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Chapter 43 – Sadyovrana Nidanam

The 43rd chapter of Madhava Nidana is Sadyovrana Nidana which deals with Traumatic Ulcers.

Etiology —

नानाधार – मुखैः शस्त्रैर्नानास्थाननिपातितैः |
भवन्ति नानाकृतयो व्रणास्तांस्तान्निबोध मे || १ ||

nānādhāra – mukhaiḥ śastrairnānāsthānanipātitaiḥ |
bhavanti nānākr̥tayō vraṇāstānstānnibōdha mē || 1 ||

Now different kinds of ulcers caused by assault with different types of sharp weapons with different kinds of edges, in different places of the body are going to be described. 1

Types —

छिन्नं भिन्नं तथा विद्धं क्षतं पिच्चितमेव च |
घृष्टमाहुस्तथा षष्टं तेषां वक्ष्यामि लक्षणम् || २ ||

chinnaṁ bhinnaṁ tathā viddhaṁ kṣataṁ piccitamēva ca |
ghr̥ṣṭamāhustathā ṣaṣṭaṁ tēṣāṁ vakṣyāmi lakṣaṇam || 2 ||

The 6 types of ulcers are —

  • Chinna (incised wound)
  • Bhinna (Punctured wound)
  • Viddha (Stabbed wound)
  • Kshata (Lacerated wound)
  • Picchita (Crushed wound), and
  • Ghrsta (Excoriated) and their features are described below. 2
Chinna (Wound after excision/ loss of a part) —

तिर्यक् छिन्न ऋजुर्वा अपि यो व्रणस्त्वायतो भवेत् |
गात्रस्य पातनं तच्च छिन्नमित्यभिधीयते || ३ ||

tiryak chinna r̥jurvā api yō vraṇastvāyatō bhavēt |
gātrasya pātanaṁ tacca chinnamityabhidhīyatē || 3 ||

The ulcer which is caused by a sharp – edged cutting instrument, in that the wound is curved or straight, wide and causes mutilation of a part of the body is known as Chinna Vrana. 3

Definition —

शक्ति – दन्तेषु – खड्गाग्र – विषाणैराशयो हतः |
यत्किञ्चित् प्रस्रवेत् तद्धि भिन्नलक्षणमुच्यते || ४ ||

śakti – dantēṣu – khaḍgāgra – viṣāṇairāśayō hataḥ |
yatkiñcit prasravēt taddhi bhinnalakṣaṇamucyatē || 4 ||

A punctured wound is caused by pointed javelin, tusk, arrow, spear, or horns of animals, into different viscera; thereby causing discharge of their contents to the exterior is known as Bhinna vrana. 4

Kostha (Thoraco -abdominal cavity) —

स्थानान्यामाग्निपक्वानां मूत्रस्य रुधिरस्य च |
हृदुण्डुकः फुप्फुसश्च कोष्ठ इत्यभिधीयते || ५ ||

sthānānyāmāgnipakvānāṁ mūtrasya rudhirasya ca |
hr̥duṇḍukaḥ phupphusaśca kōṣṭha ityabhidhīyatē || 5 ||

Abdominal viscera (kostha) have been defined as the organs holding undigested and digested eatables. It contains the

  •  stomach (Aama), and
  • The digestive juices (agni) (liver and gall bladder and pancreas)

The digested eatables relate to such limbs as

  • the Intestine (pakva),
  • urine i.e., urinary bladder (mutra),
  • blood i.e., spleen (rudhira),
  • heart (hrdaya),
  • caecum (unduka) and
  • Lungs (Phuphphusa). 5
General Features of injury to the Kostha —

तस्मिन् भिन्ने रक्तपूर्णे ज्वरो दाहश्च जायते |
मूत्रमार्ग – गुदास्येभ्यो रक्तं घ्राणाच्च गच्छति || ६ ||
मूर्च्छा श्वासस्त्रुषा आध्मानमभक्तच्छन्द एव च |
विण्मूत्र – वातसङ्गश्च स्वेदास्रावो अक्षिरक्तता || ७ ||
लोहगन्धित्वमास्यस्य गात्रदौर्गन्ध्यमेव च |
हृच्छूलं पार्श्वयोश्चापि विशेषं चात्र मे शृणु || ८ ||

tasmin bhinnē raktapūrṇē jvarō dāhaśca jāyatē |
mūtramārga – gudāsyēbhyō raktaṁ ghrāṇācca gacchati || 6||
mūrcchā śvāsastruṣā ādhmānamabhaktacchanda ēva ca |
viṇmūtra – vātasaṅgaśca svēdāsrāvō akṣiraktatā || 7||
lōhagandhitvamāsyasya gātradaurgandhyamēva ca |
hr̥cchūlaṁ pārśvayōścāpi viśēṣaṁ cātra mē śr̥ṇu || 8 ||

