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AYANAACADEMYby Dr Vijaya Dwarampudi
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22. vraṇāsrāvavijñānīyādhyāyaḥ

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Adhikarana 1 (1-2) · Śloka 2

athātō vraṇāsrāvavijñānīyamadhyāyaṁ vyākhyāsyāmaḥ ||1|| yathōvāca bhagavān dhanvantariḥ ||2||

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अथातो व्रणास्रावविज्ञानीयमध्यायं व्याख्यास्यामः ||१|| यथोवाच भगवान् धन्वन्तरिः ||२||

Meaning of the śloka

Now the chapter concerning recognition of wound discharge will be explained, as taught by Bhagavan Dhanvantari.

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ādiśabdaḥ pratijñāyāṁ luptanirdiṣṭō draṣṭavyaḥ| tēna vraṇāsrāvādivijñānīyamityarthaḥ| ētēna vēdanādayō'pi saṅgr̥hītā||1-2||

Meaning of the commentary

The commentary understands an elided word adi, meaning and related features, in the introductory declaration. The fuller sense is therefore recognition of wound discharge and other characteristics, thereby also including pain and similar features.

Key terms

vraNAsrAva (vranasrava)
Discharge flowing from a wound, used as a feature for recognition and classification.

Adhikarana 2 (3) · Śloka 3

tvaṅmāṁsasirāsnāyvasthisandhikōṣṭhamarmāṇītyaṣṭau vraṇavastūni | atra sarvavraṇasannivēśaḥ ||3||

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त्वङ्मांससिरास्नाय्वस्थिसन्धिकोष्ठमर्माणीत्यष्टौ व्रणवस्तूनि | अत्र सर्वव्रणसन्निवेशः ||३||

Meaning of the śloka

The eight structural sites of wounds are skin, flesh, vessels, ligaments or tendons, bone, joints, internal cavities or viscera, and vital points. Every wound is situated in one or more of these.

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tvagityādi| vraṇavastūni vraṇādhiṣṭhānāni| atra ēṣvityarthaḥ| vraṇasannivēśō vraṇāvasthānam||3||

Meaning of the commentary

Vranavastu means a structural seat or substrate of a wound. Atra means in these eight sites, and wound placement means the wound's location within them.

Key terms

vraNavastu (vranavastu)
A structural tissue or region that serves as the site of a wound.
koShTha (koshtha)
An internal cavity or visceral region counted among the eight wound sites.
marma
A vital point or vulnerable anatomical site in which a wound may be situated.

Adhikarana 3 (4) · Śloka 4

tatra, ādyaikavastusannivēśī tvagbhēdī vraṇaḥ sūpacaraḥ, śēṣāḥ svayamavadīryamāṇā durupacārāḥ ||4||

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तत्र, आद्यैकवस्तुसन्निवेशी त्वग्भेदी व्रणः सूपचरः, शेषाः स्वयमवदीर्यमाणा दुरुपचाराः ||४||

Meaning of the śloka

Among these, a wound confined to the first single site and dividing only the skin is easy to treat. The remaining wounds, when they mature and split open by themselves, are difficult to treat.

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tēṣāṁ madhyē ēkasminnēva vastuni vraṇasya sukhōpacaryatvaṁ darśayannāha- tatrētyādi| ādyaikavastusannivēśīti tvaksannivēśītyarthaḥ| tvagbhēdīti punarniyamārtham; ētēna tvagāśritamāṁsabhēdī na sūpacaraḥ| anyē tu ‘ādyaikavastusannivēśī tvagbhēdī ca’ ityanayōḥ padayōrmadhyē ēkatarapadēnaiva tvagvastu prāpyatē kiṁ padadvayēnēti yat padadvayaṁ tadgranthādhikyādarthādhikyaṁ bōdhayati, tēna vikr̥tākr̥tayō'pi tvagbhēdinō vraṇāḥ sūpacarā ityadhikō'rtha uktō bhavati’ iti manyantē| aparavastusannivēśinaḥ kiṁviśiṣṭā ityāha- śēṣā ityādi| śēṣā iti māṁsādyadhiṣṭhānāḥ| svayamavadīryamāṇā iti ālēpasrāvaṇādibhirvinā svayamēva pakvāḥ paścādbhinnā ityarthaḥ||4||

Meaning of the commentary

The first single site means confinement to the skin. Repeating that the wound divides the skin limits the statement: a skin-based wound that also divides flesh is not easy to treat. Others ask why both expressions are needed if either one already indicates the skin. They take the apparent redundancy as adding meaning, namely that even skin-dividing wounds with irregular as well as regular shapes are easy to treat. The remaining wounds are those located in flesh and the subsequent sites. Splitting by themselves means that they mature and later open without measures such as topical application or drainage.

Key terms

tvagbhedI vraNa (tvagbhedi vrana)
A wound dividing the skin, described as easy to treat when confined to that first structural site.
svayamavadIryamAna (svayamavadiryamana)
Maturing and breaking open spontaneously without application, drainage or similar intervention.

