Sushruta Samhita Chapter 28 Viparitaaviparita Vrana Vijnaniya Adhyaya

This article explains Sushruta Samhita Sutrasthana Chapter 28 “Viparitaaviparita Vrana Vijnaniya Adhyaya” – Knowledge of Prognosis of wounds.

Viparitaaviparita Vrana Vijnana

Knowledge of Prognosis of wounds

अथातो विपरीताविपरीतव्रणविज्ञानीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound the chapter by name Viparitaparita Vrana Vijnana Knowledge of normal and fatal signs of wounds (prognosis); as revealed by the venerable dhanvantari.
Read – Acharya Sushruta: Work, Samhita, Legacy, Amazing Facts

Rista Nirukti

Definition of Rista (fatal signs)

फलाग्निजलवृष्टीनां पुष्पधूमाम्बुदा यथा |
ख्यापयन्ति भविष्यत्त्वं तथा रिष्टानि पञ्चताम् ||३||

 Just as the flower, smoke and cloud indicate the fruit, fire and rain (respectively), occurring later on, similarly Rista indicates death coming in future.
 Note:- two terms ”Rista” and “ Arista” are  used as Synonyms- both mean signs of death only. Dalhana says that Rista (fatal signs) is of two kinds viz niyata – definite (of the future event) and aniyata – indefinite (of the future event). In the above examples, both kinds are included. Flowers and clouds are indefinite while smoke is definite. Similarly, Arista produced by the messenger, omens etc, are Aniyata (indefinite signs of death) whereas those produced by the doshas are Niyata (definite).
Read – Arishta Lakshanas – Ominous Signs And Symptoms Indicating Bad Prognosis

Arista Jnana Dussaka

Fatal signs different to recognize

तानि सौक्ष्म्यात् प्रमादाद्वा तथैवाशु व्यतिक्रमात् |
गृह्यन्ते नोद्गतान्यज्ञैर्मुमूर्षोर्न त्वसम्भवात् ||४||
ध्रुवं तु मरणं रिष्टे… |५|
In spite of being manifest in the dying person the rista (fatal signs) are not recognized by an unintelligent person (observer) due to the below mentioned reasons –

• Saukshmyat – due to minuteness (of these signs),
• Pramadat – misunderstanding (ignorance) of the observer,
• Ashu vyatikramat – due to their (signs) quick disappearance

It is not like death does not occur without manifestation of ristas i.e., fatal signs (people can die without manifestation of these signs also) but if these fatal signs occur the person will definitely die.

Mrityu Nivaran

Death Preventable

… ब्राह्मणैस्तत् किलामलैः |
रसायनतपोजप्यतत्परैर्वा निवार्यते ||५||
It (death) could be averted by –

• Brahmanas who are pure (free from desire, hatred and such other emotions),
• by those who are devoted to  Rasayanas (use of rejuvenations, elixirs, potent herbs etc),
• by ascetics devoted to tapas (penance) and japa (chanting of sacred hymns)

Rista signs and time factor

नक्षत्रपीडा बहुधा यथा कालं विपच्यते |
तथैवारिष्टपाकं च ब्रुवते बहवो जनाः ||६||
Just as many people say that troubles caused by the stars (planets) yield the result (effects) at stipulated period of time, similarly the result of arista (death) also occurs at the stipulated time; so, say many people.
Read – Bad Prognosis Based On Smell, Touch, Taste, Colour And Voice

Arista janam Avashyakam

Knowledge of fatal signs necessary

असिद्धिमाप्नुयाल्लोके प्रतिकुर्वन् गतायुषः |
अतोऽरिष्टानि यत्नेन लक्षयेत् कुशलो भिषक् ||७||
By treating the person who is going to die, the physician derives no success in this world. Hence the intelligent physician should observe the arista (signs of death) with all efforts.

Rishta Lakshanas in Vranita

Signs of death in the wounded persons

गन्धवर्णरसादीनां विशेषाणां स्वभावतः|
वैकृतं यत् तदाचष्टे व्रणिनः पक्वलक्षणम् ||८||
Any abnormal changes in smell, color, taste etc. (touch and sound) especially occurring naturally (on their own accord / without any other reason) are said to be signs of ripening (death) of the wounded persons.
Read – Injury, Wound care Ayurvedic Remedies, Medicines

Prakrita vikrita Gandha

Normal and abnormal smells

कटुस्तीक्ष्णश्च विस्रश्च गन्धस्तु पवनादिभिः |
लोहगन्धिस्तु रक्तेन व्यामिश्रः सान्निपातिकः ||९||
लाजातसीतैलसमाः किञ्चिद्विस्राश्च गन्धतः |
ज्ञेयाः प्रकृतिगन्धाः स्युः रतोऽन्यद्गन्धवैकृतम् ||१०||
Pungent, penetrating, and unpleasant are the smells of Vata etc (pitta and Kapha) respectively.
Smell of iron is due to blood.
Mixture of all these smells is due to sannipata.
Smells similar to that of laja, atasi and taila (oil) and slightly unpleasant in smell should be understood as normal odours. All other odours should be considered as abnormal.

