Treatment of fractures (Bhanga Pratisedha) in Ashtang Hridayam

 Treatment of fractures (Bhanga Pratisedha) in  Ashtang Hridayam

We shall now expound the chapter– Bhanga pratisedha (treatment of fractures); thus said Atreya and other great sages. 

Bones get broken ( fractured ) from a fall from height, assault etc; it is of two kinds, a. sandhigata-localised in the joint and b. asandhigata-in places other then the joints; inability for expansion (extension) and contraction (flexion etc.) and dislocation of the joint are the features of the first kind; whereas in the second kind profound swelling and severe pain in all positions, inability even for slight movement, production of cracking sound on rubbing are the features of fractures in brief. It is of many kinds, based on the nature of fractures. 1-3a.

Those treatments which are common to all kinds and which are useful as a routine will be described here. 3b-4a. 

Asadhya laksana Chikitsa of sandhigata bhanga 

The bone which has been crushed into very small pieces, that which causes sound on touching, in which pieces of bones have entered into the marrow cavity, the condition where, by trauma very little portion of bone is left inside the body, that condition in which raising the fractured portion makes it sink into the marrow-all these kinds are difficult to cure; so also those found in persons who are emaciated, debilitated, having predominance of vata in their body and who consume very little food. 4b-6.

Fracture of the pelvic bone in its flat portion, dislocation of joints of the waist and crushing fracture of pubic bone should be refused. 7.

Skull bones not knit together, the forehead bone is broken to pieces and that fracture which has occured in the middlle of the temples, head, back and breasts should be rejected. 8. 

That bone, which in spite of proper control (by the use of splints etc.) becomes irreregular (distorted) by improper joining, bandaging and exertion (functioning of the affected part) should be refused treatment; so also the bone and the joint which is ill-formed from the beginning itself. 9-10a.

Cartilages bend, tubular bones break, flat bones get punctured and others get cracked-most of the time; all are difficult to cure. 10b-11a. 

Chikitsa of sandhigata bhanga

The portion of bone which is displaced down should be raised up and that which is displaced up should be pulled down; that which has moved away to other places should be pulled to its normal place, that which is displaced below should be brought up by pulling, kneading, raising, constricting the skin and bandaging. 11b-12. 

All the joints of the body whether moveble or immovable should be placed in their normal position by these methods and immobalised by bands of cloth soaked in plenty of ghee. Hard, thick and smooth pieces of inner bark of kadamba, udumbara, asvattha, sarja, arjuna and palasa or even pieces of vamsa should be arranged evenly over the cloth bandage as kusa (splints) and then bandaged again. By loose bandaging stability (immobility) of the joint is not achieved and by very tight bandaging there is the possibility of pain, burning sensation, ripening, ulceration/suppuration, or swelling manifesting. 13-17a.

In summer, bandage should be removed every third day, in cold season once in seven days, in moderate seasons once in five days, or at such intervals depending on the condition of the fracture and the dosa. 17b-18a.

It (fracture) should then be bathed either with cold decoction of drugs of nyagrodhadi gana (chapter 15 of sutrasthana) and when there is pain with milk boiled with drugs of pancamula. 18b-19a. 

Or after carefully considering the nature of the land and season, cakrataila added with drugs which mitigate vata may be poured over the place comfortably warm, pouring decoctions and application of paste of drugs should be continuous both in very cold state. 19b-20.

The patient of fracture should drink gristiksira (milk of the cow which has delevered the calf within seven days). every morning added with ghee and boiled with drugs of sweet taste and laksa and then cooled. 21.

In case of fracture with a wound, the wound should be bathed with decoction of drugs of astringent taste added with more of honey and ghee. Remaining treatment is like that described for fractures. 22. 

Notes: Bhagna (fracture) is two kinds-Savrana-with a wound (compound fracture) and Avrana-without a wound (simple fracture).

Muscles which are hanging loose in the wound should be smeared with honey and ghee and then cut, sutured and bandaged appropriately. 23.

Observing that these are well adhered, fine powder of either phalini, rodhra, katphala, samanga and dhataki; or of dhataki and rodhra should be sprinkled over them; by this the wounds heal quickly. 24-25a.

Thus was described the treatment of bhanga; it is easily curable in those who have strong tissues, during autumn, in persons who are muscular and who have mild aggravation of dosa; the opposite of all these are either very difficult or impossible to cure. 25b-26a. 

By adopting the treatment described earlier, persons of early, middle and late ages should attain strength in the (fractured) joints in one, two and three months respectively.

For fractures of the waist, forelegs and thighs it is beneficial to lie on a hard wooden box fitted with five pegs to control (immobolise the leg) two each for the forelegs (calves) and thighs and one for the sole. In the same way (in fractures) of the pelvis, vertebral column, chest or the collar bone. 27b-29a.

This method may be followed in case of fracture-dislocation of the joints. 29b.

Dislocation of the joint which has become old, should be made soft by anointing with oil and fomentation and then placed in the normal position by the methods described above by using intellegence. 30.

A fracture which is not located in the joints and has healed improperly (malunion), should be broken up again and treated properly. 31.

The physician should not allow ripening (suppuration) in the fracture site; since muscle, veins, tendons, joints which develop pus do not stick together. 32.

Medicated fats described in the treament of vata vyadhi (chapter 21 of Cikitsasthana) should be made use of for the four therapies (drinking, nasal drops, anointing and enema), recipes which give strength to the body and enema therapy should be adopted. 33.

The patient of fracture should consume in proper quantities foods such as rice, ghee, juice of meat, milk etc. which are nourishing the body which do not cause heartburnt and which bestow sturdiness to the joints. 34.

Exertion (over activity of the fractured part) is not good for him; for, it will produce dislocation of the joint. The patient of fracture should not indulge in things which are salty, pungent, alkaline and sour; copulation, exposure to sunlight, exercise and dry (non-fatty) foods. 35. 

Krsna tila, well cleaned is tied into a bundle with a thick cloth and allowed to stay in flowing water for seven days. Then it is soaked in milk and decoction of madhuka daily and dried in the shade. ( this continued for seven days); once again it is soked in milk, removed of its husk and powdered, it is then mixed with the fine powder of nalada, valaka, lohitayastika, nakha, misi, plava, kustha, balatraya, aguru, kumkuma, candana, sariva, sarala, sarjarasa, amaradaru and the drugs of padmakadi gana, all drugs of fragrant smell (eladigana) and macerated with milk; medicated oil should then be cooked with the above drugs, added with the paste of saileya, rasna, amsumati, kaseru, kalanusari, nata, patra, rodhra, ksirasukla and durva, milk and oil. This oil known as Gandha taila Gandha taila is good to bestow sturdiness to the bones, cure diseases produced by vata and pitta though powerful and spread all over the body by using it in different methods therapies. 36-41.