Adhikarana 4 (5) · Śloka 5

tatrāyataścaturasrō vr̥ttastripuṭaka iti vraṇākr̥tisamāsaḥ, śēṣāstu vikr̥tākr̥tayō durupakramā bhavanti ||5||

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तत्रायतश्चतुरस्रो वृत्तस्त्रिपुटक इति व्रणाकृतिसमासः, शेषास्तु विकृताकृतयो दुरुपक्रमा भवन्ति ||५||

Meaning of the śloka

The principal wound shapes are elongated, quadrangular, circular and three-sided. Other distorted or irregular shapes are difficult to manage.

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yathā srāvajñānaṁ cikitsāhētustathā vraṇākr̥tirapīti tāṁ darśayannāha- tatrāyata ityādi| āyatō dīrghaḥ, caturasraścatuṣkōṇaḥ, vr̥ttō vartulaḥ, tripuṭakastrikōṇaḥ, itiśabda upasaṁhārē dōṣajavraṇākr̥tīnāṁ; samāsaḥ saṅkṣēpaḥ| śēṣā iti uktēbhyō'nyē ardhacandrasvastikādyā vraṇākr̥tayō vikr̥tā ityarthaḥ||5||

Meaning of the commentary

Just as recognising discharge guides treatment, recognising wound shape also does so. Ayata means long, caturasra four-cornered, vritta circular, and triputaka triangular. The list is a concise summary of shapes of dosha-origin wounds. Other forms, such as crescent-shaped and svastika-shaped wounds, are considered distorted or irregular and difficult to treat.

Key terms

vraNAkRuti (vranakriti)
The shape or configuration of a wound considered in assessing its management.

Adhikarana 5 (6) · Śloka 6

sarva ēva vraṇāḥ kṣipraṁ saṁrōhantyātmavatāṁ subhiṣagbhiścōpakrāntāḥ; anātmavatāmajñaiścōpakrāntāḥ praduṣyanti, pravr̥ddhatvāddōṣāṇām ||6||

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सर्व एव व्रणाः क्षिप्रं संरोहन्त्यात्मवतां सुभिषग्भिश्चोपक्रान्ताः; अनात्मवतामज्ञैश्चोपक्रान्ताः प्रदुष्यन्ति, प्रवृद्धत्वाद्दोषाणाम् ||६||

Meaning of the śloka

All wounds heal quickly in self-controlled patients when treated by capable physicians. Wounds deteriorate in patients lacking self-control and when treated by the unskilled, because the doshas have increased.

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vraṇināmātmavatāṁ bhiṣajāṁ guṇasampadō'pi cikitsāhētava iti darśayannāha- sarva ityādi| ātmavatāṁ pathyāhāravihārasēvinām| anātmavatāmiti ahitāhāravihārasēvinām| ajñaiścōpakrāntā iti cakārēṇātmavatāṁ subhiṣagbhirupakrāntānāmapi kuṣṭhipramēhiṇāṁ tathā kadācicchukrapravr̥ttimātrādēva vraṇaduṣṭiranuktā samuccīyatē| kutaḥ punaranātmavatāmajñabhiṣagupakrāntānāṁ vraṇānāṁ duṣṭirityāha- pravr̥ddhatvāddōṣāṇāmiti| anyē tvēvaṁ yōjayanti- ‘na kēvalamajñairupakrāntā ēva praduṣyanti, api tu pravr̥ddhatvācca dōṣāṇām’ iti||6||

Meaning of the commentary

The verse presents both the patient's discipline and the physician's competence as causes supporting treatment. Self-controlled patients follow suitable food and conduct, while those lacking self-control follow unsuitable food and conduct. The conjunction also implies an unstated qualification: even a disciplined patient treated by a good physician may sometimes suffer wound deterioration in conditions such as kushtha or prameha, or merely from seminal discharge. The stated reason for deterioration under an undisciplined patient and an ignorant physician is increased doshas. Others construe the sentence to mean that wounds deteriorate not only because they are treated by the ignorant but also because the doshas have independently increased.

Key terms

AtmavatAm (atmavatam)
Self-controlled patients who follow the prescribed suitable diet and conduct.
subhiShagbhiH (subhishagbhih)
By capable or well-qualified physicians.

Adhikarana 6 (7) · Śloka 7

tatrātisaṁvr̥tō'tivivr̥tō'tikaṭhinō'timr̥durutsannō'vasannō'tiśītō'tyuṣṇaḥ nagandhātyarthadāhapākarāgavēdanāvāniti pittēna, śēṣāḥ kaphēna; unmārgī mukhāt mukhāntaravān, utsaṅgaḥ kōṭaraḥ’ iti cakraḥ; kr̥ṣṇaraktapītaśuklādīnāṁ varṇānāmanyatamavarṇō bhairavaḥ pūtipūyamāṁsasirāsnāyuprabhr̥tibhiḥ pūrṇaḥ pūtipūyāsrāvyunmārgyutsaṅgyamanōjñadarśanagandhō'tyarthaṁ vēdanāvān dāhapākarāgakaṇḍūśōphapiḍakōpadrutō'tyarthaṁ duṣṭaśōṇitāsrāvī dīrghakālānubandhī cēti duṣṭavraṇaliṅgāni | tasya dōṣōcchrāyēṇa ṣaṭtvaṁ vibhajya yathāsvaṁ pratīkārē prayatēta ||7||

