अथातो व्रणालेपनबन्धविधिमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
आलेप आद्य उपक्रमः , एष सर्वशोफानां सामान्यः प्रधानतमश्च, तं च प्रतिरोगं वक्ष्यामः- ततो बन्धः प्रधानं, तेन शुद्धिर्व्रणरोपणमस्थिसन्धिस्थैर्यं च ||३||
Meaning of the śloka
Now the chapter on the procedure for applying pastes and bandages to wounds will be explained, as taught by Bhagavan Dhanvantari. Application of a paste is the first measure. It is common to all swellings and is the foremost measure; its disease-specific uses will be described separately. Bandaging is the principal measure after application, because it supports cleansing and healing of a wound and stability of bones and joints.
The first measure here is alepa. Although depletion is listed first in the earlier chapter on two kinds of wounds, alepa is first among medicinal substances used for external and internal cleansing. It can also be called first because it is near the beginning or because it is excellent. It is common to vata and the other kinds of swelling because all share the character of receiving an application. It is foremost among measures because it quickly relieves distress. Its use for each disease will be stated in this section and in Chikitsasthana. After the application, bandaging is principal. The final phrase supplies the sense that firmness of bone and joint results. Some teachers do not read this statement about bone and joint stability.
Key terms
Alepa (alepa)
A medicinal paste or topical application used as an initial measure for swelling.
vraNabandha (vranabandha)
Bandaging of a wound to support cleansing, healing and stability.
The application should be spread against the direction of the body hair. Applied in this direction, the medicine remains properly in place, enters the hair follicles, and its potency reaches the openings of the vessels that carry sweat.
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इदानीमालेपावचारणं तत्फलं च निर्देष्टुमाह- तत्रेत्यादि| प्रतिलोममालिम्पेदिति लोमाभिमुखमालिम्पेत्| हि यस्मादर्थे| अवतिष्ठते अवस्थितिं करोति, अनुप्रविशति च ‘औषधं’ इत्यनुवर्तते||४||
Meaning of the commentary
Pratiloma means applying the paste facing against the hair. The medicine is understood as the subject both of remaining in place and of entering the follicles.
Key terms
pratiloma
Against the natural direction of the body hair.
Adhikarana ३ (५) · Śloka ५
न च शुष्यमाणमुपेक्षेत, अन्यत्र पीडयितव्यात् |
शुष्को ह्यपार्थको रुक्करश्च ||५||
Meaning of the śloka
Do not leave an application in place while it is drying, except on a wound that is meant to receive a compressive application. Once dry, it is ineffective and causes pain.
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आलेपस्यावस्थायां कर्तव्यतामाह- न चेत्यादि| अन्यत्र पीडयितव्यादिति पीडनद्रव्यैर्मिश्रकोक्तैर्यो व्रणः पीडनीयो भवति तस्मादन्यत्र शुष्यमाणं नोपेक्षेतेत्यर्थः| हि यस्मादर्थे| अपार्थको निष्फलः||५||
Meaning of the commentary
The exception concerns a wound for which pressure is intended through the compressive substances described in the Mishraka section. On other wounds the application should not be neglected as it dries. Aparthaka means fruitless or ineffective.
Topical application is threefold: pralepa, pradeha and alepa. Pralepa is cold, thin, and may be non-drying or drying. Pradeha may be warm or cold, is thick but not spread excessively, and is non-drying. Alepa is intermediate between them. Alepa chiefly calms blood and pitta. Pradeha calms vata and kapha, cleanses and heals, and removes swelling and pain. It is used on wounds and on unbroken swellings. When applied to a wound it is additionally called kalka, while the designation alepa is restricted. It checks discharge, produces softness, removes putrid flesh, leaves no pus within, and cleanses the wound.
The distinction between pralepa and pradeha is conventional even though they are not fundamentally different, like the conventional distinction between standing and sitting. For pralepa, non-drying use applies to a wound swelling that should not be compressed, while drying use applies where compression is intended. Thus paste spread like sandalwood paste is pralepa. Others assign the stated features cold and thin to pradeha. Pradeha is warm for conditions dominated by vata or kapha and cold for those dominated by pitta or blood. It is thick, meaning that a paste formed into a mass and placed over the wound is pradeha. Some instead assign the warm-or-cold and following characteristics to pralepa. There are also textual variants in the functions: some read pradeha where alepa appears, while others read alepa where pradeha appears. Use on injured and uninjured sites means use on wounds and wound swellings. When alepa is used on an open wound it takes the additional name kalka. Niruddha means prohibited or restricted; another reading is nirodhya, with the same intended sense. The discharge checked can be blood or another fluid. Absence of internal dosha here means absence of pus within. Wound cleansing means removal of dosha-related contamination, and the conjunction also includes wound healing.
