Treatment of traumatic wounds (Sadyovrana Chikitsa) in Astangahrdaya of Vagbhata

 Treatment of traumatic wounds (Sadyovrana Chikitsa) in Astangahrdaya of Vagbhata

We shall now expound the chapter– Sadyovrana chikitsa [treatment of wounds which occur suddenly (traumatic wounds)]; Thus said atreya and other great sages.

Sadyovrana are those which occur suddenly due to trauma/injury; though innumerable localised in defferent parts of the body, these are classified as of eight kinds viz, ghrsta, avakrtta, vicchinna, pravilambita, patita, viddha, bhinna and vidalita. 1-2a.

Ghrsta is that which exudes lasika (lymph) alone or mixed with little of blood, associated with burning sensation; Avagadha is severe than ghrsta and Vicchinna still more severe than avagadha. Pravilambi is that in which only the bone remains in the place; patita is that in which the injured part has fallen off from (seperated) from the body; Viddha is a wound with small orifice caused by a foreign body any where on the body except the kostha (organs inside the trunk); such a wound occuring in the kostha is called Bhinna; Vidalita is that which occurs due to hitting (assault), squeezing and crushing of bones, found containing marrow and blood inside and has become thick. 2b-5. 

Treatment of traumatic wounds

Sadyovrana (traumatic wounds) which has severe pain should be immediately bathed (washed) in warm yasti ghrta or bala taila often.

In order to mitigate the heat of the wound, drugs which posess astringent taste, cold potency, sweet taste and unctuous properties should be made use of for lepa (external application of paste) etc. 7.

In traumatic wounds which are wide, in order to promote healing, honey ghee should be specially made use of, so also treatment which mitigate pitta and are cold. 8.

When accompanied with severe swelling, purification of the body in the upper (emesis) and lower parts (purgation) and fasting are beneficial, frequent blood letting also after consumption of food. 9.

These (above) are the methods specially suited for ghrsta and vidalita kinds; in these the bleeding is less, hence 10. paka (suppuration) develops quickly.

In others (avakrtta and vicchinna) there is copious discharge of blood generally, by loss of blood vata undergoes aggravation and causes severe pain. For this condition, drinking of fats, washing the wound, fomentation, external application of paste, warm paultice and fat enema therapy all prepared from the drugs which mitigate vata should be administered. 11-12.

Thus were described the method of treatment for the first seven days beneficial to traumatic wounds; after seven days when the severity has subsided, the treatments discribed previously (in previous chapter) should be adopted. 13.

This is the general line of treatment; further on will be described treatment special to each, seperately. 14a.

In Ghrsta kind of ulcer, the pain should be controlled first and then the wound dusted with the powder (of drugs), in Avakrtta, paste (of drugs) etc. in Vicchina and Pravilambi suturing, bandaging and squeezing should be done one after the other, as per procerdure described previously. 14b-15. 

The eye (ball) which is split (broken) is not treated which has come out and hanging loose (incurable); that and its vein not cut, then the physician should push it inside with the help of his palm holding a leaf of a lotus; goat’s ghee boiled with yastyahva, jivaka, rsabhaka, utpala and milk is beneficial for bathing the eye, nasal drops, and filling the eyes. This cures all the injuries of the eyes. 16-18.

If the eye (ball) has gone deep inside, hard pressing of the throat inducing of vomitting, cough and sneeze or control of respiration should be done and also the treatments prescribed for ulceration of the eye. 19. 

If the ear (pinna) is displaced, it should be sutured (at the proper place) and the ear filled with medicated oil. 20a. 

If the krkatika (cricoid eartilage in the neck) is found cut and air is coming out through it, it should be placed in the proper level, sutured without leaving any space in the middle and then bandaged. It is ideal to bathe the site with goat’s ghee, the patient should eat food lieing with his face up and sleep well restrained (without making movement). 21-22a.

If the extremities are injured and found distorted, they should be brought back to their normal position, sutured and bandaged with vellita bandha, using thick cloth. In case of wounds which are irregular (uneven) gosphana bandha should be tied using leather strap. 22b-23.

If in a person the scrotum is found hanging loose and the testes have come out (as a result of injury) the feet and eyes of such a person should be washed with water (first), then the testes should be pushed into the scrotum and sutured at the suture called tunnasevani (vesico-rectal raphae) then gosphana bandha should be tied, tieing one end of the band at the waist. Use of fats and fomentation should not be done to the site since the ulcer might become moist (exude pus). 24-25. 

Medicated oil prepared with kalanusari, aguru, ela, jati, candana, parpata, sila, darvi, amrta and tuttha is good for healing. 26.

