Sushruta Samhita Sutrasthana Chapter 23: Krutyakrutya Vidhi Adhyaya (Curable and Incurable Wounds)

The 23rd chapter of Sutrasthana of Sushruta Samhita is named as Krutyakrutya Vidhi Adhyaya. This chapter deals with Curable and Incurable Wounds.

अथातः कृत्याकृत्यविधिमध्यायम् व्याख्यास्यामः ॥१॥
यथोवाच भगवान धन्वन्तरिः ॥२॥

Now we will expound the chapter by name Krityakritya vidhi – curable and incurable wounds; as revealed by the venerable Dhanvantari.

Sukhasadhya Vrana: Easily curable wounds

तत्र,वयःस्थानां दृढानां प्राणवतां सत्त्ववतां (आत्मवतां )च सुचिकित्स्या व्रणाः; एकस्मिन व पुरुषे यत्रैततुणचतुष्टयम् तस्य सुखसाधनीयतमाः । तत्र, वयःस्थानां प्रत्यग्रघातुत्वादाशु व्रणा रोहन्ति, दृढानां स्थिरबहुमांसत्वाच्छस्त्रमवचार्यमाणं सिरास्नाय्वादिविशेषान्नप्राप्रोति; प्राणवतां वेदनाभिघाताहारन्त्रणादिभिर्न ग्लानिरुत्पद्यते; सत्त्ववतां दारुपैरपि क्रियाविशेषैर्न व्यथा भवति; तस्मादेतेषां सुखसाधनीयतमाः ॥३॥

Wounds are easily curable in the below mentioned persons –

–        Vayastha – Those who are youth,
–        Drdha – Those who are strong,
–        Pranavatam – Those who are valiant i.e. having strength to live,
–        Sattvavatam – Those who have very good self-control, will power and strong mind

It is important that all the above said four qualities should be found in the same person for his or her wound to get easily cured. Individual quality would not count.

a. Youth – since the tissues are new and fully grown or have strength and capacity to grow back to normal and also since the strength of the tissues are optimum, the wounds would quickly heal in the young persons.

b.   Strong Persons – In these people, the body will have stable and well-developed muscles. The sharp instruments used in these people will not reach (cause damage) to the veins, tendons etc.

c. Valiant persons – These people have strength and will to live. The pain does not exhaust or trouble the valiant people. They are also not exhausted and troubled by injury or pain caused by surgical instruments while undergoing surgery and also by restrictions over food, activities etc.

d.   Strong minded persons – These people can tolerate all hardships, pain and trouble and hence are not troubled by pain caused by even the most troublesome treatments including surgical methods.

Due to the above said reasons, the wounds would be easily curable in the above mentioned four kinds of people. Hence in these kinds of persons wounds are very easily curable.

त एव विपरीतगुणा वृद्धाकृशाल्पप्राणभीरुषु  द्रष्टव्याः  ॥४॥

The nature of wound healing is exactly opposite in the below mentioned kinds of persons –

–        Vrddhi – Old aged persons,
–        Krsha – Emaciated individuals,
–        Alpa prana – Persons who do not have strength or will to live, not valiant
–        Those who are afraid

Wounds which are curable depending on their wound

स्फिकपायुप्रजननललाटगण्डौष्ठपृष्ठकर्णफलकोषोदरजत्रुमुखाभ्यन्तरसंस्थाः सुखरोपणीया व्रणाः ॥५॥

Wounds heal quickly when they are present in the below mentioned places of the body –

–        buttocks,
–        rectum (anus),
–        genital organs (penis and vagina),
–        forehead,
–        cheeks,
–        lips,
–        back,
–        ears,
–        scrotum,
–        abdomen,
–        shoulders and
–        inside of the mouth

Krcchra Sadhya vrana: Wounds curable with difficulty

अक्षिदन्तनासापाङ्गश्रोत्रनाभिजठरसेवनीनितम्बपार्श्वकुक्षिवक्षः कक्षास्तनसन्धिभागगतः सफेनपूयरक्तानिलवाहिनोऽत्तः शल्याश्च दृश्चिकित्स्याः; अधोभागाश्चोर्ध्वभागनिर्वाहिणो, रोमान्तोपनखमर्मजङ्घास्थिसंश्रिताश्च, भगन्दरमपिचान्तर्मुखं सेवनिकुटकास्थिसंश्रितम् ॥६॥

