Sushruta Samhita Sutrasthana Chapter 19: Vranitopasaniya Adhyaya (Care of the Wounded)

The 19th chapter of Sutrasthana of Sushruta Samhita is named as Vranitopasaniya Adhyaya. This chapter deals with the information on Care of the Wounded.

अथाते व्रणितोपासनीयमध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भगवान् धन्वन्तरीः॥२॥

We will now explain the chapter by name Vranitopasaniya- care of the wounded person, as revealed by the venerable Dhanvantari.

Vranitagara: Chamber for the wounded

व्रणितस्य  प्रथममेवागारमन्विच्छेत् ; तच्चागारं प्राशस्तवास्त्वादिकं कार्यम् ॥३॥
प्रशस्तवास्तुनि गृहे शुचावातपवर्जिते ।
निवाते न च रोगाः स्युः शारीरागन्तुमानसाः ॥४॥

First of all, a chamber shall be selected and arranged for the wounded person to stay. The selected chamber should be constructed in an auspicious land and should have been constructed in accordance with vastu shastra (science of architecture) etc. A person residing in such an auspicious house (house built on an auspicious land) built in accordance with science of architecture, which is clean (free from dirt), free from sunlight (heat of the sun) falling directly and heavy breeze will not suffer from physical, metal and traumatic disorders.

Arrangement of bedding in the ward for the wounded

तस्मिन् शयनमसंबाधं सास्तीर्णं मनोज्ञं प्राक्शिरस्कं सशस्त्रम् च कुर्वीत ॥५॥
सुखचेष्टाप्रचारः स्यात स्वास्तीर्णे शयने व्रणी॥
प्राच्यां दिशि स्थिता देवास्तत्पूजार्थं च तच्छिरः ॥६॥

In such a house (chamber) proper arrangements for sleeping should be done so that the patient can sleep conveniently. The bedding should be free of troubles (comfortable to sleep), wide and long (with proper dimensions), covered with clean cloth, pleasant to the mind, fit to keep the head to the east direction (pillow towards east), and having the weapons placed beneath the pillow (to be used for protection from enemies, animals etc).

The wounded person should sleep on a wide bed, convenient for easy movements (of body parts and other activities), comfortable enough to change position and sides while sleeping. Since the Gods reside in the east, the person should sleep keeping his head in that direction as a sign of worship (respect).  

The wounded living in company of good and affectionate friends in the ward

 तस्मिन्  सुहद्भिरनुकूलैः प्रियंवदैरुपास्यमानो यथेष्टमासीत ॥७॥
सुहदो विक्षिपन्त्याशु कथाभिर्व्रणवेदनाः ।
आश्वासयन्तो बहुशः  स्वनुकूलाः प्रियंवदाः ॥८॥

In such an auspicious house (ward), the wounded person should reside or sleep (on the comfortable bedding), in the company of affectionate friends who talk pleasingly, as much and as long as he likes. 

Friends play an important role in healing as they create a serene environment which makes the wounded person forget his wounds. When friends tell many kinds of stories, the wounded person will feel in a zone of comfort and ease. It will erase the pain and discomfort of the wound and pain associated with it. The comforting and pleasing conversation that they carry on would provide assurance to the patient and he would visualize cure.

Ahita Acharika: Activities and foods to be avoided

न च दिवानिद्रावशगः  स्यात् ॥९॥
दिवास्वप्राद्व्रणे कण्डूर्गात्राणां गौरवं तथा ॥
श्वयथुर्वे रागः स्रावश्चैव भृशं भवेत् ॥१०॥

Sleeping during day time is contraindicated for the person who is wounded. By sleeping during day time, the below mentioned symptoms would get greatly increased –

–        Itching in the wound
–        Feeling of heaviness in the body
–        Swelling
–        Pain
–        Redness
–        Discharges / exudation

