Bhagna Chikitsa – Fractures in Ayurveda

 

Introduction:

Bhagna is fracture or dislocation of joint or bone. Charaka Samhitaa has described Asthi Bhagna in the Vran`a chapter. It is said that a wound with a Bhagna heals with difficulty. General treatment of Bhagna includes Asthi Sandhaana.

 

Saamaanya Chikitsaa:

Asthi Bhagna is considered as Vran`a according to Charaka.

In the condition, Asthi Bhagna (fracture) or Asthi Chyuta (dislocation), the bones should be placed in the original anatomical position properly (Reduction of the fracture). With the cotton pads (Kavalikaa) and the Kus`hikaa, using abundant Ghee (Ghrita); the bones should be placed properly and stabilized so that the reduced bone ends do not undergo displacement and result in non or mal union.

Lepana: (ointment or plaster) is carried on the fractured site. Lepana Should be prepared using Manjisht`haa, Madhuka, Raktachandana with S`hatadhauta Ghrita.

Bandhana: In the cold season, the bandage or plaster should be changed after every 7 days. In temperate climate (Saadhaaran`a), the bandage or plaster should be changed after every 5 days. In the hot season, the bandage or plaster should be changed after every 3 days. Or in general, the plaster can be changed by looking at the condition of Dosha at the fractured site. Bandha should not be loose or too tight. In either case, the bones can not be stabilized properly. There may be S`hopha (oedema), Ruk (pain), Paaka (suppuration) at the site of fracture. Therefore, proper bandaging is imperative in healing of fracture.

Parisechana: It is pouring the decoctions over the wound or Bhagna site. The cold Nyagrodhaadi Kashaaya orPanchamoolee Ksheera should be used for this purpose. Pleasantly warm (Sukhoshn`aChakrataila should be used for ParisechanaVaagbhat`a suggests use of pleasantly hot Chakrataila with Vaata pacifying drugs.

Pradeha: It is a thick or viscid ointment which is applied on the wound. It should be cold or may be hot as per the condition of the Dosha_s.

Seka and Lepana: These should be performed repeatedly and continuously. The drug used for this should be cold.

Sandhi / Bhagna Sthaapana (fixation of the joint or fracture):

  • Avanaamita (depressed) Bhagna should be elevated.
  • Unnata (elevated) Bhagna should be pressed down (Avanamana).
  • Atikshipta (thrown beyond / dislocation)
  • Bhagna should be set properly after maneuvering in the opposite direction of displacement (Aanchana).
  • Adhogata (lowered down) Bhagna should be stretched upward.

If there is any complication like Visarpa then as per the complication it should be treated.

 

 

Vis`hesha Chikitsaa:

 

Utpisht`a and Vis`hlisht`a Bhagna:

o       Any movement should be avoided in this type of Bhagna.

o       S`heeta Pariseka and Pradeha should be carried out.

o       Ghritadigdha Pat`t`a (bandage soaked in Ghee) should be used to plaster which enhances the union of the bones.

o       Kus`haa should be placed over this bandage and tied properly.

 

Savran`a Bhagna (fracture with wound /compound fracture):

Pratisaaran`a should be carried out using Nyagrodhaadi Kalka with Sarpi and Madhu; else should be treated as Bhagna.

 

S`hotha without Vran`a:

Is a condition where there is S`hotha due to trauma but there is no wound then it should be treated with S`heeta PradehaSeka.

 

Chirakaalina Sandhi Bhagna:

In a long standing joint dislocation, SnehanaSvedana should be carried out to fix the joint in original position.

 

Vishama Ulban`asamhita Prarood`ha Kaan`d`a Bhagna:

Malunited fracture of long bone with deformity should surgically refractured and put in apposition / reduced and stabilized properly till union.

 

Savran`a Bhagna:

When there is a fracture with the wound then the protruding bone should be surgically excised from the wound and then the treatment of Vran`a and Bhagna should be carried out.

