Chapter 42 – Sharira Vrana Nidanam

The 42nd Chapter of Madhava Nidana is Sharira Vrana Nidanam which deals with Organic Ulcers. An ulcer is a painful sore that is slow to heal and sometimes recurs. Ulcers aren’t uncommon. Why they appear and their corresponding symptoms typically depend on their underlying causes.

The two types of Ulcerative Lesions —

द्विधा व्रणः स विज्ञेयः शारीरगन्तुभेदतः |
दोषैराध्यस्तयोरन्यः शस्त्रादिक्षतसम्भवः || १ ||

dvidhā vraṇaḥ sa vijñēyaḥ śārīragantubhēdataḥ |
dōṣairādhyastayōranyaḥ śastrādikṣatasambhavaḥ || 1 ||

There are two kinds of ulcers (Vranas):

• Organic (Sharira) and
• Traumatic (Aagantuja).

Of these, the Vranas are caused by the doshas while the aagantuja are caused by weapons.  1

Vaatika Vrana —

स्तब्धः कठिनसंस्पर्शो मन्दस्रावो महारुजः |
तुध्यते स्फुरति श्यावो व्रणो मारुतसम्भवः || २ ||

stabdhaḥ kaṭhinasansparśō mandasrāvō mahārujaḥ |
tudhyatē sphurati śyāvō vraṇō mārutasambhavaḥ || 2 ||

The Features of Vrana caused by Vata include the following–

• Being immovable
• Hard to touch
• with scanty exudation
• With severe pain such as pricking or pulsating, and
• Blue in color. 2

Paittika Vrana —

तृष्णा – मोह – ज्वर – क्लेद – दाह दुष्ट्यवदारणैः |
व्रणं पित्तकृतं विध्याद् गन्धैः स्रावैश्च पूतिकैः || ३ ||

tr̥ṣṇā – mōha – jvara – klēda – dāha duṣṭyavadāraṇaiḥ |
vraṇaṁ pittakr̥taṁ vidhyād gandhaiḥ srāvaiśca pūtikaiḥ || 3 ||

The Pittaja Vrana features include the following —

• Thirst,
• Delusion
• Fever,
• Perspiration,
• Burning sensation,
• Cracked Skin,
• The ulcer emits bad smell and exudes foul discharge. 3

 Kaphaja Vrana —

 बहुपिच्छो गुरुः स्निग्धः स्तिमितो मन्दवेदनः |
पाण्डुवर्णो अल्पसङ्क्लेदश्चचिरपाकी कफव्रणः || ४ || 

bahupicchō guruḥ snigdhaḥ stimitō mandavēdanaḥ |
pāṇḍuvarṇō alpasaṅklēdaścacirapākī kaphavraṇaḥ || 4 ||

Vrana caused by kapha would

• exude a large amount of pus;
• it is hard, smooth, immovable,
• Slightly painful,
• Yellowish white in colour, and
• Moist.
• It suppurates slowly. 4

Raktaja Vrana —

 रक्तो रक्तस्रुति रक्ताद् — 

raktō raktasruti raktād —

Vrana caused by blood (rakta) could be red in colour. It exudes only blood.

In the cases of the Vrana caused by the combination of either two or three doshas, there would appear all their respective symptoms together.

— द्वि – त्रिजः स्यात्तदन्वयैः |

— dvi – trijaḥ syāttadanvayaiḥ |

The wounds that manifest vitiation of a combination of two doshas are identified as dvandaja and dvidoshaja wounds. The wounds that manifest vitiation of a combination of all the three doshas are called as Tridoshaja Wounds.