Key terms
pralepa
A thin topical paste, described as cold and either drying or non-drying in the main reading.
pradeha
A thick, non-drying application placed as a mass, warm or cold according to the condition.
kalka
The additional designation given here to an alepa when it is used on an open wound.
Topical application is beneficial in swellings that have not become inflamed or suppurative. According to the particular dosha, it calms that dosha and removes burning, itching and pain. It is foremost for clearing and soothing the skin, flesh and blood, excellent for calming burning, and destroys pain and itching. In diseases situated at vital points and in the private parts, a physician should apply it for cleansing. The parenthetical verse directs a proportion of unctuous substance of one-sixth in a pitta condition, one-fourth in a vata condition and one-eighth in a kapha condition.
This defines the proper stage for alepa: it is beneficial before the swelling becomes vidagdha. Once that state occurs, pradeha is used and also receives the name upanaha. An application is appropriate when, by the qualities of its ingredients, it calms the particular involved dosha. Burning is associated with pitta, itching with kapha and pain with vata. The repeated mention of burning, itching and pain indicates that these features can also arise from the affected tissues, not only from doshas. Agrya means principal or foremost.
Key terms
avidagdha shopha
A swelling that has not yet reached the inflamed or suppurative stage for which a different application is prescribed.
upanAha (upanaha)
An alternative designation given by the commentary to pradeha when used after the swelling becomes vidagdha.
Its prescribed thickness is the raised thickness of a wet buffalo hide.
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तनुत्वमालेपस्य गुणः, तनुत्वं किं प्रमाणमित्याह- तस्येत्यादि| प्रदेहस्तु महिषार्द्रचर्मोच्छ्रायापेक्षया स्थूल इति| ये तु तनुत्वं प्रदेहगुणं मन्यते, तेषां मते प्रदेहस्यैतत् प्रमाणम्||११||
Meaning of the commentary
Thinness is a quality of alepa, and this comparison specifies its measure. Pradeha, by contrast, is thicker than a wet buffalo hide. Those who regard thinness as a quality of pradeha take this stated measure to apply to pradeha instead.
Adhikarana ७ (१२-१५) · Śloka १५
न चालेपं रात्रौ प्रयुञ्जीत , मा भूच्छैत्यविहतोष्मणस्तदनिर्गमाद्विकारप्रवृत्तिरिति ||१२||
प्रदेहसाध्ये व्याधौ तु हितमालेपनं दिवा |
पित्तरक्ताभिघातोत्थे सविषे च विशेषतः ||१३||
न च पर्युषितं लेपं कदाचिदवचारयेत् |
उपर्युपरि लेपं च न कदाचित् प्रदापयेत् ||१४||
ऊष्माणं वेदनां दाहं घनत्वाज्जनयेत् स हि |
न च तेनैव लेपेन प्रदेहं दापयेत् पुनः |
शुष्कभावात्स निर्वीर्यो युक्तोऽपि स्यादपार्थकः ||१५||
Meaning of the śloka
Alepa should not be applied at night, because cold may obstruct the heat and, when that heat cannot escape, aggravation of the disorder may occur. In a disease suitable for pradeha, application during the day is beneficial, especially when the condition arises from pitta, blood, trauma or poison. A stale paste should never be applied, nor should a fresh layer be placed over an existing layer. Because of its density, such layering produces heat, pain and burning. The same paste should not be reused for pradeha; after drying it has lost its potency and is useless even if applied properly.