उत्थानसंवेशनपरिवर्तनचङ्क्रमणोच्चैर्भाषणाद्यास्वात्मचेष्टास्वप्रमत्तो व्रणं संरक्षेत् ॥११॥
स्थानासनं चङ्क्रमणं दिवास्वप्रं तथैव च ॥
व्रणितो न निषेवेत शक्तिमानपि मानवः ॥१२॥
उत्थानाद्यासनं स्थानं शय्या चातिनिषेविता ॥
प्राप्रुयान्मारुतादङ्गरुजस्तस्माद्विर्जयेत् ॥२३॥

When the wounded person is indulged in regular activities like raising, sitting, turning, walking, speaking etc. he should protect his wound carefully and see that it does not get further worsened / damaged.

In spite of the wounded person being a strong person, he should avoid doing the below mentioned activities in excess –

–        Standing
–        Sitting
–        Walking for long periods of time
–        Day sleeping

When the person indulges in the contraindicated activities like standing, sitting, sleeping etc. will lead to aggravation of vata. This would in turn lead to various kinds of pain in different parts of the body.

Therefore, the person who is wounded should avoid all these activities.

गम्यानां चस्त्रीणां संदर्शनसंभाषणसंस्पर्शनानि दूरत एव परिहरेत्। ॥१४॥
स्त्रीदर्शनादिभिः शुक्रं कदाचिच्चलितं स्रवेत् ॥
ग्राम्यधर्मकृतान्दोषान् सोऽसंसर्गेऽप्यवाप्रुयात् ॥१५॥

In spite of being sexually fit and eligible for sexual activities (copulation), the person suffering from wound has to avoid the below mentioned activities in relation to women, which would facilitate quick healing –

–        Seeing women
–        Talking to women
–        Touching the women
–        Indulgence in sex

The woman should be avoided from a long distance itself, in spite of her being eligible for having sex.  

By doing these contraindicated activities like seeing the women etc. the semen of the person who is wounded would get dislodged (from its normal seat) and flows out (gets ejaculated). Then the person will suffer from all the bad effects of copulation though he actually has not done it.  

नवधान्यमाषतिलकलात्थनिष्पावहरितकशाकाम्ललवणकटुकगुडपिष्टविकृतिवल्लूरशुष्कशाकाजाविकानूपौदकमांदवसाशीतोदककृशरापायसदधिदुग्धतक्रप्रभृतीनि परिहरेत् ॥१६॥

He should avoid the below mentioned foods and drinks strictly (until completely healed) –

–        Nava Dhanya – Freshly harvested grains
–        Masa – black gram
–        Tila – sesame
–        Kalaya – round pea
–        Kulattha – horse gram
–        Nispava – cow gram
–        Harita saka – leafy vegetables
–        Amla, lavana, katu – foods which are predominantly sour, salty and pungent in taste,
–        Guda – jaggery, treacle
–        Pishta vikriti – Foods prepared with flour,
–        Vallura – Dried meat,
–        Suska saka – dried vegetables
–        Aja avika anupa audakanam vasa – Muscle fat of goat, sheep and animals living in marshy areas and water,
–        Shitodaka – Cold water
–        Krsara – rice cooked along with green gram
–        Payasa – milk pudding
–        Dadhi- curds
–        Kshira – milk
–        Takra – buttermilk etc.

Dosha Sanjanana Varga

तक्रान्तो नवधान्यादिर्योऽयं  वर्ग उदाहतः ॥
दोषसंजननो द्येष विज्ञेयः पूयवर्धनः ॥१७॥

Dosa sanjanana varga – The foods and drinks enumerated in the above said context commencing from freshly harvested grains and ending with buttermilk is considered as Dosa Sanjanana Varga – i.e. things which would essentially cause aggravation of all the three doshas. They not only cause an increase in doshas but also increase formation of pus and hence are not beneficial for those suffering from wounds.

We can note that Acharya Dalhana has included Kuthera, Sigru, Surasa, Sumukha, Ausuri, Bhutena, Mulaka and Cukrika amongst Harita Saka – leafy vegetables (which are not conducive to health).