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तत्रातिसंवृतोऽतिविवृतोऽतिकठिनोऽतिमृदुरुत्सन्नोऽवसन्नोऽतिशीतोऽत्युष्णः नगन्धात्यर्थदाहपाकरागवेदनावानिति पित्तेन, शेषाः कफेन; उन्मार्गी मुखात् मुखान्तरवान्, उत्सङ्गः कोटरः’ इति चक्रः; कृष्णरक्तपीतशुक्लादीनां वर्णानामन्यतमवर्णो भैरवः पूतिपूयमांससिरास्नायुप्रभृतिभिः पूर्णः पूतिपूयास्राव्युन्मार्ग्युत्सङ्ग्यमनोज्ञदर्शनगन्धोऽत्यर्थं वेदनावान् दाहपाकरागकण्डूशोफपिडकोपद्रुतोऽत्यर्थं दुष्टशोणितास्रावी दीर्घकालानुबन्धी चेति दुष्टव्रणलिङ्गानि | तस्य दोषोच्छ्रायेण षट्त्वं विभज्य यथास्वं प्रतीकारे प्रयतेत ||७||

Meaning of the śloka

The signs of a deteriorated wound include an opening that is excessively contracted or excessively wide; excessive hardness or softness; raised or depressed tissue; excessive cold or heat; abnormal odor; severe burning, suppuration, redness or pain; a tract leaving the normal path, another opening, an internal pocket or cavity; black, red, yellow, white or another abnormal color; a frightening or ill-defined appearance; filling with putrid pus, flesh, vessels, ligaments and related tissues; discharge of foul pus; an aberrant tract or pocket; unpleasant appearance and odor; severe pain; complications of burning, suppuration, redness, itching, swelling or pustules; excessive discharge of vitiated blood; and persistence for a long time. The condition should be divided into six types according to the predominance of the cause, and treatment should be undertaken according to that cause.

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prāyēṇa duṣṭēṣvēva vraṇēṣu srāvā bhavanti, atastēṣāṁ duṣṭavraṇānāṁ lakṣaṇamāha- tatrātisaṁvr̥ta ityādi| atisaṁvr̥taḥ atisaṅkucitō vātēna| ativivr̥tō vyāttamukhaḥ pittaśōṇitēna| kāṭhinyaṁ vātēna| atimārdavaṁ kaphēna; anyē pittaśōṇitēna mārdavamicchanti| utsanna unnatamāṁsaḥ, avasannō hīnamāṁsō nimnākāraḥ, ētau raktapittēna; anyē vātēnōtsannāvasannatvamicchanti; ‘atrōtsannatvaṁ kaphēna’ iti kēcit| atiśaityaṁ kaphavātāt| atyauṣṇyaṁ raktapittāt| kr̥ṣṇādayō varṇā yathāsambhavaṁ vātādibhirjñēyāḥ| bhairavaḥ anavadhāritaliṅgaḥ| pūtipūyamāṁsasirāsnāyuprabhr̥tibhiḥ pūrṇa iti pūtiśabdaḥ pratyēkaṁ pūyādibhirabhisambadhyatē| ‘pūtimāṁsasirāsnāyupratipūrṇa’ ityēkē paṭhanti; pūtimāṁsasirāsnāyupratipūrṇatvaṁ tasrāvitvaṁ ca yathāsambhavaṁ vēditavyam| unmārgī tiryaggatiḥ| utsaṅgī ūrdhvagatiḥ; anyē pūyōpēkṣāvadāritamāṁsādidēśatvēnātinimnatvādutsaṅgatulyatvādutsaṅgaḥ, sō'syāstīti utsaṅgī unmārgī; utsaṅgīti kaphēna| amanōjñadarśanagandha iti amanōjñadarśanō'manōjñagandhaścētyarthaḥ amanōjñadarśanagandhatvaṁ raktapittēna, anyē dōṣatrayēṇa manyantē| atyarthaṁ vēdanāvāniti vātēna| dāhapākarāgakaṇḍūśōphētyādi, atra dāhādibhiḥ sahōpadrutaśabdaḥ pratyēkaṁ sambadhyatē; atra dāhapākarāgōpadrutatvaṁ pittaraktēna, kaṇḍūpadrutatvaṁ kaphēna, śōphōpadrutatvaṁ vātēna, piḍakōpadrutatvaṁ duṣṭaśōṇitāsrāvaśca raktapittēna, dīrghakālānubandhitvaṁ dōṣatrayēṇa| dīrghakālānubandhī cēti cakārēṇa rōpyādayō duṣṭavraṇaviśēṣā gr̥hyantē| rōpyalakṣaṇaṁ tu “bahiḥśuddha ivābhāti sa vraṇō rōpya ucyatē” ( ca. ci. a. 25)- iti carakēṇōktam| vraṇaduṣṭau cikitsāsūtraṁ darśayannāha- tasyētyādi| tasya vraṇasya ucchrāyēṇa autkaṭyēna ṣaṭtvaṁ vātapittakapharaktasannipātāgantubhēdataḥ| yathāsvaṁ svasya dōṣasyānatikramēṇa| pratīkārē cikitsitē, prayatēta prayatnaṁ kurvīta| anyē tvatra ‘dōṣōcchrāyamavēkṣya’ iti paṭhanti||7||

