Sushruta Samhita Chapter 28 Viparita Aviparita Vrana Vijnaniya Adhyaya (Knowledge of Prognosis of Wounds)

The 28th chapter of Sutrasthana of Sushruta Samhita is named as Viparita Aviparita Vrana Vijnaniya Adhyaya. This chapter deals with the information on facilitating the study.

अथातो विपरीताविपरीतव्रणविज्ञानीयामध्यायं व्याख्यास्यामः ॥१॥
यथोवाच  भगवान्  धन्वतरिः॥२॥

We will now expound the chapter by name Viparitaparita Vrana Vijnana Knowledge of normal and fatal signs of wounds (prognosis); as revealed by the venerable Dhanvantari.

Rista Nirukti: Definition of Rista (Fatal Signs)

फलाग्रिजलवृष्टीनां पुष्पधूमाम्बुदा यथा॥
ख्यपयन्ति भविष्यत्त्वं तथा रिष्टानि पञ्चताम् ॥३॥

A flower indicates that a fruit will be formed at a later time. Similarly, the smoke and cloud indicate the formation of fire and rain respectively. Similarly, Rista (certain fatal signs and symptoms) indicate that death is approaching in future.

Arista Jnana Dussaka: Fatal signs different to recognize

तानि सौक्ष्म्यात् प्रमादाद्वा तथैवाशु व्यतिक्रमात्॥
गृह्यन्ते नोद्रतान्यज्ञैर्मुमूर्षोर्न त्वसंभवात् ॥४॥
ध्रुवं तु मरणं रिष्टे ।

In spite of being manifest in the dying person the rista (fatal signs) are not recognized by an unintelligent person (observer) due to the below mentioned reasons –

–   Saukshmyat – due to minuteness (of these signs),
–   Pramadat – misunderstanding (ignorance) of the observer,
–   Ashu vyatikramat – due to their (signs) quick disappearance

It is not like death does not occur without manifestation of ristas i.e. fatal signs (people can die without manifestation of these signs also) but if these fatal signs occur the person will definitely die.

Mrityu Nivaran: Death Preventable

ब्राह्मणैस्तत् किलामलैः ।
रसायनतपोजप्यतत्परैर्वा निवार्यते ॥५॥

It (death) could be averted by –

–   Brahmanas who are pure (free from desire, hatred and such other emotions),
–   by those who are devoted to  Rasayanas (use of rejuvenations, elixirs, potent herbs etc),
–   by ascetics devoted to tapas (penance) and japa (chanting of sacred hymns)

Rista signs and time factor

नक्ष्यत्रपीड बहुधा यथा कालं विपच्यते ।
तथैवारि ष्टपाकं च ब्रुवते  बहवो जनाः ॥६॥

The troubles caused by nakshatras i.e. stars and planets definitely yield specific results in specific periods of time, opine some people.

Similarly, the aristas too, yield results in the form of death at a stipulated time is also the opinion of many people.

Arishta janam Avasyakam: Knowledge of fatal signs necessary

असिद्धिमाप्रुयाल्लोके प्रतिकुर्वत गतायुषः ॥
अतोऽरिष्टानि यत्नेन लक्ष्ययेत् कुशलो भिषक्॥७॥

The knowledge of these ristas i.e. fatal signs is very much necessary for all physicians. The physician who would treat a person who is going to die soon will anyways derive no success in this world. This is the reason an intelligent physician should keenly observe these signs of impending death in the patients with all efforts, so that he can avoid treating them (as their death is inevitable with or without treatment).

Rishta Laksanas in Vranita: Signs of death in the wounded persons

गन्धवर्णरसादादीनां विशेषाणां स्वभावतः ॥
वैकृतं यत तदाचष्टे  व्रणिनः पक्वलक्षणम् ॥८॥

In a wounded person, if the below mentioned signs are found occurring naturally on their own, without any evident reason or cause, they definitely indicate pakva lakshana i.e., ripening signs in that person. Here ripening signs means, signs that the wounded person is going to die soon. These signs are –

–   changes in smell of the owund
–   changes in the colour of the wound
–   changes in the taste of the wound
–   changes in touch of the wound
–   changes in sounds coming from the wound

Prakrta vikrta Gandha: Normal and abnormal smells

कटुस्तीक्ष्णश्च विस्त्रश्च गन्धस्तु  पवनादिभिः ॥
लोहगन्धिस्तु रक्तेन व्यामिश्रः सान्निपातिकः ॥९॥
लाजातसीतैलसमाः किंचिद्विस्त्राश्च गन्धतः ।
ज्ञेयाः प्रक्रुतिगन्धाः  स्युरतोऽन्यद्रन्धवैकृतम् ॥१०॥

Normal odours –

–   smell of laja, Atasi and taila (oil)
–   slightly unpleasant smell

All other odours other than those mentioned in the ‘normal odours’ should be considered as abnormal.

