The fifteenth chapter of Nidanasthana of Sushruta Samhita is known as as Bhagna Nidanam Adhyaya. This chapter offers with Fractures and Dislocations.
अथातो भग्नानां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We are going to now expound Bhagna Nidana – prognosis of Fractures and Dislocations as revealed by the venerable Dhanvantari.
Nidana- Causes
पतनपीडनप्रहाराक्षेपणव्यालमृगदशनप्रभृतिभिरभिघातविशेषैरनेकविधमस्थ्नां भङ्गमुपदिशन्ति ||३||
Under talked about are the causes for various sorts of bhagna (fracture of bones) –
- falling from top,
- squeezing the physique enormously,
- assault / hitting,
- very vigorous actions,
- chunk by wild animals and others assaults / harm
Bheda – Sorts
तत्र भङ्ग(ग्न)जातमनेकविधमनुसार्यमाणं द्विविधमेवोपपद्यते सन्धिमुक्तं, काण्डभग्नं च |
तत्र षड्विधं सन्धिमुक्तं, द्वादशविधं काण्डभग्नं भवति ||४||
There are completely different sorts of bhagna however all these are (grossly) of two varieties solely viz
- Sandhimukta – it’s of six sorts and
- Kandabhagna – it’s of twelve sorts
-
Sandhimukhta (dislocation of bony joints)
तत्र सन्धिमुक्तम्- उत्पिष्टं, विश्लिष्टं, विवर्तितम्, अवक्षिप्तम्, अतिक्षिप्तं, तिर्यक्क्षिप्तमिति षड्विधम् ||५||
The six forms of Sandhimukta are –
- Utpista,
- Vislista,
- Vivartita,
- Avaksipta,
- Atiksipta, and
- Tiryak Ksipta
Samanya Laksana – Normal indicators and Signs
तत्र प्रसारणाकुञ्चनविवर्तनाक्षेपणाशक्तिरुग्ररुजत्वं स्पर्शासहत्वं चेति सामान्यं सन्धिमुक्तलक्षणमुक्तम् ||६||
The final signs of Sandhimukta – dislocation of joints are –
Lack of ability to carry out the under talked about actions –
- extension,
- contraction,
- rotation and
- fast actions
Different signs embrace –
- Extreme ache
- Lack of ability to tolerate contact
Visesa Laksana – Particular signs of every sort of Sandhimukta
वैशेषिकं तूत्पिष्टे सन्धावुभयतः शोफो वेदनाप्रादुर्भावो विशेषतश्च नानाप्रकारा वेदना रात्रौ प्रादुर्भवन्ति; विश्लिष्टेऽल्पः शोफो वेदनासातत्यं सन्धिविक्रिया च; विवर्तिते तु सन्धिपार्श्वापगमनाद्विषमाङ्गता वेदना च; अवक्षिप्ते सन्धिविश्लेषस्तीव्ररुजत्वं च; अतिक्षिप्ते द्वयोः सन्ध्यस्थ्नोरतिक्रान्तता वेदना च; तिर्यक्क्षिप्ते त्वेकास्थिपार्श्वापगमनमत्यर्थं वेदना चेति ||७||
| Kind of Sandhimukta | Particular signs |
| Utpista | Swelling on each side of the joint
Ache Completely different sorts of ache, particularly occurring at night time time |
| Vislista | Slight swelling
Steady ache which happens each at day and night time Improper functioning of the joint |
| Vivartita | Joint shifts to anyone aspect
Distortion of that half which has shifted Ache |
| Avaksipta | Drooping down of the joint
ache |
| Atiksipta | Each bones making up the joint would transfer aside such {that a} hole is created between these two bones
Ache |
| Tiryak Ksipta | Anybody bone forming the joint alone will get displaced to a aspect
Ache |
-
Kanda Bhagna – fracture of shafts of bones
काण्डभग्नमत ऊर्ध्वं वक्ष्यामः- कर्कटकम्, अश्वकर्णं, चूर्णितं, पिच्चितम्, अस्थिच्छल्लितं, काण्डभग्नं, मज्जानुगतम्, अतिपातितं, वक्रं, छिन्नं, पाटितं, स्फुटितमिति द्वादशविधम् ||८||
After this, completely different sorts of Kandabhagna – fracture of the shaft of bones might be defined –
The twelve sorts of Kandabhagna (shaft fractures) are –
- Karkataka,
- Asvakarna,
- Curnita,
- Piccita,
- Asthicchallita,
- Kandabhagana
- Majjanugata,
- Atipatita,
- Vakra,
- Chinna,
- Patita and
- Sphutita
Samanya Laksana – basic symptoms-
श्वयथुबाहुल्यं स्पन्दनविवर्तनस्पर्शासहिष्णुत्वमवपीड्यमाने शब्दः स्रस्ताङ्गता विविधवेदनाप्रादुर्भावः सर्वास्ववस्थासु न शर्मलाभ इति समासेन काण्डभग्नलक्षणमुक्तम् ||९||
The final signs of fracture of shaft of bones briefly are –
- profound swelling,
- lack of ability to bear tapping, rotating and touching;
- producing sound (on the web site) when pulled (or squeezed),
- a part of the physique hanging down loosely,
- look of assorted sorts of ache, and
- not discovering consolation in any place
Visesa Laksana – particular signs of every form