Meaning of the commentary

Discharges occur mainly in deteriorated wounds, so the passage first defines such wounds. Excessive contraction is assigned to vata and an excessively gaping opening to pitta and blood. Hardness belongs to vata; excessive softness is assigned mainly to kapha, though others assign it to pitta and blood. Raised flesh and deficient, depressed flesh are assigned to blood and pitta; others assign both to vata, while some assign raised tissue to kapha. Excessive cold belongs to kapha and vata, excessive heat to blood and pitta, and black and the other colors are assigned to the doshas as applicable. Bhairava means having signs that cannot be clearly determined. In the phrase concerning putrid contents, 'putrid' applies separately to pus, flesh, vessels and ligaments. Some instead read 'filled with putrid flesh, vessels and ligaments'; filling and discharge then apply as appropriate. Unmargi means a laterally directed tract. Utsangi primarily means an upward-directed tract; others explain it as a very deep, lap-like pocket created where neglected pus has torn flesh or other tissue. Utsangi is also assigned to kapha. Unpleasant appearance and odor are assigned to blood and pitta, though others assign them to all three doshas. Severe pain belongs to vata. Burning, suppuration and redness belong to pitta and blood; itching to kapha; swelling to vata; and pustules and discharge of vitiated blood to blood and pitta. Long persistence belongs to all three doshas. The conjunction also includes special deteriorated-wound types such as ropya, which Charaka defines as appearing clean externally. The six causal divisions are vata, pitta, kapha, blood, combined doshas and external injury. Some read that the physician should examine predominance of the dosha rather than divide the condition into six.

Key terms

unmArgI (unmargi)
A wound tract that runs away from the normal path, explained as laterally directed.
utsa~ggI (utsangi)
An upward-directed tract or, alternatively, a deep pocket created by retained pus tearing internal tissue.
bhairavaH (bhairavah)
Frightening in appearance or having signs that cannot be clearly determined.

Adhikarana 7 (8) · Śloka 8

ata ūrdhvaṁ sarvasrāvān vakṣyāmaḥ- tatra ghr̥ṣṭāsu chinnāsu vā tvakṣu sphōṭē bhinnē vidāritē vā salilaprakāśō bhavatyāsrāvaḥ kiñcidvisraḥ pītāvabhāsaśca; māṁsagataḥ sarpiḥprakāśaḥ sāndraḥ śvētaḥ picchilaśca; sirāgataḥ sadyaśchinnāsu sirāsu raktātipravr̥ttiḥ pakvāsu ca tōyanāḍībhiriva tōyāgamanaṁ pūyasya, āsrāvaścātra tanurvicchinnaḥ picchilō'valambī śyāvō'vaśyāyapratimaśca; snāyugataḥ snigdhō ghanaḥ siṅghāṇakapratimaḥ saraktaśca; asthigatō'sthanyabhihatē sphuṭitē bhinnē dōṣāvadāritē vā dōṣabhakṣitatvādasthi niḥsāraṁ śuktidhautamivābhāti , āsrāvaścātra majjamiśraḥ sarudhiraḥ snigdhaśca; sandhigataḥ pīḍyamānō na pravartatē, ākuñcanaprasāraṇōnnamanavinamanapradhāvanōtkāsanapravāhaṇaiśca sravati, āsrāvaścātra picchilō'valambī sarudhirōnmathitaśca ; kōṣṭhagatō'sr̥ṅmūtrapurīṣapūyōdakāni sravati; marmagatastvagādiṣvavaruddhatvānnōcyatē | tatra tvagādigatānāmāsrāvāṇāṁ yathākramaṁ pāruṣyaśyāvāvaśyāyadadhimastukṣārōdakamāṁsadhāvanapulākōdakasannibhatvāni mārutādbhavanti; pittādgōmēdakagōmūtrabhasmaśaṅkhakaṣāyōdakamādhvīkatailasannibhatvāni; pittavadraktādativisratvaṁ ca; kaphānnavanītakāsīsamajjapiṣṭatilanālikērōdakavarāhavasāsannibhatvāni; sannipātānnālikērōdakairvārukarasakāñjikaprasādārukōdakapriyaṅguphalayakr̥nmudgayūṣasavarṇatvānīti ||8||

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अत ऊर्ध्वं सर्वस्रावान् वक्ष्यामः- तत्र घृष्टासु छिन्नासु वा त्वक्षु स्फोटे भिन्ने विदारिते वा सलिलप्रकाशो भवत्यास्रावः किञ्चिद्विस्रः पीतावभासश्च; मांसगतः सर्पिःप्रकाशः सान्द्रः श्वेतः पिच्छिलश्च; सिरागतः सद्यश्छिन्नासु सिरासु रक्तातिप्रवृत्तिः पक्वासु च तोयनाडीभिरिव तोयागमनं पूयस्य, आस्रावश्चात्र तनुर्विच्छिन्नः पिच्छिलोऽवलम्बी श्यावोऽवश्यायप्रतिमश्च; स्नायुगतः स्निग्धो घनः सिङ्घाणकप्रतिमः सरक्तश्च; अस्थिगतोऽस्थन्यभिहते स्फुटिते भिन्ने दोषावदारिते वा दोषभक्षितत्वादस्थि निःसारं शुक्तिधौतमिवाभाति , आस्रावश्चात्र मज्जमिश्रः सरुधिरः स्निग्धश्च; सन्धिगतः पीड्यमानो न प्रवर्तते, आकुञ्चनप्रसारणोन्नमनविनमनप्रधावनोत्कासनप्रवाहणैश्च स्रवति, आस्रावश्चात्र पिच्छिलोऽवलम्बी सरुधिरोन्मथितश्च ; कोष्ठगतोऽसृङ्मूत्रपुरीषपूयोदकानि स्रवति; मर्मगतस्त्वगादिष्ववरुद्धत्वान्नोच्यते | तत्र त्वगादिगतानामास्रावाणां यथाक्रमं पारुष्यश्यावावश्यायदधिमस्तुक्षारोदकमांसधावनपुलाकोदकसन्निभत्वानि मारुताद्भवन्ति; पित्ताद्गोमेदकगोमूत्रभस्मशङ्खकषायोदकमाध्वीकतैलसन्निभत्वानि; पित्तवद्रक्तादतिविस्रत्वं च; कफान्नवनीतकासीसमज्जपिष्टतिलनालिकेरोदकवराहवसासन्निभत्वानि; सन्निपातान्नालिकेरोदकैर्वारुकरसकाञ्जिकप्रसादारुकोदकप्रियङ्गुफलयकृन्मुद्गयूषसवर्णत्वानीति ||८||

