Vimlapana: Softening of Wounds, Ulcers – Types, Clinical Significance

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Vimlapana is the first type of treatment mentioned among ‘Sapta Upakrama’ i.e. the 7 types of treatments mentioned by Master Sushruta. These are meant for treatment of wounds and ulcers and also to prevent its complications.

Vimlapana means to soften or cause to wither / languish. This procedure is done to soften the wounds or ulcers. This needs to be implemented first in the treatment of wounds and ulcers. The first 6 treatments amongst the Shashti Upakrama are included under vimlapana. These treatments should be skillfully used to make the wounds or ulcers soft. The set of these 6 treatments comprise vimlapana.
Read – Shashti Upakrama Meaning, Classification, Clinical Significance

Types

Below mentioned are the 6 treatments which help in softening of wounds and ulcers.

1. Apatarpana – fasting

Apatarpana means fasting. It is done to bring the aggravated doshas to a state of balance. This should be done after having considered the quantity of aggravation of doshas and the strength and tolerance of the patient in whom the dosha aggravation has taken place.

Contraindications of apatarpana
Apatarpana should not be done in the below mentioned persons and conditions –
Urdhwa vata – belching with sounds
Trshna – those suffering from thirst / in conditions of thirst
Kshudha – in presence of hunger
Mukhashosha – in those having dryness of the mouth / oral cavity
Shramanvita – those who are fatigued
Garbhini – in pregnant women
Vrddha – in old aged patients
Bala – in children
Durbala – in those debilitated / weak persons
Bhiru – timid and scared persons
Read – How To Do Fasting? A Step By Step Guide For You

2. Alepa – anointment / application of medicinal pastes

Application of medicinal pastes on ulcers and wounds / sores should be done after considering the dosha predominance. It should be done –

in the presence of swelling around the ulcer / wound
in presence of severe pain in the ulcer / wound

The selection of medicines should be in accordance with the predominant dosha / doshas. The groups of medicines used for particular doshas in Mishraka Adhyaya chapter shall be considered for making paste and applying on the wounds and ulcers. The benefit of anointment of medicinal pastes is explained by Master Sushruta with the help of a simili.

‘Just like the fire burning a house is put off by sprinkling of water, the pain of ulcers / wounds is also relieved on application of medicinal pastes’.

Benefits of anointment of medicinal pastes
Prahladana – brings about soothing / provides comfort
Shodhana – causes cleansing
Shopha harana – removes swelling
Utsadana – helps in elevation of the depressed wound / ulcer
Vrana ropana – helps in healing of wounds / ulcers
Read – Charaka Vrana Chikitsa – 25th Chapter – Wounds, Ulcers

3. Parisheka – showering of medicinal fluids over the ulcers / sores / wounds

This is done to treat the swelling and inflammation around ulcers and wounds. The liquids are prepared with herbs capable of mitigating the predominant dosha causing the swelling and also to treat the swelling. Since it is done on the basis of predominant dosha, the medicinal liquids are different for swellings caused by different doshas. Below mentioned are the best medicinal fluids used in the treatment of ulcers and wounds according to the dosha predominance.
Read – Parisheka Sweda – Sudation By Shower – Sprinkling: Method, Health Benefits

Sanskrit Verses

Sl noType of shotha (swelling, inflammation)Medicines used
1Vataja – caused by vitiated vataGhee
Oil
Kanji (fermented medicinal liquids)
Mamsa rasa – meat soup
Ushna Kwatha – hot / warm decoctions prepared with vata alleviating herbs
2Pittaja – caused by vitiated pitta
Raktaja – caused by vitiated blood
Abhighataja – traumatic
Visha nimitta – caused by poisons
Milk
Ghee
Honey
Sharkarodaka – sugar water
Sugarcane juice
Madhuradi siddha shita kwatha – decoction prepared with sweet herbs (Kakolyadi gana group of herbs), and decoction prepared with latex yielding herbs (Kshiri vrksha kashaya) made cold
3Kaphaja – caused by vitiated kaphaOil
Urine
Ksharodaka – alkali water
Sura, shukta – fermented liquids
Kaphaghna Kwatha – Warm decoction prepared with kapha alleviating herbs

4. Abhyanga – massage with herbal oils

Massage of the ulcers and wounds too should be done after considering the predominant dosha involved. When done in this way massage not only subsides the swelling but also makes the wounds and ulcers soft.

Conditions for massage (in ulcers, wounds and sores)
It should be done before swedana (sudation) and vimlapana i.e. 5th and 6th procedures of vimlapana (will be discussed after this). It should be done after Visravana (drainage) and other procedures (which will be discussed in the 2nd treatment of sapta upakrama i.e. avasechana
Read – Abhyanga Ayurvedic Massage: How To Do? Benefits, Oil Choices

5. Sweda – sudation

Conditions for doing sudation in swellings, wounds and ulcers –
Rujavatam – those having pain
Darunanam – those which have become dry being afflicted by vitiated vata
Katinanam – those which have become hard
Read – Sweating Treatment – Swedana Types And Methods – Charaka Samhita 14

6. Vimlapana – gentle pressing / cleansing measures

This is done for dissolving the swelling. It should be done in –
Sthira shotha – swellings which are stiff and hard
Manda ruja shotha – swellings associated with mild pain

How to do?
The swelling should be massaged with herbal oils and later fomentation should be given. Following this the physician should mildly press / compress the swelling with the help of a smooth bamboo, palms or fingers.
Read – Oedema – Ayurvedic Understanding, Treatment, Home Remedies

Summary

The above said measures help in softening the wounds / ulcers. They can be mixed and matched as per the condition and used in skilful way. Following this if there is need the next treatment of vimlapana i.e. avasechana shall be administered to flush the doshas and contaminants.

Click to Consult Dr Raghuram Y.S. MD (Ayu)

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