अथातो भग्नानां चिकित्सितं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
Meaning of the śloka
Now the treatment of fractures and dislocations will be explained, as taught by the revered Dhanvantari.
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athāta ityādi||1-2||
Meaning of the commentary
The commentary only marks the conventional opening of the chapter.
Key terms
bhagna
A fracture or dislocation in this chapter.
cikitsita
Treatment or management.
Adhikarana 2 (3) · Śloka 3
alpāśinō'nātmavatō jantōrvātātmakasya ca |
upadravairvā juṣṭasya bhagnaṁ kr̥cchrēṇa sidhyati ||3||
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अल्पाशिनोऽनात्मवतो जन्तोर्वातात्मकस्य च |
उपद्रवैर्वा जुष्टस्य भग्नं कृच्छ्रेण सिध्यति ||३||
Meaning of the śloka
A fracture is said to heal with difficulty in a person who eats too little, lacks self-restraint, has a vata constitution, or is affected by complications.
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tatra prathamaṁ bhagnasya kr̥cchrasādhyatvamāha- alpāśina ityādi| anātmavataḥ ajitēndriyasya apathyaratasyētyarthaḥ| vātātmakasya vātaprakr̥tēḥ| upadravairiti upadravā jvarādhmānamūtrapurīṣasaṅgādayaḥ| amuṁ pāṭhaṁ jējjaṭō na manyatē; gayī tu manyata ityasmābhiraṅgīkr̥taḥ||3||
Meaning of the commentary
Lack of self-restraint is explained as attachment to unsuitable diet and conduct. Complications include fever, abdominal distension, and retention of urine or stool. Jejjata rejects this reading, while Gayi accepts it; the commentator follows Gayi.
Key terms
kRucchrasAdhya (kricchra-sadhya)
Difficult to heal or treat.
vAtAtmaka (vatatmaka)
Having a vata-predominant constitution.
upadrava
A complication, such as fever or retention.
Adhikarana 3 (4) · Śloka 4
lavaṇaṁ kaṭukaṁ kṣāramamlaṁ maithunamātapam |
vyāyāmaṁ ca na sēvēta bhagnō rūkṣānnamēva ca ||4||
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लवणं कटुकं क्षारमम्लं मैथुनमातपम् |
व्यायामं च न सेवेत भग्नो रूक्षान्नमेव च ||४||
Meaning of the śloka
A person with a fracture is instructed to avoid salty, pungent, alkaline, sour, and dry foods, sexual intercourse, heat from the sun, and physical exercise.
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idānīmasēvyānāha- lavaṇamityādi||4||
Meaning of the commentary
The commentary simply identifies these as factors the patient is told not to use.
The knowledgeable practitioner is directed to give a person with a fracture nourishing foods and drinks, including shali rice, meat soup, milk, ghee, and soup made from satina.
Although milk is generally prohibited for wounds, it is treated here as an exception for fracture. Others permit it only where the fracture has no open wound; another view rejects milk because it is classed with new grains and thought to promote suppuration and pus. Some read kshira-sarpis as one compound meaning ghee produced from milk. Satina is round pea; though regarded as vata-producing, its soup is accepted when prepared with ghee and related ingredients. Brimhana means promoting bodily growth.
Key terms
shAli (shali)
A variety of rice.
satIna (satina)
Round pea, according to the commentary.
bRuMhaNa (brimhana)
Nourishing or promoting bodily growth.
kShIrasarpis (kshira-sarpis)
Read either as milk and ghee or as ghee derived from milk.
Adhikarana 5 (6) · Śloka 6
madhūkōdumbarāśvatthapalāśakakubhatvacaḥ |
vaṁśasarjavaṭānāṁ ca kuśārthamupasaṁharēt ||6||
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मधूकोदुम्बराश्वत्थपलाशककुभत्वचः |
वंशसर्जवटानां च कुशार्थमुपसंहरेत् ||६||
Meaning of the śloka
The text directs collecting the bark of madhuka, udumbara, ashvattha, palasha, kakubha, bamboo, sarja, and vata to make materials for supporting and binding a fracture.
Kusha here means splinting material used for a fractured wound and includes bamboo, cane, and similar supports. 'Bark' is supplied for bamboo, sarja, and vata as well. Some read kushya, with the same meaning.
Key terms
kusha
Splinting or supporting material in this context.
bhagnabandhana (bhagna-bandhana)
Binding or splinting a fracture.
kushya
A variant reading carrying the same interpretation.
