AH-Su-Chapter 29: Shastrakarma Vidhi शास्त्रकर्म विधि / Surgical Procedures

व्रणः सञ्जायते प्रायः पाकात् श्वयथुपूर्वकात्

तमेवोपचरेत्तस्माद्रक्षन् पाकं प्रयत्नतः १ 
सुशीतलेपसेकास्रमोक्षसंशोधनादिभिः

Due to Paka (suppuration) of inflammation, Vranashotha (inflammatory ulcer) develops. Hence, swelling should be treated first, preventing the formation of pus, by all efforts, such as
Susheeta lepa – application of cold poultices,
Seka – bathing the part with cold decoction of drugs,
Asramoksha – blood letting,
Samshodhana – Purifying Panchakarma therapies. 1.

Trividha Sopha – three stages of swelling :-
Shopha – Swelling is of three types.
Ama shopha – unripe, raw, initial stage, without pus formation
Pachyamana shopha – with symptoms of inflammation, initial stage of pus formation
Pakva shopha – with full pus formation.

व्रणः सञ्जायते प्रायः पाकात् श्वयथुपूर्वकात्
तमेवोपचरेत्तस्माद्रक्षन् पाकं प्रयत्नतः
सुशीतलेपसेकास्रमोक्षसंशोधनादिभिः

Ama shopha – (unripe swelling) mild with slight heat and pain, The swelling will have the same colour as the skin. The swelling is immovable. 2.

पच्यमानो विवर्णस्तु रागी बस्तिरिवाततः
स्फुटतीव सनिस्तोदः साङ्गमर्दविजृम्भिकः
स्त्यानं विष्यन्दयत्याज्यं व्रणवत्स्पर्शनासहः

Pachyamana shopha -
Vivarna – The swelling gains a different color than that of the skin.
Ragi – it is usually red coloured.
Bastiriva – It enlarges like an animal bladder.
Nistoda – continuous bursting type of pain,
Angamarda – aches all over the body,
Vijrumbhika – excess of yawning,
Samrambha – different kinds of distressing symptoms,
Aruchi – anorexia
Daha – burning sensation all over the body
Usha – increased temperature
Trut – excessive thirst
Jvara – fever
Anidra – loss of sleep,
quick melting of solid ghee placed on the swelling and
intolerance to touch – tenderness just as in an ulcer 3 – 4.

Pakva Shotha – ripe swelling is

पक्वे अल्पवेगता म्लानिः पाण्डुता वलिसम्भवः
नामो अन्तेषून्नतिर्मध्ये कण्डूशोफादि मार्दवम्
स्पृष्टे पूयस्य सञ्चारो  भवेद्वस्ताविवाम्भसः

Alpavegata – mild in nature,
Mlani – reduced in size,
Panduta – white colour,
Valisambhava – has wrinkles on it,
depressed all round but elevated at its centre
Kandu – itching
Shopha – mild swelling,
Mardava –softness,
movement of pus can be understood by touch just as movement of water in a bladder. 5.

Doshawise symptoms in Shopha -

शूलं नर्ते अनिलात्, दाह: पित्तात्, शोफ: कफोदयात् ॥६॥

रागो रक्ताच्च पाक: स्यादतो दोषै: सशोणितै: ।

Shula – pain  due to Vata
Daha – burning sensation due to Pitta imbalance
Shopha – inflammation due to Kapha imbalance
Raga – redness and Paka – suppuration due to Rakta vitiation. 6.

पाके अतिवृत्ते अतिसुषिरस्तनुत्वग्दोषभक्षितः
वलीभिराचितः श्यावः शीर्यमाणतनूरुहः

When pus formation further increases with lapse of time there is cavity formation inside the swelling, the skin becomes thin and destroyed by the Doshas, it is covered with wrinkles, black in colour and body hairs fall off. 7.