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विशिष्टे काले आलेपावचारणविधिनिषेधे, कथञ्चित्क्रियमाणे च दोषमाह- न चेत्यादि| एतेनास्य विधिः सूच्यते; तेन वातश्लैष्मिकापाकिशोथे रात्रौ प्रदेह उपयोक्तव्यः, तथा विदह्यमाने शोथे प्रदेहो देय एव, क्षतेषु कल्कोऽपि रात्रौ दातव्य इति, तथा पित्तजे शोथे वातपित्तजे च शतधौतघृताभ्यङ्गादि दातव्यमिति| शैत्याविहतोष्मण इति ‘शोफस्य’ इति शेषः| तदनिर्गमात् शोफोष्मानिःसरणात्| विकारप्रवृत्तिर्विकाराभिवृद्धिः| शैत्यरुद्धरोमकूपत्वादनिर्गच्छन्नूष्मा आलेपेनान्तर्नीतोऽत्यर्थं शोफं पचतीत्यर्थः| स्वेदवाहिभिः सिरामुखैश्च वीर्यं प्राप्नोतीत्यत ऊर्ध्वं बहुषु प्रतिषु निबन्धपाठक्रमाद्व्यतिक्रमेण पाठक्रमोऽधिकश्च पाठो दृश्यते; स उच्यते- “तस्य प्रमाणं महिषार्द्रचर्मोत्सेधमुपदिशन्ति| न च शुष्यमाणमुपेक्षेतान्यत्र पीडयितव्यात्; शुष्को ह्यपार्थो रुक्करश्च| स त्रिविध आलेपः प्रदेहो लेपश्च| तेषामन्तरं- आलेपः शीतस्तनुरविशोषी विशोषी च, प्रदेहस्तूष्णः शीतो वा बहुलो बहुरविशोषी च, मध्यमो लेप इति| विशेषतो रक्तपित्तप्रसादकृदालेपः; प्रलेपो वातश्लेष्मप्रशमनः शोधनो रोपणः शोफवेदनापहश्च, तस्योपयोगः क्षताक्षतेषु; यस्तु क्षतेषूपयुज्यते स भूयः ‘कल्क’ इति सञ्ज्ञा लभते निरुद्धालेपनसञ्ज्ञः, तेनास्रावसन्निरोधो मृदुता पूतिमांसापकर्षणमनन्तर्दोषता व्रणशुद्धिश्च भवति| उभयगुणो लेपः| न चालेपं रात्रौ प्रयुञ्जीत, माभूच्छैत्यविहतोष्मणस्तदनिर्गमाद्विकारप्रवृत्तिरिति| त्वक्प्रसादनमेवाग्र्यं मांसरक्तप्रसादनम्| दाहप्रशमनं श्रेष्ठं तोदकण्डूविनाशनम्|| मर्मदेशेषु ये रोगा गुह्येष्वपि तथा नृणाम्| संशोधनाय तेषां हि कुर्यादालेपनं भिषक्|| अविदग्धेषु शोथेषु हितमालेपनं भवेत्| यथास्वं दोषशमनं दाहकण्डूविनाशनम्|| षड्भागं पैत्तिके स्नेहं चतुर्भागं तु वातिके| अष्टभागं तु कफजे स्नेहमात्रां प्रदापयेत्”- इति| अयं पाठो वर्तमानेषु पुस्तकेषु सर्वेष्वेव पठ्यत इत्यस्माभिः क्रममात्रं दर्शितं; न त्वयं पठनीयः; पठनीयः पुनः प्राक्तनपाठ एव, सर्वपूर्वाचार्यसम्मतत्वात्||१२-१५||
Meaning of the commentary
The prohibition concerning night use also indicates exceptions. Pradeha may be used at night in an unripe swelling dominated by vata or kapha. It is also to be used when a swelling is actively becoming inflamed, kalka may be placed on wounds at night, and applications such as massage with hundred-times-washed ghee may be given in pitta or vata-pitta swelling. In the stated explanation, cold obstructs the pores, traps the swelling's heat under the application and causes further maturation or aggravation. The commentary then records that many manuscripts contain a longer passage after the statement that potency reaches the sweat-bearing vessel openings. This alternate arrangement repeats and reorders material on thickness, drying, the three applications, their functions, night use, effects on tissues, application to vital or private regions, early swelling and dosha-specific proportions of unctuous material. The commentator presents this only to show the alternate order and says it should not be adopted; the earlier reading is preferred because all earlier teachers accept it.
Key terms
paryuShita lepa (paryushita lepa)
A stale or previously prepared paste that the passage prohibits from use.
The materials for wound bandaging are now taught: linen, cotton cloth, woollen cloth, dukula, silk, patrorna, Chinese cloth, leather, inner bark, pieces of bottle gourd, split creepers, split material, rope, plant down or fibrous fruits, santanika and metals. They are to be used after considering the disease and the time, and their particular selection is directed by the clinical context.
Because bandaging depends on its materials, these are described first. Kshauma is woven from flax fibres, though others call it another kind of cloth. Karpasa is cotton fibre and avika is woven sheep wool. Dukula is silk cloth, while others call it bark cloth. Kausheya comes from the cocoon-making worm and is commonly called trasara. Patrorna has several explanations: a blanket called ralluka; cloth used for green and other divine garments; washed silk; or fabric woven from green wool-like fibres arising from leaves of four trees including naga in regions such as Magadha and Paundraka. Chinese cloth is produced in China, is called cinayugapatta by people there, and is taken as a variety of patrorna; others identify it as netra cloth. Carma can mean hides such as antelope hide, any leather-like bandage material, or fabric woven by Turks from leather threads coated with gold paste. Antarvalkala is the middle bark after removing the outer and innermost portions. Alabushakala is a shell fragment of the bottle-gourd fruit. Latavidala can mean a split half of a creeper such as shyamalata. Some connect vidala with leather and the preceding materials; others take it as a strip of bamboo, cane or similar material and lata as the creepers. Rope is twisted from munja, balvaja or similar fibres. Tulaphala includes the fruit fibres of shalmali. Santanika may mean milk-skin; others read kushalasantanika, a two- or three-threaded weaver's product commonly called vaya, while some identify it as markatavasa. Metals include gold, tin and lead. Dense bandage materials suit vata-kapha disease, cold weather and firm sites; thin ones suit blood-pitta disease, hot weather and lax sites. Clinical context determines specific use: arishta may be tied with protective substances after snakebite, santanika used to control excessive bleeding, split creepers used to stabilize fractures, gold and other metals used to bind teeth, tin and similar metals used for arbuda or granthi, and bottle-gourd shell used for head wounds. Other materials are assigned as appropriate.
