Reference:
C.Chi.25, S.Su.5,17,18; Chi.1,2, A.H.U.25, N.R. Vran`a
Introduction:
Vran`ameans wound or ulcer. It may happen due to vitiation of Dosha or any exogenous cause like trauma. Though a wound gets healed, the scar remains there lifelong, there fore it is called as Vran`a.
Saamaanya Chikitsaa:
Like any other disease, basic considerations of treatment principles viz. S`hodhana, S`hamana, Pathya, Apathya, Aahaara, Vihaara, etc. are same. General principle of Vran`aChikitsaa is S`hodhana and Ropan`a.
Vis`hesha Chikitsaa:
Charaka describes 36 and Sus`hruta describes 60 treatment modalities for various types and stages of Vran`aincluding Vran`s`hotha. The first 3 treatments are for Vran`s`hotha and after Paat`na, last three explains Vran`aChikitsaa.
According to Sus`hruta, all treatment types could be classified into seven groups:
- Vimlaapana Dosha Vilayana in case of Vran`as`hotha.
- Avasechana – Parisheka by decoctions
- Upanaaha – Svedana with poultice.
- Paat`ana Vidaaran`a or Bhedana of Pakva Vran`as`hotha.
- S`hodhana Removal of pus and reduce Dosha Dusht`ee.
- Ropan`a Facilitate growing healthy Dhaatu and healing of wound.
- Vaikrutaapaham Restoration of proper colour and pigmentation of scar tissue.
36 Upakrama according to Charaka
- Raktaavasechana
- S`hodhana
- Langhana
- Upanaaha
- Paat`ana
- Vedhana
- Chhedana
- Lekhana
- Paachana
- Seevana
- Avapeed`ana
- Nirvaapan`a
- Sandhana
- Bhojana
- S`hamana Kvaatha
- S`hamana Ghrita
- Lomaharan`a
- Varn`ya Avachurn`ana
- Eshan`a
- S`hodhana Kashaaya
- S`hodhana Lepa
- S`hodhana Taila
- Roopan`a Kashaaya
- Roopan`a Taila
- Roopan`a Lepa
- Patra
- Abhyatara bandhana
- Baahya bandhana
- Uttasaadana
- Dahana
- Avasaadana
- Maardavakara Dhoopa
- Lepa Kaat`hinyakara
- Dhoopa Kaat`hinyakara
- Lepa Maardavakara
- Avachurn`ana Ropan`a
60 Upakrama by Sus`hruta.
- Apatarpan`a
- Aalepa
- Parisheka
- Abhyanga
- Svedana
- Vimlaapana
- Upanaaha
- Paachana
- Visraavan`a
- Snehana
- Vamana
- Virechana
- Chhedana
- Bhedana
- Daran`a
- Lekhana
- Eshan`a
- Aharan`a
- Vyadhana
- Seevana
- Sandhaana
- Visraavan`a
- Peed`ana
- S`hon`itasthaapana
- Nirvaapan`a
- Utkaarikaa
- Kashaaya
- Varti
- Kalka
- Ghrita
- Taila
- Rasakriyaa
- Avachoorn`ana
- Vran`aDhoopana
- Utsaadana
- Avasaadana
- Mridukarma
- Daarun`a Karma
- Kshaarakarma
- Agnikarma
- Krishn`a Karma
- Pan`d`oo Karma
- Pratisaaran`a
- Romasanjanana
- Romas`haatana
- Bastikarma
- Uttarabasti
- Bandhana
- Patraadaana
- Krimighna
- Brimhan`a
- Vishaghna
- hirovirechana
- Nasya
- Kavala
- Dhoomapaana
- Madhu
- Ghrita
- Yantra
- Aahaara
- Rakshaa Vidhaana
(Out of above 61, Gayadaasa and Jejjat`a have not mentioned Paachana and Lomaapaharan`a as separate treatments.)
Dusht`a Vran`aChikitsaa:
Vran`aS`hodhana
Objective of Dusht`a Vran`aChikitsaa is Vran`aS`hodhana. It means cleansing of wounds by various measures. S`huddha Vran`ais further managed by Roopan`a drugs.
Vran`aS`hodhana is done by tissue debridement, foreign body removal, irrigation of wound, poultice and other topical applications of certain drugs.
Saarvadehika S`hodhana
According to Sus`hruta, Kost`ha S`hodhana should be done followed by Langhana or Laghu, Katu, Tikta Aahaara.
Local treatment
For local treatment, 7 formulation types are indicated according to specific type of wounds.