कफजेषु तु शोफेषु गम्भीरं पाकमेत्यसृक्
पक्वलिङ्गं ततो अस्पृष्टं यत्र स्याच्छीतशोफता
त्वक्सावर्ण्यं रुजो अल्पत्वं घनस्पर्शत्वमश्मवत्
रक्तपाकमिति ब्रूयात्तं प्राज्ञो मुक्तसंशयः

If the swelling produced by predominance of Kapha, ripening takes place slowly, hence signs of ripening do not manifest clearly, the swelling which is cold to touch, of the same colour as of the skin with milkd pain, hard to touch, like a stone. IT is also known as Raktapaka.8 – 9.

Shastra Karma Vidhi – Procedure of surgical operation:-

अल्पसत्वे अबले बाले पाकाद्वा अत्यर्थमुद्धते
दारणं मर्मसन्ध्यादिस्थिते चान्यत्र पाटनम्

In persons with weak mind, who are debilitated, in children, or when the swelling is elevated by accumulation of pus, when it is located on vulnerable spots, joints etc., the treatment is

Darana – making the abscess burst by application of Alkalies (Kshara) whereas in other cases except the above, the treatment is –

Patana -  cutting open by sharp instruments. 10.

आमच्छेदे सिरास्नायुव्यापदो अस्रुगतिस्रुतिः
रुजो अतिवृद्धिर्दरणं विसर्पो वा क्षतोद्भवाः
तिष्ठन्नन्तः पुनः पूयः सिरास्नाय्वसृगामिषम्
विवृद्धो दहति क्षिप्रं तृणोल्पमिवानिलः

Cutting an unripe swelling leads to diseases of the veins and tendons, profuse bleeding, immense pain, tearing of the skin or Visarpa (spreading ulcers).
The pus remaining inside and increasing in quantity, quickly burns away the veins, tendons blood and muscles just as – spark of fire burns away a hay stack. 11 – 12.

यष्च्छिनत्त्याममज्ञानाद्यश्च पक्वमुपेक्षते
श्वपचाविव विज्ञेयौ तावनिश्चितकारिणौ

The surgeon who by ignorance cuts open an unripe swelling and he who neglects a ripe swelling – without cutting open – both should be considered as mean surgeons performing indiscriminate acts. 13.

Purvakarma – Pre-operative procedures:-

प्राक् शस्त्रकर्मणश्चेष्टं भोजयेदन्नमातुरम्
पानपं पाययेन्मद्यं तीक्ष्णं यो वेदनाक्षमः
न मूर्च्छत्यन्नसंयोगान्मत्तः शस्त्रं न् बुध्यते

Before undertaking surgical opening of an abscess the patient should be given the food he likes;
The person accustomed to alcoholic drinks may be given a drink of strong wine which makes him withstand the pain. 14 – 15.

अन्यत्र मूढगर्भाश्ममुखरोगोदरातुरात्

Except for those patients suffering from obstructed delivery, renal calculus, diseases of the mouth and the abdomen – such patients should be given neither food nor wine before the operation. 15½.

Pradhana Karma – operation proper:-

अथाहृतोपकरणं वैद्यः प्राङ्मुखामातुरम्
संमुखो यन्त्रयित्वा आशु न्यस्येन्मर्मादि वर्जयन्
अनुलोमं सुनिशितं शस्त्रमापूयदर्शनात्
सकृदेवाहरेत्तच्च

Next, keeping all the equipments required, the physician should make the patient sit facing east.
Sitting in front of him and facing him, the physician should incise the swelling with his well sharpened instrument,
Incision being made in the direction of the hair – downward, avoiding vulnerable parts, deep enough till the pus is seen, and then removing the instrument quickly. 16 – 17

पाके तु सुमहत्यपि
पातयेत् द्वयङ्गुलं संयग्द्वयङ्गुलञ्चङ्गुलान्तरम्
एषित्वा सम्यगेषिण्या परितः सुनिरूपितम्
अङ्गुलीनालवालैर्वा यथादेशं यथाशयम्
यतो गतं गतिं विद्यादुत्सङ्गो यत्र यत्र च
तत्र तत्र व्रणं कुर्यात्सुविभक्तं निराशयम्
त्रायतं च विशालं च यथा दोषो न तिष्ठति

If the area of pus formation is great, the incisions may be either one, two or three Angula – (fingers breadth) apart;
The interior is then thoroughly excavated with either a probe, finger, tube or hairs of animals, as appropriate to the site and area of the swelling,
The pus path is determined, cutting through the bulge of the wounds, creating a well cleaned, wide and deep wound so that no vitiating material can remain inside. 18 – 20.