When the kostha is injured and it is filled with blood, fever and burning sensation are produced and bleeding occurs through the urethra, rectum, mouth or the nose. It is associated with

  • Fainting,
  • Difficult respiration,
  • thirst
  • distension of the stomach
  •  Loss of appetite,
  • Blockage to movement of urine, faeces and flatus,
  • Continuous respiration,
  • Redness of the eyes,
  • Smell of iron from the mouth,
  • Bad smell of the body and
  • Pain in the precordium and
  • The sides of chest and stomach. 6-8
Injury to the stomach —

आमाशयस्थे रुधिरे रुधिरं छर्दयत्यपि |
आध्मानमतिमात्रं च शूलं च भृशदारुणम् || ९ ||

āmāśayasthē rudhirē rudhiraṁ chardayatyapi |
ādhmānamatimātraṁ ca śūlaṁ ca bhr̥śadāruṇam || 9 ||

There could be vomiting of blood, severe distension, and pain in the stomach if it (Aamashaya) is punctured. 9

Injury to colon —

पक्वाशयेगते चापि रुजा गौरवमेव च |
अधःकाये विशेषेण शीतता च भवेदिह || १० || 

pakvāśayēgatē cāpi rujā gauravamēva ca |
adhaḥkāyē viśēṣēṇa śītatā ca bhavēdiha || 10 ||

There could be severe pain, heaviness, and coldness of the lower extremities if small and large intestines (pakvaashaya)  are punctured.10

Viddha (Penetrating wound) —

सूक्ष्मास्यशल्याभिहतं यदङ्गं त्वाशयं विना |
उत्तुण्डितं निर्गतं वा तद्विद्धमिति निर्दिशेत् || ११ ||

sūkṣmāsyaśalyābhihataṁ yadaṅgaṁ tvāśayaṁ vinā |
uttuṇḍitaṁ nirgataṁ vā tadviddhamiti nirdiśēt || 11 ||

The ulcer that is caused by a pointed instrument at a limb away from any viscera; that produces slight swelling is known as stab wound (viddha vrana). The instrument used could remain lodged inside the limb of the body or the case may be otherwise. In either case, the wound is to be identified as the stab wound (viddha vrana) only. 11

Kshata (Lacerated wound) —

 नातिच्छिन्नं नातिभिन्नमुभयोर्लक्षणान्वितम् |
विषमं व्रणमङ्गे यत्तत् क्षतं त्वभिधीयते || १२ || 

 nāticchinnaṁ nātibhinnamubhayōrlakṣaṇānvitam |
viṣamaṁ vraṇamaṅgē yattat kṣataṁ tvabhidhīyatē || 12 ||

The ulcer that is neither deeply incised nor punctured but has mild features of both of them and is irregular in shape is known as lacerated wound. (Ksata Vrana). 12

Piccita (Crush injury) —

प्रहार – पीडनाभ्यां तु यदङ्गं पृथुतां गतम् |
सास्थि तत् पिच्चितं विध्यान्मज्ज – रक्तपरिप्लुतम् || १३ ||

 prahāra – pīḍanābhyāṁ tu yadaṅgaṁ pr̥thutāṁ gatam |
sāsthi tat piccitaṁ vidhyānmajja – raktapariplutam || 13 ||

The ulcer which is caused by a blow or pressure with a blunt weapon and by which a part of the body is flattened along with the bone marrow with blood flowing out therefrom is known as crushed wound (Picchita vrana). 13

Ghrsta (Abrasions) —

 घर्षणादभिघाताद्वा यदङ्गं विगतत्वचम् |
उषा – स्रावान्वितं तच्च घृष्टमित्यभिधीयते || १४ || 

gharṣaṇādabhighātādvā yadaṅgaṁ vigatatvacam |
uṣā – srāvānvitaṁ tacca ghr̥ṣṭamityabhidhīyatē || 14 ||

The ulcer that is caused by friction or mild blow, in that the skin is peeled off producing mild burning sensation and flow of watery fluid, is known as Ghrsta Vrana. 14