Meaning of the śloka

The text next describes wound discharges. From abraded or cut skin, or from a blister that has burst or been opened, the discharge resembles water, is slightly visra and has a yellowish appearance. From flesh it resembles ghee and is thick, white and slimy. From vessels, a newly cut vessel bleeds profusely; when suppurated, pus arrives as water through channels, and the discharge is thin, intermittent, slimy, hanging, dusky and like dew. From ligaments the discharge is unctuous, thick, like congealed nasal mucus and mixed with blood. When bone is struck, cracked, broken or eroded by doshas, it loses substance and appears like a washed shell; its discharge contains marrow and blood and is unctuous. Discharge from a joint does not flow when merely pressed, but flows with flexion, extension, raising, lowering, running, coughing or straining; it is slimy, hanging, bloody and churned. From the body cavity flow blood, urine, feces, pus and water-like fluid. Discharge from a vital point is not described separately because vital points are contained within skin and the other tissues. In wounds of skin and the other tissues, vata-related discharges may resemble rough fluid, dusky fluid, dew, curd-water, alkaline water, meat-washing water or pulaka water. Pitta-related discharges may resemble gomedaka, cow urine, ash-water, conch-water, astringent decoction, madhvika or oil. Blood-related discharge resembles pitta discharge and has an especially raw odor. Kapha-related discharges may resemble fresh butter, kasisa, marrow, flour, sesame, coconut water or boar fat. Discharge from combined doshas may have the color of coconut water, ervaruka juice, clarified kanjika, aruka water, priyangu fruit, liver or mudga soup.

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atra vraṇaduṣṭirasūtritā'pyuktā, tāṁ nirdiśya vraṇāsrāvānnirdiśannāha- ata ūrdhvamityādi| sarvasrāvāniti sarvavraṇavastūnāṁ sarvadōṣāṇāmāgantōśca vraṇasya srāvānityarthaḥ| ghr̥ṣṭāsu chinnāsvityāgantōḥ, tvakṣviti sambandhaḥ; bahuvacanaṁ tu saptatvagapēkṣayā| atra tvaggrahaṇāllakṣaṇayā rasādhiṣṭhānō vraṇa uktaḥ| sphōṭē iti tvaksthitē vraṇē, bhinnē svayaṁ bhinnē, vidāritē yatnēna vidāritē ityarthaḥ; atra bhinnē vidāritē iti śārīravraṇasya| salilaprakāśa iti udakarasayōracchayōstvacāmadhiṣṭhānatvāt| visra āmagandhiḥ, pītāvabhāsaḥ pākārambhakēṇa pittēnētyarthaḥ| māṁsagata iti māṁsagata āsrāva ityarthaḥ| sarpiḥprakāśastrāvatvamāgantōḥ| sāndraśvētapicchilatvaṁ śārīrasya| sirāgata ityādi sirāgrahaṇēna raktādhiṣṭhānō vraṇa uktaḥ; sadyaśchinnāsvityāgantōḥ; pakvāsvityādi śārīrasya| vicchinna iti alpālpapravartanam| avalambī avalambanaśīlaḥ| snāyugata ityādi snāyugrahaṇēna mēdō'dhiṣṭhānō vraṇa uktaḥ, anyē tu ‘mēdōmajjānau ghr̥tavadvilīyētē,atō vraṇādhiṣṭhānatvaṁ naiva tayōḥ’ iti vadanti| siṅghāṇakō raktamiśrō ghanībhūtaḥ ślēṣmā| asthigata ityādi| abhihatē iti abhighātajē vraṇē, bhinnē vidāritē cēti śārīrē| asthi niḥsāraṁ kō'rthaḥ? laghu; ‘bhavati’ ityadhyāhāraḥ| śuktidhautamivābhāti śuktiriva śōbhatē tathā dhautamiva śōbhatē'sthīti sambadhyatē| sandhigata ityādi| unnamanamiti bāhujaṅghādīnāmūrdhvaṁ nayanam| vinamanaṁ gātrāṇāmadhaḥprāpaṇam| pravāhaṇamiti kunthanam| sarudhirōnmathitaścēti rudhirēṇaivōnmathitaśca| kōṣṭhagata ityādi kōṣṭhagata iti maladhātusamudāyādhiṣṭhānō vraṇa uktaḥ| udakamatra rasaklēda ēva gr̥hyatē pītaṁ vā| marmagata ityādi| avaruddha iti saṅgr̥hīta ityarthaḥ| dōṣāsrāvānnirdiśannāha-tatra tvagādigatānāmityādi| tatra marmavarjitēṣu saptasu tvagādivraṇavastuṣu vātapittakaphasannipātānāṁ sapta sapta srāvā yathākramēṇa draṣṭavyā ityēkē; anyē tu tvagādiṣu vātādiliṅgānāṁ madhyē kiñcit kvaciditi varṇayanti| pittādgōmēdētyādi|- gōmēdaka iti maṇirāpītaḥ| ērvārukarasaḥ karkaṭikārasaḥ; kāñjikaprasāda iti kāñjikasyōparyacchaḥ; ārukamanēnaiva nāmnā prasiddham||8||