 

Oordhvakaayika Bhagna:

When there is Bhagna in the supraclavicular portion then the treatment given should be Maastishkya, Karn`apooran`a, Ghritapaana and Nasya.

 

Pralambamaana Vran`a Maamsa:

In the wound where the muscular tissue is hanging down, it should be smeared with the Madhu and Ghrita and carefully replaced in its proper place and bandaging should be done. It should be followed by Avachoorn`ana withSamangaaDhaatakeeRodhraKat`phala etc. which help to heal the wound quickly.

 

Samutpisht`a (Choorn`itaNakha Sandhi : –

This is the crushed nail which causes accumulation of the blood at the site. It should be removed using the instrumentAaraa. After the blood letting, it should be plastered by S`haalipisht`a (flour of S`haali variety of rice)

 

 

Anguli Bhagna:

Dislocated or fractured finger should be fixed properly at its original position. It should be bandaged with fine bandage. After that Ghrita Seka should be carried out. Normal finger adjacent to the affected should be used in bandaging to stabilize the affected finger

 

(PaadaTala Bhagna:

Paada Tala should be massaged gently with Ghrita (Ghee). It should be then bandaged with a bandage and a Kus`haa.Vyaayaama is prohibited strictly.

 

Janghaa and Ooru Bhagna:

Janghaa and Ooru both are plastered with the skins of the trees like Madhooka etc. the barks selected should be of cold attribute and potency.

  • Aanchana: Both the ankle joints should be held firmly by a strong man and the distal bone fragment is rotated in circular movements till both the fragments are in complete apposition. This should be carried out in the types ofBhagna like Sphut`ita and Pichchita.
  • Pas`hchaat KarmaKapaat`a S`hayana is advised by Sus`hruta. It is useful for the immobilization of a patient. This helps to keep the fractured site immobile. Five bolts are to be used for the Kapaat`a S`hayana.

 

Kat`i Bhagna:

Upward or downward Aanchana (traction) should be carried out in Kat`i Bhagna. When Sandhi is properly fixed then it should be treated with Basti (Sneha Basti D`alhan`a)

 

Pars`hukaa Bhagna:

In the fracture of ribs, massage with Ghee should be carried out wherever there is fracture. Proper bandaging should be done after keeping Kavalikaa (a piece of cloth) at the site of the fracture. A person should have oil tub bath (Tailapoorn`a Kat`aaha or Dron`ee)

 

Skandha Bhagna:

With the help of a wooden pestle (round end of a Musala), axilla should be elevated, when there is dislocation or fracture in the shoulder joint. When it is fixed properly, it is bandaged with Svastika Bandha.

 

Koorpara Sandhi Bhagna:

In the fracture of elbow joint, it should be massaged with the thumb. The dislocation should be fixed properly. The joint should be flexed after extension. Snehaseka should be carried out.

 

Jaanu Bhagna:

Procedure same as in Koorpara Sandhi should be carried out.

 

Gulpha Bhagna:

Procedure same as in Koorpara Sandhi should be carried out.

 

Man`ibandha Bhagna:

Procedure same as in Koorpara Sandhi should be carried out.

 

Hasta Tala Bhagna:

The palm should be made even and tied with the wood measuring same as of the palm.

Pariseka with Aama Taila should be carried out. Then, Mritpin`d`a or Paashaan`a (stone) should be held to regain the strength of the hand. The clay ball should be replaced by heavier balls like stone and then metal with increase in the physical power and suppleness of the palm musculature

 

Akshaka Bhagna:

With the help of a wooden pestle (Musala), depressed Akshaka Asthi should be elevated. If it is depressed, then it should be elevated. It should be tightly bandaged.

 

Baahu Bhagna:

Procedure same as Ooru should be carried out in Baahu Bhagna.

 

Greevaa Bhagna:

When the neck is tilted or it is moved to the downward direction, then it should be elevated. It should be covered with the Kus`haa and cloth. Person should be lying on the back (Uttaana) for 7 days.