Below mentioned kinds of wounds are curable with difficulty –

Those situated in the below mentioned parts of the body –

–        eyes
–        teeth
–        nose
–        outer angle of the eye,
–        ears,
–        umbilicus,
–        sutures / raphae,
–        buttocks,
–        flanks,
–        epigastric region of the abdomen,
–        chest,
–        axillae,
–        breasts and
–        joints,

Also,

–        the wounds which have sinus in them which are discharging froth, pus, blood and gas (air)
–        the wounds which have a foreign body inside them
–        those discharging pus etc. secretions from below upwards,
–        wounds located near the border of the hairs in the head,
–        wounds present near the roots of the nails,
–        wounds in marmas – vital spots
–        wounds over the bones of the foreleg
–        wound of fistula (in anus) which is facing inwards,
–        wound situated on the raphae
–        wounds on pelvic bone, near tailbone (coccyx)

कुष्ठिनां विषजुष्टानां  शोषिणां मधुमेहिनाम् ।
व्रणाः कृच्छ्रेण सिध्यन्ति येषां चापि  व्रने व्रणाः॥७॥

Wounds heal with difficulty in persons who are suffering from the below mentioned conditions –

–        skin diseases / leprosy,
–        poisoning,
–        consumption / emaciation, severe loss of tissues,
–        diabetes,
–        already existing wounds

Yapya vrana: Wounds which persist long

अवपाटिकानिरुद्धप्रकाशसन्निरुरुद्धगुदजतठराणि, ग्रन्थिक्षतक्रिमयः प्रतिश्यायजाः कोष्ठजाश्च त्वद्गोषिणां वा ये परिक्षतेषु दृश्यन्ते ,शर्करा सिकतामेहो वातकुण्दलिकाष्ठीला दन्तशर्करोपकुशः कण्ठशालूकं निष्कोषणदूषिताश्च  दन्तवेष्टा विसर्पास्थिक्षतोरः क्षतव्रणग्रन्थिप्रभृतयश्च याप्याः ॥८॥

Wounds produced by the below mentioned conditions are considered to be yapya (manageable / relievable but persisting for long, cannot be completely cured) –

–        paraphimosis and phimosis,
–        stenosis / obstruction of rectum,
–        abdominal enlargement,
–        cystic swellings, injury (or injury of cystic swellings) and worms / worms developing in the wound over a tumor,
–        worms appearing in nasal catarrh (rhinitis),
–        worms appearing in the abdominal viscera / diseases of the abdominal viscera,
–        worms found in the wounds / ulcers of (related to or caused by) skin diseases and diabetes
–        sarkara meha and sikata meha (types of diabetes),
–        vatakundalika – pain in the urinary bladder,
–        ashtila – prostatic enlargement
–        tartar, gingivitis and tonsillitis
–        use of harmful dentifrices, poisonous tooth pastes / powders which would damage and destroy the gums and teeth
–        erysipelas,
–        wound / tear of the bone,
–        wound or tear of chest (lungs),
–        cysts or small tumors occurring on the wounds

Importance of ‘timely and suitable treatment’ of wounds

साध्या याप्यत्वमायान्ति याप्याश्चासाध्यतां तथा ।
घ्नन्ति प्राणानसाध्यास्तु नराणामक्रियावताम् ॥९॥

The wounds should be promptly treated in time because in those who do not take suitable treatments, there are chances that the prognosis of the wounds might change and the below mentioned may happen –

–        curable wounds become manageable,
–        those which are manageable or relievable become incurable and
–        those which are incurable might take away one’s life

Yapya Vyakhya: Definition of yapya

यापनियं विजानीयात्  क्रिया धारयते तु यम् ।
क्रियायां तु  निवृत्तायां सद्य एव विनश्यति ॥१०॥
प्राप्ता क्रिया धारयति याप्यव्याधितमातुरम् ।
प्रपतिष्यदिवगारं विष्कम्भं साधुयोजितः ॥११॥

Yapya Rogas are those diseases which are manageable or relievable but cannot be completely cured. Acharya says that these diseases will be under control with the help of regular treatment i.e. they are manageable until prompt treatment is given regularly. But the same diseases would kill the person immediately (within a short time) after withdrawing /stopping the treatment. In case of these diseases, the patient can sustain as long as proper and timely treatment is in process. The same diseases would kill him once the treatment is stopped. Later, the master gives an analogy to explain the prognosis of these conditions. Yapya diseases are just like a house supported by properly placed pillars. The house would collapse when the support i.e. pillars are removed.