Meaning of the commentary

The passage covers discharges from every wound tissue, doshic type and externally caused wound. Abraded or cut skin indicates external injury; the plural skin refers to the seven layers, and by implication a skin wound represents one based in rasa. A spontaneously burst blister is distinguished from one deliberately opened. Its watery character reflects water and rasa being clear and based in skin; visra means a raw odor, and yellow indicates pitta beginning the ripening process. For flesh, ghee-like discharge belongs to external injury, while thickness, whiteness and sliminess belong to an internally produced wound. Mention of vessels indicates a blood-based wound: fresh cutting is external injury, while suppuration is internal. Intermittent means flowing a little at a time, and hanging means tending to trail or depend. Mention of ligaments is taken to indicate a fat-based wound, although others deny fat and marrow as wound bases because both liquefy like ghee. Singhanaka is thickened kapha mixed with blood. In bone, trauma denotes an external wound, while breaking and erosion may be internal. Loss of substance means lightness. The bone is said to shine like a shell and as if washed. Raising and lowering refer to moving limbs upward and downward, while pravahana means straining. A cavity wound represents the aggregate seat of waste tissues; its water may be rasa-derived moisture or consumed water. A vital-point wound is subsumed under the other tissue sites. For doshic discharge similes, one interpretation distributes seven examples for each dosha across the seven non-vital wound tissues. Another says individual doshic signs occur only in whichever tissue site is applicable. Gomedaka is a yellowish jewel, ervaruka is cucumber, kanjikaprasada is the clear upper part of kanjika, and aruka is a substance known by that name.

Key terms

AsrAvaH (asravah)
Discharge from a wound, classified here by tissue location and doshic appearance.
vicchinnaH (vicchinnah)
Intermittent, flowing only a little at a time.
si~gghANakapratimaH (singhanakapratimah)
Resembling thickened nasal mucus mixed with blood.

Adhikarana 8 (9-10) · Śloka 10

ślōkau cātra bhavataḥ- pakvāśayādasādhyastu pulākōdakasannibhaḥ | kṣārōdakanibhaḥ srāvō varjyō raktāśayātsravan ||9|| āmāśayāt kalāyāmbhōnibhaśca trikasandhijaḥ | srāvānētān parīkṣyādau tataḥ karmācarēdbhiṣak ||10||

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श्लोकौ चात्र भवतः- पक्वाशयादसाध्यस्तु पुलाकोदकसन्निभः | क्षारोदकनिभः स्रावो वर्ज्यो रक्ताशयात्स्रवन् ||९|| आमाशयात् कलायाम्भोनिभश्च त्रिकसन्धिजः | स्रावानेतान् परीक्ष्यादौ ततः कर्माचरेद्भिषक् ||१०||

Meaning of the śloka

A discharge from the lower digestive reservoir resembling pulaka water is incurable, and a discharge from the seat of blood resembling alkaline water should be rejected. A discharge from the upper digestive reservoir resembling kalaya water, and one arising from the trika joint, should likewise be assessed. The physician should first examine these discharges and only then undertake treatment.

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sthānabhēdāt srāvasyāsādhyatvakhyāpanāya ślōkau prāha- pakvāśayādityādi| pulākōdakaṁ gavēdhukōdakaṁ, gavēdhukastr̥ṇaviśēṣaḥ, ‘jalagōdhūma’ iti lōkē; anyē tu pulākaśabdēnāprāptapākaṁ dhānyamāhuḥ| āmāśayādityādi| kalāyō'tra tripuṭakaḥ| trikasandhija iti bāhugrīvāsthitrayasaṅghātō'tra trikaṁ, tasya sandhau jāta iti||9-10||

Meaning of the commentary

These verses identify prognosis according to the origin and appearance of discharge. Pulaka water is glossed as water of gavedhuka, a kind of grass popularly called water-wheat; others take pulaka to mean grain that has not fully ripened. Kalaya here is triputaka. The trika is described as the conjunction of three bones of the arm and neck, and trikasandhija means arising at that joint.

Key terms

pulAkodakasannibhaH (pulakodakasannibhah)
Resembling water of gavedhuka, or alternatively water associated with incompletely ripened grain.
trikasandhijaH (trikasandhijah)
Arising from the trika joint, explained as a junction involving three bones of the arm and neck.