मद्यागुर्वाज्यसुमनापद्मचन्दनचम्पकैः |
सगन्धा दिव्यगन्धाश्च मुमूर्षूणां व्रणाः स्मृताः ||११||
श्ववाजिमूषिकध्वाङ्क्षपूतिवल्लूरमत्कुणैः |
सगन्धाः पङ्कगन्धाश्च भूमिगन्धाश्च गर्हिताः ||१२||

Smell similar to wine, aguru, Ajya (ghee) sumana, Padma, Candana and campaka and divine smells manifest in the wounds of the dying person.
Wounds having the smell similar to the dog, horse, mouse, crow, dry meat, decomposed meat, bed bug, slush and earth (mud) are despised (undesired) smell.

Varna Arista

Colour indicating death

कुङ्कुमध्यामकङ्कुष्ठसवर्णाः पित्तकोपतः |
न दह्यन्ते न चूष्यन्ते भिषक् तान् परिवर्जयेत् ||१३||
कण्डूमन्तः स्थिराः श्वेताः स्निग्धाः कफनिमित्ततः |
दूयन्ते वाऽपि दह्यन्ते भिषक् तान् परिवर्जयेत् ||१४||
कृष्णास्तु ये तनुस्रावा वातजा मर्मतापिनः |
स्वल्पामपि न कुर्वन्ति रुजं तान् परिवर्जयेत् ||१५||
Colours similar to Kumkuma, Dhyama and Karkustha develop (in the wound) when there is aggravation of Pitta but there is no burning and sucking pain. The physician should reject such a patient.
When there is aggravation of kapha (in the wound), itching, stability (immovable), whiteness, unctuousness and eruptions (swelling) develop but will have pain and sucking pain then the physician should reject such a patient.
When wounds which are black in colour, having thin exudates and troubling the vital spots occur due to aggravation of vata (in the wound) but not having even slight pain, the patient should be rejected.
Read – Symptoms Of Vata Dosha Increase And Imbalance – Vata Vruddhi Lakshana

 Shabda Sparsha arishtas

Sounds and touch indicating death

क्ष्वेडन्ति घुर्घुरायन्ते ज्वलन्तीव च ये व्रणाः |
त्वङ्मांसस्थाश्च पवनं सशब्दं विसृजन्ति ये ||१६||
ये च मर्मस्वसम्भूता भवन्त्यत्यर्थवेदनाः
दह्यन्ते चान्तरत्यर्थं बहिः शीताश्च ये व्रणाः ||१७||
दह्यन्ते बहिरत्यर्थं भवन्त्यन्तश्च शीतलाः |१८|
Wounds with below mentioned features should be rejected –

• producing sounds such as cracking, purring or burning,
• wounds located on the skin and muscles emitting air (gas) accompanied with sound, and
• the wounds, which though not located on the vital spots still produce very severe pain or
• those wounds which have burning sensation inside and cold outside or are cold inside and have burning sensation outside (are fatal signs)

Akriti Arista

Shapes indicating death

शक्तिध्वजरथाः कुन्तवाजिवारणगोवृषाः ||१८||
येषु चाप्यवभासेरन् प्रासादाकृतयस्तथा |
चूर्णावकीर्णा इव ये भान्तिचानवचूर्णिताः ||१९||
प्राणमांसक्षयश्वासकासारोचकपीडिताः |
प्रवृद्धपूयरुधिरा व्रणा येषां च मर्मसु ||२०||
Wounds which appear like Sakti (spear, a kind of weapon), flag, chariot, Kunta (lance), horse, elephant, cow, bull or a palace, or appear as sprinkled with dust even though not done so (are fatal signs).
Wounds give rise to loss of strength and muscles, producing dyspnoea, cough, loss of taste, great increase of (aggravation of) pus and blood and those situated on vital spots (are fatal signs).

क्रियाभिः सम्यगारब्धा न सिद्ध्यन्ति च ये व्रणाः |
वर्जयेत्तानपि प्राज्ञः संरक्षन्नात्मनो यशः ||२१||
Wounds, which do not heal though the treatments have been started properly, should also be rejected by the wise physician, protecting his own reputation.

इति श्रीसुश्रुतसंहितायां सूत्रस्थाने विपरीताविरीतप्रणविज्ञानीयो नामाष्टाविंश्तितमोऽध्यायः ॥२८॥
 Thus ends the Twenty-eight chapters by name Viparitaviparita Vrana Vijnana, in Sutra sthana of Susrutha Samhita.