Avoiding Madya: Drinking wine etc.

मद्यपश्च मैरेयारिष्टासवसीधुसुराविकारान् परिहरेत् ॥१८॥
मद्यमम्लं तथा रुक्षं तीक्ष्णमुष्णं च वीर्यतः ।
आशुकारि च तत् पीतं क्षिप्रं व्यापादयेद्रणम् ॥१९॥

Those persons who are addicted to drinking of wine should avoid the below mentioned alcoholic drinks –

–        Maireya
–        Arista
–        Asava
–        Sidhu
–        By-products of Sura

The Madya – wine which has the below mentioned qualities would destroy the wound and quickly produce great damage, when consumed –

–        Sour
–        Dry
–        Penetrating
–        Hot in potency
–        Quick acting

वातातपरजोधूमावश्यायतिसेवनातिभोजनानिष्टभोजनश्रवणदर्शनेर्ष्यामर्षभयशोकध्यानरात्रिजागरणविषमाशनशयनोपवाग्व्यायामस्थानचङ्क्रमणशीतवातविरूद्धाध्यशनाजीर्णमक्षिकाद्या बाधाः परिहरेत् ॥२०॥

The below mentioned too should be avoided by the patient suffering from wounds, so as to facilitate quick healing –

–        Too much exposure to breeze, sunlight, dust, smoke, mist, dew,
–        Excessive consumption of food
–        Disliked or unsuitable foods
–        Hearing unpleasant sounds and voices
–        Seeing unpleasant and disliked things
–        Excessive feeling of jealousy and anger
–        Fear, grief, worry,
–        Keeping awake during night time
–        Consumption of incompatible foods
–        Irregular sleeping habits
–        Fasting
–        Speaking loudly
–        Physical exercise in excess
–        Inactivity or standing still doing nothing, in a place
–        Roaming in forbidden places
–        Exposure to cold wind
–        Consumption of wrong and unhealthy combination of foods wherein foods of mutually opposite qualities are mixed up
–        Eating foods repeatedly in very short intervals, even before the previously taken food is digested
–        Indigestion or consuming foods which cause or tend to cause indigestion
–        Troubled by flies etc.

व्रणिनः संप्रतप्तस्य कारणैरेवमादिभिः ॥
क्षीणशोणितमांसस्य भुक्तं सम्यक् न जिर्यति ॥२१॥
अजीर्णात् पवनादीनां विभ्रमो बलवान् भवेत् ॥
ततः शोफरुजास्त्रावदाहपाकानवाप्रुयात् ॥२२॥

In the wounded person, the food that he has consumed does not get digested properly when he is troubled by the above said or any other similar causes. The food will not get digested even in wounded persons in whom there is severe depletion of blood and muscles.

Due to this indigestion, there will be immense aggravation (or dislodgement to other seats) of vata etc doshas (vata, pitta and kapha). This in turn would lead to manifestation of swelling, pain, discharges (exudation), burning sensation and suppuration (pus formation).

Disciplined life recommended for a wounded person

सदा नीचनखरोम्णा शुरीचा शुक्लवाससा शन्तिमङ्ग्लदेवताब्राह्मणगुरुपरेण भवितव्यमिति ।
तत् कस्य हेतोः ? हिंसाविहाराणि हि महावीर्याणि रक्षांसि पशुपतिकुबेरकुमारानुचराणिमांसशोणिताप्रियत्वात् क्षतजानिमित्तं व्रणिनमुपसर्पन्ति,सत्कारार्थ, जिघांसूनि वा कदाचित् ॥२३॥

The person who is wounded should be very disciplined and should strictly follow the below mentioned indications –

–        He should regularly trim his nails and hairs and keep them short
–        Keep self clean,
–        Wear white dress,
–        Should be indulged in observance of propitiatory and auspicious rites,
–        Be devoted to the service of Gods, Brahmanas and Teachers

Why should he follow all these rules and regulations?

