Many forms of bone disruption are taught as resulting from particular kinds of trauma, including falling, crushing or forceful pressure, blows, violent twisting or movement, bites from dangerous wild animals, and similar injuries.
The commentary presents these as causes of bhagna. Prahāra includes blows from a fist, club, sword, arrow, and similar objects. Ākṣepaṇa means excessively forceful movement. Bites by dangerous animals include attacks by tigers and similar creatures. ‘And so forth’ also includes obstruction or injury arising during forceful fighting and related events. Anekavidha means that the resulting disruptions are of many kinds.
Key terms
asthibha~gga (asthi-bhaṅga)
Disruption or fracture of bone.
patana
A fall.
pIDana (pīḍana)
Crushing or forceful pressure.
prahAra (prahāra)
A blow or strike, including with weapons or other objects.
AkShepaNa (ākṣepaṇa)
Excessively forceful movement or twisting.
vyAlamRugadashana (vyāla-mṛga-daśana)
Biting or mauling by a dangerous wild animal.
Adhikarana 3 (4) · Śloka 4
tatra bhaṅga(gna)jātamanēkavidhamanusāryamāṇaṁ dvividhamēvōpapadyatē sandhimuktaṁ, kāṇḍabhagnaṁ ca |
tatra ṣaḍvidhaṁ sandhimuktaṁ, dvādaśavidhaṁ kāṇḍabhagnaṁ bhavati ||4||
Although the group of bhagna injuries has many forms, it can be arranged under two main classes: sandhimukta, displacement at a joint, and kāṇḍabhagna, fracture through the shaft or body of a bone. Sandhimukta is said to have six forms and kāṇḍabhagna twelve.
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tēṣāṁ dvaividhyamāha- tatrētyādi| bhagnajātamiti jātaṁ samūhaḥ| anusāryamāṇam anusartuṁ prēryamāṇam| ‘anuśriyamāṇaṁ’ ityēkē paṭhanti| sandhimuktakāṇḍabhagnayōrlakṣaṇamāha- tatra parvaṇītyādi; ayaṁ pāṭhō'bhāvānna likhitō na ca vyākhyātaḥ||4||
Meaning of the commentary
The commentary explains jāta as a group or collection and reads the passage as reducing the many injuries to two broad classes. It glosses anusāryamāṇa as being directed or made to follow a classification; some instead read anuśriyamāṇa. The transmitted source visibly varies between bhaṅga and bhagna. The commentary then announces signs of sandhimukta and kāṇḍabhagna beginning with words equivalent to ‘at the joint,’ but states that this passage was unavailable and therefore was neither copied nor explained.
Key terms
sandhimukta (sandhi-mukta)
A joint whose normal articulation is displaced or disrupted in the classical classification.
Sandhimukta, displacement or disruption of a joint, is classified into six forms: utpiṣṭa, viśliṣṭa, vivartita, avakṣipta, atikṣipta, and tiryakkṣipta.
The general signs of sandhimukta are inability to extend, bend, rotate, or move the affected joint forcefully, together with severe pain and inability to tolerate touch.
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tatra sandhimuktasya sāmānyalakṣaṇamāha- tatra prasāraṇētyādi| vivartanaṁ viparītavartanam, ākṣēpaṇamatiśayēna cālanam||6||
Meaning of the commentary
The commentary identifies these as the shared signs of joint displacement. Vivartana means turning in the opposite or abnormal direction, and ākṣepaṇa means excessive or forceful movement.
Key terms
prasAraNAshakti (prasāraṇāśakti)
Inability to extend the joint.
Aku~jcanAshakti (ākuñcanāśakti)
Inability to flex or bend the joint.
vivartanAshakti (vivartanāśakti)
Inability to rotate or turn the joint, including in an abnormal direction.
AkShepaNAshakti (ākṣepaṇāśakti)
Inability to perform forceful or extensive movement.
The particular signs of the six joint injuries are described as follows. In utpishta there is swelling on both sides of the joint, pain, and especially varied pains appearing at night. Vishlishta has little swelling, continuous pain, and alteration of the joint. Vivartita produces an uneven limb because the joint has moved sideways, with pain. Avakshipta involves displacement of the joint downward and severe pain. Atikshipta involves excessive separation of the two articulating bones and pain. Tiryakkshipta involves sideways displacement of one bone and very severe pain.
The commentary glosses utpishta as crushed and vishlishta as a jarred or separated joint; sandhau is understood where omitted. Vivartita means turned abnormally, and its deformity results from both articulating bones turning and moving sideways; its pain is also irregular. In avakshipta the joint has moved downward, while in atikshipta it has moved far beyond its position, with extreme pain understood from the conjunction. In tiryakkshipta only one bone moves sideways, whereas in vivartita both do.
