Sushruta Samhita Chapter 18 Vranalepana Bandhana Vidhi Adhyaya

This article explains Sushruta Samhita Sutrasthana Chapter 18 “Vranalepana Bandhana vidhi”- Poultice and bandaging of wounds.

 Vrannalepana Bandhana Vidhi- Poulticing and Bandaging of wounds
We will now expound the chapter by name “Vranalepana Bandhana vidhi” – poultice and bandaging of wounds as revealed by venerable Dhanvantari.
Read – Acharya Sushruta: Work, Samhita, Legacy, Amazing Facts

Importance of Alepa and Bandha

Alepa – application of paste of drugs etc, on the wound is the first treatment. This is common treatment for all kinds of swellings and also the most important one. We will describe this in different diseases separately.
Next, (after alepa) Bandha – bandaging is the important treatment. This causes cleansing of the wounds; healing wounds and establishes the stability of bones and joints.

Alepa should be done in praltiloma way (in the upward direction). When done in this way only the medicine stays properly (on the wound), enters into the hair follicles and channels of sweat and gets vitalized by the orifices of the veins.
The dried anointments should not be neglected (should be removed quickly) except the one intended for squeezing. Dried anointment / poultice is useless and cause pain also.
Read – Lepa Kalpana: Ayurvedic Dosage Forms For External Application

Alepa Bheda

Kinds of poultices
Alepa is of three kinds’

• Pralepa
• Pradeha and
• Alepa

Difference between paralepa and pradeha is that

• pralepa is applied cold, thin, is either of not drying up or drying type, while
• pradeha is applied either warm or cold, thick or thin and ‘not drying up’ type
• alepa is the middle of these two (intermediate) and it mitigates (balances) aggravated blood and Pitta

Pradeha mitigates the aggravated Vata and Slesma (Kapha), cleanses and heals the wound, relieves swelling and pain also. It is useful in both conditions – swelling with wound (ulcer) and swelling without wound.
That which is used in wounds / injury is known as kalka (paste or wick). It is also known as niruddhalepana.  This will help in arresting the discharges (stopping the exudation), bringing softness, destruction of decayed (suppurated) muscles, and removal of doshas from within the wound (ulcer) and cleansing of the wounds (ulcer).
Read – Charaka Vrana Chikitsa – 25th Chapter – Wounds, Ulcers

Alepa Phala

Benefits of anointing
Alepana i.e., application of herbal paste (poultice) is beneficial in unripe swellings. Apart from this it mitigates the Doshas (associated with swelling) and relieves burning sensation, itching and pain. It is foremost in clearing (soothing, calming) the skin, muscles and blood (removing their blemishes) and is best in relieving burning sensation, pricking pain and itching. Alepana (anointment / poultice) can also be used to cleanse or palliate diseases occurring in the vital spots of the body or genital areas.

In diseases of Pitta origin fats (oil, ghee etc.) should be added to the paste in one sixth proportion. Likewise, in diseases of vata, one fourth proportion of fats and in diseases of kapha, one eighth part of fats is added.
Read – Poultice (Upanaha) Meaning, Types, Clinical Significance, Uses

Alepa Vidhi

Procedure
Its (of the anointment / poultice) thickness should be equal to that of the moist skin (hide) of the buffalo (0.25cm approximately).
Anointment / poultice should not be applied at night, because the heat of the swelling being obstructed by the cold of the night, gives rise to many abnormalities (increase of the existing disease, manifestation of new complications).
In diseases which are curable by Pradeha (warm anointment) and mainly in diseases caused due to increased pitta, blood or raktapitta – bleeding disorders, diseases caused due to injury and effect of poisons it is beneficial to apply the medicinal pastes (anointment) in the morning.
The medicinal paste which has been prepared on the previous day should not be administered on the next day (i.e., the medicinal paste should be prepared fresh every day and should not be carried over).
Similarly, the second layer of anointing should not be administered on the previously existing layer of anointment (on the afflicted part of the body). This means to tell that the anointment which has been applied previously should be removed before administering the fresh layer of anointment. By doing so (one layer of anointment applied over a pre-existing one) the thickness of the anointment increases. This gives rise to increased heat, pain and burning sensation (in the affected site).