Adhikarana 6 (7) · Śloka 7
ālēpanārthaṁ mañjiṣṭhāṁ madhukaṁ raktacandanam |
śatadhautaghr̥tōnmiśraṁ śālipiṣṭaṁ ca saṁharēt ||7||
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आलेपनार्थं मञ्जिष्ठां मधुकं रक्तचन्दनम् |
शतधौतघृतोन्मिश्रं शालिपिष्टं च संहरेत् ||७||
Meaning of the śloka
For an external application, the text directs combining manjishtha, madhuka, red sandalwood, rice flour, and ghee washed one hundred times.
These are the substances for a fracture paste and are combined together. Some read 'bring it ground with sour liquid' instead of rice flour; this is explained as ground with kanjika.
Key terms
Alepa (alepa)
A topical paste.
shatadhautaghRuta (shata-dhauta-ghrita)
Ghee said to have been washed one hundred times.
kA~jjika (kanjika)
A sour fermented grain liquid in the variant reading.
The text recommends renewing the fracture bandage every seven days in mild seasons, every five days in moderate seasons, and every three days in hot seasons, or according to the condition of the fracture and its dosha involvement.
If a fracture is bound too loosely, stability does not develop. If bound too tightly, swelling, pain, and suppuration arise in the skin and other tissues. Therefore those knowledgeable in fractures recommend a moderate bandage.
Of the three bandage tensions—tight, even, and loose—the tight and loose forms are harmful in fracture, so only even or moderate binding is recommended. Sandhi-sthairya means firmness or stability of the joint.
Key terms
atishithila (ati-shithila)
Excessively loose.
gADha (gadha)
Tight binding.
sAdhAraNabandha (sadharana-bandha)
Moderate or even bandaging.
pAka (paka)
Suppuration or inflammatory breakdown.
Adhikarana 9 (11) · Śloka 11
nyagrōdhādikaṣāyaṁ tu suśītaṁ pariṣēcanē |
pañcamūlīvipakvaṁ tu kṣīraṁ kuryāt savēdanē ||11||
The text prescribes a very cool Nyagrodhadi decoction for pouring over the injury and, when pain is present, milk prepared with the smaller Panchamula group.
Cool Nyagrodhadi pouring is intended for a pitta constitution and hot weather, to promote union and prevent suppuration. The Panchamula milk is an alternative where vata predominates together with pitta and pain; the smaller Panchamula is selected because it is regarded as cooling in potency.
Key terms
pariSheka (parisheka)
Pouring a liquid over the injured area.
nyagrodhAdi (Nyagrodhadi)
A classical group used for a cool decoction.
laghupa~jcamUla (laghu-panchamula)
The smaller group of five roots.
Adhikarana 10 (12) · Śloka 12
sukhōṣṇamavacāryaṁ vā cakratailaṁ vijānatā |12|
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सुखोष्णमवचार्यं वा चक्रतैलं विजानता |१२|
Meaning of the śloka
A knowledgeable practitioner may apply pleasantly warm chakrataila as a pouring treatment.
This is prescribed when vata and kapha predominate, pain is present, and the weather is cold. Some define chakrataila as oil extracted by pressing and used immediately; others call it unheated oil collected by the method used for anu oil.
Key terms
cakrataila (chakra-taila)
Oil whose method of preparation is disputed between freshly pressed and unheated extraction.
sukhoShNa (sukhoshna)
Pleasantly or mildly warm.
Adhikarana 11 (12) · Śloka 13
vibhajya kālaṁ dōṣaṁ ca dōṣaghnauṣadhasaṁyutam ||12||
pariṣēkaṁ pradēhaṁ ca vidadhyācchītamēva ca |13|
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विभज्य कालं दोषं च दोषघ्नौषधसंयुतम् ||१२||
परिषेकं प्रदेहं च विदध्याच्छीतमेव च |१३|
Meaning of the śloka
After distinguishing the season and dosha, the text directs use of a pouring liquid and paste containing medicines that oppose the relevant dosha, generally cool but also warm when those factors call for it.
In the morning, the person with a fracture is instructed to drink cool milk from a cow that has recently calved, prepared with sweet herbs, ghee, and laksha.
Grishti is a cow after its first delivery, and sweet herbs are those of the Kakolyadi group. The commentary specifies a daily formulation: a karsha of herbs cooked in eight times milk and four times water until only milk remains, then combined with a karsha each of ghee and laksha. It is given on an empty or light stomach rather than after eating.
When a fracture is accompanied by a wound, the text directs applying an astringent preparation dominated by ghee and honey to the wound, while managing the remaining diet and conduct as for fracture generally.
Pratisarya means applying or coating. The astringent preparation is a Nyagrodhadi paste in which ghee and honey predominate. The remaining measures refer to diet, conduct, and related care.
A fracture managed with the preceding diet and conduct is said to be easier to heal in early life, in a person with little dosha disturbance, and during a cool season.
