Introduction

Ayurveda is a science of life and is believed to exist as long as the origin of life on this earth as is mentioned in Charaka Samhita. Ever since the life originated, human being has been susceptible to injury, which made him to think about healing from very early stage of development. In Ayurveda, particularly Acharya Sushruta has mentioned various types of vrana¹ and their management², which is of prime importance 3 in any surgical practice. The Vrana Is one of the most important and fundamental aspects of Shalya Tantra, as after every trauma or any surgical procedures surgeon should think about the healing of wound, so every surgeon needs exclusive knowledge of wounds and its healing. Here detailed description of Vrana is available in various Ayurvedic texts. Acharya Sushruta an ancient Indian Surgeon has described Vrana as one of the main subjects in his treatise Sushruta Samhita. He has described Vrana from its different aspects, right from definition, causes, etio-pathogenesis, till the management of its scar tissue formation.

HISTORICAL REVIEW- Historical review helps to explore hidden facts and ideas of concerned subject. Vedas and epics provide us knowledge of surgery and wound healing treatments. Battlefields in those days yielded enough opportunities to counter many types of injury which led to the rapid expansion of the knowledge. The earliest record of treatment of wound is found in Vedas the oldest book of world written about 3000BC.

A. VEDIC PERIOD

Rugveda-There was description of about injured leg of queen Bisphala being treated by amputation. ³

Samveda-In Samveda also Vrana Ropana of a prince who was injured during war has been depicted. ?

Atharvaveda-Here in Atharvaveda Following terms appears which may be included under Vrana.

Kshetriya – It is a disease like Kustha. ?

B.SAMHITA PERIOD

Charaka Samhita- Acharya Charaka has mentioned us concepts of Vrana and its management. In charaka samhita in Dwivraniya Adhyaya of Chikitsastana. ?

Sushruta Samhita- Detail description of Vrana and its management discussed by Sushruta. During this time the knowledge of wound was its peak level. The subject of wound healing forms the central theme of Sushruta Samhita. As emphasized while giving the definition of Shalya Tantra he says Tantras in which knowledge of various Shalya, discharges from Vrana, and dushta Vrana along with three stages of Vrana shopha is dealt with Shalya Tantra.

C. SANGRAHA PERIOD

Astanga Sangraha (5th Century A.D)- In Astangsangraha there are many preparations for treatment of wound and described 8 types of traumatic wound and also emphasized on Ghrit and Taila base ointment for local use.

Vrida Madhava (9th Century A.D)- Advice use of Jatyadi Ghrit in the management of Aagantuja Vrana.

Sarangadhara Samhita- Application of Nimba dala kalka in Vrana has been brought out. In purva khand Taila is mentioned for Vrana under Taila Kalpana.

Nirukti of Vrana

“Vrana Gaatra Vichurnane, Vrana yati iti Vrana ha?

Gaatra, Part of body or tissue and Vichurnan Means discontinuity, damage, break, or destruction. Damage or destruction of the part or tissue of body part is termed as Vrana.

Definition: - (Paribhasha of Vrana)

Vrunoti Yasmaat Roodhe api Vrana vastu na Nashyati | Aadeha Dhaaranaat Tasmaat Vrana ityuccyate budhaihi ||

Sushruta defines Vrana is a condition where the tissues in the body are selectively destroyed and after repair leaves a scar for whole life.

CLASSIFICATION OF VRANA

Vrana are broadly classified into two according to their origin and etiology.

1.Nijavrana-Nijavrana are formed by vitiated doshas

2.Aganlacerationsa-Aganthuja vrana are caused by external factors such as incision, punctures, lacerations, poisoned cuts, bruises etc. It can also be caused by bites of men, animals, birds, reptiles etc.

Vrana are again classified into two based on the Dosha dushti, they are Dushta vrana and Shudha vrana. Vrana having more dosha dushti is called as Dushta vrana and those having less or no dosha dushti are called as shudha vrana. Another type of vrana is the Sadhyo Vrana which is manifested by external causes. They include accidental wounds or traumatic wounds and surgical wounds. So these sadyovrana can also be called as aganthujavrana or sudhavrana. They can be correlated with “wounds” described in Western science.

PANCH LAKSHANA NIDANA

NIDANA-Two types of vrana nidana have been mentioned in all classical texts of Ayurveda.