The medicinal paste left out after applying the anointment should not be used for anointing (applying poultice) once again because the left-out medicine would have dried out and have lost its potency. Even if this is applied it does not serve any purpose.
Read – Veerya, Potency Of Herbs And Doshas – Inter-relationship

Bandhana Dravya

Bandaging Material
Now, we will describe the materials useful for bandaging, these are, cloth made from Ksauma (flax), Karpasa (cotton), Avika (sheep’s wool) Dukula (very fine cloth piece or raiment made from the inner bark of this plant), Kauseya (silk), Patrorna (garment of woven silk), Cinapatra (cloth made in china / silk cloth), carma (hide), Atarvalkala (inner layer of barks), Alabusakala (pieces of  Alabu ground), lata (creeper), vidala (split bamboo), Rajju (rope), Tulaphala Santanika (pad made from wool of silk cotton fruit) and metals (sheets of silver, copper, iron etc). These are to be used as found appropriate to the disease, time (season) etc. Their mention will be made with reference to the context (diseases, place etc).
Read – Sushruta Samhita Chapter 5 Agropaharaniya Adhyaya

Bandha Vishesha

Patterns of Bandaging
Bandha Visesa – Below mentioned are fourteen kinds of / patterns of bandaging –

1. Kosha
2. Dama
3. Svastika
4. Anuvellita
5. Mutoli (or pratoli)
6. Madala
7. Sthagika
8. Yamaka
9. Khatva
10. China
11. Vibandha
12. Vitana
13. Gophana
14. Panchangi

Their shapes are generally implied in their names itself.
Read – Sushruta Samhita Chapter 7 Yantra Vidhi Adhyaya

Uses of different kinds of bandhas

Sl No	Name of the Bandha (bandage)	Shape of the bandage / meaning	Area of usage
1	Kosha	cocoon – like sac, envelop, scabbard	should be used for the joints of thumb and fingers
2	Dama	wound round like a belt	for the part of the body which has pain or cramps
3	Svastika	cruciform, like plus mark	for the joints, kurcaka (area over metatarsals), between the brows, between the breasts, palms, soles and ears
4	Anuvellita	bent underneath, twisted,	for the extremities
5	Mutoli (pratoli)	broad, winding	for the neck and penis
6	Mandala	round, disc, like, ring like, circular	for parts of the body which are round/cylindrical
7	Sthagika	to conceal / heal, stump like	for the tips of the thumbs, fingers and penis
8	Yamaka	twin, double, with two-fold / parts	for two wounds side by side
9	Khatva	swigs, hammock like	for the lower jaw, temples and cheeks
10	China	thread like T shaped	for the outer canthus of eyes
11	Vibandha	obstructive, biding from both sides	for the back, abdomen and chest
12	Vitana	tent like, canopy like	for the head (scalp)
13	Gophana	like horns of the cow	for the chin, nose, lips, shoulders, and urinary bladder
14	Panchangi	with five parts, five tailed	for part / organs above the shoulders

Or the physician may use any pattern or method of bandage which is well suited and gets well placed (sitting tight and right) on the affected part and apply it accordingly.

Bandha Niyantraa

Tightening the bandage

Yantrana (control, tightening / putting knots to keep the bandage in place) may be done at three places, viz, above, below and sides of the wound.

Bandha vidhi

Procedure of tying bandage
A thick Kavalika (wick or roll of paste of drugs) should be kept on the wound. Then bandage should be tied moving it in the direction of the left hand (bandage held in the left hand and tied with right hand), straight without folding, without any twists and in a proper way and inserting a soft pad (of cotton cloth, gauze). The knot should not be tied on the wound as that gives rise to pain.

Vikesika (wick) and Aushada (medicine or paste of drugs) i.e., paste of drugs applied on a band of cloth or threads which is rolled and made like a wick – should be neither very unctuous nor very dry, or uneven (irregular). This is because too much of unctuousness produces exudations, too much of dryness produces tearing and keeping it irregularly causes friction at the edges of the wound.
Read – Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma

Trividha Bandha

Three kinds of tieing
Depending on the location (site) of the wound, bandaging is of three kinds, viz, Gadha (tight), Sama (even / moderate) and Sithila (loose). Tight bandaging is that which though tied firmly or pressed does not cause any pain. Loose bandaging is that which exhales (allows movements of air from inside) / moves when the person breathes (exhales). Even bandaging (moderate) is that which is neither too tight nor too loose.

Areas of the body where three types of bandaging should be done
Tight bandaging should be done on the buttocks, pit of the abdomen, axillae, groins, thighs and head. Moderate bandaging should be done on the extremities, face, ears, throat, penis, scrotum, back, flank, abdomen and chest. Loose bandage should be done on the eyes and joints (of bones).

In wound of Pitta origin,

• If situated on places indicated for tight bandaging, then moderate kind of bandaging should be done.
• If the wound is situated in places of even (moderate) bandaging then loose bandaging should be done.
• If the wound is situated on places meant for loose bandaging, no bandaging should be done i.e., the wound should be left open.

This procedure is same in diseases caused by vitiation of blood.