The text directs raising a part displaced downward, pressing down one displaced upward, applying traction to one excessively shifted, and moving upward one displaced below.
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idānīṁ dvividhānāmapi sandhimuktakāṇḍabhagnānāṁ pratīkārōpāyānāha- avanāmitamityādi| avanāmitam adhōgatam| unnahyēt ūrdhvaṁ kuryādityarthaḥ| atikṣiptam atiprēritam, upari vartayēdupari nayēdityarthaḥ| gayī tu avanāmitamityādi paṭhitvā pañca sthāpanōpāyānāha, sa ca pāṭhō'bhāvānna likhitaḥ||17||-
Meaning of the commentary
These are methods for both dislocation and shaft fracture. Avanamita means displaced downward and unnahyet means to raise it. Atikshipta means excessively driven or shifted, and 'move upward' means bring it to a higher position. Gayi reads the passage as five methods of placement, but the additional reading is not supplied in the commentary's source.
The knowledgeable physician is instructed to restore all movable and immovable joints, and also shaft fractures, through traction, pressure and positional movements, controlled repositioning, and then bandaging.
Pressure includes bending, raising, and turning. Samkshepa is explained as correct driving or repositioning and is assigned particularly to a crush injury. The part is first aligned by traction and related methods and then treated with bandaging. Movable joints include those of the limbs, waist, and jaw; others are immovable. Gayi interprets samkshepa as flexion and regards it as redundant with pressure, rejects Jejjata's reading, and gives an alternative line naming traction, upward pressure, elevation, disturbance or mobilization, and bandaging.
A physician should not strike or move a crushed or dislocated joint. Cold irrigation and pastes are applied; when the effect of trauma subsides, the joint is expected to return toward its natural state. It is wrapped according to method with a ghee-coated cloth, kusa grass is placed over it, and a bandage is applied.
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idānīmutpiṣṭaviśliṣṭayōścikitsitamāha- utpiṣṭamityādi| utpiṣṭaṁ viśliṣṭaṁ ca sandhiṁ na ghaṭṭayēnna cālayēt; utpiṣṭaḥ cūrṇitaḥ, viśliṣṭaḥ vighaṭitaḥ svasthānāccyuta ityarthaḥ| pradēhō lēpaḥ||20-21||-
Meaning of the commentary
The commentary explains utpishta as crushed and vishlishta as separated or displaced from its normal position. Neither should be struck or moved. Pradeha means a topical paste.
Samutpishta means crushed, and raktanugata means associated with vitiated blood. The ara is identified as a leather-worker's pointed tool used to puncture the site and let blood out.
Alignment is described through positioning maneuvers such as bending and straightening. The bandage must be thin or fine because a thick one would cause pressure and discomfort.
For a fracture of the sole, the foot is anointed with ghee, kusa grass is placed over it, and it is secured with a cloth bandage. Exercise is prohibited.
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talabhagnacikitsitamāha- abhyajyētyādi||25||
Meaning of the commentary
The commentary introduces this directly as treatment for a fracture of the sole and adds no further explanation.
Key terms
talabhagna
A fracture involving the sole or plantar region.
kushottara
Having a layer of kusa grass placed over the site.
vyAyAma (vyayama)
Exercise or exertion, prohibited here.
Adhikarana 23 (26) · Śloka 26
abhyajyāyāmayējjaṅghāmūruṁ ca susamāhitaḥ |
dattvā vr̥kṣatvacaḥ śītā vastrapaṭṭēna vēṣṭayēt ||26||
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अभ्यज्यायामयेज्जङ्घामूरुं च सुसमाहितः |
दत्त्वा वृक्षत्वचः शीता वस्त्रपट्टेन वेष्टयेत् ||२६||
Meaning of the śloka
For fractures of the lower leg and thigh, the text directs careful anointing and traction, placement of cool tree bark as splints, and wrapping with cloth.
Jangha is the leg above the foot in the region of the long bones. Ayamayet is glossed as binding, with the parenthetical wording uncertain. The practitioner must act carefully. The cool bark is from banyan and similar trees and is placed as kusa or splinting material.
Key terms
ja~gghA (jangha)
The lower leg, especially the long-bone region.
Uru (uru)
The thigh.
AyAmana (ayamana)
Traction or extension, glossed in the commentary as binding.
One explanation has a circular splint applied and bent or drawn like a wheel. Gayi instead describes strong attendants holding both heels and feet and rapidly rotating the fractured person's body so that its motion resembles a wheel. The words split and crushed qualify the thigh bone. The commentary further says that in similar fractures, bone completely detached from surrounding tissues is removed before even bandaging.