विशेषस्तु सम्मूढमुभयतोऽस्थि मध्ये भ(ल)ग्नं ग्रन्थिरिवोन्नतं कर्कटकम्, अश्वकर्णवदुद्गतमश्वकर्णकं, स्पृश्यमानं शब्दवच्चूर्णितमवगच्छेत्, पिच्चितं पृथुतां गतमनल्पशोफं, पार्श्वयोरस्थि हीनोद्गतमस्थिच्छलितं, वेल्लते प्रकम्पमानं काण्डभग्नम्, अस्थ्यवयवोऽस्थिमध्यमनुप्रविश्य मज्जानमुन्नह्यतीति मज्जानुगतम्, अस्थि निःशेषतश्छिन्नमतिपातितम्, आभुग्नमविमुक्तास्थि वक्रम्, अन्यतरपार्श्वावशिष्टं छिन्नं, पाटितमणुबहुविदारितं वेदनावच्च, शूकपूर्णमिवाध्मातं विपुलं विस्फुटितं स्फुटितमिति ||१०||
Kind of Kandabhagna |
Particular signs |
| Karkataka | The 2 damaged ends of the bone have moved aside
Bulging within the center, resembling a tumor |
| Asvakarna | Ends of the bones are raised up
Raised elements resemble ear of the horse |
| Curnita | The damaged bones produce sounds as if damaged into items, when felt by fingers |
| Piccita | The bone turns into thick and has profound swelling on the web site of fracture |
| Asthicchallita | One a part of the bone has dropped under and the opposite half is raised above on the web site of fracture |
| Kanda Bhagna | The fractured bone has tremors / trembles (shaking actions) when shaken |
| Majjanugata | Part of piece of the bone or center portion of the bone will get into (pierces into) the bone marrow and displaces it. |
| Atipatita | Whole bone is damaged into items, with none half remaining intact |
| Vakra | The bone is bent inwards / has change into curved with out getting indifferent |
| Chinna | Bone has moved to the opposite aspect |
| Patita | Bone is cut up into many items
Ache |
| Sphutita | Bone is extra swollen
Feels as if the bone is crammed with thorns Bone is enormously cut up (chopped off) |
Sadhyasadhyata – prognosis
तेषु चूर्णितच्छिन्नातिपातितमज्जानुगतानि कृच्छ्रसाध्यानि, कृशवृद्धबालानां क्षतक्षीणकुष्ठिश्वासिनां सन्ध्युपगतं चेति ||११||
The under talked about sorts of fractures are troublesome to remedy –
- Curnita
- Chinna
- Atipatita
- Majjanugata
Fractures are additionally incurable in –
- emaciated, previous aged individuals and kids,
- these emaciated,
- previous aged folks and kids,
- these affected by harm to lungs, pores and skin problems and dyspnea,
- these which happen close to bony joints
भवन्ति चात्र:-
भिन्नं कपालं कट्यां तु सन्धिमुक्तं तथा च्युतम् |
जघनं प्रति पिष्टं च वर्जयेत्तच्चिकित्सकः ||१२||
असंश्लिष्टं कपालं तु ललाटे चूर्णितं च यत् |
भग्नं स्तनान्तरे शङ्खे पृष्ठे मूर्ध्नि च वर्जयेत् ||१३||
आदितो यच्च दुर्जातमस्थि सन्धिरथापि वा |
सम्यग्यमितमप्यस्थि दुर्न्यासाद्दुर्निबन्धनात् [२] ||१४||
सङ्क्षोभाद्वाऽपि यद्गच्छेद्विक्रियां तच्च वर्जयेत् |१५|
मध्यस्य वयसोऽवस्थास्तिस्रो याः परिकीर्तिताः ||१५||
तत्र स्थिरो भवेज्जन्तुरुपक्रान्तो विजानता [१] |१६|
Some extra verses right here
Under talked about circumstances shall be rejected by the doctor since they’re incurable –
- fracture of bones or dislocation of joints and displacement of flat bones of the pinnacle and pelvis
- crushed pubic bone
- fractured items of the flat bones of the pinnacle not nicely unified
- brow bone crushed into items
- fractures occurring in between the breasts
- fractures in temples, again and head
- fracture occurring within the bone which has not shaped correctly proper from the start of his life,
- dislocation occurring within the joint which has not shaped correctly proper from the start of his life
- fractures occurring in bones or dislocation occurring in joints which have developed correctly however at present not performing their perform correctly due to improper putting or bandaging or as a result of vigorous motion
Among the many three phases of life, the individual might be robust and steady within the center age. The remedy of fractures and dislocations must be undertaken after contemplating this.
तरुणास्थीनि नम्यन्ते भज्यन्ते नलकानि तु ||१६||
कपालानि विभिद्यन्ते स्फुटन्ति रुचकानि च ||१७||
Under talked about are the impact of assault on completely different constructions –
- younger bones bend
- hole bones break
- flat bones get punctured
- tooth change into cracked
इति सुश्रुतसंहितायां निदानस्थाने भग्ननिदानं नाम पञ्चदशोऽध्यायः ||१५||
Thus ends the fifteenth chapter by title Bhagna nidana in Nidana Sthana of Susruta Samhita.
