SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

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3SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

THE INCIDENCE

The agricultural sector(194.5per10,000 workers),

The mining (168.8 per 10,000 workers),

The construction (111.7 per 10,000 workers)

The manufacturing (87.5 per 10,000 workers).

The males had significantly higher incidence rate than females except for the educational sector.

4SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

RESEARCHES

27 P.G. dissertations From 1966 to 1996,

1Ph.D. works

棧An approach to human ailments is as old as the evolution of human being. The most ancient practiced medical science is Ayurveda.

棧Orthopedic surgery - Bhagna Chikitsa

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ASTHI SHAREERA

Asthi - Stable and Strong.

Develops during third month of intrauterine life.

Pitrujabhava is responsible for the formation of Asthi.

Asthivaha srothasa is the channel through which the nutrients are being circulated within the asthidhatu.

Medasa and Jaghana are the moola of asthivaha srotasa.

SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

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ASTHI SANKHYA

ASTHI PRAKARA

ASTHI KARYA

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SHABDHOTPATTI

Bhanjayatithibhagna| | (Shabdasthoma )

PARYAYA Bhagna, Bheda, Bhedana, Bhanjana, Vibhaga. NIDANA

Patana,Peedana,Praharena,Akshepana,Vyalamrugadashana, Balavadnigraha, Abhipatanishesha

EFFECT OF TRAUMA ON BONES :1. Cartilage's Bend2. Long bones -Break3. Flat bones - Crack4. Teeth - Fragmented5. Curved bones - Crack or Break.

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CLASSIFICATION OF BHAGNA

[A] 1) Sandhimukta 2) Kandabhagna. (Sushruta)

[B] 1) Sandhibhagna 2) Asandhibhagna.(Vagbhata)

[C] 1)Savrana bhagna 2) Avrana bhagna.(Madhukosha)

Classification of Kandabhagna

Name ofBhagna

Sushruta Vagbhata A.H.

Vagbhata A.S.

Charaka BhavaPrakasha

MadhavaNidana

Sharangadhara

Karkataka + + + --- + + ---Ashwakarana + + + --- + + ---Choornita + + + --- Vichoorni

taVichoorn

ita---

Picchita + + + --- + + ---Asthichallita + + + --- + Asthichall

ika---

Kandabhagna + Vellita Vellita --- + + ---Majjanugata + + + --- + Majjagata ---Atipatita + + + --- + + ---Vakra + + + --- + + ---Chinna + Shoshita Shoshita --- + + ---Patita + Darita Darita --- + + ---Sphutita + + + --- Visphutita + ---

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GENERAL FEATURES OF 'KANDABHAGNA'

Shvyathubahulyam

Sparshasahisnutvam

Avapidyamane shabda

Vividhavedanapradurbhavah

Sarvasu Avasthasu Na Sharmalabha

SPECIFIC FEATURES OF INDIVUDAL 'KANDABHAGNA'

1)Karkataka -- Depressed Fracture

(2)Ashwakarana - Complete Oblique Fracture

(3) Churnitam-- Comminuted Fracture

(4) Pichhitam- Compressed Fracture

(5) Asthichallita--Periosteal Avulsion

(6) Kanda bhagna -- Complete Spiral Fracture

(7) Majjanugatam-- Impacted fracture

(8) Atipatitam -- Complete compound fracture

(9) Vakra -- Greenstick Fracture

(10) Chinnam -- Incomplete Fracture

(11) Patitam --Cracked fracture of Flat Bones

12)

Sputita -- Fissured Fracture

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SUSHRUTA'S CLASSIFICATIONWITH NEAREST MODERN

COMPARISON

Karkataka: Depressed fracture.

Ashwakarana:Complete oblique fracture.

Churnitam: Comminuted fracture

Pichhitam: Fracture by compression.

Asthichallita : Sub periosteal avulsion.

Kandabhagna: Complete spiral fracture.

Majjanugatam: Impacted fracture.

Atipatitam: Complete compound fracture.

Vakra : Green stick fracture.

Chinnam: Incomplete fracture.

Patitam: Comminuted fracture flat bones.

Sputita: Fissured fracture.

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TYPE OF

PROGNOSIS

PATIENT

FRACTURE BONE

FRACTURE

S EASONAL VARIATION

AGESTATUS OF

SITE OF STATUS OF

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(1) Local (2) Systemic.

(1) Local complications Malunion Fragmented Fracture.

(2) Systemic complications Fever, Abdominal distension, Cessation of passages of excreta

Due to tightbandaging

Swelling,pain,AvascularizationGangrene

(1) Principles of Bhagna Chikitsa.

(2) General Management of Bhagna.

(3) Specific Management for different types of fractures.

(4) Medicinal preparations for different kinds of fractures

(5) Pathyaa-Pathya.

(6) Clinical criteria of fracture healing.

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Four Principles of Treatment

1) Anchana (Traction) 2) Peedana( Manipulation)

3) Sankshepan(Opposition 4)Bandhana(Immobilization)

and stabilization)

General Treatment of Bhagna.

1) Pariseka 2) Lepana.