For a fracture or displacement at the hip, the text directs drawing the person upward or downward according to the displacement, securing the joint after restoring its position, and then treating with oil enemas.
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kaṭibhagnacikitsāmāha- āñchēdūrdhvamityādi| āñchēdūrdhvamadhō vā'pīti ūrdhvagatamasthi adhaḥ kr̥tvā badhnīyāt, adhōgataṁ tūrdhvaṁ kr̥tvā badhnīyādityarthaḥ| bastibhiḥ snēhabastibhiḥ| nanu kaṭibhagnamasādhyamuktaṁ; tadyathā- “bhinnaṁ kapālaṁ kaṭyāṁ tu sandhimuktaṁ tathā cyutam| jaghanaṁ prati piṣṭaṁ ca varjayēttu vicakṣaṇaḥ” (ni. 15) iti vyarthamēva cikitsitaṁ? naivaṁ, prati piṣṭaṁ cēti cakārō varjayēdityatra draṣṭavyaḥ, tēnānēna yāpyatvaṁ samuccīyatē; ētaduktaṁ bhavati- kapālabhēdō varjyaḥ, sandhimuktasandhicyutē tu yāpyē, tēna tadviṣayacikitsitamidaṁ sārthakamiti gayī; jējjaṭastu varjayēdityatra varjanaśabdaḥ kr̥cchrasādhyatvapratipādanārthō na tu niṣēdhārtha ityāha||28||
Meaning of the commentary
A bone displaced upward is moved downward and one displaced downward is moved upward before binding. The commentary addresses an apparent conflict with an earlier statement that hip injury should be abandoned. Gayi interprets skull fracture as incurable but hip dislocation as manageable rather than curable; Jejjata says 'abandon' there indicates difficult curability rather than an absolute prohibition.
Key terms
kaTibhagna (katibhagna)
Fracture or disruption at the hip or pelvic region.
sandhimukta
A joint displaced from its normal articulation.
yApya (yapya)
Manageable or maintainable rather than fully curable.
For fractured ribs, the standing patient is anointed with ghee and the affected right or left ribs are stroked into alignment. Supports are applied and the chest is carefully wrapped in a spiral bandage. The person may also be laid in a vat or wooden trough filled with oil.
Parshuka denotes ribs attached toward the back, and bending is treated as their fracture. The patient is upright rather than seated. Alignment is attempted with a ghee-coated hand. Nibandhani is interpreted as muscle-like ties; kavalika as bamboo or similar splint pieces, though others say cloth pads. The trough is wooden and boat-shaped.
Key terms
parshukA (parshuka)
A rib attached toward the posterior thorax.
kavalikA (kavalika)
A bamboo splint piece or, alternatively, a cloth pad.
vellitakabandha
A spiral chest bandage.
droNI (droni)
A boat-shaped wooden trough.
Adhikarana 27 (31) · Śloka 31
musalēnōtkṣipēt kakṣāmaṁsasandhau visaṁhatē |
sthānasthitaṁ ca badhnīyāt svastikēna vicakṣaṇaḥ ||31||
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मुसलेनोत्क्षिपेत् कक्षामंससन्धौ विसंहते |
स्थानस्थितं च बध्नीयात् स्वस्तिकेन विचक्षणः ||३१||
Meaning of the śloka
When the shoulder joint is dislocated, the text directs lifting the armpit with a pestle, restoring the joint to its position, and securing it with a svastika bandage.
The pestle raises the axilla. Amsasandhi is the articulation at the head of the upper arm, and visamhata means dislocated. Svastika is a specific crossing form of bandage.
Key terms
aMsasandhi (amsasandhi)
The shoulder articulation at the head of the upper arm.
visaMhata (visamhata)
Dislocated or separated.
musala
A pestle used historically as a reduction lever.
svastikabandha
A crossing bandage used to secure the shoulder.
Adhikarana 28 (32) · Śloka 33
kaurparaṁ tu tathā sandhimaṅguṣṭhēnānumārjayēt |
anumr̥jya tataḥ sandhiṁ pīḍayēt kūrparāccyutam ||32||
prasāryākuñcayēccainaṁ snēhasēkaṁ ca dāpayēt |33|
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कौर्परं तु तथा सन्धिमङ्गुष्ठेनानुमार्जयेत् |
अनुमृज्य ततः सन्धिं पीडयेत् कूर्पराच्च्युतम् ||३२||
प्रसार्याकुञ्चयेच्चैनं स्नेहसेकं च दापयेत् |३३|
Meaning of the śloka
For a displaced elbow, the joint is rubbed with the thumb to identify its course, pressed back into position, extended and flexed, and irrigated with oil.