शस्त्रवैद्य गुण – Characters Desired in a Surgeon

शौर्यं आशुक्रिया तीक्ष्णं शस्त्रं अस्वेद वेपथू ॥२१॥

असम्मोहश्च वैद्यस्य शस्त्रकर्मणि शस्यते ।

Shaurya – Courage,
Ashukriya – quickness of action,
Teekshna shastra – keeping his instruments very sharp,
Asveda – not sweating
A vepathu – not trembling,
Asammoha – not getting confused
these are the qualities best desired of the 21.

तिर्यक्छिन्द्याल्ललाटभ्रूदन्तवेश्तकजत्रुणि
कुक्षिकक्षाक्षिकूटौष्ठकपोलगलवङ्क्षणे
अन्यत्र छेदनात्तिर्यक् सिरास्नायुविपाटनम्

Tiryak Cheda – The incision should be made horizontally curved in places such as the forehead, brows, gums of teeth, shoulders, abdomen, axillae, eye sockets, lips, cheeks, throat and groins; horizontal incision, in other places might lead to cutting of the veins, tendons etc. 22 – 23.

Sastrakarmottara Vidhi – Paschat Karma – post-operative procedures

शास्त्रे अवचारिते वाग्भिः शीताम्भोभिश्च
रोगिणाम्
आश्वास्य परितो अङ्गुल्या परिपीड्य व्रणं ततः
क्षालयित्वा कषायेण प्लोतेनाम्भो अपनीय च
गुग्गुल्वगुरुसिद्धार्थहिङ्गुसर्जरसान्वितैः
धूपयेत्पटुषट्ग्रन्था निम्बपत्रैर्घृतप्लुतैः
तिलकल्काज्यमधुभिर्यथास्वं भेषजेन च
दिग्धां वर्तिं ततो दध्यात्तैरेवाच्छादयेच्च ताम्
घृताक्तैः सक्तुभिश्चोर्ध्वं घनां कवलिकां ततः
निधाय युक्त्या बध्नीयत्पट्टेन सुसमाहितम्
पार्श्व सव्ये अपसव्ये वा नाधस्तान्नैव चोपरि

After removing the sharp instruments, the patient should be comforted with encouraging words and cold water;
The area all around should be squeezed,
The wound is washed with decoction of drugs
Moisture is removed by wiping with cotton wool.
The wound should be fumigated with the smoke of Guggulu, Aguru, Siddhartha, Hingu (Asa foetida), Sarjarasa, Patu (Salt), Sadgrantha(Acorus calamus) or leaves of Nimba (neem), mixed with ghee;
Then a wick prepared from paste of Tila, ghee, honey and appropriate drugs should be placed inside the wound and also covered over.
A thick plaster prepared from corn flour and ghee is put on and bandaged with a thick sheet of cloth, winding it either from right to left or left to right but not from either top or bottom. 24 – 28.

शुचिसूक्ष्मदृढाः पट्टाः कवल्यः सविकेशिकाः
धूपिता मृदवः श्लक्ष्णा निर्वलीका व्रणे हिताः

The bandage cloth should be clean, thin and strong; the medicinal wick should consist of cotton threads which are fumigated, soft, smooth and devoid of folds, these are beneficial to the ulcers. 29.

कुर्वीतानन्तरं तस्य रक्षां रक्षोनिषिद्धये
बलिं चोपहरेत्तेभ्यः

Ulcer should be protected from the invasion of bad evils (microbes), insects, flies which feed on blood. They should be offered oblations. 30

सदा मूर्ध्ना च धारयेत्
लक्ष्मीं गुहामतिगुहां जटिलां ब्रह्मचारिणीम्
वचां छत्रामतिच्छत्रां दुर्वां सिद्धार्थकानापि
ततः स्नेहदिनेहोक्तं तस्याचारं समादिशेत्
दिवास्वप्ने व्रणे कण्डूरागरुक्शोफपूयकृत्

The patient should always wear on his head, potent herbs such as Lakshmi, Guha, Atiguha, Jatila, Brahmacharini, Vacha, Chatra, Atichatra, Durva or Siddharthaka.
He should be made to follow the regimen prescribed for the day of oil drinking as part of Snehana therapy;
sleeping during day leads to production of itching, redness, pain, swelling and pus in the ulcer. 31 – 32.

