Sushruta Samhita Nidanasthana Chapter 15 Bhagna Nidanam (Fractures and Dislocations)

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 – analysis of Fractures and Dislocations as revealed by the venerable Dhanvantari.

 Nidana- Causes

पतनपीडनप्रहाराक्षेपणव्यालमृगदशनप्रभृतिभिरभिघातविशेषैरनेकविधमस्थ्नां भङ्गमुपदिशन्ति ||३||

Beneath talked about are the causes for various sorts of bhagna (fracture of bones) –

• falling from peak,
• squeezing the physique tremendously,
• assault / hitting,
• very vigorous actions,
• chew 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 totally different sorts of bhagna however all these are (grossly) of two sorts solely viz

1. Sandhimukta – it’s of six sorts and
2. Kandabhagna – it’s of twelve sorts

1. Sandhimukhta (dislocation of bony joints)

तत्र सन्धिमुक्तम्- उत्पिष्टं, विश्लिष्टं, विवर्तितम्, अवक्षिप्तम्, अतिक्षिप्तं, तिर्यक्क्षिप्तमिति षड्विधम् ||५||

The six forms of Sandhimukta are –

1. Utpista,
2. Vislista,
3. Vivartita,
4. Avaksipta,
5. Atiksipta, and
6. Tiryak Ksipta

Samanya Laksana – Common indicators and Signs

तत्र प्रसारणाकुञ्चनविवर्तनाक्षेपणाशक्तिरुग्ररुजत्वं स्पर्शासहत्वं चेति सामान्यं सन्धिमुक्तलक्षणमुक्तम् ||६||

The final signs of Sandhimukta – dislocation of joints are –

Incapacity to carry out the beneath talked about actions –

• extension,
• contraction,
• rotation and
• fast actions

Different signs embrace –

• Extreme ache
• Incapacity to tolerate contact

Visesa Laksana – Particular signs of every type 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 either side of the joint Ache Totally 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 facet 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 facet Ache

2. 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, totally different sorts of Kandabhagna – fracture of the shaft of bones can 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 – normal symptoms-

श्वयथुबाहुल्यं स्पन्दनविवर्तनस्पर्शासहिष्णुत्वमवपीड्यमाने शब्दः स्रस्ताङ्गता विविधवेदनाप्रादुर्भावः सर्वास्ववस्थासु न शर्मलाभ इति समासेन काण्डभग्नलक्षणमुक्तम् ||९||

The final signs of fracture of shaft of bones in short are –

• profound swelling,
• incapacity to bear tapping, rotating and touching;
• producing sound (on the website) when pulled (or squeezed),
• a part of the physique hanging down loosely,
• look of varied 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||

Sadhyasadhyata – prognosis

तेषु चूर्णितच्छिन्नातिपातितमज्जानुगतानि कृच्छ्रसाध्यानि, कृशवृद्धबालानां क्षतक्षीणकुष्ठिश्वासिनां सन्ध्युपगतं चेति ||११||

The beneath talked about sorts of fractures are tough to treatment –

• Curnita
• Chinna
• Atipatita
• Majjanugata

Fractures are additionally incurable in –

• emaciated, previous aged individuals and youngsters,
• these emaciated,
• previous aged folks and youngsters,
• these affected by harm to lungs, pores and skin issues 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

Beneath talked about situations 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 fashioned correctly proper from the start of his life,
• dislocation occurring within the joint which has not fashioned 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 operate correctly due to improper inserting or bandaging or as a result of vigorous motion

Among the many three levels of life, the individual can be robust and secure within the center age. The therapy of fractures and dislocations ought to be undertaken after contemplating this.

तरुणास्थीनि नम्यन्ते भज्यन्ते नलकानि तु ||१६||
कपालानि विभिद्यन्ते स्फुटन्ति रुचकानि च ||१७||

Beneath talked about are the impact of assault on totally different buildings –

• younger bones bend
• hole bones break
• flat bones get punctured
• tooth develop into cracked

इति सुश्रुतसंहितायां निदानस्थाने भग्ननिदानं नाम पञ्चदशोऽध्यायः ||१५||

Thus ends the fifteenth chapter by identify Bhagna nidana in Nidana Sthana of Susruta Samhita.