 

Hanu Bhagna:

In the dislocation of mandible, the bone should be fixed at its original position by using ball of the thumb in the mouth cavity bilaterally. After SvedanaPanchaangee Bandha should be applied. Nasya by Vaataghna and Madhura Ghritashould be carried out.

 

Danta Bhagna:

Moving but not fractured teeth with bleeding should be plastered with cold drugs externally. Sandhaaneeya Dravyashould be used. Danta Chaalana is not curable in the old age. Hollow stalk of lotus is used to feed the patient.

 

Naasaa Bhagna:

Naasaa which is depressed internally should be elevated using a probe. Hollow probe (Dvimukhee Naad`ee) should be used for this purpose. It should be bandaged with cloth and Ghrita Seka should be carried out. Fixation by GhritaplutaPichu in the Naasaaput`a is necessary.

 

Karn`a Bhagna:

Fractured ear should be evenly fixed using Ghrita. All the treatment of Sadya Kshata should be carried out then.

 

Kapaala Bhagna:

When there is no secretion of Mastulunga and the bone is fractured then Madhu and Ghrita (Ghee) should be administered. Ghrita should be consumed internally for 7 days.

 

Supporting instruments to treat Bhagna:

Kus`haa These are the skins of the trees like Vams`ha (Bamboo), MadhookaUdumbaraAs`hvatthaPalaas`ha,KakubhaSarja etc. which are used to tie the fractured site.

Kapaat`a It is a panel prepared from the wood, for lying down a patient with the help of which mobilization of a patient is possible. With the 5 bolts, the body parts are fixed to the panel so that fractured site can not be moved and the union of the bones becomes easier. This is called as Kapaat`a S`hayana. It is a molded wooden bed where the patient with a fracture of the vertebral column can lie after reduction to ensure stability and prevent delayed union. A flat bed is also used with strategically placed five nails to prevent foot drop and external rotation of the affected leg.

 

Kalpa Used for treatment of Bhagna:

Gandha Taila Su.Chi. 3/55 – 66; A.H.U.27/36 – 41

 

Trapusaadi Yamaka (Taila and Vasaa) Su. Chi. 3/66 – 68

Milk of a cow which has had only one calf (Grisht`i) with Ghrita and Laakshaa and Madhura Aushadha should be given in the morning to drink. This milk should be cold.

All the Sneha Kalpa which are mentioned in the Vaata Vyaadhi along with Bastikarma.

 

Period for recovery from Sandhi Moksha:

In earlier age Sandhi gets fixed within one month. In middle age Sandhi gets fixed within two months. In later ageSandhi gets fixed within three months.

 

Pathya:

Rasa – Madhura, Kashaaya

Gun`a/Karma – Brimhan`a, Snigdha, Guru

S`hooka – S`hasht`eeka S`haalee

S`haaka – Pat`ola, Las`hoona, S`higru, Aamalakee, S`haalincha, Baala Moolaka

S`himbee – Sateena

Maamsa – Maamsa, Maamsarasa

Dugdha – GhritaSantaanikaa Dugdha

Drava – Madhura Rasaatmaka Aushadha, Draakshaasiddha Jala, S`heeta Jala

Kritaanna – Mudga Yoosha, Sateena Yoosha, Maamsarasa

Other – Ghrita, Dugdha, Sneha, Bandhana Brimhan`a Annapaana (nourishing diet)

Diet should be Avidaahee (non spicy food) and Paisht`ika (made of flour).

 

Apathya:

Rasa – Lavan`a, Kat`u, Amla

Gun`a/ karma – Rooksha

Other – Maithuna, Aatapa, Vyaayaama, Kshaara

 

 

 

Precautions (to be avoided):

Glaani (fatigue to the point of drowsiness) should be avoided as it may cause delayed union of the bones.

Lavan`a (salty diet), Kat`uka (pungent diet), Kshaara (alkaline food), Amla (sour diet), Rooksha Aahaara (dry food),Maithuna (sexual intercourse), Aatapa (sunshine), Vyaayaama (exercises) should be avoided.

All care should be taken to prevent suppuration of the fracture site or wound.

 

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