स्त्रीणां तु स्म्रुतिसंस्पर्शदर्शनैश्चलितस्रुते
शुक्रे व्यवायजान् दोषानसंसर्गे अप्यवाप्नुयात्

Remembrance, touch and sight of women, which produce ejaculation of semen leads to other bad effects of intercourse, though not indulged into actually. 33.

व्रणे श्वयथुरायासात् स च रागश्च जागरात्
तो च रुक् च दिवास्वापात्ताश्च मृत्युश्च मैथुनात्

Swelling gets increased in an ulcer by strenuous activities,
Redness increases by keeping awake at night,
Pain by sleeping during day;
death occurs by indulging in copulation.

Diet after surgery – 

भोजनं च यथासात्म्यं यवगोधूमषष्टिकाः
मसूरमुद्गतुवरीजीवन्तीसुनिषण्णकाः
बालमूलकवर्ताकतण्डुलीयकावास्तुकम्
कारवेल्लककर्कोटपटोलकटुकाफलम्
सैन्धवं दाडिमं धात्री घृतं तप्त हिमं जलम्
जीर्णशाल्योदनं स्निग्धमल्पमुष्णोदकोत्तरम्
भुञ्जानो जाङ्गलैर्मांसैः शीघ्रं व्रणमपोहति

The food of the patient should be that which is accustomed such as barley, wheat, rice of sixty day ripening (shashtika shali), Masura – lentil, Mudga (green-gram), Tuvari – (tur dal), Jivanti, Sunisannaka, tender Mulaka (Radish), Vartaka, Tanduliyaka, Vastuka, Karavella (biiter gourd), Karkota, Patola (Pointed gourd) , Katukaphala – fruit of Katurohini, Saindhava (Black salt), Dadima (pomegranate), Dhatri (Amla), Ghrita (ghee), water boiled and cooled.
Mess prepared from old rice added with fats consumed in little quantity along with meat of animals of desert – like regions, followed by drinking of warm water helps for the quick healing of ulcers. 34 – 36.

अशितं मात्रया काले पथ्यं याति जरां सुखम्
अजीर्णत्त्वनिलादीनां विभ्रमो बलवान् भवेत्
ततः शोफरुजापाकदाहानाहानवाप्नुयात्

Food, to be consumed in limited quantity at the appropriate time and which is healthy, undergoes digestion properly, Indigestion by over eating etc. leads to disorders of Vata and other Doshas which might be powerful so as to cause increase of swelling, pain, putrefaction, burning sensation and distention of the abdomen. 37 – 38.

Food to be avoided –

नवं धान्यं तिलान् माषान् मद्यं मांसमजाङ्गलम्
क्षीरेक्षुविकृतीरम्लं लवणं कटुकं त्यजेत्
यच्चान्यदपि विष्टम्भि विदाहि गुरु शीतलम्
वर्गो अयं नवधान्यादिर्व्रणिनः सर्वदोषकृत्

Fresh grains, Tila (sesame), Masha (black gram), wines, meat other than of animals of desert like regions, products of milk and sugarcane, substances which are sour, salt and pungent should be avoided;
Any other substance which causes constipation, burning sensation during digestion, which are not easy to digest and which are cold in potency;
This group of substances gives rise to aggravation of all the Doshas in persons suffering from ulcers. 39 – 40.

मद्यं तीक्ष्णोष्णरूक्षाम्लमाशु व्यापदयेद्व्रणम्

Strong penetrating, hot wines, with high percentage of alcohol, dry – non-unctous and sour, quickly cause death of the patient of ulcers. 40½.