Key terms
patrorNa (patrorna)
A bandage textile with several competing identifications preserved by the commentary, including a blanket, washed silk and leaf-fibre cloth.
santAnikA (santanika)
A bandage material variously identified as milk-skin or, under a variant reading, a lightly woven thread product.
There are fourteen special forms of bandage: Kosha, Dama, Svastika, Anuvellita, Mutoli, Mandala, Sthagika, Yamaka, Khatva, Cina, Vibandha, Vitana, Gophana and Pancangi. Their shapes are for the most part indicated by their names.
Because the names alone cannot reveal every form, the commentary quotes descriptions from another work. Kosha is made in the form of a sheath after filling the site with medicines and is said to be free from constricting ties. Dama has the shape of a four-ended cord. Svastika is sewn in a svastika form and then wrapped; this wrapping is Anuvellita. Mutoli has many limbs, resembles a fist and has many net-like openings; physicians also call it Gotundika or Calani. Mandala is a circular wrapping. Sthagika is filled like a small bag with medicines and secured with cloth. A circular bandage used for a pair of wounds is called Yamaka. Khatva is four-ended like a bedstead. Cina is surrounded by many strips. Vibandha is a varied bandage furnished with six cindhikas according to the transmitted reading. Vitana resembles a canopy. Gophana is known as a sling used to raise a stone or ball of jaggery and is fashioned in that shape. Pancangi is made with five strips and used for joining or stabilization.
Key terms
bandhavisheSha (bandhavishesha)
A particular named configuration of bandage selected according to shape and purpose.
gophaNA (gophana)
A sling-shaped bandage compared with a device used to lift a stone or ball of jaggery.
Among the bandages, kosha should be used on the joints of the thumb and fingers; dama on a narrow body part; svastika on joints, kurcaka regions, the eyebrows, between the breasts, the palms and soles, and the ears; anuvellita on the limbs; mutoli or pratoli on the neck and penis; mandala on a rounded part; sthagika on the tips of the thumb, fingers and penis; yamaka for paired wounds; khatva on the jaw, temple and cheek; cina at the outer corners of the eyes; vibandha on the back, abdomen and chest; vitana on the head; gophana on the chin, nose, lips, shoulder and bladder region; and pancangi above the clavicles. A bandage may also be used on whichever body region it fits well.
This passage assigns the fourteen bandage forms to body regions. The word parva applies to the joints of both thumbs and fingers. A narrow part is a constricted body region. Kurcaka lies on both sides above the kshipra vital point, while kshipra is between the great toe and the adjacent toe; 'between' applies separately to the eyebrows and breasts, and tala includes both palm and sole. Limbs means thighs and arms. Rounded parts include the side of the arm, abdomen, thighs and back. 'Tip' applies separately to the thumb, fingers and penis. Hanu is the jaw joint, shankha the region between eyebrow and ear, and ganda the cheek. Apanga is the outer corner of the eye. The chest here is described as the region above the heart, between the breasts and below the root of the neck. Murdhan is the head; cibuka is the fleshy and bony prominence below the lip; amsa is the head of the arm; basti is the urinary bladder region; and above the clavicles means above the root of the neck. The verb 'should apply' carries through the whole list. The closing statement allows the regional assignments to vary when practical need shows that another bandage has a better form and fit.
Key terms
caturdashabandheShu (caturdashabandheshu)
The fourteen named forms of bandaging distributed among different body regions.
suniviShTaH (sunivishtah)
Well fitted or of a suitable form for the particular body region.
Adhikarana ११ (१९) · Śloka १९
यन्त्रणमूर्ध्वमधस्तिर्यक् च ||१९||
Meaning of the śloka
The securing turn of a bandage may run upward, downward or transversely.
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बन्धो मृदुसमावगाढभेदात्त्रिविधः, स च यन्त्रणमन्तरेण न सम्भवति, अतो यन्त्रणं निर्देष्टुमाह- यन्त्रणमूर्ध्वमधस्तिर्यक् चेति| यन्त्रणं पट्टग्रन्थेर्बन्धनं, तच्चोर्ध्वादिभेदेन त्रिप्रकारं, व्रणाकृतीनां नानाविधत्वात्| चकार ऊर्ध्वादिभेदानेव समुच्चिनोति||१९||
Meaning of the commentary
Bandaging is threefold as tight, even or loose, but none can be accomplished without securing it. Yantrana means fastening the knot of the bandage. It has the three directions stated because wounds have many different shapes. The conjunction simply collects these three directional types.