 Wound with an impacted foreign body in the thoraco – abdominal cavity —

 श्यावं सशोथं पिडकाचितं च मुहुर्मुहुः शोणितवाहिनं च |
मृदूद्गतं बुद्बुदतुल्यमांसं व्रणं सशल्यं सरुजं वदन्ति || १५ ||

śyāvaṁ saśōthaṁ piḍakācitaṁ ca muhurmuhuḥ śōṇitavāhinaṁ ca |
mr̥dūdgataṁ budbudatulyamānsaṁ vraṇaṁ saśalyaṁ sarujaṁ vadanti || 15 ||

The wounds that appear blue, swollen, bulged out, soft; in which the surrounding muscles feel frothy and painful. If there is frequent bleeding too, the case should be known as an ulcer in which the foreign body (shalya) remains hidden inside. 15

त्वचो अतीत्य सिरादीनि भित्त्वा वा परिहृत्य वा |
कोष्टे प्रतिष्टितं शल्यं कुर्यादुक्तानुपद्रवान् || १६ ||

tvacō atītya sirādīni bhittvā vā parihr̥tya vā |
kōṣṭē pratiṣṭitaṁ śalyaṁ kuryāduktānupadravān || 16||

Features of the foreign body (shalya) that injures the skin and blood vessels and that is lodged inside the stomach include the following:

  • Accumulation of blood inside the stomach,
  • Pallor of the skin. 16
The incurable patient —

 तत्रान्तर्लोहितं पाण्डु – शीतपादकराननम् |
शीतोच्छवासं रक्तनेत्रमानद्धं च विवर्जयेत् || १७ || 

 tatrāntarlōhitaṁ pāṇḍu – śītapādakarānanam |
śītōcchavāsaṁ raktanētramānaddhaṁ ca vivarjayēt || 17 ||

If the blood reaches the stomach, if the face of the patient turns yellow in colour and if his head, arms, and legs turn cold as complications of the disease the situation of the patient should be understood as critical and incurable. The wise physicians should not take up such cases of the Kosthabheda kind of vrana. 17

General clinical features of injury to the marmas —

 भ्रमः प्रलापः पतनं प्रमोहो विचेष्टनं ग्लानिरथोष्णता च |
स्रस्ताङ्गता मूर्च्छनमूर्ध्ववातस्तीव्रा रुजो वातकृताश्च तास्ताः || १८ ||
मांसोदकाभं रुधिरं च गच्छेत् सर्वेन्द्रियार्थोपरमस्तथैव |
दशार्धसङ्ख्येष्वथ विक्षतेषु सामान्यतो मर्मसु लिङ्गमुक्तम् || १९ || 

 bhramaḥ pralāpaḥ patanaṁ pramōhō vicēṣṭanaṁ glānirathōṣṇatā ca |
srastāṅgatā mūrcchanamūrdhvavātastīvrā rujō vātakr̥tāśca tāstāḥ || 18 ||
mānsōdakābhaṁ rudhiraṁ ca gacchēt sarvēndriyārthōparamastathaiva |
daśārdhasaṅkhyēṣvatha vikṣatēṣu sāmānyatō marmasu liṅgamuktam || 19 ||

The features of the injury to marma or vital spots of the body include the following:

  • Confusion
  • Delirium
  • Falling down,
  • Dizziness,
  • Uncoordinated Limbs,

He would feel,

  • Depression,
  • A feeling of heat,
  • Flaccidity of limbs.

There is —

  • Fainting,
  • Belching,
  • Various and severe types of Vatika Pain.

The wound would discharge of blood that resembles the meat washings and cessation of functioning of all the sense organs, these are the usual features of injury to the five types of marmas i.e, muscles, vessels, sinews, bones and joints. 18-19

Clinical features of injury to the specific parts/ marmas

Injury to the vessels —

 सुरेन्द्रगोपप्रतिमं प्रभूतं रक्तं स्रवेत् तत्क्षयजश्च वायुः |
करोति रोगान् विविधान् यथोक्तान् सिरासु विद्धास्वथ वा क्षतासु || २० || 

surēndragōpapratimaṁ prabhūtaṁ raktaṁ sravēt tatkṣayajaśca vāyuḥ |
karōti rōgān vividhān yathōktān sirāsu viddhāsvatha vā kṣatāsu || 20 ||

Injury to the sinews —

कौब्ज्यं शरीरावयवावसादः क्रियास्वशक्तिस्तुमुला रुजश्च |
चिराद् व्रणो रोहति यस्य चापि तं स्नायुविद्धं पुरुषं व्यवस्येत् || २१ ||

kaubjyaṁ śarīrāvayavāvasādaḥ kriyāsvaśaktistumulā rujaśca |
cirād vraṇō rōhati yasya cāpi taṁ snāyuviddhaṁ puruṣaṁ vyavasyēt || 21 ||

When particular structures are injured special features manifest. These have been described as below:

Several disorders are caused later on if blood vessels (siras) are injured and there could be heavy discharge of blood that appears bright red in color like the insect Indragopa.