वालोशीरैश्च वीज्येत न् चैनं परिघट्टयेत्
न तुदेन्न च कण्डूयेचेष्टमानश्च पालयेत्
स्निग्धवृद्धद्विजातीनां कथाः शृण्वन्मनः प्रियाः
आशावान् व्याधिमोक्षाय क्षिप्रं व्रणमपोहति

The ulcer site should be fanned either with tuft of hairs of animals or with that of Ushira (Vetiver) grass.
It should not be beaten, poked, or scratched with nails, it should be protected from injury while doing other activities;
The person who engages himself in hearing pleasant stories, meeting with virtuous elderly persons of the twice born castes (Brahmin), he who is hopeful of cure of the disease gets rid of the ulcer quickly. 41-42.

तृतीयेअह्नि पुनः कुर्याद्व्रणकर्म च पूर्ववत्
प्रक्षालनादि, दिवसे द्वितीये नाचारेत्तथा
तीव्रव्यथो विग्रथितश्चिरात्संरोहति व्रणः

On the third day, the same treatment such as washing the ulcer etc. are done, as explained earlier;
These should not be done on the second day as that will give rise to severe pain, formation of tumors and delayed healing of the ulcer. 43 – 44.

स्निग्धां रूक्षां शलथां गाढां दुर्न्यस्तां च विकेशिकम्
व्रणे न दद्यात्कल्कं वा स्नेहात्क्लेदो विवर्द्धते
मांसच्छेदो अतिरुग्रौक्ष्याद्दरणं शोणितागमः
शलथातिगाढदुर्न्यासैर्व्रणवर्त्मावघर्षणम्

The wick of cotton threads smeared with paste of drugs and also the paste of drugs should neither be very unctuous (oily) nor very dry; neither flabby nor very thick – hard and should not be improperly placed;
Because unctuousness (oily, fatty) increases moistness,
dryness causes tears in the muscles, severe pain, lacerations and bleeding.
Flabby, hard and improperly placed wick produces friction of the edges of the ulcer. 45 – 46.

सपूतिमांसं सोत्सङ्गं सगतिं पूयगर्भिणम्
व्रणं विशोधयेच्छीघ्रं स्थितः ह्यन्तर्विकेशिका

When the medicinal wick remaining long inside the ulcer produces putrefaction of the muscles, elevated surface, loss of tissues and accumulation of pus inside, then the ulcer should be cleaned – cleared of its contents quickly. 47.

व्यम्लं तु पाटितं शोफं पाचनैः समुपाचरेत्
भोजनैरुपनाहैश्च नातिव्रणविरोधिभिः

When an unripe swelling has been cut open by ignorance it should be treated with foods and poultices which bring about ripening but which are not very opposed / harmful to the ulcer. 48.

Sadyovrana Chikitsa – treatment of traumatic wounds -

सद्यः सद्योव्रणान् सीव्यद्विवृतानभिघातजान्
मेदोजांल्लिखितान् ग्रन्थीन् ह्रस्वाः पालीश्च कर्णयोः
शिरोक्षिकूटनासौष्टगण्डकर्णोरुबाहुषु
ग्रीवाललाटमुष्कस्फिङ्मेढ्रपायूदरादिषु
गम्भीरेषुप्रदेशेषु मांसलेष्वचलेषु च

Traumatic wounds which are recent and wide should be sutured immediately;
So also the ulcers which are made by scraping fatty tumors, Pinna of the ears which are thin, ulcers located on the head, eye-sockets, nose, lips, cheeks, ears, arms neck, forehead, scrotum, buttocks, penis, rectum, abdomen etc which are situated on important fleshy and immovable parts should be sutured. 49 – 50.

Wounds that should not be sutured immediately -

न तु वङ्क्ष्णकक्षादावल्पमांसे चले व्रणान्
वायुनिर्वाहिणः शल्यगर्भान् क्षारविषाग्निजान्

That are on groins, axilla, etc, which are less muscular and movable, ulcers which emit air (gas), which have foreign body inside, which are produced by alkalies (kshara), poisons and fire should not be sutured. 51.