- Kashaaya When Vran`ais associated with foul smell, excess discharge then Kashaaya of S`hodhana drugs should be used for washing of wounds.
- Varti Mamsadhisht`hita Vran`a, Vivaritamukha and deep wounds vranas Shodhana varti is indicated. This is prepared by Trivritta,Danti,Karanja,Hartal, Chitrak,etc.
- Kalka Vran`aover Maamsa Sandhi, foul smelling Vran`a, excessively vitiated Dosha are treated by Kalka.
- Ghrita For Pittaja and Raktaja Vran`a, where Daaha and Paaka are prominent factors, medicated Ghrita of Triphala etc is used for S`hodhana.
- Taila In Uttaana Maamsa, Rooksha, Alpa Sraavi, Dusht`a Vran`a, oil prepared by Apaamaarga, Aaraghvada, Nimba, etc are used for S`hodhana.
- Rasakriyaa Dusht`a Vran`anot responding to Taila, is treated with Rasakriyaa. For this S`haalasaaradi Gan`a is used.
- Churn`a In Meda Dusht`i, Uttaana Vran`a, S`hodhana is done by sprinkling powders of formulations like Kaasisaadi Choorn`a etc.
S`hastrakarma:
Considering nature of wound, following S`hastrakarma should be used.
| Paat`ana | Vyaadhana | Chhedana | Lekhana | Seevana | Prachhana |
| Naad`eeVran`a | Jalodara | Udvritta vran`a | Kilaasa | Kukshegata Gambheera Vran`a | Vaataarkta |
| PakvaVran`aS`hotha] | Pakva gulma | Sthoola paryanta vran`a | Kusht`ha | Atipaat`ita Vran`a | Granthi |
| Kshatodora | Raktaja Gulma | Utsanna Vran`a | Paat`ita Vran`a | Pid`ikaa | |
| Baddhagudodara | Visarpa | Kat`hina Vran`a | Kotha | ||
| Antas`halyastha S`hotha. | Pid`ikaa | Vran`aars`ha | Raktaman`d`la | ||
| Vran`awith multiple pus pockets and small opening. | Raktaja Roga | Adhi Maamsa (Vran`aSthaane) | Kushtha | ||
| Apaaki Vran`a | |||||
| Snaayu Kotha |
Types of bandages: (Vran`aBandha)
| Types of Bandha | English equivalent | Indicated sites |
| Kos`ha Bandha | Sheath bandage | Angushtha , Angulee Parva |
| Daama Bandha | Sabandhaaga, Whole body | |
| Svastika Bandha | Cross or Spica bandage | Sandhi , Koorchaka ,BhrooStanaantara , Tala Karn`a |
| Anuvellita Bandha | Spiral bandage | S`haakhaa (Hasta Paada) |
| Muttolee Bandha | Greevaa, Med`hra | |
| Sthagikaa Bandha | Stump bandage | Angustha, Anguli , Med`hraagra |
| Yamaka Bandha | Yamala Vran`a(Samyukta Vran`a) | |
| Khat`va Bandha | Four tailed bandage | S`hankha, Hanu Gan`d`a |
| China Bandha | Eye bandage | Netra , Apaanga |
| Vibandha Bandha | Multiple tailed bandage | Prisht`ha, Udara, Uraha |
| Vitaana Bandha | Capheline bandage | S`hira |
| Gophan`a Bandha | Sling bandage or T bandage | Chibuka, Naasaa, Oshtha, Basti |
| Panchaangee Bandha | Urdhva Jatrugata | |
| Utsangee Bandha | Arm sling bandage | Baahu |
| Man`dala Bandha | Udara, Ooru, Baahu |
Considering Vran`a Vastu, site, involved Dosha, appropriate treatment should be planned. Physician or surgeon should be aware of contraindications, limitations, dos and donts of each procedure. Following other procedures are mentioned in Vran`a Chikitsaa:
Aavasthika Chikitsaa:
Aagantu Vran`a
Therapeutic procedures in Vran`a
Indications for Kshaarakarma:
- Utasanna Vran`a,
- Kat`hina Vran`a
- Kan`d`oo yukta Vran`a
- Wound with elevated edges due to granulation, which is hard and itching wound
- Chronic non -healing wound.
- Durvis`hodhya individuals.
Indications of Incision:
- Aayata (Rectangular)
- Vis`haala (Broad)
- Sama (Equal )
- Suvibhakta (Clear )
- Niraas`hraya (Free from pus pockets and adjacent tissues)
Indications of Eshan`a:
- After Paat`ana
- Vran`awith small opening.
