The holy Dhanvantari, the foremost of the pious and the greatest of all discoursers, thus discoursed to his disciple Sus'ruta, the son of Vis'vámitra. 2.
I shall describe the shapes of the various kinds of Vrana (sores or wounds) caused by weapons of variously shaped edges in the different parts of the human body. Traumatic ulcers have a variety of shapes. Some of these are elongated, others are rectangular, or triangular, or circular, while some are crescent shaped, or extended, or have a zigzag shape, and some are hollow in the middle like a saucer, and lastly some have she shapes of a barley corn (bulged out at the middle). An abscess or a swelling, due to the several Doshas and which spontaneouly bursts out, may assume any of the aforesaid forms, while the one effected by a surgeon's knife should never have a distorted or an improper shape. A surgeon thoroughly familiar with the shapes of ulcers is never puzzled at the sight of one of a terrible and distorted shape. 3~5.
Physicians of yore have grouped these variously shaped traumatic ulcers under six broad sub-heads, such as the Chhinna (cut), Bhinna (punctured or perforated), Viddha (pierced), Kshata (contused), Pichchita (crushed), and the Ghrishta (mangled or lacerated) according to their common features and I shall describe their symptoms. 6.
A traumatic ulcer which is oblique or straight and elongated is called a Chhinna (cut) ulcer, while a complete severance of a part or member of the body is also designated by that name. A perforation of any of the cavities or receptacles of the body by the tip of a Kunta, spear, Rishti, or a sword or by a horn, attended with a little discharge, constitutes what is called a Bhinna (punctured) wound or ulcer. The Amás'aya (stomach), the Pakvás'aya (intestines), the Agnyás'aya (gall-bladder?) the Mutrás'aya (urinary bladder), the Raktás'aya (receptacle of blood), the heart, the Unduka and the lungs constitute what is called the Koshtha (viscid). A perforation (of the wall of any) of the As'ayas causes it to become filled with blood which is discharged through the urethra, the anus, the mouth or the nostrils and is attended with fever, thirst, fainting fits, dyspnoea, burning sensations, tympanites, suppression of stool, urine and flatus (Váta) with an aversion for food, perspiration, redness of the eyes, a bloody smell in the mouth, and feted one in the body and an aching pain in the heart and in the sides. 7 - 10.
Now hear me discourse on (their) detailed symptoms. A perforation of the wall of the Amás'aya (stomach) is marked by constant vomiting of blood, excessive tympanites and an excruciating pain. A perforation of the Pakvás'aya fills it with blood and is attended with extreme pain, a heaviness in the limbs, coldness of the sub-umbilical region, and bleeding through the (lower) ducts and orifices of the body. Even in the absence of any perforation, the Antras (intestines) are filled with blood through the small pores or apertures in their walls in the same manner as a pitcher with its mouth firmly covered may be filled through the pores (in its sides), and a sense of heaviness is also perceived in their inside. 11-13.
A wound or an ulcer caused by any sharp pointed Salya (shaft) in any part of the body other than the aforesaid As'ayas with or without that Salya being extricated is called a Viddha (pierced one). An ulcer which is neither a cut nor a perforation or puncture but partakes of the nature of both and is uneven is called a Kshata (wound,). A part of the body with the local bone crushed between the folds of a door or by a blow becomes extended and covered with blood and marrow and is called a Pichchita (thrashed) wound or ulcer. The skin of any part of the body suffering abrasion through friction or from any other such like causes and attended with heat and a secretion is called a Ghrishta (mangled or lacerated) wound or ulcer. 14-17.
A part or member of the body any wise cut, perforated, pierced or wounded which is attended with excessive bleeding and with the local Váyu enraged or aggravated by the incidental bleeding, or haemorrhage will occasion excruciating pain. Potions of Sneha (oily or fatty liquids) and using the same as a washing (in a lukewarm state) should be advised in such cases. Preparation of Ves'aváras and other Kris'arás largely mixed with oil or clarified butter should be used as poultices and fomentations with the Másha pulse, etc., and the use of oily ungents and emulsive Vastis (enematas) * prepared with decoctions of Váyu-subduing drugs should be applied. A crushed or thrashed wound or abrasion is not attended with any excessive bleeding an absolute absence whereof, (on the contrary) gives rise to an excessive burning sensation and suppuration in the affected part. Cold washes and cooling plasters should be used in these cases for the alleviation of the burning and suppuration as well as for the cooling of the (incarcerated) heat. What has been specifically said of these six forms of ulcers, or wounds should be understood to include the treatment of all kinds of traumatic wounds or ulcers as well. 18 - 20.
* Snehapána is recommended when the ulcer is in a region above the umbilicus and Vasti-karma when the ulcer is in a subumbilical region.