The Compendium of Caraka 6.25: pañcaviṃśo 'adhyāyaḥ/

Now we shall expound the treatment of the two types of wounds.

Thus said the venerable Ātreya.

To Ātreya, who knows higher and lower truths and is free from the pain of pride and intoxication, / Agniveśa, at the proper time, humbly said this:

"O venerable one! Two kinds of wounds were previously mentioned in the Compendium of Diseases; / you ought to declare their symptoms and treatment, O giver of well-being!"

Hearing these words of Agniveśa, the teacher said: / "The two wounds previously mentioned are the innate and the exogenous.

Hear properly, gentle one, their signs and their medicine: / the innate arises from bodily doṣas; the exogenous arises from external causes.

Exogenous wounds arise from striking, binding, falling, / or injury from fangs, teeth, and claws, as well as from contact with poison, fire, or weapons.

They are declared to differ from innate wounds / in their medicines—such as mantras, antidotes, and cool unguents—in their causes, and in parts of their symptoms.

For exogenous wounds that do not subside, having innate causes [mixed in], / one should administer the remedy for innate [wounds], paying heed to the strength of the doṣas.

Vāta, pitta, and kapha, corrupted by their respective causes, / resort to the external channels and produce innate wounds in humans.

A wound arising from wind is stiff, hard to the touch, / has scanty discharge and very severe pain, pricks, throbs, and is dusky.

One should treat a wind wound with filling [applications], drafts of unctuous substances, / unctuous sudation, poultices, thick unguents, and affusions.

One should recognize a wound caused by pitta by thirst, confusion, fever, perspiration, burning, corruption, / tearing, and by putrid odors and discharges.

With cold, sweet, and bitter thick unguents and affusions, / drafts of ghee, and purgation, one should pacify a paittika wound.

A kapha wound is very slimy, heavy, unctuous, numb, with mild pain, / pale in color, with little moistening, and slow to heal.

With astringent, pungent, dry, and hot thick unguents and affusions, / and likewise with fasting and digestive [therapies], one should pacify a kapha wound.

By divisions of diversity, twenty kinds of wounds are stated for those two; / their examination is threefold; twelve are remembered as severely vitiated;

there are eight sites, likewise [eight] odors, and fourteen discharges; / sixteen complications, and twenty-four doṣa-[types];

and likewise thirty-six proven therapeutic procedures are recounted. / Hear from me all of these being divided as they are proclaimed:

Curable, incurable; likewise corrupted, uncorrupted; located in a vital spot, and not; / closed, severe, discharging, poisoned, irregularly situated;

having a shelf-like pocket, and elevated; and one should know [the remaining ten] wounds by their opposites. / Thus, by divisions of diversity, twenty wounds are stated.

Examination is taught to be threefold: by inspection, interrogation, and touch: / from inspection of age, complexion, body, and sense faculties;

the cause, pain, adaptability, digestive power, and strength are to be examined by the wise from speech; / and through touch, softness and coldness are to be examined, along with their opposites.

White, with sunken margins, with very thick margins, very yellowish-tawny, / blue, dusky, with extensive eruptions, red, black, extremely putrid,

requiring healing, and jar-mouthed (kumbhīmukha)—these are the twelve corrupted wounds. / Twenty-four doṣas are indeed designated according to an alternate formulation.

Skin, vessels, flesh, fat, bone, tendon, vital spots, and internal viscera: / these eight wound sites are designated in the compendium.

Ghee, oil, muscle fat, pus, blood, dusky, sour, and putrid: / eight odors of wounds are proclaimed by those who know wound odors.

Lymph, water, pus, blood, turmeric-colored, reddish, yellowish-tawny, / astringent-colored, blue, green, unctuous, dry, white, and black—

thus fourteen wound discharges are designated by their appearances. / Erysipelas, hemiplegia, vessel stiffness, convulsion,

confusion, madness, wound pain, fever, thirst, lockjaw, / cough, vomiting, diarrhea, hiccup, dyspnea, and trembling—

sixteen complications of wounds are declared by experts on wounds. / From sloughing of tendons, sloughing of vessels, depth, being eaten by worms,

fracture of bone, the presence of a foreign body, poisonousness, spreading, / splitting by nails or wood, excessive friction against skin and hair,

faulty bandaging, excessive oiling, emaciation from excessive medication, / indigestion, overeating, eating incompatible or unwholesome foods,

grief, anger, daytime sleep, physical exercise, and sexual intercourse, / and from lack of treatment in embodied beings, wounds do not attain pacification.