सीव्येच्चास्थिशुष्कास्रतृणरोमापनीय तु
प्रलम्बि मांस विच्छिन्नं निवेश्य स्वनिवेशने
सन्ध्यस्थि च स्थिते रक्ते स्नाय्वा सूत्रेण वल्कलैः
सीव्येन्न दूरे नासन्ने गृह्य्न्नाल्पं न वा बहु

Suturing should be done only after removing loose pieces of bones, dried blood clots, grass, hairs etc; by placing the torn and hanging pieces of muscles in their proper places, keeping the joints of bones and bones fractured in their normal positions and after the stoppage of bleeding; by making use of tendons of animals, threads of cotton, silk, flax etc. or inner fibres of bark of trees;
Suturing being done neither very far apart nor very close, holding neither very much of the tissues nor very little. 52 – 53½.

सान्त्वयित्वा ततश्चार्तं व्रणे मधुघृतद्रुतैः
अञ्जनक्षौमजमषीफलिनीशल्लकीफलैः
सरोध्रमधुकैर्दिग्धे युञ्ज्यात्बन्धनादि पूर्ववत्

After suturing, having comforted the patient with encouraging words, cold water drink, fanning etc. the ulcer should be covered with cotton swab soaked in a mixture of honey, melted ghee, Anjana – Srotonjana, ash of Ksyauma (flax), Phalini, fruit of Shallaki, Rodhra and Madhuka; then bandaging and other measures done as described previously. 54 – 55.

व्रणो निः शोणितौष्ठो यः किञ्चिदेवावलिख्य तम्
सञ्जातरुधिरं सीव्येत्सन्धानं ह्यस्य शोणितम्

The edges of the ulcer which are not bleeding should be scraped a little to induce bleeding and sutured when the blood is flowing; for the blood is the cause – agent for healing of the ulcers. 56.

Bandhana – bandages:-

बन्धनानि तु देशादीनन् वीक्ष्य युञ्जीत तेषु च
आविकाजिनकौशेयमुष्णं, क्षौमं तु शीतलम्
शीतोष्णं तूलसन्तानकार्पासस्नायुवल्कजम्
ताम्रायस्त्रपुसीसानि व्रणे मेधः कफाधिके
भङ्गे च युञ्ज्यात्फलकं चर्मवल्ककुशादि च

Bandages suitable to the site of the ulcer / organs of the body should be made use of.
Among them, that prepared from sheeps skin, and silk is hot.
Bandage from flax is cold,
that from silk-cotton, cotton, tendons of animals – aponeuroses, sheaths, thin layers of tendons etc. and bark of trees is both hot and cold;
wounds which have more of fat and Kapha, should be covered with thin sheets of copper, iron, zinc, or lead; so also the fractures;
In case of fractures bandaging should be done by using leather, bark of trees and splints – hard and flat pieces of bamboo, wood, metal etc. 57 – 58.

स्वनामानुगताकारा बन्धास्तु दश पञ्च च
केशस्वस्तिकमुत्तोलीचीनदामानुवेल्लितम्
खट्वाविबन्धस्थगिकावितानोत्सङ्गोष्फणाः
यमकं मण्डलाख्यं च पञ्चाङ्गी चेति योजयेत्
विदध्यात्तेषु तेष्वेव कोशमङ्गुलीपर्वासु
स्वस्तिकं कर्णकक्षादिस्तेनेषूक्तं च सन्धिषु
मुत्तोलीं मेढ्रग्रीवादौयुञ्ज्याचीनमपाङ्गयोः
सम्बाधे अङ्गे तया दाम, शाखास्वेवानुवेल्लितम्
खट्वां गण्डे हनौ शङ्खे, विबन्धं पृष्ठकोदरे
अङ्गुष्ठाङ्गूलिमेढ्राग्रे स्थागिकामन्त्रवृद्धिषु
वितानं पृथुलाङ्गादौतथा शिरसि चेरयेत्
विलम्बिनि तथोत्सङ्गं, नासौष्ठचिबुकादिषु
गोष्फणं सन्धिषु तथा, यमकं यमिकं व्रणे
वृत्ते अङ्गं मण्डलाख्यं च , पञ्चाङ्गीं चोर्ध्वजत्रुषु
यो यत्र सुनिविष्टः स्यात्तं तेषां तत्र बुद्धिमान्

