Dushta Vrana W.S.R. to Varicose Ulcer - A Standpoint through Ancient Discipline
Although varicose veins were probably recognized in pre-history, the first written reference appears to be the Ebers papyrus, dated 1550 BC. However, Hippocrates was the first to note the association between venous veins and ulceration. During roman times, a number of physicians including Galen, Celsus, Aetius of aminda and Paules Aegien advised avulsion and cauterization for treatment of varicose veins and the use of bandages for the treatment of leg ulcers. In 10th to the 18th century, various physicians attributed ulceration of the legs to the accumulation of black bile, menstrual blood. They believed that ulceration in the legs served a useful purpose in getting rid of these vile substances. In 19th century various authors like Brodie, Astley Cooper, and Hodgson stressed the importance of leg ulceration and the term Varicose Ulcer was coined [1]. Even in our Ayurvedic classics the explanation of wound and its management were being explained in detail since the prevedic period.
Editorial
Although varicose veins were probably recognized in pre-history, the first written reference appears to be the Ebers papyrus, dated 1550 BC. However, Hippocrates was the first to note the association between venous veins and ulceration. During roman times, a number of physicians including Galen, Celsus, Aetius of aminda and Paules Aegien advised avulsion and cauterization for treatment of varicose veins and the use of bandages for the treatment of leg ulcers. In 10th to the 18th century, various physicians attributed ulceration of the legs to the accumulation of black bile, menstrual blood. They believed that ulceration in the legs served a useful purpose in getting rid of these vile substances. In 19th century various authors like Brodie, Astley Cooper, and Hodgson stressed the importance of leg ulceration and the term Varicose Ulcer was coined [1]. Even in our Ayurvedic classics the explanation of wound and its management were being explained in detail since the prevedic period.
Prevedic Period
In this very period Ayurvedic science started. God Brahma is the profounder of Ayurved. He memorized and imparted it to Daksha Prajapati who in turn taught the Ashwini Kumaras. In that period Lord Shiva was also considered to be the physician. Ayurved avatarana states that Brahma, the creator of universe, memorized Ayurved (science of life) by meditation & imparted it to Dakshaprajapati who in turn taught the Ashwini Kumaras. Lord Shiva attached an elephant’s head on his son’s body so he was also considered as physician at that time [2].
Vedic Period
From 1500 BC-600 BC Rigveda & Atarvaveda are the chief sources of medical information’s. About vrana various references are available.
Riga Veda
- In Rigveda rudra is considered as validya & we find a verse addressed to god rudra the processor of healing medicines.
- Ashwini kumaras are considered as most important physicians in Rigveda. Various references related to their work are available. E.g. when vishphalas leg was severed [3].
Atharva Veda
- We get various references regarding vrana,vrana vedana. Vrana chikitsa in 2nd pada.
- In sadyo vrana produced due to abhighata, sheeta jaladhara is told for stoppage of blood & to reduce intensity of pain.
- In battle, Ashwinikumaras substituted her leg with artificial one [4].
Post Vedic Period
• This is the period where the Ayurved developed to a great extent. In the Purana, Upanishad, Smruti etc plenty of references regarding vrana are available.
In Mahabhaarat during time of Kurukshetra yudda various references regarding wound management are mentioned [5].
**Samhita Period**
**Charaka Samhita**
- Charaka described vrana & its management in detail in the Dvivraniya adhyaya in chikitsa stana. It includes the varieties of vrana, their lakshanas, vrana vedana, sraava, gandha & its management [6].
**Sushruta Samhita**
- Detail review of vrana & its management.
- The whole surrasthana he explains vrana etiology, lakshanas, vranitaagaara, raksha vidhi, types, sraava, dushta, shudda, ruhyamaana & rudha vrana.
- In chikitsa stana he explains sadyo vrana & its management.
- Shashti upakrama for management of vrana [17].
**Bhela Samhita**
- Like Charaka the various formulations & management of vrana was explained by him [8].
**Madhava Nidana**
- Types, character of vrana are explained in 42nd chapter & about Aagantuja vrana he explained in 43rd chapter [9].
**Bhaishajya Ratnaavali**
- In vrana chikitsa adhyaya, various lepas for vrana vedana & shodhana kashayaas were explained.