From the discharge, the odor, and the doṣa, along with complications, / wounds of multiple doṣic flaws become difficult to cure.

Born in the skin and flesh, in an easily accessible region, in a youth, devoid of complications, / in an intelligent person, fresh, and in the right season, a wound is held to be easily curable.

Lacking any of these qualities, a wound is held to be difficult; / but one lacking all is to be known as incurable and beyond treatment.

For wounds, cleansing should be performed from the very beginning according to proximity: / by upper-tract [emetics], lower-tract [purgatives], instruments, and enemas.

For the wounds of those whose bodies are cleansed immediately subside. / Hear now in proper order all the therapeutic procedures henceforth:

Swelling-relieving, sixfold surgical operation, compression, / cooling, joining, sudation, pacification, probing,

cleansing and healing decoctions with their unguents, / two oils of those properties, leaves for covering, two kinds of bandaging,

diet, elevating, cautery of two kinds with depressing, / hardening and softening, fumigation and auspicious anointing,

dusting of wounds, restoring complexion, healing, and hair restoration— / thus thirty-six therapeutic procedures for wounds are designated.

Recognizing swelling as the preliminary symptom of wounds from the outset, / the physician should perform bloodletting to pacify an unborn wound.

One should cleanse those with many doṣas, but make those with few doṣas fast; / or one should overcome those dominated by wind beforehand with astringents and ghees.

A cool unguent made of the barks of nyagrodha, udumbara, aśvattha, plakṣa, and vetasa / with ghee is preeminent in cooling down swelling.

Vijayā, madhuka, vīrā, lotus rhizome, śatāvarī, / blue water lily, and nāgapuṣpa with sandalwood make a thick unguent.

Roasted barley flour, madhuka, and ghee with sugar make a thick unguent; / and non-burning foods are the best medicine in swelling.

If a swelling thus treated does not subside, / opening it after it is ripened with poultices is said to be beneficial.

A ball of roasted barley flour with oil or ghee, or with both, / pleasantly warm, is praised as a poultice to ripen the swelling.

A ball of roasted barley flour with sesame, linseed, sour curd, / yeast, kuṣṭha, and salt is commended for poulticing.

One should pronounce a swelling as undergoing suppuration by pain, burning, redness, and pricking; / and as fully suppurated when it feels like a water bladder and is elevated upon pressing.

Umā, then guggulu, the milk of snuhī, the droppings of chicken and pigeon, / alkali produced from palāśa, hemakṣīrī, and mukūlaka—

this group of drugs is declared for rupturing a ripened swelling / in a delicate patient; but for a difficult case, the surgical knife is declared supreme.

Incision, puncturing, excision, and scraping, / scarification, and suturing: that is the sixfold surgical procedure.

Sinus wounds, suppurated swellings, and likewise an abdomen ruptured by injury or perforation, / and those swellings containing an internal foreign body: those, and whatever are of that kind, are to be incised.

Abdomens with ascites, fully suppurated gulmas and those arising from blood, / blood diseases, and erysipelas-pustules and the like are to be punctured.

Wounds that are raised, thick-bordered, elevated, and hard, / and excess growths such as hemorrhoids, one should manage by excision.

The wise physician should scrape kilāsa together with kuṣṭha, which are scrapeable; / [and for] vātāsṛg-nodules, pustules along with urticarial rashes, red circular patches,

forms of kuṣṭha, an injured limb, and swellings, the physician should perform scarification; / but that which is incised deeply in the abdomen, belly, and so on, is to be sutured.

Thus the sixfold surgical procedure has been indicated by the wise. / Those wounds which have narrow orifices and internal cavities, one should squeeze.

Peas, lentils, and wheat, together with hareṇu, / made into a paste without unctuous substances, are praised for squeezing out wounds.