Bandages are of the same shapes implied in their very names and are fifteen in number; they are
Kosha, Swasthika, Muttoli, China, Dama, Anuvellita, Khatva, Vibandha, Sthagika, Vitana, Utsanga, Gosphana, Yamaka, Sthagika, Mandala and Panchangi;
Kosha kind should be used for the joints of fingers,
Swastika for the ears, Axilla etc. for breasts and joints;
Mittoli for the penis, neck etc.;
China for the outer canthus of the eyes;
Dama at places of junction of body parts such as groins etc.;
Anuvellita for the extremities,
Khatva for cheeks, lower jaw and temples;
Vibandha for the back and abdomen;
Sthagika for the thumb, fingers, tip of the penis, and in hernia in the groins;
Vitana for organs which are thick and also for the head;
Utsanga for hanging parts;
Gosphana for the nose, lips, joints etc;
Yamaka for places having two adjacent ulcers;
Mandala for parts which are round;
Pancangi for parts above the shoulders.

An intelligent physician should apply, that type of bandage which is most suitable to the place of the body. 59 – 61.

Tight bandage – 

बध्नीयाद्गाढमूरुस्फिक्कक्षावङ्क्ष्णमूर्धसु
शाखावदनकर्णोरः पृष्ठपार्श्वगलोदरे
समं मेहनमुष्के च, नेत्रे सन्धिषु च श्लथम्
बध्नीयाच्छिथिलस्थाने वातश्लेष्मोद्भवे समम्
गाढमेव समस्थाने, भृशं गाढं तदाशये
शीते वसन्ते अपि च तौ मोक्षणीयौ त्रयहात्रयहात्
पित्तरक्तोत्थयोर्बन्धो गाढस्थाने समो मतः
समस्थाने श्लथो, नैव शिथिलस्याशये तथा
सायंप्रातस्तयोर्मोक्षो ग्रीष्मे शरदपि चेष्यते

Bandage should be tied tight over the thighs, buttocks, axillae, groins, and head; it should be moderate over the extremities, face, ears, chest, back, flanks, neck, abdomen, penis and scrotum;
On places which are even neither hard nor flabby it should be tight, it should be very tight if the ulcer is situated on the seats – organs of Vata and Kapha.

Moderate tight bandage - it should be moderate over the eyes, joints etc;
so also on places which are flabby, on places where the ulcer has been produced by Vata and Kapha it should be moderate, bandage should be removed once in three days during Sita – cold and Vasanta (spring) seasons.

Loose bandage – Bandage should be tied moderately tight on hard parts if the ulcer on them are produced by Pitta and Rakta, and on even-parts, it should be loose; on places where loose bandaging is prescribed, it should not be tied at all; during Grisma – summer and Sarat – autumn bandage should be removed in the evening and morning. 62 – 65½.

अबद्धो दंशमशकशीतवातादिपीडितः
दुष्टीभवेच्चिरं चात्र न तिष्ठेत्स्नेहभेषजम्
कृच्छ्रेण शुद्धिं रूढिं वा याति रूढो विवर्णताम्

If the ulcer is not bandaged, it gets contaminated by the bite of mosquitoes, cold breeze etc., the fats and medicines applied to the ulcer do not stay on, the ulcer requires long time to become clean without pus etc. and get healed, and even after healing it will be discoloured the skin over the area does not get back the normal colour of the body. 66 – 67.

बद्धस्तु चूर्णितो भग्नो विश्लिष्टः पाटितो अपि वा
छिन्नस्नायुसिरो अप्याशु सुखं संरोहति व्रणः
उत्थानशयनाध्यासु सर्वेहासु न पीड्यते
उद्वृत्तौष्ठः समुत्सन्नो विषमः कठिनो अतिरुक्
समो मृदुररुक् शीघ्रं व्रणः शुद्ध्यति रोहति

Bandaging helps easy and quick healing of wounds in which the bones are found crushed or fractured, joints are dislocated, which are cut up by the physician, in which tendons and veins are severed, by bandaging there will be no pain during getting up, lying down and such other acts; swelling of the part of the body which are either uneven, hard and very painful or even soft, and painless – all become clean and heal quick. 69.

