22. vraṇāsrāvavijñānīyādhyāyaḥ

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Meaning of the commentary

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