Prognosis —

त्वङ्ग्मांसजः सुखे देशे तरुणस्यानुपद्रवः || ५ ||
धीमतो अभिनवः काले सुखे साध्यः सुखं व्रणः |

tvaṅgmānsajaḥ sukhē dēśē taruṇasyānupadravaḥ || 5 ||
dhīmatō abhinavaḥ kālē sukhē sādhyaḥ sukhaṁ vraṇaḥ |

The ulcers that are easily curable include the following —

• One that is located in the skin or muscles;
• In a convenient place,
• Of recent origin and uncomplicated;
• That has involved a strong person;
• That is in appropriate time, season, age and the like. 5

गुणैरन्यतमैर्हिर्नस्ततः कृच्छ्रो व्रणः स्मृतः || ६ ||
सर्वैर्विहीनो विज्ञेयस्त्वसाध्यो भूर्युपद्रवः |

guṇairanyatamairhirnastataḥ kr̥cchrō vraṇaḥ smr̥taḥ || 6 ||
sarvairvihīnō vijñēyastvasādhyō bhūryupadravaḥ |

Those ulcers that possess the similar features described above cannot be cured; while those that are devoid of any of the above qualities can be cured. 6

An infected wound/ ulcer —

 पूतिः पूयातिदुष्टासृक् स्राव्युत्सङ्गी चिरस्थितिः ||७ ||
दुष्टो व्रणो अतिगन्धादिः शुद्धलिङ्गविपर्ययः |

pūtiḥ pūyātiduṣṭāsr̥k srāvyutsaṅgī cirasthitiḥ ||7 ||
duṣṭō vraṇō atigandhādiḥ śuddhaliṅgaviparyayaḥ |

Those ulcers that produce bad smell or spoilt blood, have sinuses inside, that remain for long periods, that emit foul – smell and the ones that do not possess any features of a clean ulcer are known as Dusta Vrana ulcers. 7

A Clean ulcer —

जिह्वातलाभो अतिमृदुः श्लक्ष्णः स्निग्धो अल्पवेदनः || ८ ||
सुव्यवस्थो नीरास्रावः शुद्धो व्रण इति स्मृतः |

jihvātalābhō atimr̥duḥ ślakṣṇaḥ snigdhō alpavēdanaḥ || 8 ||
suvyavasthō nīrāsrāvaḥ śuddhō vraṇa iti smr̥taḥ |

A clean ulcer (Shuddha vrana) is the one that is like the upper surface of the tongue, very soft, smooth, and moist, with mild pain, even without sprouts and sinuses. It does not discharge anything. 8

A Healing Ulcer —

कपोतवर्णप्रतिमा यस्यान्ताः क्लेदवर्जिताः || ९ ||
स्थिराश्च पिडकावन्तो रोहतीति तमादिशेत् |

kapōtavarṇapratimā yasyāntāḥ klēdavarjitāḥ || 9 ||
sthirāśca piḍakāvantō rōhatīti tamādiśēt |

At the stage of healing, an ulcer (vrana) would manifest such features:

• The color of a pigeon,
• Slightly blackish at its edges,
• No exudation, and
• Absence of a fissured floor.
• It is studded with granulations. 9

A Properly Healed Ulcer —

रूढवतर्मानमग्रन्थिमशूनमरुजं व्रणम् || १० ||
त्वक्सवर्णं समतलं सम्यग्रूढं विनिर्दिशेत् |

rūḍhavatarmānamagranthimaśūnamarujaṁ vraṇam || 10 ||
tvaksavarṇaṁ samatalaṁ samyagrūḍhaṁ vinirdiśēt |

Features of ulcer (vrana) that has been healed up include the following:

• Edges closing up,
• No elevations in the middle,
• No swelling,
• No pain,
• The site of the ulcer attaining the normal level and color of the skin. 10

 Generalised Systemic Diseases as  causes of Incurability —

कुष्टिनां विषजुष्टानां शोषिणां मधुमेहिनाम् || ११||
व्रणाः कृच्छ्रेण सिध्यन्ति येषां चापि व्रणो व्रणाः | 

kuṣṭināṁ viṣajuṣṭānāṁ śōṣiṇāṁ madhumēhinām || 11||
vraṇāḥ kr̥cchrēṇa sidhyanti yēṣāṁ cāpi vraṇō vraṇāḥ |