Asadhya Vrana: Incurable wounds

अत ऊर्ध्वमसाध्यान वक्ष्यामः- मांसपिण्डवदुद्रताः प्रसेकिनोऽन्तःपूयवेदनावन्तोऽश्वापानवदुद्वुटत्तौष्ठाः, केचित्  कठिना गोशृङ्गवदुद्रतममृदुमाम्सप्ररोहाः, अपरे दुष्टरुधिरास्राविणस्तनुशीतपिच्छिलास्राविणो वा मध्योन्नता:, केचिदवसन्नशुशिरपर्यन्ताः शणतूलवत् स्नायुजालवन्तो  दुर्दर्शनाः, वसामेदोमज्जमस्तुलुङ्गस्राविणश्च दोषसमुत्थाः, पीतासितमूत्रपूरीषवातवाहिनश्च  कोष्ठस्थाः  त  एवोभयतोभागव्रणमुखेषु  पूयरक्तनिर्वाहिणः, (क्षीणमांसानां च) सर्वतोगतयश्चाणुमुखा माम्सबुद्वुदवन्तः, सशब्दवातवाहिनश्च शिरः कण्ठस्थाः, क्षीणमांसानां च पूयरक्तनिर्वाहिणोऽरोचकाविपाककासश्वासोपद्रवयुक्ताः, भिन्ने वा शिराः कपाले यत्र मस्तुलुङ्गदर्शनं त्रिदोषलोङ्गप्रादुर्भावह् कासश्वासौ वा यस्येति ॥१२॥

After this, the features of the wounds which are incurable will be described –

Wounds presenting with the below mentioned features are considered to be incurable –

–        wounds elevated like a ball of muscle,
–        discharging copious exudation (pus, blood etc) in excess,
–        which are filled with pus inside them,
–        associated with pain,
–        lips (edges) of the wound are bulged out like the anus (anal opening) of a horse,
–        some are hard, raised like the cow’s horn,
–        some others have soft muscular sprouts protruding out,
–        some wounds exude vitiated blood and some others discharge exudates which are thin, cold and slimy,
–        those elevated at the centre,
–        some having their edges dipping inwards (into the wound) and cavities / perforations formed inside,
–        some having network of ligaments which resemble beams (wick) of silk cotton and have ugly appearance,
–        those which are produced by aggravated doshas (and due to the aggravation of doshas in them) and exuding muscle fat, fat, marrow and brain like matter
–        wounds occurring in the alimentary tract from which there occurs yellow or black colored discharges or there is discharge of urine, feces or wind (fart / gas),
–        the same (wounds of the alimentary tract) exuding pus and blood from their orifices at both ends i.e. from mouth and anal opening along with exudes from the wounds,
–        wounds occurring in persons who have depletion of muscles and spread all over;
–        those wounds having sinuses with minute orifices spread all over,
–        those having bubbles (sprouts) of muscles,
–        wounds situated in the head and throat bringing out air (gas) accompanied with sound,
–        wounds in persons having  emaciated muscles, exuding pus and blood,
–        wounds associated (complicated with presence of) with  loss of taste, indigestion, cough, dyspnoea and such other complications (secondary  diseases),
–        wound caused by fracture of the skull through  which the  brain matter is visible;
–        wounds in which symptoms of all the three doshas develop,
–        wounds associated or complicated by presence of cough and dyspnoea,

Agantu Vrana

भवतो चात्र:-
वसां मेदोऽथ मज्जानं मस्तुलुङ्गं च यः स्रवेत् ।
आगन्तुस्तु व्रणः सिध्येन्न सिध्येद्दोषसंभवः ॥१३॥