2.Nidana of Aganthujavrana (Sadyovrana)¹?

The Aagantuja Varnas are caused by trauma from pashu, purusha, vyaala, pakshi, peedana, prapatana, teekshanaoushada, Agni, kshara, visha, kapaala, shringa.

Samprapti- The Samprapthi is also divided into two depending upon the type of vrana.

Nijavrana Samprapti- In Nijavrana, the tridoshas by their respective etiological factors get deranged and getting lodged in the Vranaadhishtana and produces vrana.

Aganthuja vrana Samprapthi- Aganthujavrana are caused due to direct external injuries to the body. The local structures i.e. twak mamasa, sira, snayu, asthi, marma etc. are disrupted according to etiological factors producing sadyovrana or aganthujavrana. Here structural derangement occurs first followed by vitiation of doshas. If at this stage it is not treated it progresses into Dushtavrana.

Purva Rupa- The prodromal symptoms of vrana are shotha, i.e. a localized swelling which is due to Dosha dushti and is according to respective doshas. It is seen only in nijavrana. Madhava Nidana has described the prodromal symptom of vrana as “Ekadeshotthitha Shotha”.

Rupa

Two types of lakshana have been seen in vrana, viz.

1.Saamanya lakshana – Pain is present in all types of vrana in accordance with the dosha.

2.Vishesha lakshana – It is the lakshana of dosha dushti which is according to the doshas involved in the manifestation of vrana.

c. Lakshanas of Ruhyaman Vrana-Ruhyaman Vrana is characterized by the absence of slough on the floor and it is Dry in nature, this is the stage of repair.

Features-

•Kapota Varna i.e. grey colour like pigeon

•Anta-kledavarjita margins of the Vrana are dry. Absence of Muco-purulent discharge or ‘kleda.’

•Anta-sthira Vrana margins are firm with granulation tissue.

•Chipitikayukta – surrounded by shreds of epithelium

d. Lakshanas of Rudha Vrana

The clinical features of Rudha Vrana are the absence of any pathology at the site of lesion like absence of nodules, swelling, pain and different colours and surface is of the same level as the surrounding normal part of the body. This is the last stage of wound healing. It shows following features.

• Rudhavartmanam: - complete healing by approximation of wound mmargins.

• Agranthi: - there is no hyper-granulation or glandular mass or induration.

• Ashunam: absence of swelling.

• Arujam: absence of pain.

• Twak-savarna: - having colour like the skin.

• Samatalam: at the same level of the skin.

EXAMINATION OF VRANA

Pancha Lakshanas for Examination ¹?

Acharya Sushruta described local examination based on fallowing parameters like

1.Varna 2.Gandha 3.Srava 4.Vedana 5.Akriti

Discussion

In ayurvedic science the acharya sushruta mentioned many different aspects of vrana regarding characteristics, types, pathogenesis its treatment modalities and prognosis in his treaties sushruta samhita. He mentioned the characters of vrana (wound) in Vrana prashniya Adhyaya. But before that he categorically emphasized the care of wounded patients and diets which could be beneficial to the patient. He was totally aware of the aetiopathogenesis of vrana and classified vrana into mainly two categories 1. Nija vrana and 2. Agantuja vrana. Acharya sushruta mentioned five kinds of examination for vrana in sushruta samhita as follows: - Vrana akruti (Size and shape of wound), Vrana srava (Discharge of wound), Vrana vedana (Pain), Vrana Varna (Colour) and Vrana gandha (Smell). Using all five senses and interrogation. So, with the help of above examination we can make diagnosis of stages of wound according to these signs. The treatment has been planned by Sushruta according to the classification of Vrana. He has described many different approaches for Dushta and shuddha vrana. Sushruta advocated Shastra Karma in management of vrana if needed and local application of ropana drugs in the traumatic wounds, to facilitate union.

Conclusion

From the above review, we observe that vranas have been described by different Acharyas in Ayurveda and their treatment vary according to their types and different Acharyas. Though no specific Samprapti regarding Vrana exists in any Ayurvedic text, an attempt is made here to checkout a specific etiopathogenesis of the disease called Vrana. The Classical ayurvedic treaties deals with the vrana and management. The vrana is either wound or ulcer or surgical wound. Common complication of wound like infection, non-healing or delayed healing and the abnormal scar after healing are well dealt in ayurveda by means of shasti upakarmas.