Better Prognosis of Traumatic Ulcer —

वसां मेदो अथ मज्जानं मस्तुलुङ्गं च यः स्रवेत् || १२ ||
आगन्तुजो व्रणः सिद्ध्येन्न सिद्ध्येद्योषसम्भवः |

vasāṁ mēdō atha majjānaṁ mastuluṅgaṁ ca yaḥ sravēt || 12 ||
āgantujō vraṇaḥ siddhyēnna siddhyēdyōṣasambhavah |

It is difficult to cure the Vranas that have involved persons

• who are suffering from Leprosy,
• Effects of poison,
• Tuberculosis, and
• Diabetes mellitus.

Likewise, traumatic ulcer that exudes out muscle fat, fat, marrow, brain matter and the like, can be cured but the cases of organic ulcers cannot be cured. 11-12

Odors indicating fatal prognosis —

मध्यागुर्वाज्य – समुना – पद्म – चन्दन – चम्पकैः || १३ ||
सगन्धा दिव्यगन्धाश्च मुमूर्षूणां व्रणाः स्मृताः |

madhyāgurvājya – samunā – padma – candana – campakaiḥ || 13 ||
sagandhā divyagandhāśca mumūrṣūṇāṁ vraṇāḥ smr̥tāḥ |

Some of the smells that are otherwise pleasant but are indication of a fatal case of vrana include the following:

• A smell similar to alcohol,
• The plant Aquillaria agallocha (aguru),
• Ghee,
• Jasmine flower,
• Lotus flower,
• Sandalwood, and the
• Campaka Flower. 13

Other bad prognostic features —

ये च मर्मस्वसम्भूता भवन्त्यत्यर्थवेदनाः || १४ ||
दह्यन्ते चान्तरत्यर्थं बहिः शीताश्च ये व्रणाः |
दह्यन्ते बहिरत्यर्थं भवन्त्यन्तश्च शीतलाः || १५ ||
प्राणमांसक्षय – श्वास – कासारोचकपीडिताः |
प्रवृद्धपूय – रुधिरा व्रणा येषां च मर्मसु || १६ ||
क्रियाभिः सम्यगारब्धा न सिध्यन्ति च ये व्रणाः |
वर्जयेदपि तान् वैद्यः संरक्षन्नात्मनो यशः || १७ || 

yē ca marmasvasambhūtā bhavantyatyarthavēdanāḥ || 14 ||
dahyantē cāntaratyarthaṁ bahiḥ śītāśca yē vraṇāḥ |
dahyantē bahiratyarthaṁ bhavantyantaśca śītalāḥ || 15 ||
prāṇamānsakṣaya – śvāsa – kāsārōcakapīḍitāḥ |
pravr̥ddhapūya – rudhirā vraṇā yēṣāṁ ca marmasu || 16 ||
kriyābhiḥ samyagārabdhā na sidhyanti ca yē vraṇāḥ |
varjayēdapi tān vaidyaḥ sanrakṣannātmanō yaśaḥ || 17 ||

The physician who keeps in mind his reputation must avoid the patients with ulcers (vranas) manifesting on vital organs, the ones having severe pain, burning sensation inside and cold outside or vice versa. Similarly, wise physician should not take up cases of Vranas that cause loss of strength, emaciation, promoted respiration, cough and loss of appetite. It is also advised to avoid the patients with ulcers (vranas) discharging large quantities of pus or blood. One should also avoid those patients that do not respond to treatment though well planned. 14-17

श्री माधवकरविरचिते माधवनिदाने शारीरव्रणनिदानं समाप्तम् || ४२ ||

 śrī mādhavakaraviracitē mādhavanidānē śārīravraṇanidānaṁ samāptam || 42 ||

Thus concludes the Chapter on Sharira Vrana.

Source — 

1. Ulcers