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=== Introduction ===
=== Introduction ===
The term ''vrana'' literally means destruction or rupture or discontinuation of body tissues. This chapter gives comprehensive information about endogenous and exogenous ulcers. ''Trividha pariksha'' or three different ways of examination of ulcer is done by ''darshana'' (inspection), ''prashna'' (interrogation) and ''sparshana'' (palpation). Inspection i.e. visual examination deals with general examination (whole body) and local examination (specific part or organ) to make proper diagnosis. The etiological factors, nature of pain, ability to get used to food (''satmya/asatmya''), drugs, status of digestive power etc are examined by interrogation. Palpation is the mode of direct examination done by palpating the margin, size, depth, temperature, stiffness or hardness etc. Prognosis of ulcer is determined by its location eg. skin (''tvaka''), blood vessels (''shira''), muscle tissue (''mamsa''), fatty tissue (''meda''), bone (''asthi''), ligament (''snayu''), vital organs (''marma'')<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, chikitsa sthana Chap 1, shlok no.134 , Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 16.</ref>,visceras of chest and abdomen (''antarashraya'')<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, chikitsa sthana Chap 2, shlok no.12 , Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 19.</ref>,<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sharira sthana, Chap 7, shlok no. 10 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 913.</ref>.
The term ''vrana'' literally means destruction or rupture or discontinuation of body tissues. This chapter gives comprehensive information about endogenous and exogenous ulcers. ''Trividha pariksha'' or three different ways of examination of ulcer is done by ''darshana'' (inspection), ''prashna'' (interrogation) and ''sparshana'' (palpation). Inspection i.e. visual examination deals with general examination (whole body) and local examination (specific part or organ) to make proper diagnosis. The etiological factors, nature of pain, ability to get used to food (''satmya/asatmya''), drugs, status of digestive power etc are examined by interrogation. Palpation is the mode of direct examination done by palpating the margin, size, depth, temperature, stiffness or hardness etc. Prognosis of ulcer is determined by its location eg. skin (''tvaka''), blood vessels (''shira''), muscle tissue (''mamsa''), fatty tissue (''meda''), bone (''asthi''), ligament (''snayu''), vital organs (''marma'')<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, chikitsa sthana Chap 1, shlok no.134 , Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 16.</ref>,visceras of chest and abdomen (''antarashraya'')<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, chikitsa sthana Chap 2, shlok no.12 , Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 19.</ref>,<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sharira sthana, Chap 7, shlok no. 10 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 913.</ref>.
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)<ref>Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika, Uttara tantra Chap 26, shlok no.13 , Reprint 2005, Chaukhambha Sanskrit Sansthan, Varanasi, pp 26</ref> 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<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sutrasthana, Chap 16, shlok no.17 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 321.</ref> 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)<ref>Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika, Uttara tantra Chap 26, shlok no.13 , Reprint 2005, Chaukhambha Sanskrit Sansthan, Varanasi, pp 26</ref> 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<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 16, shlok no.17 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 321.</ref> 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.
=== Sanskrit Text, Transliteration and English Translation ===
=== Sanskrit Text, Transliteration and English Translation ===
==== Indications and process of six fold surgical procedures ====
==== Indications and process of six fold surgical procedures ====
Six types of surgical procedures are described for treatment of ulcer such as ''patana'' (incision), ''vyadhana'' (puncturing), ''chhedana'' (excision), ''lekhana'' (scrapping), ''pracchana'' (scarification) and ''seevana'' (suturing). ''Patana'' procedure described by Charaka is same as for ''bhedana'' by Sushruta. Any similar or new procedure can be applied in wound management as per the surgeon’s freedom. <ref>K. H. Krishnamurthy, editor Prof. P.V. Sharma, Bhela Samhita, Chikitsa sthana, Chap.27, Shloka 14-15, pp 468, Reprint 2008, Chaukhambha Visvabharati, Varanasi.</ref>
Six types of surgical procedures are described for treatment of ulcer such as ''patana'' (incision), ''vyadhana'' (puncturing), ''chhedana'' (excision), ''lekhana'' (scrapping), ''pracchana'' (scarification) and ''seevana'' (suturing). ''Patana'' procedure described by Charak is same as for ''bhedana'' by Sushruta. Any similar or new procedure can be applied in wound management as per the surgeon’s freedom. <ref>K. H. Krishnamurthy, editor Prof. P.V. Sharma, Bhela Samhita, Chikitsa sthana, Chap.27, Shloka 14-15, pp 468, Reprint 2008, Chaukhambha Visvabharati, Varanasi.</ref>
===== ''Pidana'' (Compression) =====
===== ''Pidana'' (Compression) =====
==== Diet: Wholesome and unwholesome aahar-vihar and ulcer healing promoters ====
==== Diet: Wholesome and unwholesome aahar-vihar and ulcer healing promoters ====
''Lavana'' is ''vishyandi'' i. e. producing more secretions from tissues; it aggravates ''kapha'' and ''pitta'' and mitigates ''vata''.<ref>Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika, Sutra sthana Chap 6, shlok no.143, Reprint 2005, Chaukhambha Sanskrit Sansthan,Varanasi, pp 64</ref> Due to ''kapha'' and ''pitta'' vitiating properties it causes sliminess (''kledana'') and burning pain. Excessive ''lavana, amla'' and ''katu rasa'' will provoke ''vata dosha'' and may produce various types of pain. ''Vidahi'' food also leads to burning sensation due to ''srotorodha'' while sexual intercourse leads to ''dhatukshaya'' and aggravates ''vata''. <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Chikitsa sthana, Chap 28, shlok no.59 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 788</ref>, <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Vimana sthana, Chap 5, shlok no.24 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 714</ref>. Day time sleep causes ''srotorodha'' and gives rise to vitiation of ''kapha'' that leads to swelling. Elevation of depressed ulcer is very important aspect of healing process. In Ayurvedic classics ''stanya janana'' (galactogogue),<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sutrasthana, Chap 4, shlok no.17 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 83</ref> ''jeevaniya'' (life promoters e.g. vitamins)<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sutrasthana, Chap 4, shlok no.1 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 71.</ref> and ''brimhaniya gana'' (nourishing drugs)<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sutrasthana, Chap 4, shlok no.2 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 72.</ref> are described. All these drugs have nutritional value (''dhatu poshana'') that helps in ulcer healing.