Some verse here:-

Agantu vranas are the wounds caused by trauma / accidents. The prognosis of these wounds is as follows –
–        agantu vranas which has exudation of muscle fat, fat, bone marrow and brain matter might get cured
–        agantu vranas which are produced by aggravation of doshas and are also associated with exudation of muscle fat etc. are incurable

Prognosis of wounds

अमर्मोपहितेदेशे सिरासन्ध्यस्थिवर्जिते ।
विकारोयोऽनुपर्येति तदसाध्यस्य लक्षणम् ॥१४॥
क्रमेणोपचयं प्राप्य धातूननुगतः शनैः ।
न शक्य उन्मूलयितुं वृद्धो वृक्ष इवामयः ॥१५॥
स स्थिरत्वान्महत्त्वाच्च धात्वनुक्रमणेन च ।
निहन्त्यौषधवीर्याणि मन्त्रान् दुष्टग्रहो यथा ॥१६॥

The wounds are not curable if –

–        they vitiate and destroy all the tissues, even in places of the body which is not a marma (vital spot) and the place where the wound occurs is not having veins, joints or bones and
–        the wounds are not responding to any kind of treatments

It is not possible to cure wounds which grow steadily involving the tissues gradually, one after the other, just like an old-big tree grows slowly and steadily.

Just like the malicious planets nullify the effect and power of the hymns, the wounds having the below mentioned features will nullify the potency of all the medicines –

–        wound which is stable / fixed and stubborn,
–        which has greatly increased
–        invades all the tissues gradually, one after the other

अतो यो विपरितः स्यात् सुखसाध्यह् स उच्यते ॥
अबद्धमूलः क्षुपको यद्वदुत्पाअटने सुखः ॥१७॥

The wound would become curable when it presents with the features opposite to those above said. The wound which is not firmly rooted is also easily curable just like a young plant which can be easily plucked out.

Shuddha Vrana: Clean wound

 त्रिभिर्दोषैरनाक्रान्तः श्यावौष्ठः पिडकी समः॥
अवेदनो निरास्रावो व्रणः शुद्ध इहोच्यते ॥१८॥

The wound with the below mentioned features is said to be a suddha vrana (clean / healing wound) –

–        that which is  not invaded / affected by the tridoshas,
–        that whose lips (edges) are blue in color,
–        that which  has  developed (small) eruptions (granulation tissues) which are even,
–        that which is not associated with pain and exudation,

Rohati Vranam: Wound which is healing

कपोतवर्णप्रतिमा यस्यान्ताः क्लेदवर्जिताः |
स्थिराश्चिपिटिकावन्तो रोहतीति तमादिशेत् ||१९||

That (wound) which has the color similar to that of a pigeon, which is devoid of pus etc (moisture, exudation), stable, and having chipitaka – dry, white, soft flakes of skin adhering firmly is considered to be healing.  

Rudha Vrana: Healed wound

 रुढवर्त्मानमग्रन्थिमशूनमरूजं व्रणम् ॥
त्वक्सवर्णं समतलं सम्यग्रूढं विनिर्दिसोत् ॥२०॥

The wound whose lips (edges) have healed, which does not have knots of muscles in it, which does not have swelling all round it, which is not associated with pain, has same color as that of the surrounding skin, and which has become even is considered as samyak rudha i.e. properly healed wound.

Reasons for healed wound to get torn

दोषप्रकोपाद्वचायामादभिघातादजीर्नत ः ॥|
हर्षात् क्रोधाद्भयाद्वाऽपिव्रणो रुढोपि दिर्यते ॥२१॥

Below mentioned are the causes for tears (cracked further) to occur in a healed wound –

–        aggravation of doshas in the wound
–        indulgence in physical exercise
–        injury
–        indigestion
–        too much of joy / excitement, anger or fear

 इति श्रीसुश्रुतसंहितायां सूत्रस्थाने कृत्याकृत्यविधिर्नाम त्रयोविंशोऽध्यायः ॥२३॥

 Thus ends the twenty third chapter named Krityakrtya vidhi in Sutra Sthana of Susrutha Samhita.