Adhikarana 9 (11) · Śloka 11

ata ūrdhvaṁ sarvavraṇavēdanā vakṣyāmaḥ- tōdanabhēdanatāḍanacchēdanāyāmanamanthanavikṣēpaṇacumucumāyananirdahanāvabhañjanasphōṭana vidāraṇōtpāṭanakampanavividhaśūlaviślēṣaṇavikiraṇastambhanapūraṇasvapnākuñjanāṅku śikāḥ sambhavanti, animittavividhavēdanāprādurbhāvō vā muhurmuhuryatrāgacchanti vēdanāviśēṣāstaṁ vātikamiti vidyāt; ōṣacōṣaparidāhadhūmāyanāni yatra gātramaṅgārāvakīrṇamiva pacyatē yatra cōṣmābhivr̥ddhiḥ kṣatē kṣārāvasiktavacca vēdanāviśēṣāstaṁ paittikamiti vidyāt; pittavadraktasamutthaṁ jānīyāt; kaṇḍūrgurutvaṁ suptatvamupadēhō'lpavēdanatvaṁ stambhaḥ śaityaṁ ca yatra taṁ ślaiṣmikamiti vidyāt; yatra sarvāsāṁ vēdanānāmutpattistaṁ sānnipātikamiti vidyāt ||11||

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अत ऊर्ध्वं सर्वव्रणवेदना वक्ष्यामः- तोदनभेदनताडनच्छेदनायामनमन्थनविक्षेपणचुमुचुमायननिर्दहनावभञ्जनस्फोटन विदारणोत्पाटनकम्पनविविधशूलविश्लेषणविकिरणस्तम्भनपूरणस्वप्नाकुञ्जनाङ्कु शिकाः सम्भवन्ति, अनिमित्तविविधवेदनाप्रादुर्भावो वा मुहुर्मुहुर्यत्रागच्छन्ति वेदनाविशेषास्तं वातिकमिति विद्यात्; ओषचोषपरिदाहधूमायनानि यत्र गात्रमङ्गारावकीर्णमिव पच्यते यत्र चोष्माभिवृद्धिः क्षते क्षारावसिक्तवच्च वेदनाविशेषास्तं पैत्तिकमिति विद्यात्; पित्तवद्रक्तसमुत्थं जानीयात्; कण्डूर्गुरुत्वं सुप्तत्वमुपदेहोऽल्पवेदनत्वं स्तम्भः शैत्यं च यत्र तं श्लैष्मिकमिति विद्यात्; यत्र सर्वासां वेदनानामुत्पत्तिस्तं सान्निपातिकमिति विद्यात् ||११||

Meaning of the śloka

The pains of wounds are now described. A wound is known as vatika when it repeatedly develops causeless, varying sensations such as pricking, splitting, beating, cutting, stretching, churning, displacement, tingling, complete burning, crushing, bursting, tearing, pulling upward, trembling, diverse colicky separation, scattering, stiffness, fullness, numbness, contraction and ankushika. In a paittika wound there are localized burning, a sucking sensation, pervasive burning and a smoky feeling; the limb seems cooked as if covered with embers, heat increases, and an injury pains as if sprinkled with alkali. Pain arising from rakta resembles that of pitta. A shlaishmika wound has itching, heaviness, numbness, a coated feeling, little pain, stiffness and coldness. A sannipatika wound has pains of every kind.

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srāvānantaraṁ vātādivēdanā nirdiśannāha- ata ūrdhvamityādi| tōdanaṁ sūcibhiriva; bhēdanaṁ tvagvidāraṇamiva vēdanāviśēṣaḥ; tāḍanaṁ daṇḍādibhirāhanyata ivētyarthaḥ; chēdanaṁ dvidhā kriyata iva śastrādibhiḥ; āyāmanaṁ saṅkucitāṅgadēśasya dīrghīkaraṇamiva; manthanaṁ manthanakādibhirvraṇāntarmathyata iva; vikṣēpaṇaṁ prēryata iva; cumucumāyanaṁ sarṣaparājikākalkalipta iva; nirdahanaṁ niḥśēṣaṁ vahninā dahyata iva; avabhañjanaṁ sañcūrṇyata iva; sphōṭanaṁ pāṣāṇādibhiriva; vidāraṇaṁ nakhādibhiścīryata iva; utpāṭanam ūrdhvamākr̥ṣyata iva; kampanaṁ vēpyata iva; vividhaśūlaviślēṣaṇaṁ nānāprakārārtiśūlāhatagātrasyēva vēdanāviśēṣaḥ; vikiraṇaṁ vraṇāvayavā nānāsthānēṣu vikīryanta ivēti; stambhanaṁ stabdhatā; pūraṇaṁ bharaṇaṁ; svapanaṁ prasuptiḥ; ākuñcanaṁ kuṭilīkaraṇamiva; aṅkuśikā khallīviśēṣaḥ, anyē ‘aṅkuśanipātākarṣaṇamivāṅkuśikā’ ityācakṣatē| ōṣacōṣaparidāhētyādi|- ōṣa ēkadēśikō dāhaḥ; cōṣa ācūṣaṇasamatvādityēkē, pipāsētyanyē; pari samantatō dāhaḥ paridāhaḥ; dhūmāyanaṁ dhūmōdvamanamivāṅgānām| kaṇḍurgurutvamityādi|-suptatvaṁ nakhamakṣikāmaśakādidaṁśavēdanānabhijñatvam; upadēhō liptamivēti||11||

