Dermatology (c): Wounds

In the above subsection on carbuncles, there already is information on wound management while treating the carbuncle.

A couple of descriptions particularly on wounds are found in the Dharmaguptaka Bhaiṣajyaskandhaka.

Dharmaguptaka:—“At that time a monk was afflicted with a wound.^[1] There was a need of anointing [the wound] with spittle [and] hot-pressing [it] with the bottom of a water-boiling pot.^[2] The monk informed [this] to the Buddha. The Buddha said: ‘[I] allow the use.’”^[3]

“Then there was a monk afflicted with a wound. The physician instructed [him] to make a medicine for anointing the wound. The Buddha said: ‘[I] allow making [it].’ His wound became ripened.^[4] It should be cut open [and] applied with medicine. [The Buddha said:] ‘From now on, [I] allow cutting open a wound with a knife. [If] there is a trouble of foul smell from the wound, it should be washed with [fluid] like decoction of root; decoction of stem, leaf, flower, [or] fruit; and urine.’ Then [the monk] cleansed [the wound] by hand [and he] suffered from pain. [The Buddha said:] ‘Use feather to cleanse [the wound]. If the medicinal fluid is lost [due to] flowing, use a thing to surround and block all around [the edge of the wound]. If there is a trouble of [the wound] getting dry, use oil to anoint [the wound]. If a thing drops onto the wound, use an object to cover [the wound]. If the wound is foul-smelling, anoint [it] with a scented substance.’”^[5]

According to Āyurveda, there are two kinds of wounds (Pāli: vaṇa; Sanskrit: vraṇa): endogenous and exogenous. An endogenous wound is caused by the humours and blood which are aggravated by respective causative factors. Aggravated humours become stuck in the external pathway of the body and give rise to ulcer formation. An exogenous wound is due to injury from attack by human or animal; accident; exposure to fire, irritant, or poison; and so on. A wound can form at the skin, blood vessel, muscle, joint, bone, ligament, vital spot, or internal organ (Caraka Saṃhitā Cikitsāsthāna 25. 6-7, 10; Suśruta Saṃhitā Cikitsāsthāna 1. 3, Sūtrasthāna 22. 3; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 25. 1, 12-13). Treatment for wounds has been well developed as shown in classical Āyurvedic texts. Various measures are employed: thirty-six as per the Caraka Saṃhitā and sixty the Suśruta Saṃhitā. These differ only in enumerating the details. The chief measures include: applying, sprinkling, and anointing the wound with various forms of drugs such as paste, powder, ghee, oil, decoction, wick, or gel; fomentation; gentle pressure; bloodletting;emesis; purgation; surgical procedures (such as incision, excision, scraping, probing, extraction, puncturing, draining, suturing and so on); cleansing;healing; dressing; bandaging; stopping bleeding; fumigation; covering with leaves; stimulating or retarding the growth of granulation tissue; softening or hardening of granulation tissue; cauterisation by caustic alkali or heat;disinfection; restoring skin colour and hair; dietary regimen; protective measures (e.g. talisman and incantation especially for exogenous type of wound); and so on. Each of these measures has its function, as described in the medical treatises (Caraka Saṃhitā Cikitsāsthāna 25. 39 ff,; Suśruta Saṃhitā Sūtrasthāna 18. 3 ff., Cikitsāsthāna 1. 8 ff.; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 25. 23 ff.).^[6]

In modern medicine, a wound is the result of a “loss of anatomic structure in tissue following the transfer of kinetic, chemical, or thermal energy” (Franz 2010, 47). A wound undergoes a healing process of several phases: coagulation, inflammation, proliferation (of collagen, blood vessels, and epithelial cells), and wound remodelling. The healing process, however, can be interfered by local and/or systemic factors, such as wound infection or contamination, repeated irritation or trauma at the wound, presence of foreign body or necrotic tissue in the wound, poor tissue circulation, wound desiccation, tension and oedema at the wound, poor nutrition of the patient, comorbid conditions (e.g. diabetes, malignancy, jaundice, uremia), certain treatments (e.g. steroids, chemotherapy, radiotherapy), smoking, and so on. In modern surgery, management of a wound is classified as primary intention healing, secondary intention healing, and delayed primary closure. Primary intention healing is that the edges of the wound are approximated by suturing or any closure method if the wound is clean and has low risk of infection. Secondary intention healing is that, when the wound has high risk of infection or is already infected, it is left open and is allowed to heal by formation of granulation tissue, epithelial tissue, and wound contracture. Delayed primary closure is that a wound with a risk of developing infection is left open for three to five days and then it is closed primarily if there is no obvious infection. Other measures which are also important for wound management include haemostasis by pressure or ligation of bleeding vessels, regular cleansing of the wound, removal of necrotic or scarred tissues, use of suitable dressings, employment of skin grafts or flaps, appropriate administration of antibiotics, and pain relief (Johnson and Lissauer 2008, 16-20; McLatchie, Borley, and Chikwe 2013, 146-147).

Wound management is described in the accounts on the treatment of carbuncles, but there is also additional information pertaining to wound care found in the Dharmaguptaka Bhaiṣajyaskandhaka. Various measures for treating wounds had already been developed in ancient India, as shown in the classical Āyurvedic texts. In modern medicine, knowledge of wounds and their care is well advanced especially in the disciplines of pathology and surgery.

Footnotes and references:

[1]:

瘡, in classical Chinese, means a wound or sore.

[2]:

This may be performed for the purpose of ripening the wound or cauterising it.

[3]:

Taishō Tripiṭaka 1428. 870c4-5: “爾時比丘患瘡，須唾塗以銚底熨。比丘白佛，佛言：「聽用。」”

[4]:

It seems to mean that a wound has become an abscess, which needs to be cut open.

[5]:

Taishō Tripiṭaka 1428. 877a19-25: “時有比丘患瘡，醫教作塗瘡藥，佛言：「聽作。」彼瘡熟，應以刀破著藥。「自今已去，聽以刀破瘡。患瘡臭應洗，若以根湯、莖葉華菓湯，及小便洗。」時以手洗患痛。「以鳥毛洗。若藥汁流棄，以物擁障四邊。若患燥以油塗，若上棄以物覆，若瘡臭香塗。」”

[6]:

These mearures are general treatments for any type of wound. In addition, there are chapters in the Suśruta Saṃhitā and the Aṣṭāṅga Hṛdaya Saṃhitā especially dealing with treatments for traumatic wounds (Suśruta Saṃhitā Cikitsāsthāna 2; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 26).