The Rakshasas i.e. demons keep roaming around in search of pleasure. They derive pleasure by harming others. They are powerful entities and are followers of Pasupati – Lord Shiva, Kubera – God of wealth, Lord Kumara. The Rakshasas are very much fonts of flesh and food which are available to wounded people. They move around the wounded persons either in search of blood or for receiving respect and worship from them or even for killing the person if he or she does not offer worship or oblation to them. Therefore, it is mandatory for the person to follow the rules and regulations mentioned above and be disciplined. This will not only help in warding off the Rakshasas but will also enable quick recovery from wounds.

How to satisfy the demons?

भवति चात्र
तेषां सत्कारकामानां प्रयतेतान्तारात्मना॥
धूपबल्युपहारांश्च भक्ष्यांश्चैवोपहारयेत् ॥२४॥

A verse here in

Since the demons desire worship, they should be worshiped with utmost devotion.

These demons should be frequently worshipped by

–        means of offering incense,
–        ritual worship with prayers, flowers etc and
–        by offering oblations like fresh blood of animals, other eatables etc.

ते तु संतर्पिता आत्मवन्तं न हिस्युः ।
तस्मात्  सततमतन्द्रितो जनपरिवुतो  नित्यं दीपोदकशस्रस्रग्दामपुष्पलाजाद्यलङ्कृते वेशनि संपन्मङ्गलमोऽनुकूलाः कथाः श्रृण्वन्नासीत ॥२५॥
संपदाद्यनुकूलाभिः कथाभिः प्रीतमानसः ।
आशावान् व्यधिमोक्षाय क्षिप्रं शुखमवाप्रुयात् ॥२३॥

The demons will not harm the person suffering from wound who remains disciplined, once they are satisfied by the worship and oblation etc. that they would receive.

Therefore it is important that the wounded person should always –

–        remain without investing himself into sensual pleasures and lassitude
–        be surrounded by friends, relatives and people who are dear and near to him,
–        reside in a house or ward which is decorated and illuminated with lights, has water, weapons, garland, rope or cloth band, flowers, laja – parched rice etc.
–        keep his mind pleasant with wealth and listening likable music and stories which are meaningful, auspicious and pleasing to the mind

The person suffering from wounds would obtain health and happiness in quick time if he gets habituated to listening to the stories bestowing wealth, auspiciousness and pleasantness to the mind and also keep himself hopeful of getting cured from his ailments.

Raksha Karma: Protective rite

ऋग्यजुःसामाथर्ववेदाभिहितैरपरैश्चशीर्विधा नैरुपाध्याया भिषजश्च सन्ध्यो रक्षां कुर्युः ॥२७॥

The Raksha Karma i.e. protective rites shall be conducted by both the priest and the physician every day. This shall be performed during the junction of the night and morning and also at the junction of morning and night i.e. early morning and early evening in accordance with the indications documented in the Vedas by the name Rigveda, Yajurveda, Samaveda and Atharvaveda. Other benedictory hymns should also be recited for the protection of the patients.

Dhupa: Fumigation

सर्षपारिष्टपत्राभ्यां सर्पिषा लवणेन च ।
द्विरह्नः कारयेद्धपं दशरत्रमतन्द्रितः ॥२८॥

Sarshapa – mustard and leaves of Arista – Azadirachta indica – neem – added with ghee and salt should be used for fumigating the chamber in which the wounded patient is kept. It should be done twice a day for ten days, without laziness.

छत्रामतिच्छत्रां लाङ्गलीं जटिलां ब्रह्मचारिणीं लक्ष्मीं गुहामतिगुहां वचामतिविषां शतवीर्यां सहस्रवीर्यां सिद्धार्थकांश्च शिरसा  धारयेत् ॥ १९॥
व्यज्येत बालव्यजनैर्व्रणं न च विघट्टयेत् ।
न तुदेन्न च कण्डूयेच्छयानः परिपालयेत् ॥३०॥
अनेन विधिना युक्तामादावेव निशाचराः ।
वनं केशरिणाऽऽक्रान्तं वर्जयन्ति मृगा इव ॥३१॥

Dharana – The below mentioned herbs shall be worn as amulets on the head –

–        Chatra,
–        Atichatra,
–        Langali,
–        Jatila,
–        Brahmacarini,
–        Lakshmi, Guha,
–        Atiguha,
–        Vacha,
–        Ativisha,
–        Satavirya,
–        Sahasravirya  

Fans made up of hairs of animals should be used to fan the wounds. The wounds should never be hit, pricked or scratched while the patient is sleeping and this shall be informed to him.