स्थिराणामल्पमांसानां रौक्ष्यादनुपरोहताम्
प्रच्छाद्यमौषधं पत्रैर्यथादोषं यथर्तु च
अजीर्णतरुणाच्छिद्रैः समन्तात्सुनिवेशितैः
धौतैरकर्कशोः क्षीरिभुर्जार्जुनकदम्बजैः

Ulcers which are persisting long, which have very little of muscular tissue, which do not heal to dryness absence of moisture should be applied with medicines which are wrapped in leaves of trees, appropriate to the Doshas involved and the seasons; the leaves should not be ripened ones but should be young – tender ones, not having holes, good in all respects, washed well and not rough, should belong to trees which have milky sap, Bhurja, Arjuna or Kadamba. 70 – 71.

Bandaging contra indication – 

कुष्ठिनामग्निदग्धानां पिटिकामधुमेहिनाम्
कर्णिकाश्चोन्दुरुविषे क्षारदग्धा विषान्विताः
बन्धनीया न मांसपाके गुदपाके च दारुणे
शीर्यमाणाः सरुग्दाहाः शोफावस्थाविसर्पिणः

Bandaging should not be done for ulcers which are of leprosy or burns by fire, of diabetes mellitus, of rat bite, burnt by alkalies, caused by poison, which have putrefaction of the muscles, severe ulcerations of the rectum, which are degenerating with loss of tissues which have pain and burning sensation, which retain the swelling over long period and which spread to other parts. 72 – 73.

अरक्षया व्रणे यस्मिन् मक्षिका निक्षिपेत्कृमीन्
ते भक्षयन्तः कुर्वन्ति रुजाशोफास्रसंस्रवान्
सुरसादिं प्रयुञ्जीत तत्र धावनपूरणे
सप्तपर्णकरञ्जार्कनिम्बराजादनत्वचः
गोमूत्रोकल्कितो लेपः सेकः क्षारम्बुना हितः
प्रच्छाद्य मांसपेश्या वा व्रणं तानाशु निर्हरेत्

Flies deposit worms – bacteria etc. inside the ulcers which are not protected by bandaging, they – bacteria by devouring the tissues produce pain, swelling and bleeding; for washing and filling of such septic ulcers the drugs of Surasadigana – vide chapter 15 should be Rajadana prepared with cows urine should be applied, bathing the ulcer with solution of alkalies is beneficial or scarification of the muscle tissues, by these measures the worms – bacteria etc. should be removed out quick. 74 – 76.

न चैनं त्वरमाणो अन्तः सदोषमुपहारयेत्
सो अल्पेनाप्यपचारेण भूयो विकुरुते यतः

Hasty healing of the ulcer which has residue of the Doshas inside, should not be attempted; for it will flare up greatly even with slight improper regimen. 77.

रूढेअप्यजीर्णव्यायामव्यवायादीन् विवर्जयेत्
हर्षं क्रोधं भयं चापि यावदास्थैर्यसम्भवात्
आदारेणानुवर्त्यो अयं मासान् षट् सप्त वा विधिः

Even after the ulcer has healed the patient should avoid indigestion, physical activities, copulation etc; great rejoicing, anger, fear etc. till he attains his full strength, he should lead a disciplined life for at least six or seven months. 78 – 79.

उत्पद्यमानासु च तासु तासु वार्तासु दोषादिबलानुसारी
तैस्तैरुपायैः प्रयतश्चिकित्सेदालोचयन् विस्तरमुत्तरोक्तम्

Such other conditions which manifest should be managed with methods appropriate to the strength of the Doshas etc., in the light of the details furnished on the Uttara Tantra – the last section of this treatise (vide chapter 25 – 27) 80.

Thus ends the twenty ninth chapter called Shastrakarma Vidhi in sutrasthana of Astanga hrudaya composed by Vaghata.