The elbow lies at the middle of the arm. Anumarjana means rubbing or palpating; in a displaced joint this is done to find the path of the joint surfaces. The supplied commentary ends incompletely.
Key terms
kUrparasandhi (kurparasandhi)
The elbow joint.
cyuta (chyuta)
Displaced or dislocated.
anumArjana (anumarjana)
Palpation or rubbing intended to identify the joint's course.
prasAraNAku~jcana (prasaranakunchana)
Extension and flexion after historical reduction.
Adhikarana 29 (33) · Śloka 33
ēvaṁ jānuni gulphē ca maṇibandhē ca kārayēt ||33||
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एवं जानुनि गुल्फे च मणिबन्धे च कारयेत् ||३३||
Meaning of the śloka
The same method described for the elbow is extended to the knee, ankle, and wrist.
The instruction applies the elbow-joint treatment by analogy. Gulpha is the prominence or joint above the heel, and manibandha is the wrist above the palm.
उभे तले समे कृत्वा तलभग्नस्य देहिनः |
बध्नीयादामतैलेन परिषेकं च कारयेत् ||३४||
मृत्पिण्डं धारयेत् पूर्वं लवणं च ततः परम् |
हस्ते जातबले चापि कुर्यात् पाषाणधारणम् ||३५||
Meaning of the śloka
For a fractured palm, the two surfaces are made even, bandaged, and irrigated with unprocessed oil. Rehabilitation progresses from holding a lump of earth, then salt, and finally a stone once strength returns to the hand.
Jejjata interprets the two surfaces as palm and sole. Gayi instead understands both palms: the injured one is matched with the other, or both injured hands with a similarly shaped wooden piece. Others compare either palm or sole with a matching wooden form and bind both together. The graded objects restore function. Jejjata rejects the transmitted earth-then-salt reading and instead reads successive balls of cow dung, clay, and finally stone.
Key terms
talabhagna
A fracture of the palm or, in some interpretations, a plantar surface.
Amataila (amataila)
Uncooked or unprocessed oil.
mRutpiNDa (mritpinda)
A lump of earth used in graded rehabilitation.
pAShANadhAraNa (pashanadharana)
Holding a stone after strength returns.
Adhikarana 31 (36) · Śloka 36
sannamunnamayēt svinnamakṣakaṁ musalēna tu |
tathōnnataṁ pīḍayēcca badhnīyādgāḍhamēva ca ||36||
View original
सन्नमुन्नमयेत् स्विन्नमक्षकं मुसलेन तु |
तथोन्नतं पीडयेच्च बध्नीयाद्गाढमेव च ||३६||
Meaning of the śloka
For the akshaka displaced downward, the text directs warming it and lifting it with a pestle; when displaced upward, pressing it downward with a pestle. It is then firmly bandaged.
Sanna means sunk downward. The pestle is used to elevate it; an upward displacement is first warmed and then pressed down. Akshaka is located above the shoulder joint.
Key terms
akShaka (akshaka)
A structure above the shoulder joint, commonly understood in the clavicular region.
sanna
Depressed or displaced downward.
unnata
Raised or displaced upward.
musala
A pestle used historically for leverage.
Adhikarana 32 (37) · Śloka 37
ūruvaccāpi kartavyaṁ bāhubhagnacikitsitam |37|
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ऊरुवच्चापि कर्तव्यं बाहुभग्नचिकित्सितम् |३७|
Meaning of the śloka
A fracture of the upper arm is to be treated in the same way as a fracture of the thigh.
When the neck is twisted or displaced downward, the text directs grasping the posterior neck depression and jaws to lift the person. Even splints are placed, the neck is wrapped with cloth, and the person is kept supine for seven nights under attentive care.
Vivritta means crooked or twisted. Avatu is the depression at the posterior neck joint. Jejjata understands both the depression and jaws as grasped during elevation; Gayi applies grasping the depression to downward displacement and the jaws to twisting. Some take sama as qualifying even placement of splints, while others take it as a wrap neither too tight nor too loose. Atandrita implies an attentive physician. The supplied commentary ends incompletely.
Key terms
vivRttagrIvA (vivrittagriva)
A twisted or crooked neck.
avaTu (avatu)
The posterior neck depression or joint region.
hanu
The jaw used as a point of grasp in the historical maneuver.
For a dislocated jaw, the two jaw bones are brought evenly together and warmed; once properly positioned, a five-part bandage is applied. Ghee prepared with vata-calming and sweet-group herbs is praised for nasal administration.