Specific Rx for different types of fractures

Fracture with the wound / compound fracture Wash with 'Nyagrodhadi gana dravyas'

Honey and Ghee should be applied. Rest is as in case of general management.

Phalanx fracture or dislocation, First set in its natural position Bandaged with pieces of thin linen Sprinkled with ghee. Etc.

29SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

Rehabilitation

1) MritapindaDharan 2) LavanaDharana 3) PashanaDharna

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THE LIST OF DRUGS IN THE MANAGEMENT OFFRACTURES

1.Gandha Taila 2. Gandhaprasarini Taila

3. Chakrataila 4. BhagnasandhanaTaila

5. BhagnasandhanaVati 6. Laksha Guggulu

7.LashunadiVati, 8.MadhuyasthiKsheerapaka

9. Pravala Panchamruta 10. Rajata Bhasma

Rejuvenators

1. Haritaki 2. Yastimadhu

3. Amalaki 4. Lashuna

5. Pippali 6. Kakoli, Ksheera Kakoli etc..

7. Shilajitu 8. Godhooma

9. Priyangu 10. Kapitha Phala Majja.

Lavana, Katu Rasa, Kshara and Alma article of foodLive on strictest continence,

Over exposure to sun Physical exercises.

Shali rice, meat soup,Milk, ghee, soup of pulse andNutritive and constructive food and drink,

CCCLLLIIINNNIIICCCAAALLL SSSIIIGGGNNNSSS OOOFFF IIIDDDEEEAAALLLLLLYYY UUUNNNIIITTTEEEDDD BBBOOONNNEEE

1) No swelling or hardness on palpation.

2) Absence of shortening and deformity.

3) Painless and easy movements

SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

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MMMAAANNNJJJ IIISSSTTTHHHAAA

YYYAAASSSHHHTTTIII MMMAAADDDHHHUUU

SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

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SSSHHHAAALLLIII

SSSHHHAAATTTAAADDDHHHOOOUUUTTTAAA---GGGRRRIIITTTHHHAAA

SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

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RRRAAAKKKTTTAAA CCCHHHAAANNNDDDAAANNNAAA

DDDRRRUUUGGGSSS UUUSSSEEEDDD FFFOOORRR KKKSSSHHHEEEEEERRRAAAPPPAAAKKKAAA

GHRISHTA-KSHEERA

SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

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LLLAAAKKKSSSHHHAAA

SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

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DRUGS USED FOR THE SPLINTS

UDUMBAR

AAASSSHHHWWWAAATTTTTTHHHAAA

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PALASHA

VANSHA

, ,

Drugs Used for LEPA

Drugs Rasa Guna Veerya Vipaka

Manjistha Kashaya, Guru Ushna Katu.

Tikta Ruksha

Yesthimadhu Madhura Guru Sheeta Madhura

Raktachandana Madhura Guru Sheeta. Katu

Shalipisti Madhura Snigda Sheeta Madhura

Kashaya

Drugs Used for KSHEERAPAKA

Laksha Kashaya Snigdha Anushna Katu

Laghu

Shatadhautaghrita Madhura Guru Sheeta Madhura

Drugs required for lepa and ksheera paka :

1) Lepa

2) Ksheerapaka i) Ksheera ii) Yashti madhu iii) Laksha iv) Ghee.i) Ksheera ii) Yashti madhu iii) Laksha iv) Ghee.

Source of data

Criteria of selection of Patients :

i ) Male or Female

ii) Hospitalized or Ambulant.

iii) Simple or Closed Fractures.

iv) Fractures of Humerus, Radius, Ulna, Femur, Tibia,Fibula, Metacarpals, Metatarsals, and Phalangeswhich can be reduced by closed reduction methodwith or without general Anesthesia.

v) Stable fractures i.e. fractures in which the alignment

of bony ends can be maintained without internal fixation.

Criteria of Exclusion of patients :

i) Open or compound fractures.

ii) Simple fractures with wounds were excluded.

iii) Pathological fractures, Stress Fractures, and complicated

fractures.

iv) Fractures requiring open reduction and internal fixation.

v) Fractures associated with other debilitating diseases like

Diabetes, Tuberculosis, Leprosy, Asthma is excluded.

vi) Patients suggestive of Osteomyelitis and other bone

diseases.

vii) Patients above the age of 75 years.

43SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

Trial Procedure

Investigations X- RAYLaboratory investigations

MANAGEMENT OF FRACTURES IN GROUP -A.

44SUSHRUTA'S TECHNIQUE IN THE MANAGEMENT OF AVRA NAKANDABHAGNA

Drug Supply and Dosage: Lakshaksheera Paka was

given 100ml. Daily in the morning.

Ahara : Patient's usual vegetarian and non vegetarian dietwas continued with restrictions of Lavana, Katu, Amla rasa,Kshara and Ruksha dravyas.

Vihara: Atapa sevana and Vyayama were restricted.

RADIOGRAPHS SHOWING HEALING OF BONE

Follow up:Parameters of assessmenta) Subjective improvement. b) Objective improvement.

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