- Sadyo vrana chikitsa was explained in separate chapter [10].
Even since the birth of mankind, trauma is the first type of ailment which the man must have experienced & treatment of resultant effect of trauma viz, the wound must have been the lesion which received the first attention & which required surgical treatment. Due to constant exposure to trauma, man has been susceptible to wounding. The response of tissue to the injury has formed the basis of all surgical practices. Wound & its management have been dealt since the beginning of the Vedas to the current era & has been a major problem since the early stages of medical study. In spite of brilliant advances in surgical field, wound management still remains a subject of speculation. In Ayurveda particularly Sushruta has mentioned various types of wounds & their management which is of fundamental importance for any surgical practice.
Lots of advancement has taken place in modern science to diagnose & treat most of complicated diseases but management of chronic infected ulcer is still a problem before scientist. No doubt a simple traumatic ulcer does not require any special care, healing take place naturally. But sometimes the simple ulcer may change into a chronic non-healing ulcer. There are certain factors that are responsible for changing a simple ulcer into a chronic or non-healing ulcer. These factors are low vitality, smoking, alcohol addiction, malnutrition, old age, constant irritation to the ulcer, certain debilitating diseases like diabetes, tuberculosis, leprosy, hepatitis, poor surgical technique that leave devitalized tissue, foreign material of any kind including drain, sutures etc.
In Ayurved, such infected wounds are treated as dustha vrana. All the wounds if not treated properly may turn into dustha vrana which always heal by secondary intention along with scar formation or may assume such proportions which may necessitate amputation. Systematized records about the management of wounds are available in Sushruta Samhita. Sushruta has exhaustively studied the subject of wound management. The problem of wound healing is a vital problem faced by clinician even today [11].
**References**
- www.books.google.co.in.
- Vagbhatacharya (1998).
Astanga Hridaya. Shastri kashinath.Varanasi, Choukambha Orientalia, pp:
8. K.H.krishnamoorty, Bhela Samhita, edited by PV
Sharma, Chowkhamba vishwabharati, Varanasi, pp: 466.
9. Shastri SS, Vijayrakshita S, Madavkara S (1996)
Chowkambha Sanskrit Sansthan, Varanasi, pp: 97.
10. Shastri KAS, Ratnavali B (2002) Chowkhamba
Sanskrit Sansthan, Varanasi, pp: 556.
11. Sushruta, Samhita S, Trikamji AJ (1998) chaukambha, Sanskrit samstana Varanasi, pp: 396.
References
-
www.books.google.co.in.
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Vagbhatacharya (1998). Astanga Hridaya. Shastri kashinath.Varanasi, Choukambha Orientalia, pp: 4.
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Kapiladev Dwiwedi. Vedon mein Ayurveda, Vishwabharathi Anusandhana Parishada, Bhdohi, Uttar Pradesh, pp: 175.
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Kapiladev Dwiwedi. Vedon mein Ayurveda. Vishwabharathi Anusandhana Parishada, Bhdohi, Uttar Pradesh, pp: 175.
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Bhagvadgeeta, http://www.krishna.com.
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Agnivesha, Trikamji AJ (2007) Charaka samhitha with Ayurveda Dipika commentary of Chakrapanidatta; Chikitsasthana, Varanasi, Chaukambha Prakashan, pp: 591-597.
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Sushruta, Trikamji AJ (2005) Sushruta Samhita with Nibandhasangraha Com of Dalhanacarya and Nyaya Candrika Panjika of Gayadas Acharaya on Nidanasthana; Chikitsasthana, Varanasi, by Chaukhambha Orientalia, pp: 415.
-
K.H.krishnamoorty, Bhela Samhita, edited by PV Sharma, Chowkhamba vishwabharati, Varanasi, pp: 466.
-
Shastri SS, Vijayrakshita S, Madavkara S (1996) Chowkambha Sanskrit Sansthan, Varanasi, pp: 97.
-
Shastri KAS, Ratnavali B (2002) Chowkhamba Sanskrit Sansthan, Varanasi, pp: 556.
-
Sushruta, Samhita S, Trikamji AJ (1998) chaukambha, Sanskrit samstana Varanasi, pp: 396.
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