Bringing the jaw bones together means aligning the right with the left. Visamhata means displaced from its position. Panchangi is a five-tailed form of bandage. Vata-calming herbs are identified differently as bhadradaru and related plants or the vidarigandhadi group; sweet herbs are the kakolyadi group, used as paste and decoction to prepare the ghee.
In a young person, loosened but unbroken teeth that are bleeding are to be pressed back into place, treated externally with cooling applications and cool water, and then managed with substances intended to help them reattach. Milk is to be drunk through a lotus stalk. In an older person, loosened teeth are to be left untreated by this method.
A nose driven inward or turned aside by fracture is to be straightened with a probe. Two-ended tubes are then placed separately in the nostrils, the nose is wrapped with a bandage, and ghee is poured over it.
The commentary explains sanna as forced inward by trauma and vivritta as crooked. The depressed nose is lifted with a probe and the crooked nose straightened. The tubes have inner and outer openings to permit breathing and the discharge of nasal mucus. The final measure is irrigation with ghee.
Key terms
nAsAbhagna (nasa-bhagna)
A traumatic fracture or displacement of the nose.
shalAkA (shalaka)
A probe or rod used historically for elevation and reduction.
dvimukhI nADI (dvimukhi-nadi)
A tube open at both ends placed in a nostril.
ghRutaseka (ghrita-seka)
Pouring or irrigation with ghee.
Adhikarana 37 (45) · Śloka 45
bhagnaṁ karṇaṁ tu badhnīyāt samaṁ kr̥tvā ghr̥taplutam |
sadyaḥkṣatavidhānaṁ ca tataḥ paścāt samācarēt ||45||
A fractured or displaced ear is to be restored to an even position, coated with ghee, and bandaged. It is then managed according to the regimen for a fresh wound.
The commentary takes the ear injury as crooked or driven inward and says the fresh-wound regimen includes massage with honey and ghee and cooling irrigation. It preserves another reading stating that the fresh-wound regimen is also used when an eye has come out. Some reject this line because a ruptured eye is already described as untreatable; others retain it to account for two types of eye injury.
Key terms
karNabhagna (karna-bhagna)
A fractured, bent, or displaced external ear.
sadyaHkShatavidhi (sadyah-kshata-vidhi)
The historical regimen for a fresh wound.
nirgata nayana (nirgata-nayana)
An eye displaced outward in the disputed variant.
akarmaNya (akarmanya)
Considered unsuitable for treatment in the cited discussion.
For a fracture of the skull without discharge of brain matter, the text directs applying honey and ghee, bandaging the injury, and drinking ghee for seven days.
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kapālabhagnacikitsitamāha- mastuluṅgādvinētyādi| mastuluṅgasrāvē tu prāgabhihitaiva bālavartirityabhiprāyaḥ||46||
Meaning of the commentary
The commentary says that when brain matter is discharged, the wick treatment described earlier is intended instead.
Key terms
kapAlabhagna (kapala-bhagna)
A fracture of the skull.
mastulu~gga (mastulunga)
Brain substance or intracranial tissue in this context.
madhusarpiH (madhu-sarpis)
Honey and ghee.
bAlavarti (bala-varti)
A previously described wick treatment referenced for exposed or discharged brain matter.
When a body part becomes swollen but the skin is unbroken after a fall or blow, the physician is directed to use cool external pastes and cool irrigation.
The commentary emphasizes that both pastes and irrigations should be cool and never warm, because the injury is understood to have lost much blood and heat is feared to cause suppuration.
Key terms
abhighAta (abhighata)
A blow or traumatic impact.
akShata (akshata)
Without an open break in the skin.
pradeha
An external medicinal paste.
seka
Pouring or irrigation over the injured area.
Adhikarana 40 (48-49) · Śloka 49
atha jaṅghōrubhagnānāṁ kapāṭaśayanaṁ hitam |
kīlakā bandhanārthaṁ ca pañca kāryā vijānatā ||48||
yathā na calanaṁ tasya bhagnasya kriyatē tathā |
sandhērubhayatō dvau dvau talē caikaśca kīlakaḥ ||49||
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अथ जङ्घोरुभग्नानां कपाटशयनं हितम् |
कीलका बन्धनार्थं च पञ्च कार्या विजानता ||४८||
यथा न चलनं तस्य भग्नस्य क्रियते तथा |
सन्धेरुभयतो द्वौ द्वौ तले चैकश्च कीलकः ||४९||
Meaning of the śloka
For fractures of the leg or thigh, lying on a rigid door-like board is prescribed. Five pegs are arranged to prevent movement: two on either side of each adjacent joint and one at the sole.