Key terms
utpiShTa (utpishta)
A crushed joint injury with bilateral swelling and varied pain.
vishliShTa (vishlishta)
A jarred or separated joint with persistent pain and altered shape.
vivartita
Abnormal turning and lateral displacement involving both joint bones.
avakShipta (avakshipta)
Downward displacement of a joint.
atikShipta (atikshipta)
Marked displacement or separation beyond the normal joint position.
tiryakkShipta (tiryakkshipta)
Sideways displacement involving one articulating bone.
The text next lists twelve varieties of shaft fracture: karkataka, ashvakarna, churnita, picchita, asthichallita, kandabhagna, majjanugata, atipatita, vakra, chinna, patita, and sphutita.
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kāṇḍabhagnamityādi||8||
Meaning of the commentary
The commentary only introduces this list and provides no additional explanation here.
Key terms
kANDabhagna (kandabhagna)
Fracture of the shaft of a bone and also one named subtype in the list.
karkaTaka (karkataka)
One of the twelve named shaft-fracture patterns.
cUrNita (churnita)
A crushed or fragmented fracture pattern.
majjAnugata (majjanugata)
A fracture pattern involving penetration toward the marrow.
chinna
A partially divided fracture pattern, explained later.
The general signs of a shaft fracture are pronounced swelling; intolerance of movement, turning, or touch; a sound when the area is pressed; loss of normal support or alignment of the limb; varied pains; and inability to obtain comfort in any position.
The individual fracture patterns are then described. Karkataka is elevated like a knot at the middle of a bone injured from both sides; ashvakarnaka projects like a horse's ear. Churnita produces a sound on touch. Picchita appears compressed, broadened, and greatly swollen. Asthichallita has deficient bone on the sides with a projecting fragment. The specifically named kandabhagna moves or shakes. In majjanugata, one bone fragment enters the bone and presses into the marrow. Atipatita is completely divided. Vakra is bent while the bone remains connected. Chinna retains continuity on one side. Patita has many minute splits and pain. Sphutita is swollen and broad, with pain likened to being filled with grain awns.
The commentary records several interpretive differences. It first glosses the karkataka wording as highly evident to touch, while Gayadasa explains compression from both sides causing extension, depression, and a knot-like central projection; the reading unna(dga)ta is uncertain. Asthichallika is an alternative name for asthichallita. Although kandabhagna can name all twelve shaft fractures, one subtype receives the name specifically. Vakra is only slightly bent. Gayi assigns the description of many small fissures to sphutita and the following description to patita, reversing the received allocation. Shuka means a grain awn and conveys a particular pain; Gayi also reads vipulaikadari, 'having one broad fissure,' instead of vipulam visphutitam.
Key terms
karkaTaka (karkataka)
A fracture with a central knot-like projection in the preferred explanation.
ashvakarNaka (ashvakarnaka)
A projecting fracture compared with a horse's ear.
cUrNita (churnita)
A fragmented fracture associated here with sound on touch.
asthicchallita (asthichallita)
A fracture with a projecting bone fragment and loss at the sides.
majjAnugata (majjanugata)
A fragment driven inward toward the marrow.
atipAtita (atipatita)
A completely divided bone.
sphuTita (sphutita)
A fissured fracture whose precise distinction from patita varies by reading.
Among these fractures, churnita, chinna, atipatita, and majjanugata are said to be difficult to treat. Fractures in a thin, elderly, or young person; in someone depleted by injury, affected by kushtha, or troubled by breathlessness; and fractures involving a joint are also considered difficult.
The commentary introduces the difficult-to-treat group and says that the conjunction also includes a fracture situated in the shaft itself.
Key terms
kRucchrasAdhya (krichchhrasadhya)
Difficult to treat or heal in the historical prognosis.
cUrNita (churnita)
A fragmented fracture type.
atipAtita (atipatita)
A completely divided fracture.
majjAnugata (majjanugata)
A fracture driven toward the marrow.
sandhyupagata
A fracture involving a joint.
kANDopagata (kandopagata)
Situated in the bone shaft, added by the commentary.