Key terms
yantraNam (yantranam)
The securing or fastening of the bandage knot in an upward, downward or transverse direction.
Adhikarana १२ (२०) · Śloka २०
तत्र घनां कवलिकां दत्त्वा वामहस्तपरिक्षेपमृजुमनाविद्धमसङ्कुचितं मृदु पट्टं निवेश्य बध्नीयात् |
न च व्रणस्योपरि कुर्याद्ग्रन्थिमाबाधकरं च ||२०||
Meaning of the śloka
A thick kavalika should first be placed. A soft bandage cloth should then be applied with a left-hand turn, straight, untwisted and without folds, and tied. The knot should not be placed over the wound or made so that it causes pressure and discomfort.
Kavalika is the layer placed between the medicine and the cloth to keep the medicine in position; it may consist of bark or leaves such as those of udumbara. Others define it as a soft cloth folded double or fourfold. One explanation says that a bandage arranged by a left-hand turn is auspicious. Others say that when the cloth is turned with the left hand, the right hand can complete the bandage properly. Still others permit either a left- or right-hand turn according to the site, stating that the left-hand turn is mentioned for ease of performance. Straightness depends on the required placement. Anaviddha means not twisted or entangled; others gloss it as not confused. Asankucita means free from folds, and mridu means soft. A troublesome knot is one that causes pressure all around; a knot placed on either side or on the back may also disturb sleep.
Key terms
kavalikA (kavalika)
A retaining layer between medicine and bandage cloth, alternatively described as soft cloth folded two or four times.
vAmahastaparikShepam (vamahastaparikshepam)
A bandage turn made with the left hand; the commentary preserves differing reasons and permits direction to vary by site.
Adhikarana १३ (२१) · Śloka २१
न च विकेशिकौषधे अतिस्निग्धे अतिरूक्षे विषमे वा कुर्वीत; यस्मादतिस्नेहात् क्लेदो, रौक्ष्याच्छेदो, दुर्न्यासाद्व्रणवर्त्मावघर्षणमिति ||२१||
Meaning of the śloka
Neither a vikeshika nor a medicinal application should be made excessively unctuous, excessively dry or unevenly placed. Excessive unctuousness produces moisture, dryness causes splitting, and faulty placement abrades the wound opening.
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तत्रौषधकल्कव्रणवर्त्योः स्निग्धादिभावं नियमयन्नाह- न चेत्यादि| विकेशिकौषधे इति तिलकल्कमधुघृताक्तवस्त्रस्य सूत्रस्य वा वर्तिर्विकेशिका, सा च पूतिमांसोत्सङ्गगतिपूयगर्भेषु व्रणेषु निक्षिप्यते; औषधमिह औषधकल्कः, स च केवलकल्कः पूतिमांसोत्सङ्गगत्यस्थ्यन्तरपूयवर्जितेषु व्रणेषु दीयते; एतद्विपर्ययव्रणेषु पुनर्विकेशिकौषधकल्कयोरुभयोरप्युपयोगः| विषमे दुर्न्यस्ते; अन्ये ‘विषमे’ इति न पठन्ति| विकेशिकौषधयोरतिस्निग्धातिरूक्षदुर्न्यस्तयोर्दोषं वक्तुमाह- यस्मादतिस्नेहात् क्लेद इति|- क्लेदो व्रणस्यार्द्रत्वम्| छेदः संहतयोर्व्रणौष्ठयोर्द्विधाकरणम्| दुर्न्यासात् दुष्प्रवेशात्| व्रणवर्त्म व्रणमुखम्| गयदासाचार्यस्त्वन्यथाऽऽपातनिकां गृहीत्वा पाठमन्यथा पठति- “अतिस्नेहातिरूक्षयोर्विकेशिकौषधयोर्दोषं युक्तियुक्तस्नेहतो गुणं च वक्तुमाह- कस्मात्? अतिस्नेहात् क्लेदो रौक्ष्याच्छेदो युक्तस्नेहात् सम्यगुपरोह” इति||२१||
Meaning of the commentary
The passage regulates the degree of unctuousness and related qualities in medicinal paste and wound wicks. Vikeshika is a wick of cloth or thread coated with sesame paste, honey and ghee. It is placed in wounds containing putrid flesh, an internal pocket, a tract or enclosed pus. Here aushadha means a medicinal paste alone, used in wounds other than those involving putrid flesh, pockets, tracts or pus between bones. In wounds of the opposite kind, both vikeshika and medicinal paste are used. Vishama means improperly placed, though some do not read this word. Kleda is excessive moisture of the wound; cheda is separation of the two joined wound margins; faulty placement means difficult or improper insertion; and vranavartman is the wound opening. Gayadasa reads and explains the passage differently: it states the faults of excessive unctuousness and excessive dryness, then adds that properly measured unctuousness produces proper healing.