Bark of śālmalī, root of balā, and likewise shoots of nyagrodha, / or what is indicated as the nyagrodhādi group, or else the balādi group—

one should know that as a soothing unguent, and as an affusion with them, / or with hundred-times-washed ghee, milk, or licorice water,

one should soothe thoroughly cold wounds dominated by raktapitta. / Having smeared drooping wound-tissues with honey and ghee,

the physician should join them evenly and secure them with bandages. / Knowing them to be evenly and properly situated, with phalinī, lodhra, and kaṭphala,

along with samaṅgā and dhātakī, powdered, he should dust [the wound]; / or with the powder of the five barks together with the powder of oyster shell,

or with the powders of dhātakī and lodhra; in that way those wounds heal. / A fractured bone or a dislocated joint the physician should set evenly again,

having aligned it evenly with the other, symmetrical limb, / stabilized by firm splint-bandages and splints.

He should bind it immovably and comfortably with bandages having copious ghee; / and he should manage him with foods that do not cause burning and are made from flour.

For debility is not beneficial to him, as it causes separation of the joints. / For complications such as visarpa in dislocated and injured limbs,

the physician who knows the proper time should treat them at the appropriate time based on their respective treatments. / Wounds that are dry, intensely painful, stiff, and dominated by vāta / should be fomented by the method of saṅkara-fomentation with kṛśarā and milk-pudding,

and with prepared vaiśavāra made from domestic, burrowing, aquatic, and marsh animals, / and with hot poultices; in that way the wounded person becomes comfortable.

For those wounds dominated by vāta that have burning and pain, / linseed and sesame seeds, fried and cooled down in milk,

having ground them with that very milk, the physician should make an unguent. / Balā, guḍūcī, madhuka, pṛśniparṇī, śatāvarī,

jīvantī, sugar, milk, oil, fish-fat, and ghee, / prepared along with beeswax, is snehaśarkarā, which destroys colic pain.

With water boiled with the two pañcamūlas, or with milk, / or with lukewarm ghee along with oil, one should sprinkle affusions.

Barley meal together with licorice, sesame, and ghee, / one should give as a lukewarm unguent to pacify burning and pain.

And a poultice consisting of green gram milk-pudding with sesame should be made. / This procedure is beneficial in wounds for pacifying pain and burning.

Those wounds which have a small orifice, copious discharge, and internal cavities, / and do not reside in vital points, probing is declared beneficial for them.

One should know probing instruments to be of two kinds: soft and hard— / by soft plant stems, or by a metal rod.

In a deep, muscular region, the wound to be incised should be known as probeable with a metal rod; / the physician [should know it as probeable] with plant stems in the opposite case.

Recognizing wounds that are foul-smelling, discolored, discharging profusely, and severely painful / as unpurified, one should treat them with purifying remedies.

Triphalā, khadira, dārvī, the nyagrodhādi group, balā, kuśa, / and leaves of nimba and kola: their decoctions are considered purifying.

Sesame paste with salt, the two haridrās, trivṛt, ghee, / licorice, and leaves of nimba: [this] cool unguent is a purifier of wounds.

Neither excessively red, nor excessively pale, nor excessively dark, nor exceedingly painful, / neither elevated nor indented: a wound that is cleansed is ready for healing.

Nyagrodha, udumbara, aśvattha, kadamba, plakṣa, and vetasa, / karavīra, arka, and kuṭaja: their decoctions are wound-healing.

Candana, filaments of lotus, bark of dārvī, blue lotus, / the two medās, mūrvā, samaṅgā, and licorice are wound-healing.

Prapauṇḍarīka, jīvantī, gojihvā, dhātakī, balā— / one should apply a healing cool unguent containing sesame together with ghee on the wound.

Kampillaka, viḍaṅga, vatsaka, triphalā, balā, / paṭola, picumarda, lodhra, musta, priyaṅgu,

khadira, dhātakī, sarja, cardamom, aguru, and candana: / oil to be prepared having ground these is supreme for healing wounds.

Prapauṇḍarīka, licorice, the two kākolīs, and the two candanas— / oil prepared with equal parts of these is supreme for healing wounds.

Or oil prepared with fresh juice of dūrvā, or with kampillaka, / and with the paste of the bark of dārvī, is paramount for healing wounds.