Features when tendon nerves (snayus) are injured include the following:

  •  Decrease in height,
  • Drooping of the body parts,
  • Loss of function,
  • Very severe pain. 

Such wounds take a long time to heal. 20-21

Injury to the joints —

शोषाभिवृद्धिस्तुमुला रुजश्च बलक्षयः सर्वत एव शोथः |
क्षतेषु सन्धिष्वचलाचलेषु स्यात् सर्वकर्मोपरमश्च लिङ्गम् || २२ ||

śōṣābhivr̥ddhistumulā rujaśca balakṣayaḥ sarvata ēva śōthaḥ |
kṣatēṣu sandhiṣvacalācalēṣu syāt sarvakarmōparamaśca liṅgam || 22 ||

There could be increase of the swelling, severe pain, loss of strength, oedema  in other parts of the body and total loss of functions if mobile or immobile bony joints are injured. 22

Injury to the bones —

 घोरा रुजो यस्य निशादिनेषु सर्वास्ववस्थासु च नैति शान्तिम् |
भिषग्विपः चिद्विदितार्थसूत्रस्तमस्थिविद्धं पुरुषं व्यवस्येत् || २३ || 

ghōrā rujō yasya niśādinēṣu sarvāsvavasthāsu ca naiti śāntim |
bhiṣagvipaḥ cidviditārthasūtrastamasthividdhaṁ puruṣaṁ vyavasyēt || 23 ||

Severe pain continuously throughout the day and night and absence of relief in any posture are the features by that the talented physician who is well conversant with the science of wounds should recognize a person  who is suffering from injury to the bones. 23

Injury to the muscles —

यथास्वमेतानि विभावयेच्च लिङ्गानि मर्मस्वभिताडितेषु |
पाण्डुर्विवर्णः स्पृशितं न वेत्ति यो मांसमर्मण्यभिपीडितः स्यात् || २४ || 

 yathāsvamētāni vibhāvayēcca liṅgāni marmasvabhitāḍitēṣu |
pāṇḍurvivarṇaḥ spr̥śitaṁ na vētti yō mānsamarmaṇyabhipīḍitaḥ syāt || 24 ||

In persons, whose vital organs are injured similar symptoms will be found. It will result in anemia, discoloration of skin and loss of tactile sensation if vital spots of muscles are injured. 24

Complications of Wounds —

विसर्पः पक्षाघातश्च सिरास्तम्भो अपतानकः |
मोहोन्माद – व्रणरुजो ज्वरस्तृष्णा हनुग्रहः || २५ ||
कासश्छर्दिरतिसारो हिक्का श्वासः सवेपथुः |
षोडशोपद्रवाः प्रोक्ता व्रणानां व्रणचिन्तकैः || २६ ||

 visarpaḥ pakṣāghātaśca sirāstambhō apatānakaḥ |
mōhōnmāda – vraṇarujō jvarastr̥ṣṇā hanugrahaḥ || 25 ||
kāsaśchardiratisārō hikkā śvāsaḥ savēpathuḥ |
ṣōḍaśōpadravāḥ prōktā vraṇānāṁ vraṇacintakaiḥ || 26 ||

The 16 complications of the wounds as told by the specialists are —

  • Erysipelas,
  • Hemiplegia,
  • Stiffness of the head,
  • Tetanus,
  • Delusion,
  • Insanity,
  • Severe pain in the wound,
  • Fever,
  • Thirst,
  • Lockjaw,
  • Cough,
  • Vomiting,
  • Diarrhoea,
  • Hiccough,
  • Difficulty in breathing, and
  • Tremors. 25-26

इति श्री माधवकरविरचिते माधवनिदाने सद्योव्रणनिदानं समाप्तम् || ४३ ||

iti śrī mādhavakaraviracitē mādhavanidānē sadyōvraṇanidānaṁ samāptam || 43 ||

Thus concludes the Chapter on Sadyovrana.