मद्यागुर्णज्यसुमनापद्मचन्दनचम्पकैः ।
सगन्धा दिव्यगन्धाश्च मुमूर्षूणां  व्रणाः स्मृताः ॥११॥
श्ववाजिमूषिकध्वाङ्खपूतिवल्लूरमत्कुणैः ।
सगन्धाः  पङ्कगन्धाश्च भूमिगन्धाश्च  गर्हिताः ॥ १२॥

Smell similar to the below mentioned things are manifested in the wounds of the person who will die soon –

–       wine
–       aguru
–       ajya – ghee
–       sumana
–       chandana – sandalwood
–       campaka

Smells similar to the below mentioned are also considered as undesired smells which would indicate the approaching death –

–   dog
–   horse
–   mouse
–   crow
–   dry meat
–   decomposed meat
–   bedbug
–   slush
–   earth / mud

Varna Arishta: Colour indicating death

कुड्कुमध्यामकङ्कुष्ठसवर्णाः पित्तकोपतः ।
न दह्यन्ते न चूष्यन्ते भिषक् तान परिवर्जयेत् ॥१३॥
कण्डूमन्तः स्थिराः श्वेताः  स्निग्धाः कफनिमित्ततः ।
दूयन्ते वाऽपि दह्यन्ते भिषक् तान् परिवर्जयेत् ॥१४॥
कृष्णास्तु ये तनुस्रावा वातजा मर्मतापित ः ।
स्वल्पामपि न कुर्वन्ति सूजं तान्  परिवर्जयेत् ॥१५॥

When there is pitta aggravation in the wound, colours similar to kumkuma, dhyama and karkustha develop in the wounds. There is absence of burning sensation and sucking pain in the wounds. Such patients should be rejected by the physician.

When there is aggravation of kapha (in the wound), itching, stability (immovable), whiteness, unctuousness and eruptions (swelling) develop but will have pain and sucking pain then the physician should reject such a patient.

The physician should not treat the patient having below mentioned symptoms in relation to the wounds (because he is going to die) –

–   blackish discoloration of wounds
–   discharge of thin exudates from the wounds
–   wounds affecting and troubling the marmas – vital spots
–   when these symptoms occur due to aggravation of vata in the wounds but not even have slightest pain (pain is a feature of vata aggravation)

Shabda Sparsha arishtas: Sounds and touch indicating death:-

क्ष्वेडन्ति घुर्घुरान्ते ज्वलन्तीव च ये व्रणाः ॥
त्वड्मासस्थाश्च पवनं  सशब्दं विसृजान्ति ये॥१६॥
ये च मर्मस्वसंभूता भवन्त्यत्यर्थवेदनाः ॥
दह्यन्ते चान्तरत्यर्थं बहिः शीराश्च ये व्रणाः ॥२७॥
दह्यन्ते बहिरत्यर्थं भवन्त्यन्तश्च शीतलाः ॥

Wounds with below mentioned features should be rejected –

–   producing sounds such as cracking, purring or burning,
–   wounds located on the skin and muscles emitting air (gas) accompanied with sound, and
–   the wounds, which though not located on the vital spots still produce very severe pain or
–   those wounds which have burning sensation inside and cold outside or are cold inside and have burning sensation outside (are fatal signs)

Akriti Arista: Shapes indicating death

शाक्तिध्वजरथाः कुन्तवाजिवारणगोवृषाः ॥२८॥
येषु चाप्यवभासेरन् प्रासादाकृतयस्तथा॥
चूर्णावकीर्णा इव  ये भान्तिचानवचूर्णिताः ॥।१९॥
प्राणमांसक्षयश्वासकासारोचकपीडिताः ॥
प्रवृद्धपूयरुधिरा व्रणा येषां च मर्मसु॥२०॥

Below mentioned shapes of the wounds should be considered as fatal signs. Wounds appear like –

–   sakti – a kind of spear like weapon
–   flag
–   chariot
–   lance
–   horse
–   elephant
–   cow
–   bull
–   palace
–   as if sprinkled with dust (though it is not done)

Below mentioned are also the signs of death, when caused by wounds –

–   loss of strength and muscles,
–   dyspnoea,
–   cough,
–   loss of taste
–   severe increase of pus and blood in the wound,
–   wound situated in the region of marma – vital spot

क्रियाभिः सम्यगारब्धा न सिद्ध्चन्ति च ये व्राणाः ॥
वर्जतेन्तानपि प्राज्ञः संरक्षन्नात्मने, यशः ॥२१॥

To protect his own name and reputation, the wise physician should reject the wounds which do not heal in spite of proper treatments being started at tight times.

इति श्रीसुश्रुतसंहितायां सूत्रस्थाने विपरीताविरीतप्रणविज्ञानीयो नामाष्टाविंश्तितमोऽध्यायः ॥२८॥

 Thus ends the Twenty-eight chapters by name Viparitaviparita Vrana Vijnana, in Sutra sthana of Susrutha Samhita.