Key terms
vikeshikA (vikeshika)
A cloth or thread wick coated with sesame paste, honey and ghee and placed in specified cavity-forming or pus-containing wounds.
Although the named bandages have already been enumerated, this passage divides their manner of application into three according to the wound's location in a major or minor body part. An objection asks why dosha and time are not also stated, since later passages vary bandaging by both. The response is that dosha and time merely produce differences in the wound site and therefore need not be listed separately. Others suppose that a lost conjunction originally followed 'difference of wound site,' thereby also including unexpressed differences of dosha and time. Another explanation understands the three types as arising from differences among wounds caused by vata and other doshas, differences of bodily sites, and differences of time. Some interpret vranayatana as the wound's shape or arrangement, but the commentator rejects this as incoherent.
Key terms
vraNAyatanavisheShAt (vranayatanavisheshat)
According to difference in the wound's site; the commentary records broader and disputed interpretations involving dosha, time, shape or arrangement.
gADhaH samaH shithilaH (gadhah samah shithilah)
The three degrees of bandaging: tight, even and loose.
A tight bandage applies pressure but causes no pain. A loose bandage leaves breathing space and does not press deeply. A bandage that is neither tight nor loose is called even.
The verse defines the three degrees. A tight bandage presses or sits deeply without causing pain. Socchvasa describes the loose bandage as leaving space and not exerting deep pressure.
Key terms
socchvAsaH (socchvasah)
Having breathing room or free space, hence not pressing deeply.
A tight bandage is used on the buttocks, flanks, axillae, groins, thighs and head. An even bandage is used on the limbs, face, ears, throat, penis, scrotum, back, sides, abdomen and chest. A loose bandage is used on the eyes and joints.
This passage assigns the three degrees of bandaging according to wound location. Sphic means the two posterior parts of the waist or buttocks, vankshana is the hip or groin joint, medhra is the penis, and mushka is the scrotum.
Adhikarana १७ (२५) · Śloka २५
तत्र पैत्तिकं गाढस्थाने समं बध्नीयात्, समस्थाने शिथिलं, शिथिलस्थाने नैव; एवं शोणितदुष्टं च; श्लैष्मिकं शिथिलस्थाने समं, समस्थाने गाढं, गाढस्थाने गाढतरं; एवं वातदुष्टं च ||२५||
Meaning of the śloka
A wound affected by pitta should be bandaged evenly at a site normally requiring a tight bandage, loosely at a site normally requiring an even bandage, and not at all at a site normally requiring a loose bandage. The same applies when blood is vitiated. A wound affected by kapha should be bandaged evenly at a normally loose site, tightly at a normally even site, and more tightly at a normally tight site. The same applies when vata is vitiated.
A pitta-affected wound should be bandaged twice during the day in autumn and summer; the same applies to one troubled by blood. A kapha-affected wound should be bandaged every third day in winter and spring; the same applies to one troubled by vata. Reasoning in this manner, the physician should also alter the bandaging according to the condition.
This passage varies bandaging according to time. Dvirahnah means that the bandage is to be applied twice within the day. The closing instruction tells the physician to infer further adjustments independently and change the bandaging as circumstances require. Examples given are bandaging a pitta-kapha condition every two days in the morning during summer and autumn, a pitta condition every day in winter, and a kapha condition every two days in the evening during seasons beginning with the rains.
Key terms
dvirahnaH (dvirahnah)
Twice during the course of a day.
bandhaviparyayam
A change from the stated bandaging schedule or manner as required by the patient's condition.
If a tight bandage is applied where an even or loose bandage is indicated, the vikeshika and medicines become ineffective, and swelling and pain arise. If a loose bandage is applied where a tight or even one is indicated, the vikeshika and medicines fall out, and movement of the bandage rubs the margins of the wound. If an even bandage is applied where a tight or loose one is indicated, the intended benefit is not obtained.
The passage explains the faults produced when the degree of bandaging does not match the site. In the first case, the conjunction also includes redness among the effects of an excessively tight bandage.
Key terms
vikeshikA (vikeshika)
The medicinal wick or dressing retained at the wound by the bandage.
vraNavartmAvagharShaNam (vranavartmavagharshanam)
Friction or abrasion of the wound margins caused by movement of a loose bandage.
Adhikarana २० (२८) · Śloka २८
अविपरीतबन्धे वेदनोपशान्तिरसृक्प्रसादो मार्दवं च ||२८||
Meaning of the śloka
When a bandage is applied in the proper manner, pain subsides, the blood becomes clear or normal, and the part becomes soft.
