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Various complications of ulcers like visarpa (erysipelas), pakshaghata (hemiplegia), shirastambha (constricted vessels), jwara (fever) etc. are described. Sloughing of ligaments and vessels, deep seated appearance of maggots, fracture of bone near the ulcer, presence of foreign body in the ulcer etc hamper the healing process. Treatment of nija vrana (endogenous ulcer) is different from agantuja vrana (exogenous ulcer) because endogenous ulcers are caused by vitiation of vatadi doshaja, and exogenous ulcers are initially caused by various type of trauma such as vadha (stab injury etc.), bandha (excessive tying), prapatana (injury due to fall), injury due to teeth and nail etc. But later on in exogenous ulcers also involvement of dosha takes place and then treatment should be adopted as nija vrana (endogenous ulcer).[ ] In endogenous ulcers, shodhana therapy should be adopted by vamana (emesis), virechana (purgation) and basti (medicated enema) and blood letting for removal of doshaja (toxic materials) from body [ ] and agnikarma. Agnikarma has ushna guna (hot property) which is opposite to vata and kapha. Due to heat, vasodilation leads to alleviation of srotorodha resulting in proper vascularity to organ or part. In exogenous ulcers, local treatment with use of kshara (alkaline substances), surgical intervention and cauterization is recommended.   

Various complications of ulcers like visarpa (erysipelas), pakshaghata (hemiplegia), shirastambha (constricted vessels), jwara (fever) etc. are described. Sloughing of ligaments and vessels, deep seated appearance of maggots, fracture of bone near the ulcer, presence of foreign body in the ulcer etc hamper the healing process. Treatment of nija vrana (endogenous ulcer) is different from agantuja vrana (exogenous ulcer) because endogenous ulcers are caused by vitiation of vatadi doshaja, and exogenous ulcers are initially caused by various type of trauma such as vadha (stab injury etc.), bandha (excessive tying), prapatana (injury due to fall), injury due to teeth and nail etc. But later on in exogenous ulcers also involvement of dosha takes place and then treatment should be adopted as nija vrana (endogenous ulcer).[ ] In endogenous ulcers, shodhana therapy should be adopted by vamana (emesis), virechana (purgation) and basti (medicated enema) and blood letting for removal of doshaja (toxic materials) from body [ ] and agnikarma. Agnikarma has ushna guna (hot property) which is opposite to vata and kapha. Due to heat, vasodilation leads to alleviation of srotorodha resulting in proper vascularity to organ or part. In exogenous ulcers, local treatment with use of kshara (alkaline substances), surgical intervention and cauterization is recommended.   

The chapter, translation and transliteration:

=== Sanskrit Text, Transliteration and English Translation ===

 

अथातो द्विव्रणीयचिकित्सितं व्याख्यास्यामः ||१||  

अथातो द्विव्रणीयचिकित्सितं व्याख्यास्यामः ||१||  

इति ह स्माह भगवानात्रेयः ||२||

इति ह स्माह भगवानात्रेयः ||२||