By that very method for oil, the physician should prepare ghee, / having observed a wound requiring healing to be dominated by raktapitta.

The wise physician should prescribe the leaves of kadamba, arjuna, nimba, / pāṭalī, pippala, and arka for covering wounds.

A bandage made of tree bark, or skin, or linen is recorded as beneficial for wounds; / and bandaging is praised as of two kinds: left and right.

Salty, sour, pungent, hot, burning, and heavy / food and drink the wounded person should avoid, as well as sexual intercourse.

Food and drink that is not excessively cold, heavy, or unctuous, non-burning, and appropriate to the wound / is beneficial for the wound; and not sleeping during the day is beneficial.

Those drugs which increase breast milk, promote vitality, and are nourishing, / one should prescribe for elevating depressed wounds.

Nodes of bhūrja, stone, kāsīsa, downward-evacuating drugs, guggulu, / and likewise droppings of sparrow and pigeon, depress elevated wounds.

When bleeding is excessively profuse, in excised growths that should be cut, / in nodules caused by kapha, in swellings of the cheek, in stiffness of vāta and pain of vāta,

in cases of deep pus and lymph, and in deep-seated, firm, / and severed limb regions, the action of fire is highly commended.

With beeswax, with oil, with bone-marrow, honey, muscle-fat, and ghee, / or with heated various metals, one who knows the distinctions of cauterization should burn.

In dry, delicate persons, deep wounds dominated by vāta / he should burn with unctuous substances and beeswax; otherwise, with metals and honey.

In the young, the weak, the aged, the pregnant woman, those afflicted with internal hemorrhage, / those beset with thirst and fever, weak persons, those suffering from poison,

the application of fire must not be prescribed; nor in wounds of ligaments and vital spots, / in wounds containing poisonous foreign bodies, and in wounds of the eyes and kuṣṭha.

Considering the strength of the disease and doshas, expert in dosage, time, and [digestive] fire, / he may also apply alkali in the functions belonging to surgery and fire.

Wounds attain firmness when fumigated with fragrant substances and heartwoods; / indeed, wounds attain looseness with fumigations of ghee, bone-marrow, and muscle-fat.

Pains, discharges, odors, and worms residing in the wound, / as well as laxity and softness, subside by fumigation.

Lodhra, leaf-buds of nyagrodha, khadira, triphalā, and ghee / make a cool unguent that effects looseness and tenderness in wounds.

Wounds that are painful, hard, stiff, and without discharge— / one should repeatedly apply a cool unguent of barley powder mixed with ghee to them.

Or, with milk puddings of mudga, ṣaṣṭika, and śāli grains in due order, / or with vitalizing drugs along with ghee, he should constantly nourish them.

With powders of the bark of kakubha, udumbara, aśvattha, lodhra, jambu, and kaṭphala, / dusted over them, wounds quickly take on skin.

Realgar, cardamom, mañjiṣṭhā, lac, and the two turmerics: / [this] cool unguent with ghee and honey is supreme for purifying the skin.

Iron dust with kāsīsa and flowers of triphalā: / this paste immediately produces blackness in the newly formed skin.

With kālīyaka, nata, amrāsthi, gold, kāntā, and rasottama, / an application along with cow-dung juice is supreme for restoring the natural color.

Dhyāmaka, root of aśvattha and nicula, lac along with red ochre, / gold, amṛtāsaṅga, and kāsīsa: this produces normal skin color.

With ash of the skin, hair, hoof, horn, and bone of four-legged animals / mixed with oil and dusted on, the ground becomes hairy again.

And whatever sixteen complications of wounds have been proclaimed, / their treatment has been stated according to its own nature in its respective treatment [chapter].

Here are two verses:

The two wounds, the varieties of wounds, examination, and vitiation, / locations, odors, discharges, complications, and the therapies:

in the section on wounds, the sage expounded this group of nine with the questions, / in detail and in brief, to the wise Agniveśa.

Thus ends the twenty-fifth chapter, titled 'The Treatment of the Two Types of Wounds', in the Cikitsāsthāna of the treatise composed by Agniveśa, redacted by Caraka, and restored by Dṛḍhabala.