''Lavana'' is ''vishyandi'' i. e. producing more secretions from tissues; it aggravates ''kapha'' and ''pitta'' and mitigates ''vata''.<ref>Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika, Sutra sthana Chap 6, shlok no.143, Reprint 2005, Chaukhambha Sanskrit Sansthan,Varanasi, pp 64</ref> Due to ''kapha'' and ''pitta'' vitiating properties it causes sliminess (''kledana'') and burning pain. Excessive ''lavana, amla'' and ''katu rasa'' will provoke ''vata dosha'' and may produce various types of pain. ''Vidahi'' food also leads to burning sensation due to ''srotorodha'' while sexual intercourse leads to ''dhatukshaya'' and aggravates ''vata''. <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Chikitsa sthana, Chap 28, shlok no.59 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 788</ref>, <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Vimana sthana, Chap 5, shlok no.24 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 714</ref>. Day time sleep causes ''srotorodha'' and gives rise to vitiation of ''kapha'' that leads to swelling. Elevation of depressed ulcer is very important aspect of healing process. In Ayurvedic classics ''stanya janana'' (galactogogue),<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 4, shlok no.17 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 83</ref> ''jeevaniya'' (life promoters e.g. vitamins)<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 4, shlok no.1 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 71.</ref> and ''brimhaniya gana'' (nourishing drugs)<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 4, shlok no.2 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 72.</ref> are described. All these drugs have nutritional value (''dhatu poshana'') that helps in ulcer healing.
==== Indications and contraindications of agnikarma (cauterization) in various disorders ====
==== Indications and contraindications of agnikarma (cauterization) in various disorders ====
The ingredients like bala (Sida cordifolia Linn.), kusa (Desmostachya bipinnata Stapf.), badara (Zizyphus jujube Lam.), trivrit (Operculina turpethum Linn.), karavira (Nerium indicum Mill.), kutaja (Holarrhena antidysentrica Linn.), meda (Polygonatum airrhifolium Royle), mahameda (Polygonatum airrhifolium Royle), murva (Marsdenia tenacissima W. & A.), lajjalu (Mimosa pudica Linn.), gojihva (Onosma bracteatum Wall.), dhataki, ela (Elleteria cardamomum Maton.), aguru (Aquilaria agallocha Roxb.), kakoli (Roscoca procera Wall.), ksirakakoli (Roscoca procera Wall.) are mentioned for wound healing so there is a scope to find out their clinical wound healing effect.
The ingredients like bala (Sida cordifolia Linn.), kusa (Desmostachya bipinnata Stapf.), badara (Zizyphus jujube Lam.), trivrit (Operculina turpethum Linn.), karavira (Nerium indicum Mill.), kutaja (Holarrhena antidysentrica Linn.), meda (Polygonatum airrhifolium Royle), mahameda (Polygonatum airrhifolium Royle), murva (Marsdenia tenacissima W. & A.), lajjalu (Mimosa pudica Linn.), gojihva (Onosma bracteatum Wall.), dhataki, ela (Elleteria cardamomum Maton.), aguru (Aquilaria agallocha Roxb.), kakoli (Roscoca procera Wall.), ksirakakoli (Roscoca procera Wall.) are mentioned for wound healing so there is a scope to find out their clinical wound healing effect.
Charak mentioned some formulations for shodhan (cleansing) and ropan (healing) in this chapter. Along with single drug these formulations need to be further studied for their scientific validation.
==== ''Shodhana'' (Cleansing) formulations ====
==== ''Shodhana'' (Cleansing) formulations ====
#Lodhra, leafbuds of nyagrodha, khadira, triphala and ghrita - this combination used as paste provides looseness and softness in wounds.
#Lodhra, leafbuds of nyagrodha, khadira, triphala and ghrita - this combination used as paste provides looseness and softness in wounds.
The role of diet is very important in wounded patients which can be considered for further research as Charaka mentioned that wounded patients should abstain from salt, sour, pungent, hot, burning and heavy food and drinks and also sexual intercourse.
The role of diet is very important in wounded patients which can be considered for further research as Charak mentioned that wounded patients should abstain from salt, sour, pungent, hot, burning and heavy food and drinks and also sexual intercourse.
=== Glossary ===
=== Glossary ===