Just like all other animals would run away from the forest invaded from the lion, the Nisacaras – demons or night prowlers would get away from the patient and would not bother him when he resorts to these activities right from the beginning of the treatment.

Hitahara: Suitable foods

जीर्णशाल्योदनं स्निग्धमल्पमुष्णं द्रवेत्तरम् ।
भूञ्जानो जाङ्गलैर्मांसैःशीघ्रं व्रणमपोहति॥३२॥
तण्डुलीयकजीवन्तीसुनिषण्णकवास्तुकैः ।
बालमूलकवार्ताकपटोलैः कारवेल्लकैः ॥३३॥
सदाडिमैः सामलकैर्घुतभृष्टैःससैन्धवैः ।
अन्यैरेंवगुणैर्वाऽपि मुद्रादीनां रसेन वा।
सक्तून् विलेपीं कुल्माषाञ्जलं चापि श्रॄतं पिबेत् ॥३४॥

Old rice should be used to prepare cooked rice (porridge) in little quantity. It should be made unctuous and warm, with more liquid (water). This porridge shall be consumed daily along with jangala mamsa i.e. meat of animals living in desert like regions. This food would help in quick healing of wounds.

Soup prepared from the below mentioned herbs, fried in ghee, mixed with rock salt, powder of pomegranate and juice of Amalaki – Emblica officinalis should be consumed –

–        Tanduliyaka,
–        Jivanti
–        Sunisannaka
–        Vastuka
–        Balamulaka
–        Vartaka
–        Patola and
–        Karavellaka

Also, other substances similar in qualities like those mentioned above and cooked rice shall be taken along with soup of mudga (green gram) etc. Saktu – flour paste, Vilepi – gruel, Kulmasa – cooked pulses and boiled water are also beneficial.

दिवा न निद्रावशगो निवातगृहगोचरः |
व्रणी वैद्यवशे तिष्ठञ् शीघ्रं व्रणमपोहति ||३५||
(व्रणे श्वयथुरायासात् स च रागश्च जागारात् |
तौ च रुक् च दिवास्वापात्ताश्च मृत्युश्च मैथुनात्) ||३६||
एवंवृत्तसमाचारो व्रणी सम्पद्यते सुखी |
आयुश्च दीर्घमाप्नोति धन्वन्तरिवचो यथा ||३७||

The wounds of the person who follows the below said, gets cured quickly –

–        He should not sleep during day time
–        He should remain inside the house / chamber devoid of breeze specially designed or allotted for nursing the wounds
–        He should be under the control of the physician and promptly follow the instructions of the physician in relation to diet, activities, consumption of medicines etc.

Swelling occurs in and around the wound due to exertion of any type.

Similarly, redness along with swelling occurs due to habitually keeping awake at night.

When the patient excessively keeps awake at night, swelling, redness and pain would occur.

Excessive sleeping during day time, swelling, redness and pain would occur.

Similarly, swelling, redness, pain and death would occur due to excessive indulgence in copulation.

According to Lord Dhanvantari, the wounded person would definitely obtain health, happiness and longevity only if he adheres to this regimen of food and activities strictly.

इति श्रीसुश्रुतसंहितायां सूत्रस्थाने व्रणितोपासनीयोनामैकोनविंशोऽध्यायः ॥१९॥

Thus ends the nineteenth chapter by name Vranitopasaniya, in Sutra sthana of Susruta Samhita.