Adhikarana 11 (12-14) · Śloka 15
bhavanti cātra- bhinnaṁ kapālaṁ kaṭyāṁ tu sandhimuktaṁ tathā cyutam |
jaghanaṁ prati piṣṭaṁ ca varjayēttaccikitsakaḥ ||12||
asaṁśliṣṭaṁ kapālaṁ tu lalāṭē cūrṇitaṁ ca yat |
bhagnaṁ stanāntarē śaṅkhē pr̥ṣṭhē mūrdhni ca varjayēt ||13||
āditō yacca durjātamasthi sandhirathāpi vā |
samyagyamitamapyasthi durnyāsāddurnibandhanāt ||14||
saṅkṣōbhādvā'pi yadgacchēdvikriyāṁ tacca varjayēt |15|
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भवन्ति चात्र- भिन्नं कपालं कट्यां तु सन्धिमुक्तं तथा च्युतम् |
जघनं प्रति पिष्टं च वर्जयेत्तच्चिकित्सकः ||१२||
असंश्लिष्टं कपालं तु ललाटे चूर्णितं च यत् |
भग्नं स्तनान्तरे शङ्खे पृष्ठे मूर्ध्नि च वर्जयेत् ||१३||
आदितो यच्च दुर्जातमस्थि सन्धिरथापि वा |
सम्यग्यमितमप्यस्थि दुर्न्यासाद्दुर्निबन्धनात् ||१४||
सङ्क्षोभाद्वाऽपि यद्गच्छेद्विक्रियां तच्च वर्जयेत् |१५|
Meaning of the śloka
The physician is instructed to leave aside, as having an unfavorable classical prognosis, a split or severely fractured pelvic plate; any of the stated forms of joint displacement at the hip; a pelvis crushed in that region; a joint whose surfaces no longer meet; a comminuted fracture of the forehead; and fractures or dislocations involving the region between the breasts, temple, back, or head. A bone or joint that was badly aligned from the beginning is likewise to be avoided. Even a bone initially placed correctly is considered unfavorable if poor positioning, inadequate binding, or renewed disturbance causes deformity.
The commentary enumerates injuries considered incurable in the classical account. A split plate is treated as a shaft-type fracture, while all six kinds of sandhimukta are included. Cyuta is glossed as separated and hanging; although it is already a type of joint displacement, it is named separately to emphasize it. A crushed injury at the pelvic region is also classified under sandhimukta. Asamshlishta means a disrupted joint, and a comminuted forehead injury is categorized as a shaft fracture. The general word bhagna should be understood to include both joint displacement and shaft fracture. The final verses extend the unfavorable prognosis to any bone or joint that was difficult to unite from the outset, or that later deforms because of poor placement, poor binding, or movement such as that caused by sexual activity. The supplied commentary ends incompletely after verses 12-14 although the source includes the line numbered 15.
Key terms
sandhimukta
A classical category of displacement or separation at a joint.
kANDabhagna (kandabhagna)
A fracture of the bone proper or shaft-type category in the commentary.
cyuta (chyuta)
Displaced, separated, or hanging.
asaMshliShTa (asamshlishta)
A joint whose surfaces are disrupted or do not meet.
cUrNita (churnita)
Crushed or comminuted.
durnyAsa-durnibandhana (durnyasa-durnibandhana)
Poor positioning and inadequate binding of an injury.
Adhikarana 12 (15) · Śloka 16
madhyasya vayasō'vasthāstisrō yāḥ parikīrtitāḥ ||15||
tatra sthirō bhavējjanturupakrāntō vijānatā |16|
The commentary identifies the three stages of middle age as extending from after the sixteenth year through completion of the fortieth year. The supplied commentary ends incompletely after verse 15 although the source continues with the line numbered 16.
Key terms
madhyama vayas
Middle age in the classical life-stage scheme.
tisro avasthA (tisro avastha)
Three stages within the stated age period.
upakrAnta (upakranta)
Undertaken for treatment or treated.
vijAnat (vijanat)
A knowledgeable practitioner.
sthira
Stable, firm, or successfully restored in context.
Adhikarana 13 (16) · Śloka 17
taruṇāsthīni namyantē bhajyantē nalakāni tu ||16||
kapālāni vibhidyantē sphuṭanti rucakāni ca ||17||
The commentary distinguishes fracture patterns by five classical kinds of bone. Taruna bones are found at the nose, ear, throat, and orbital prominence; they bend, giving the vakra type of injury. Nalaka bones are the long bones of the limbs and break or snap. Kapala bones are plate-like bones such as those of the skull and undergo splitting injuries, including cracking and cleaving. Ruchaka means the teeth, in which a cracked injury occurs. The conjunction also includes cracking in valaya bones. Thus the five stated bone types are taruna, nalaka, kapala, valaya, and ruchaka. The supplied commentary ends incompletely after verse 16 although the source includes verse 17.
Key terms
taruNAsthi (tarunasthi)
A flexible classical bone type at sites such as the nose, ear, throat, and orbital prominence.
इति सुश्रुतसंहितायां निदानस्थाने भग्ननिदानं नाम पञ्चदशोऽध्यायः ||१५||
Meaning of the śloka
Thus ends the fifteenth chapter of the Nidanasthana in the Sushruta Samhita, entitled Bhagnanidana, the diagnostic account of fractures and dislocations.
The commentary colophon states that the fifteenth chapter of the Nidanasthana is complete in Shri Dalhana's explanation of Sushruta entitled Nibandhasangraha.
Key terms
bhagna
A classical injury category encompassing fractures and joint displacements in this chapter.
bhagnanidAna (Bhagnanidana)
The chapter on causes and diagnostic description of fractures and dislocations.
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.