For diseases (wounds) of Sleshma (Kapha) origin,

• If the wound is situated on places meant for loose bandaging, then moderate bandaging should be done.
• If the wound is situated in places meant for even or moderate bandaging then tight bandaging should be done.
• If the wound is situated on places meant for tight bandaging, then tighter bandaging should be done.

This procedure is the same for diseases (wounds) caused by aggravated Vata.’
Read – Injury, Wound care Ayurvedic Remedies, Medicines

Bandhana Kala

Frequency of Bandaging
In diseases of Pitta origin, and during autumn and summer, bandaging should be done twice in a day. This is the same for diseases produced by vitiated blood.
In diseases of Slesma (Kapha) and in early winter and spring, bandaging should be done once in three days. This is the same for diseases produced by aggravation of Vata.
In this way the physician should decide by his own intelligence (the suitable time of bandaging).
 If tight bandaging is done on places indicated for moderate and loose bandaging, and then the drug inside the wick of paste (drug and wick) becomes a waste, and there will be swelling and pain.
If the bandage is applied loose on places indicated for tight and moderate binding then the medicine inside the wick will fall off, and there will be damage to the edges of the wound due to friction (due to the movement of the cloth and drug).
If a moderate kind of binding is done on places indicated for tight and loose bandaging there will be no effect (of bandaging).

When the bandage is applied in the upper manner, there will be relief of pain, purification of blood and softness of the wound.
Read – Avasechana Method of Wound Care: Meaning, Types, Clinical Significance

Bandha Abhava

Absence of Bandaging
If bandaging is not done, the wound will be troubled especially by bites of flies, assault of grass, pieces of wood, stone pebbles, sand, cold, wind, sunlight etc. Many kinds of pain and complications develop, the wound becomes vitiated (contaminated/septic) and anointments / poultices etc. get dried (quickly).

Bandha Guna

Benefits of Bandaging
Crushed and lacerated wounds, fractures, dislocation of joints, the fractured or dislocated bones hanging free, and the torn bones, tendons, veins etc. heal quickly by bandaging. The wounded person will be able to sit, walk and stand easily, find comfort in lying and sitting and the wound heals quickly.

Abhandhya

Contraindications for bandaging
Bandaging should not be done on wounds caused by –

• vitiated Pitta and rakta (blood)
• injury and poison
• when accompanied with edema, burning sensation, pus formation (suppuration), red coloration, pain and such troubles
• wounds caused by alkali and fire
• when the muscles of the wound are decomposed and falls off

Other contraindications for bandaging
Bandaging should also not be done in the below mentioned conditions –

• wounds of leprosy
• wounds caused by fire burns
• ulcers / wounds caused by the spread of poison caused by rat bite
• wounds / ulcers caused or associated with poison (having poison in them)
• wounds caused by suppuration of muscles (gangrene) and
• (severe) ulceration / suppuration of the rectum

The intelligent physician should decide by his own wisdom, whether to apply bandage or not; the wound specialist should decide bandaging after considering the nature of habitat, dosas and seasons.
Read – Relationship Of Doshas With Seasons

Sangraha Shloka

Summarizing verses
Yantrana – bandage knot (bandaging by tying knot) is of three kinds viz

• urdhwa – above
• tiryak – at the sides and
• adhah – below (the wound)

Now I will describe the procedure of bandaging.

Firstly, a lint / wick is placed on the wound on which a layer of medicinal paste is applied (anointed). On this, a thick pad of cloth (gauze) is placed over the anointment and a soft bandage is tied on it.
The wick and the paste of drugs inside the wick should not be very unctuous or dry; because very unctuous paste gives rise to exudation and very dry paste causes abrasion (of the edges) of the wound.
The wick and the drugs with suitable unctuousness will help in healing of the wounds.
If the wick is not placed properly, it causes friction of the edges of the wound, makes the ulcer irregular in shape, causes obstruction to flow of discharges or increases the flow of discharges. Therefore, the physician should apply the wick of paste in a proper manner after having known (observing and examining) the nature of wounds.
In wounds produced by Pitta or Rakta the wick should be applied once only and in wounds of Kapha and vata origin, it may be applied many times. The wound should be pressed / squeezed with the palm of the hand (of the physician) from above downwards to discharge the exudates from the wound. All kinds of bandages should be tied such that its ends or knot are not seen from outside i.e., they should be tied appropriately.

The same procedure is followed even for joining the damaged lips. Bandaging in these conditions should be done with discretion and good knowledge. With this the wound will not get contaminated (or will not cause any trouble) while getting up, lying down, sleeping, walking or riding on different kinds of animals.
Wounds which are located on the muscles, skin, joints, bone, alimentary tract (viscera), veins, ligaments etc. which are superficial or deep and all those (wounds) which are uneven (irregular) will not get cured without bandaging (suitably).