharging foul blood or thin, cold, sticky discharge, slightly elevated, some sunken, hollow, with tendons network, difficult to observe, those caused by doshas, discharging fat, marrow, and brain-like substance, those of yellow, black urine, feces, and air in the abdomen, those discharging pus and blood from both ends, those with small mouths, flesh bubbles, air-sounding located in the head and throat, those discharging pus and blood in weak persons, associated with anorexia, indigestion, cough, and dyspnea, or in cases where brain matter is seen in a fractured skull, with signs of all three doshas, cough, and dyspnea."
This shloka details various types of wounds and conditions deemed incurable due to their nature and symptoms, highlighting the complexity and challenges in treating such cases.
भवति चात्र-
वसां मेदोऽथ मज्जानं मस्तुलुङ्गं च यः स्रवेत् |
आगन्तुस्तु व्रणः सिध्येन्न सिध्येद्दोषसम्भवः ||१३||
"Moreover, A wound discharging fat, marrow, or brain matter caused by an external injury may heal, but if caused by doshas, it does not heal."
This shloka highlights the difference in the prognosis of wounds discharging essential bodily substances like fat, marrow, or brain matter. It suggests that while such wounds resulting from external injuries might heal, those caused by internal doshas are much more difficult to treat.
अमर्मोपहिते देशे सिरासन्ध्यस्थिवर्जिते |
विकारोयोऽनुपर्येति तदसाध्यस्य लक्षणम् ||१४||
"A condition affecting a non-vital part of the body, free from veins, joints, and bones, that does not progress is a sign of an incurable condition."
This shloka explains that when a condition affects a non-vital area, lacks involvement of veins, joints, and bones, and shows no progression, it is considered a sign of incurability.
क्रमेणोपचयं प्राप्य ; धातूननुगतः शनैः |
न शक्य उन्मूलयितुं वृद्धो वृक्ष इवामयः ||१५||
स स्थिरत्वान्महत्त्वाच्च धात्वनुक्रमणेन च |
निहन्त्यौषधवीर्याणि मन्त्रान् दुष्टग्रहो यथा ||१६||
"Gradually increasing and reaching the tissues slowly, like an old tree, the disease cannot be eradicated. Due to its stability and magnitude, and the gradual involvement of tissues, it destroys the potency of medicines, like an evil spirit nullifies charms."
These shlokas illustrate the nature of chronic diseases. Just like an old tree deeply rooted, chronic diseases gradually infiltrate the body's tissues and become difficult to eradicate. The stubbornness and magnitude of these diseases reduce the effectiveness of treatments, similar to how an evil spirit can nullify charms.
अतो यो विपरीतः स्यात् सुखसाध्यः स उच्यते |
अबद्धमूलः क्षुपको यद्वदुत्पाटने सुखः ||१७||
"Therefore, the condition which is opposite (to the incurable ones) is considered easily treatable; like an unrooted shrub, it is easy to uproot."
This shloka explains that conditions which do not have deep roots and are opposite in nature to the incurable ones are considered easily treatable, just as it is easy to uproot a shrub that is not deeply rooted.
त्रिभिर्दोषैरनाक्रान्तः श्यावौष्ठः पिडकी समः |
अवेदनो निरास्रावो व्रणः शुद्ध इहोच्यते ||१८||
"A wound not afflicted by the three doshas, with pale lips, a slight elevation, painless, and without discharge, is considered clean."
This shloka describes the characteristics of a wound that is considered clean and free from complications, emphasizing the absence of the three doshas, pain, and discharge as indicators of a healthy wound.
कपोतवर्णप्रतिमा यस्यान्ताः क्लेदवर्जिताः |
स्थिराश्चिपिटिकावन्तो रोहतीति तमादिशेत् ||१९||
"A wound resembling the color of a pigeon, with dry edges, firm and slightly elevated, is indicative of healing."
This shloka describes the characteristics of a wound that is healing, emphasizing a pigeon-like color, dry edges, firmness, and slight elevation as signs of a positive recovery.
रूढवर्त्मानमग्रन्थिमशूनमरुजं व्रणम् |
त्वक्सवर्णं समतलं सम्यग्रूढं विनिर्दिशेत् ||२०||
"A wound that has healed edges, is free from granulation tissue, swelling, and pain, is of the same color as the surrounding skin, flat and smooth, is considered completely healed."
This shloka provides the characteristics of a completely healed wound, emphasizing healed edges, lack of granulation tissue, absence of swelling and pain, matching skin color, flatness, and smoothness as indicators of a fully recovered wound.
दोषप्रकोपाद्व्यायामादभिघातादजीर्णतः |
हर्षात् क्रोधाद्भयाद्वाऽपि व्रणो रूढोऽपि दीर्यते ||२१||
"Due to the aggravation of doshas, excessive exercise, injury, indigestion, excessive joy, anger, or fear, a wound that has healed may reopen."
This shloka highlights the factors that can cause a previously healed wound to reopen, emphasizing the importance of maintaining balance and avoiding extremes in emotions, physical activity, and diet for proper wound healing.
इति सुश्रुतसंहितायां सूत्रस्थाने कृत्याकृत्यविधिर्नाम त्रयोविंशोऽध्यायः ||२३||
"Thus ends the twenty-third chapter named 'Kriya-Kriya Vidhi' (Guidelines on What to Do and What Not to Do) in the Sutra Sthana of the Sushruta Samhita."
This shloka marks the conclusion of the twenty-third chapter of the Sushruta Samhita, emphasizing the importance of understanding the guidelines for appropriate actions and contraindications as detailed in this chapter.