The commentary primarily applies this to shaft fractures, though some include both principal fracture types. Some say the rigid board is required for transport; others say it prevents movement of the supported limb. For a leg fracture, two pegs flank the ankle, two flank the knee, and one is at the sole. For a thigh fracture, pairs flank the knee and groin with one at the sole. If both leg and thigh are fractured, seven pegs are described: pairs outside both ankles, knees, and groins, plus one at the sole. Another reading says two pegs on each side of the leg or thigh and one at the sole, but the commentator rejects it; a further Gayi variant is mentioned but unavailable and therefore not recorded.
श्रोण्यां वा पृष्ठवंशे वा वक्षस्यक्षकयोस्तथा |
भग्नसन्धिविमोक्षेषु विधिमेनं समाचरेत् ||५०||
Meaning of the śloka
The same rigid-board and immobilization method is prescribed for fractures or joint dislocations involving the pelvis, spinal column, chest, or the two shoulder-top regions.
The commentary identifies shroni with the pelvic or waist region, vakshas with the chest, and akshaka with the areas above the shoulder joints. The method includes the rigid board, pegs, and restraint and is applied both to shaft fractures and the two types of joint displacement.
Key terms
shroNI (shroni)
The pelvis or waist region.
pRuShThavaMsha (prishtha-vamsha)
The spinal column.
vakShas (vakshas)
The chest.
akShaka (akshaka)
The paired regions above the shoulder joints.
sandhivimokSha (sandhi-vimoksha)
Displacement or dislocation of a joint.
Adhikarana 42 (51) · Śloka 51
sandhīṁściravimuktāṁstu snigdhān svinnān mr̥dūkr̥tān uktairvidhānairbuddhyā ca samyak prakr̥timānayēt ||51||
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सन्धींश्चिरविमुक्तांस्तु स्निग्धान् स्विन्नान् मृदूकृतान् उक्तैर्विधानैर्बुद्ध्या च सम्यक् प्रकृतिमानयेत् ||५१||
Meaning of the śloka
Long-standing dislocated joints are to be made unctuous, warmed, and softened, and then restored to their natural position by the stated methods together with sound judgment.
After describing recent fractures, the commentary identifies this as treatment for an old dislocation. 'Together with judgment' implies that the practitioner must also reason out what is appropriate rather than rely only on the stated rules.
Key terms
ciravimukta sandhi (chira-vimukta-sandhi)
A joint that has remained dislocated for a long time.
snigdha
Made unctuous.
svinna
Warmed or fomented.
prakRtimAnayet (prakritim anayet)
Restore to the natural position.
Adhikarana 43 (52) · Śloka 52
kāṇḍabhagnē prarūḍhē tu viṣamōlbaṇasaṁhitē |
āpōthya samayēdbhagnaṁ tatō bhagnavadācarēt ||52||
When a shaft fracture has healed in a displaced, prominent, or uneven position, the text directs that it be separated again, aligned evenly, and then treated as a new fracture.
The commentary presents this after the old-dislocation treatment as the method for an old shaft fracture. Apothya means separating the united bone, and samayet means making it even or aligned.
A dry piece of bone projecting at the edge of a wound is to be carefully cut away without creating another wound. When a wound lies near the end of a joint, it should be managed according to the regimen for a fracture with an open wound.
The commentary glosses kalpayet as 'cut away.' Vranante means at one part or edge of the wound, and samahita means acting carefully so that no additional wound is produced. Sandhyante means near a joint, and the passage specifically concerns that area when it is wounded.
For fractures of the upper body, the text recommends a head-retaining oil procedure, filling the ears with oil, drinking ghee, and nasal medication; for fractures of the limbs, it recommends an oil enema.
The head procedure is a form of shirobasti using oil-soaked cloth or similar materials. Jejjata reads the allocation differently: nasal medication is for fractures of the knees, lower legs, and both arms, while drinking ghee and enema apply throughout. Gayi instead assigns all measures through nasya to upper-body fractures and enema to limb fractures.
Key terms
mastiShkya (mastishkya)
A head-retaining oil procedure related to shirobasti.
karNapUraNa (karna-purana)
Filling the ear with oil.
nasya
Nasal administration of medicine.
anuvAsana (anuvasana)
An unctuous enema.
prashAkhA (prashakha)
Major limb branches, here including arms and lower limbs.
The text gives an elaborate preparation called Gandha oil for fractures. Black sesame is repeatedly soaked and dried over successive seven-day periods in flowing water, cow's milk, madhuka water, and milk again; it is combined with many aromatic and strengthening plants, pressed with medicated milk, and the extracted oil is cooked gently with another large group of herbs. The oil is claimed to be useful in all fracture treatments and, by drinking, massage, nasal administration, enema, food, or other uses, for convulsions, paralysis, dry palate, facial palsy, neck stiffness, head disease, ear pain, jaw restriction, deafness, impaired vision, and reproductive depletion. It is also claimed to enlarge the neck, shoulders, and chest and make the face lotus-like and fragrant, and is described as a royal preparation that removes all vata disorders.