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यथोचितबन्धगुणमाह- अविपरीतबन्ध इत्यादि||२८||
Meaning of the commentary
The commentary identifies these as the benefits of a bandage applied with the degree of tightness appropriate to the site.
Key terms
aviparItabandhaH (aviparitabandhah)
A bandage applied correctly, without reversing the degree of tightness prescribed for the site.
A wound left without a bandage is repeatedly injured by biting flies, mosquitoes, grass, wood, stones, dust, cold, wind, sunlight and similar agents. Afflicted by various kinds of pain, it becomes unhealthy or deformed, and its pastes and other applications dry out.
The verse describes the disadvantages of omitting a bandage. Damsha is explained as a forest fly, upala as stone, pamshu as dust and atapa as heat from the sun. To become dushta means to undergo an unhealthy alteration or deformity.
Key terms
duShTatAmupaiti (dushtatam upaiti)
The wound becomes unhealthy, altered or deformed through exposure and injury.
A part that is crushed into many pieces, churned or disordered, fractured, dislocated, displaced and hanging, or has severed bone, ligament or blood vessel, heals quickly with bandaging. With such support, the wounded person sleeps, walks and stands comfortably, and the wound heals quickly while the person is lying or seated.
The commentary presents the extensive benefits of bandaging. Churnita means broken into many fragments; mathita means churned or violently disturbed; bhagna refers to a shaft-like fracture; vishlishta means dislocated at a joint; and atipatita means displaced from its position and hanging down. The word severed is connected separately with bone, ligament and blood vessel. The next verse praises bandaging in all four circumstances of walking, coming or going, standing and lying down. Shete means sleeps, and tishthati means remaining upright; when the patient is on a bed or seat, comfort is to be understood.
Key terms
cUrNitam (churnitam)
Crushed or broken into many fragments.
atipAtitam (atipatitam)
Displaced from its normal position and hanging down.
Wounds caused by pitta, rakta, trauma or poison should not be bandaged when they are dominated by swelling, burning, suppuration, redness, pricking pain and other pain. Wounds burned by alkali or fire, and wounds whose flesh has become putrefied and broken down through suppuration, should likewise not be bandaged.
The word nimitta, cause, applies separately to pitta, rakta, trauma and poison. The verse then specifies when such wounds are unsuitable for bandaging. The stated toda is pricking pain and indicates association with vata; bandaging would greatly intensify it, so no bandage should be applied. One variant reads 'dominated by pricking pain and burning.' Another reads 'dominated by swelling, pricking pain, burning, redness, suppuration and pain.' Wounds in which the flesh has sloughed or disintegrated through suppuration are also not to be bandaged.
Key terms
abandhyAH (abandhyah)
Conditions in which a bandage should not be applied.
Flesh that has putrefied, sloughed or broken down following suppuration.
Adhikarana २४ (३३-३५) · Śloka ३५
कुष्ठिनामग्निदग्धानां पिडका मधुमेहिनाम् |
कर्णिकाश्चोन्दुरुविषे विषजुष्टाश्च ये व्रणाः ||३३||
मांसपाके न बध्यन्ते गुदपाके च दारुणे |
स्वबुद्ध्या चापि विभजेत्कृत्याकृत्यांश्च बुद्धिमान् ||३४||
देशं दोषं च विज्ञाय व्रणं च व्रणकोविदः |
ऋतूंश्च परिसङ्ख्याय ततो बन्धान्निवेशयेत् ||३५||
Meaning of the śloka
Pustules in people with kushtha or madhumeha, lesions produced by fire burns, karnika caused by rodent poison, wounds affected by poison, wounds with destruction of flesh, and severe suppuration in the anal region should not be bandaged. A discerning physician should use personal judgment to distinguish what should and should not be done. A physician skilled in wounds should assess the bodily site, the dosha, the wound and the season, and only then apply a bandage.
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उक्तानुक्तमर्थं सुखपाठार्थं श्लोकैर्निर्दिशन्नाह- कुष्ठिनामित्यादि| कुष्ठिप्रभृतीनां मांसपाके सति व्रणा न बध्यन्ते| मधुमेहिनां पिडका इति गुदपाके च दारुण इति बन्धो न कार्य इत्यर्थः| कृत्याकृत्यान् साध्यासाध्यान् | देशं स्फिक्कुक्षिकक्षादिकम्| दोषं वातादिकम्| व्रणकोविदो व्रणविद्वान् ऋतून् शीतोष्णसाधारणान्| परिसङ्ख्याय सम्यग्बुद्ध्वा| निवेशयेत् कुर्यादित्यर्थः||३३-३५||
Meaning of the commentary
The verses restate earlier expressed and unexpressed points in an easily recited form. The commentary explains that wounds in persons with kushtha and the other stated conditions are not bandaged when there is destruction of flesh. It separately confirms that pustules of people with madhumeha and severe anal suppuration are not to be bandaged. What should and should not be done is glossed as what is treatable and untreatable. Desha means sites such as the buttock, abdomen and axilla; dosha means vata and the others; a vranakovida is one knowledgeable about wounds; and the seasons are classified as cold, hot and moderate. Parisankhyaya means after understanding all these factors correctly.