The limb which has been completely cut off should be bandaged using kosabandha and then treated like any ulcer. 27.

In Viddha kind of wound from which the foreign body has been removed, the treatment prescribed for vidalita wound, should be done. 28a.

After removing the foreign body from the head (scalp) a wick of hair should be inserted into that holes, otherwise by discharge of mastulunga (brain mattar) cala (vata) getting aggravated may kill the person; after the wounds heal, the wick of hair should be removed one after the other.

In case of elimination of brain matter, the patient should partake the brain of other animals. 30a.

Wound caused by removal of foreign bodies should be plugged with (cotton) wick soaked in fats (oil or ghee), 30. 

The wounds which are deep seated, with minute mouth (orifice) and exuding blood should be bathed with cakra taila (oil dribbling from the pestle of the oil mill) pushed inside through the minute tubes. 31. 

Signs of injury to internal viscera

If the organs of the trunk are wounded/ injured there is accumilation of blood inside, fainting, pain in the region of the heart and flonks, fever, burning sensation, thirst, flatulance, lack of desire for food, obstruction fo faeces, urine and flatus, dyspnoea, sweating, redness of the eyes, smell of iron from the mouth and abnormal smell in body. 32-33.

If the blood has accumilated in the stomach, there is vomiting of blood and the person dies by profound flatulence and severe pain. 34. 

If the blood has accumilated in the large intestines, there is pain, heaviness below the umbilius, coldness and blood comes out through the orifices (of faeces etc.). 35.

The organs even though not wounded (visibly) gets filled with blood from minute channels from all the sides just like the urinary bladder from the urine. 36.

The person who has accumilation of blood inside, whose feet, expired air, hands and face are cold, eyes are red, face is pale and abdomen bloated should be rejected. 37. 

Treatment of visceral wounds 

If accumulation of blood is in the stomach emesis is beneficial and if it is in the large intestine, purgation and decoction enema without addition of fats; with drugs of hot potency and of purgative properties. 38.

He should partake his food with the soup of yava, kola or kulattha without adding fats or drink yavagu (gruel) added with saindhava. 39.

 The patient wounded in the viscera who has lost much blood should drink blood ( of animals). 40a. 

Kosthabheda is of two kinds viz klistantra and chidrantra, in the first fainting etc. are mild and in the second they are very troublesome; in klistantra life of the person is doubtful (may survive or may not survive) but in chidrantra, the person does not survive at all. 40-41. 

The person though wounded in the internal organs surely survives when the faeces, urine and flatus begun to come out in their normal passages and when other complications get relieved. 42.

The intestine which is not wounded and which has come out should be pushed inside but not otherwise (if it is wounded); that should be pushed inside only after it is held ight by the head of the big ants– thus say some others. 43.

The intesine contaminated with grass, blood, sand etc. should be washed well with water and the physician with his hands smeared with ghee and nails pared, should push the intestine slowly. 44.

The intestine which is dry should be moistened with milk and more of ghee, then with his fingers the physician should squeeze the throat and stimulate him with water. Soon the intestine enters into the abdomen by these methods. If the intestines do not get in, then the abdomen should be cut open to the required size and the intestine pushed in 45-47a.

When the intestine occupies its proper place the wound should be sutured; if displaced again it the away may take life, by aggravation. A band of cloth should be wound round the abdomen and soaked daily with ghee. He should drink warm milk added with citra taila (castor oil) in order to make the faeces soft and flatus to move down. This procedure should be continued for one year along with other therapies prescribed in the treatment of ulcers. 47b-50a.

If the medas varti (wick of fat / pancreas) has come out, it should be cleaned with soft ash or decoction of astrigent drugs or fine powder of roots of trees, then made straight, tied firm with thread and cut, then after buched with red hot iron; if not done so, it may lead to pain, gurglings or death. Next the wound should be bathed with honey or milk boiled with sarkara, citra, laksa, goksura and yastyahva, this is best to relieve pain and burning sensation. Medicated oil prescribed for medoja granthi previously (vide chapter 31) should also be adopted for anointing in this condition also. 50-54.

Mamsi, Medicated oil prepared with talisa, padmaka, herenu, aguru, candana, the two haridra, seed of padma, usira and madhuka, is good for healing of ulcers. 55-56a.

In wound which are caused by concealed blow, in which parts of the body have got displaced, which are irregular and greatly elevated, treatments such as tarpana (nourishment), mardana (massage), abhyanjana (oil anointing), etc. which are prescribed for vatasra ( gout) should be done. 56b-57a.

The person whose body is badly wounded, churned, emaciated, injured in the vital organs and badly damaged should be kept in bath-tub filled with medicated oil and the patient consuming juice of meat as food. 57b-572.