The commentary explains the repeated seven-day processing stages and several competing ingredient proportions. Jejjata gives one ratio, Gayi a six-part scheme, and Vangadatta equal combined herbal powder and sesame powder. Repetition of yashtimadhu and tagara may signal double portions or mandatory inclusion. Medicated milk is prepared with aromatic substances, used warm to moisten and press the sesame, and the extracted oil is then cooked with four times milk and the listed paste ingredients over gentle fire. Numerous botanical identifications and a milk-cooking rule are supplied. The oil is called Gandha oil here but Anu oil in Vaitarana. It is said to be made especially for kings because it requires extensive resources, though not forbidden to others.
Key terms
gandhataila (gandha-taila)
The elaborate aromatic medicated oil described in this passage.
bhAvanA (bhavana)
Repeated soaking or levigation of a substance with liquid.
mRdu agni (mridu-agni)
Gentle heat used during historical oil cooking.
AkShepaka (akshepaka)
A classical disorder involving convulsive or spasmodic movements.
pakShaghAta (pakshaghata)
A classical paralytic disorder affecting one side or part of the body.
Oils from trapusa, bibhitaka, and priyala are combined with sweet-group herbs and, if available, animal fat, then cooked in ten parts milk. The text describes the resulting unctuous preparation as quickly aiding fractures when used for drinking, massage, nasal medication, enema, or irrigation.
The commentary identifies trapusa as a type of cucumber, aksha as bibhitaka, and priyala as chara; the sweet substances are the Kakolyadi group and are used in a proportion relative to the fat base. Animal fat is included only if available, and seka means irrigation. Some authorities consider this passage non-authoritative or not part of the original text.
Key terms
trapusa
A cucumber-like plant whose oil is used.
akSha (aksha)
Bibhitaka in this commentary.
vasA (vasa)
Animal fat, added if available.
snehottama
A preparation praised as especially unctuous.
anArSha (anarsha)
Regarded by some as not belonging to the authoritative original text.
The physician should strive to prevent a fracture from developing suppuration, because once flesh, vessels, and ligaments have suppurated, healing is achieved only with difficulty.
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idānīṁ bhagnē bāhyānāmābhyantarāṇāṁ ca pākakāriṇāṁ parihārāya pākapraśamakāriṇāṁ ca sēvanāyāha- bhagnaṁ naitītyādi| naiti na gacchatītyarthaḥ| prayatēta prayatnaṁ kurvītētyarthaḥ||69||
Meaning of the commentary
The commentary says this instructs avoidance of external and internal factors that promote suppuration and use of measures that calm it. Na eti simply means 'does not go toward' suppuration, and prayateta means the physician should make a deliberate effort.
Key terms
pAka (paka)
Suppuration or destructive inflammatory change in this context.
mAMsa (mamsa)
Flesh or soft tissue.
sirA (sira)
A vessel-like classical structure.
snAyu (snayu)
A binding fibrous structure such as ligament or tendon in context, without exact uniform equivalence.
Adhikarana 49 (70) · Śloka 70
bhagnaṁ sandhimanāviddhamahīnāṅgamanulbaṇam |
sukhacēṣṭāpracāraṁ ca saṁhitaṁ samyagādiśēt ||70||
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भग्नं सन्धिमनाविद्धमहीनाङ्गमनुल्बणम् |
सुखचेष्टाप्रचारं च संहितं सम्यगादिशेत् ||७०||
Meaning of the śloka
A fracture is said to have united properly when the bone or joint is not distorted, the limb has neither shortening nor loss of a part, there is no prominence, and flexion, extension, and other movements can be performed comfortably.
The commentary lists these as signs of sound union. Anaviddha means not disordered or distorted, anulbana means not raised or prominent, and free range of activity includes bending, straightening, and related movement.
Key terms
samyak saMhita (samyak-samhita)
Properly united or healed.
anAviddha (anaviddha)
Not distorted or disordered.
ahInA~gga (ahina-anga)
Without shortening, deficiency, or loss of the limb or part.
anulbaNa (anulbana)
Without abnormal prominence.
ceShTApracAra (cheshta-prachara)
Range and ease of movement, including flexion and extension.
The commentary states that the third chapter of the Cikitsasthana is complete in Dalhana's Nibandhasangraha commentary on Sushruta; the transmitted text notes a spelling variant in Dalhana's name.
Key terms
bhagna
Fracture and, in the chapter's broader usage, traumatic disruption including dislocation.