Key terms
kRutyAkRutyAn (krityakrityan)
What should or should not be undertaken, explained here in relation to treatability and untreatability.
vraNakovidaH (vranakovidah)
A physician knowledgeable and experienced in wounds.
Adhikarana २५ (३६-४५) · Śloka ४५
ऊर्ध्वं तिर्यगधस्ताच्च यन्त्रणा त्रिविधा स्मृता |
यथा च बध्यते बन्धस्तथा वक्ष्याम्यशेषतः ||३६||
घनां कवलिकां दत्त्वा मृदु चैवापि पट्टकम् |
विकेशिकामौषधं च नातिस्निग्धं समाचरेत् ||३७||
प्रक्लेदयत्यतिस्निग्धा तथा रूक्षा क्षिणोति च |
युक्तस्नेहा रोपयति दुर्न्यस्ता वर्त्म घर्षति ||३८||
विषमं च व्रणं कुर्यात् स्तम्भयेत् स्रावयेत्तथा |
यथाव्रणं विदित्वा तु योगं वैद्यः प्रयोजयेत् ||३९||
पित्तजे रक्तजे वाऽपि सकृदेव परिक्षिपेत् |
असकृत् कफजे वाऽपि वातजे च विचक्षणः ||४०||
तलेन प्रतिपीड्याथ स्रावयेदनुलोमतः |
सर्वांश्च बन्धान् गूढान्तान् सन्धींश्च विनिवेशयेत् ||४१||
ओष्ठस्याप्येष सन्धाने यथोद्दिष्टो विधिः स्मृतः |
बुद्ध्योत्प्रेक्ष्याभियुक्तेन तथा चास्थिषु जानता ||४२||
उत्तिष्ठतो निषण्णस्य शयनं चाधिगच्छतः |
गच्छतो विविधैर्यानैर्नास्य दुष्यति स व्रणः ||४३||
ये च स्युर्मांससंस्था वै त्वग्गताश्च तथा व्रणाः |
सन्ध्यस्थिकोष्ठलप्राप्ताश्च सिरास्नायुगतास्तथा ||४४||
तथाऽवगाढगम्भीराः सर्वतो विषमस्थिताः |
नैते साधयितुं शक्या ऋते बन्धाद्भवन्ति हि ||४५||
Meaning of the śloka
Bandaging restraint is described in three directions: upward, transverse and downward. The complete method of applying a bandage is then stated. Place a thick kavalika, a soft bandage, a vikeshika and medicine that is neither excessively oily nor dry. Excessive oil causes moisture and maceration, while dryness wastes the tissue; the proper amount of oil promotes healing. Incorrect placement rubs the wound margin, makes the wound uneven, obstructs it or causes discharge. The physician should understand the wound and apply the suitable method. In pitta- or rakta-origin wounds the skilled physician should wrap the bandage only once; in kapha- or vata-origin wounds it may be wrapped repeatedly. After pressing with the palm, drain in the natural direction. Apply all bandages with their ends concealed and position all joints correctly. The same stated method is used for joining a lip, and a knowledgeable, practised physician should reason out its corresponding use for joining bones. With proper bandaging, the wound is not impaired when the person rises, sits, lies down or travels in different vehicles. Wounds situated in muscle or skin, reaching joints, bones or body cavities, involving blood vessels or ligaments, deeply penetrating, or irregularly situated on all sides cannot be successfully treated without bandaging.
Some students of Sushruta read these summary verses to clarify the preceding prose. Unevenness of a wound means depressions and elevations. Obstruction and drainage here concern pus. Wrapping once means making a single turn with the bandage. The repeated wording on all bandages and joints is explained as applying every bandage with its ends hidden and appropriately positioning every joint. The method stated for joining is also remembered for repair of a lip. A knowledgeable and experienced physician should use reason to adapt the same principle for joining bones. Avagadha means deep because of penetration. The commentary gives an explicit textual-history qualification: Gayadasa judged this passage non-authoritative; Brahmadeva, following him, explained parts of it. Because both transmitted it, Dalhana also wrote it down and explained portions of it.
Key terms
yantraNA (yantrana)
Supportive restraint by bandaging, directed upward, transversely or downward according to need.
kavalikA (kavalika)
A thick pad placed beneath or as part of the wound dressing.
gUDhAntAn (gudhantan)
Applied with the ends of the bandage concealed or securely tucked.