- Vran`a with excessive exudation(Sraava)
- Vran`a with pus pockets(Pooyakosha)
- Vran`awhich are not situated at vital points(Amarmasthaanashriata)
Agnikarma indications:
- Roodhira Atiparvritti
- Chhina Vran`a
- Adhimaamsaja Vran`a
- Kaphajagranthi
- Galagan`d`a
- Vaatastambha
- Vaataaja Arti
- Good`ha Pooya
- Good`ha Lasikaa
- Gambhira Vran`a
- Sthira Vran`a
- Sputa Vran`a
Dusht`a Vran`aChikitsaa:
Vran`aS`hodhana:
Vran`aS`hodhana aims at cleansing or purification of wounds. The first principle is to make it S`huddha, by various measures.. It is done by tissue debridement, foreign body removal, irrigation of wound, poultice and other topical applications of certain drugs. Vran`aS`hodhana also include Saarvadehika Chikitsaa as Kost`ha S`hodhana and followed by Langhana etc procedures. Once Vran`abecomes S`huddha, it is further managed by Roopan`a drugs.
Vaataja Vran`a:
- Snehana Yukta Svedana
- Upanaahana
- Pardeha
- Parisheka
- Das`hamoola Vaatahara Dravya
Pittaja Vran`a
- S`heeta, Madhura, Tikta, Dravya Parisheka & Pradeha
- Ghritapaana
- Virechana
- Nyaghrodhadi Padmakaadi Gan`a
Kaphaja Vran`a
- Ushn`a Kshaaya Katu Dravya Parisheka & Pradeha
- Langhana
- Paachana
- Aaragvadhaadi Gan`a
Vran`aRopan`a:
Ropan`a is healing of wounds by facilitating growth of healthy Dhaatu. It is achieved by Snigdha, Mridu, Madhura, Kashaaya drugs.
Factors affecting wound healing:|
The factors which delay wound healing are Dosha Prakopaka Hetu. Charaka has described 24 factors which affect wound healing as:
- Snaayukleda
- Siraakleda
- Asthibheda
- Gambheera Vran`a
- Krimi
- Visha
- Nakhabheda
- Achikitsita Vran`a
- Mithyaabandhana
- Shalyayukta
- Atisnigdha
- Ajeerna
- Atibhojana
- Viruddhaahara
- Krodha
- Asaatyma Bhojana
- S`hoka
- Divaasvaapa
- Vyaayaama
- Maithuna
- Bhaishajya Karshan`a
- Kost`ha Prabheda
- Charmalomatighat`t`anam
- Avyaayaama
Pathya:
Rasa – Madhura, Tikta, Kashaaya
Gun`a/Karma – Snigdha, Ushn`a, Drava, Laghu, Agni Deepaka, Avidaahee, Brihan`eeya, Jeevaneeya
S`hooka – Puraan`a Yava, Shasht`ika S`haalee, Godhuma, Rakta S`haalee
S`haaka – Pat`ola, Vetraagra, Baala Moolaka, Vaartaaka, Kaarvellaka, Karkot`a, Tan`d`uleeyaka, Nimba Patra, S`haalincha S`haaka, Haritakee, Bibheetakee, Aamalakee, Kut`akee, Jeevantee, Saindhava
S`himbee – Masoora, Aad`hakee
Dugdha – Ghrita
Drava – Taila
Kritaanna – Mudga Yoosha, Vilepee, Jaangala Maamsarasa
Other –Madhu, S`harkaraa
Apathya:
Rasa – Amla, Lavan`a, Kat`u
Gun`a – Rooksha, S`heeta, Guru
Dhaanya – Nava Dhaanya
S`haaka – Patra S`haaka
S`himbee – Sateena, Kulattha, Maasha
Maamsa – Aanoopa Pas`hu Pakshee Maamsarasa
Dugdha – Dugdha, Dugdha Janya Padaartha, Dadhi, Dugdha Nisrita Saktu
Drava – Madya
Other – Shrama, Maithuna, Divaasvaapa, Uchchha Bhaashan`a, S`hoka, Viruddhaanna, Asaatmya Bhojana, Ikshu Vikriti, Gud`a, Sneha
Search Anveshaka:
Search Kalpa, Dravya, Aahaara, Chikitsaa Karma, Vihaara
Adhikaara – Vran`a
Vyaadhi – Vran`a, Vran`as`hotha
Karma – Vran`aS`hodhana, Vran`aRopan`a, Daaha Pras`hamana, S`hoola Pras`hamana
Last updated on March 4th, 2021 at 06:53 am