Meaning of the commentary

The commentary explains each vata sensation by analogy: needle-pricking, skin splitting, blows, cutting in two, stretching a contracted part, churning inside, being driven aside, mustard-paste tingling, total burning, crushing, bursting by stones, tearing by nails, upward pulling, shaking, varied severe colic, and the wound's parts scattering. Stambhana is rigidity, purana fullness, svapana numbness and akunchana contraction. Ankushika is identified as a kind of khalli; others explain it as the pull caused by the strike of a goad. Osha is localized burning; chosha is likened by some to suction, while others interpret it as thirst; paridaha is burning all around; and dhumayana feels like smoke rising from the limbs. Kapha-type numbness means not perceiving the pain of nail pressure or bites from flies, mosquitoes and similar creatures; upadeha feels as though coated.

Key terms

a~gkushikA (ankushika)
A vata-type pain, identified either as a kind of khalli or as a sensation like pulling with a goad.

Adhikarana 10 (12) · Śloka 12

ata ūrdhvaṁ vraṇavarṇān vakṣyāmaḥ- bhasmakapōtāsthivarṇaḥ paruṣō'ruṇaḥ kr̥ṣṇa iti mārutajasyaḥ nīlaḥ pītō haritaḥ śyāvaḥ kr̥ṣṇō raktaḥ piṅgalaḥ kapila iti raktapittasamutthayōḥ; śvētaḥ snigdhaḥ pāṇḍuriti ślēṣmajasya; sarvavarṇōpētaḥ sānnipātika iti ||12||

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अत ऊर्ध्वं व्रणवर्णान् वक्ष्यामः- भस्मकपोतास्थिवर्णः परुषोऽरुणः कृष्ण इति मारुतजस्यः नीलः पीतो हरितः श्यावः कृष्णो रक्तः पिङ्गलः कपिल इति रक्तपित्तसमुत्थयोः; श्वेतः स्निग्धः पाण्डुरिति श्लेष्मजस्य; सर्ववर्णोपेतः सान्निपातिक इति ||१२||

Meaning of the śloka

Wound colours are now described. A wound caused by vata may be ash-coloured, pigeon-grey, bone-coloured, rough-coloured, reddish-brown or black. Wounds arising from rakta or pitta may be blue, yellow, green, dark, black, red, tawny or brownish. A kapha wound is white, glossy or pale. A sannipatika wound displays all colours.

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vēdanāḥ pratipādya vraṇavarṇānnirdiśannāha- ata ūrdhvamityādi| dōṣadūṣyasaṁyōgarāśēranyatvānmārutajē'pi vraṇē varṇasadbhāvaḥ||12||

Meaning of the commentary

After explaining pain, the text classifies wound colours. Even a vata wound has colour because the particular combination of dosha and affected tissue produces a distinct resultant condition.

Adhikarana 11 (13) · Śloka 13

bhavati cātra- na kēvalaṁ vraṇēṣūktō vēdanāvarṇasaṅgrahaḥ | sarvaśōphavikārēṣu vraṇavallakṣayēdbhiṣak ||13||

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भवति चात्र- न केवलं व्रणेषूक्तो वेदनावर्णसङ्ग्रहः | सर्वशोफविकारेषु व्रणवल्लक्षयेद्भिषक् ||१३||

Meaning of the śloka

The collected descriptions of pain and colour do not apply only to wounds. A physician should identify them in every disorder arising from swelling just as in a wound.

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sāmānyavraṇanirdiṣṭān dōṣaduṣṭisrāvavēdanāvarṇān śōphaviśēṣēṣvapi vidradhyalajīgranthyādiṣu nirdiśannāha- na kēvalaṁ vraṇēṣūkta ityādi| śōthavikārēṣviti śōthārabdhavikārēṣu vidradhyādiṣviti||13||

Meaning of the commentary

The doshic disturbance, discharge, pain and colour described generally for wounds also apply to particular swelling disorders such as vidradhi, alaji and granthi. 'Disorders of swelling' means disorders that originate from swelling.

Adhikarana puṣpikā · Śloka 22

iti suśrutasaṁhitāyāṁ sūtrasthānē vraṇāsrāvavijñānīyō nāma dvāviṁśatitamō'dhyāyaḥ ||22||

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इति सुश्रुतसंहितायां सूत्रस्थाने व्रणास्रावविज्ञानीयो नाम द्वाविंशतितमोऽध्यायः ||२२||

Meaning of the śloka

Thus ends the twenty-second chapter, called Vranasravavijnaniya, in the Sutrasthana of the Sushruta Samhita.

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iti śrīḍalha(hla)ṇaviracitāyāṁ nibandhasaṅgrahākhyāyāṁ suśrutavyākhyāyāṁ sūtrasthānē dvāviṁśatitamō'dhyāyaḥ||22||

Meaning of the commentary

Thus ends the twenty-second chapter in the Sutrasthana of the Nibandhasangraha commentary on Sushruta, composed by Shri Dalhana.

← 21. vraṇapraśnādhyāyaḥ23. kr̥tyākr̥tyavidhyadhyāyaḥ →