Dagdha Chikitsa in Detail

Science is not merely a collection of facts and relationship but is more than a composite of these facts, accumulated and systematically correlated over the ages. Classics of Ayurveda has emphasized at various places to take care of wounds which occurs either as a result of vitiated Doshas or of traumatic in origin. Agni Dagdha (Burn) is the thermal coagulative necrosis of tissue, as a result of injury caused by dry heat like flame, radiant heat, electricity, lightning, X-Rays, or highly heated substance (Sun burn etc.). In Ayurveda Acharya Sushruta explained briefly about Agni Dagdha Vrana, in Sutrasthan, chapter 12 Agnikarma vidhi adhyaya in detail. He has mentioned in detail about the prakara, lakshanas, and the management of Agni Dagdha Vrana. Similarly other Acharyas also mentioned Agni Dagdha in their respected samhitas in brief.

Agni Dagdha Vrana is cause by the application of heat. Explained in the context of cauterization under the heading “Itaratha Dagdha”. Again this has been classified as that caused by dry heat (Ruksha Dagdha) that caused by fats and oils (Snigdha Dagdha ). Among these two varieties the Snigdha Dagdha is more painful than Ruksha Dagdha. Because Sneha Dravya enters the minute channels along with heat and destroys the deeper tissues immediately.

Types of Dagdha

Ushna vata atap dagdha :- Burn caused by hot air and weather which gives the explanation to sun stroke.
Ati – Tejasa dagdha :- The burn wound caused due to irritating particle or by irritation.
Sheeta Varshaneela Dagdha :- Burn caused by excess cold weather and cold water.
Indra Vajragni Dagdha :- Burn caused due to lightning.

Dagdha Derivation

“Dhyate sma iti” means that which burns. By these derivations the word Dagdha is been derived hence concluding Dagdha as burn.

Synonyms

Prustaha, Plusta, Uditaha.

Dictionary meaning

Dagdha means burnt, scorched, consumed by fire, fomented, painted etc. Dagdha means burning or kindling.

Etymology

The word ‘Vrana’ is derived from the root “Vriya” meaning of “to Recover”, which is further suffixed by “ach” in the sense of bhava. The “Ch’ sound is joined and the form remains “Vran” + “a”, in the sense of “Gatra Vichuranane”.

Etiological factors of Dagdha Vrana

• Agni
• Kshara
• Sheetavarshaneela
• Ati – Tejasa
• Indravajragni
• Ushna vata atapa

Samprapti of Dagdha Vrana

When blood comes in contact of fire immediately it becomes more vitiated. At the same time Pitta also gets, vitiated due to its similarity in Virya, rasa & also its characters. Due to this patient suffers from severe pain and burning sensation. Immediately there will be formation of blisters on the body and patient suffers from fever and thirst.

Classification Of Dagdha

Vrana: Sushrutacharya has mentioned Agni Dagdha as Pramad Dagdha
or Etaratha Dagdha.This Pramad Dagdha has four types.
i. Plushtadagdha
ii. Durdagdha
iii. Samyakdagdha
iv. Atidagdha

Plushta dagdha: A condition where there is discoloration (redness) and severe burning sensation in a burn area is called plushta dagdha (Superficial partial thickness burn).

Durdagdha: There is eruption of blisters in association with severe burning sensation, redness, inflammation, pain and the wound takes long time to heal. Different types of pain felt by patient like sucking, burning etc. there will be erythema and suppuration of the wound. Pain will be more and heals lately. (Second degree burn).

Samyak dagdha

The wound which is no deep seated, color is like that of Tala phala (palm fruit, Blackish at borders and whitish at center) and it is of optimum depth. These are all the characteristic feature of the properly cauterized burn wound. Particular pattern of the features have been explained for the cautery of
deeper tissues like

Samyak Dagdha Lakshanas of Twak (Skin)

There will be production of sound, foul smelling, contracted skin.

Samyak Dagdha Lakshanas of mamsa

Colour of the wound will be greyish, there will be edema, pain will be less, wound will be dry and contracted.

Samyak Dagdha Lakshanas of Sira and Snayu

Blackish discoloration and the wound is elevated. Discharge will not be seen.

Samyak Dagdha Lakshanas of Sandhi and Asthi

Wound will be dry; slightly whitish in color, wound surface will be rough and hard. These are the features, which can be seen by the proper cauterization, on particular site according to the need of the disease. But even these features can also be seen in the accidental burn injuries where it needs proper treatment according to the condition.

Atidagdha

There is presence of excessive necrosed muscle etc. in the wound area, person’s body is stiff, severe pain all over body, suffers from fever , excessive thirst and loses consciousness. (III degree burn).

Chikitsa of Dagdha Vrana:

Vranitagara : Vranitagara should be Shreshtha and free from dust, it should be built in such a way that direct sun light and air should not enter the room and that it is comfortable for vranita. The wards, the beds provided to the patients should be nice, well laid, provided with comfortable mattress and patients head end should be towards east. He should be associated with his well wishers. They should be able to console him in different ways.

It should be advised to the patient not to sleep during the day; as it gives rise to a sensation of itching, heaviness in the limbs, edema, pain, redness and copious discharge from the wound. Patient should carefully protect the wound while carrying on his own activities, such as getting up, lying down, changing sides as well as moving and speaking loudly etc. A wounded person even of a strong built should not indulge in standing, sitting, moving about for long and day sleep. All these must be avoided because of excessive standing, sitting; lying down on the bed may cause pain all over the body due to vitiation of Vata.

The vranita should avoid exposure to excessive wind, hot sunlight, dust, smoke and physical exercise. The wounded should keep his nails cut, hairs short, remain clean and wear white clothes, otherwise the virulent organisms, invade the patients tissues through the ulcers.One who is cheerful and optimistic regarding cure from disease, is sure to obtain it early. Fumigation should be done twice a day for three days carefully by Sarshapa, Arishta Patra (Neem), Ghee and Salt.One should blow air on the wound by fans made up of hairs, should not rub the wound, nor prick it or scratch it and protect the same by remaining in the bed.

The wounded that does not sleep in the day, lives in a house protected from wind and follows the instructions of surgeon is cured of his wound quickly. The wound which become edematous by physical exercise, becomes red and by keeping awake at night. Both edema and redness along with pain may be observed by indulging in day sleep and even death may occur if patient indulges in sexual intercourse.

Treatment Of Plusta Dagdha Vrana

Burnt areas should be made warm by Agni and application also done is by Ushna Veeryayukta Dravyas. Due to the contact with the fire the body becomes more warm and so also the blood. In this condition if cold measures are employed or cold water is sprinkled it may lead to the excessive Skandana of blood (Viscosity). So for this reason one has to use warm water for washing and drinking. Cold water and cold thing should never be used.

Treatment Of Durdagdha Vrana

In this type both cold and warm measures has to be employed. But the Ghee, paste or any external application as well as medicine which is used for Seka should contain Sheeta Veerya Dravyas.

Treatment Of Samyak Dagdha Vrana

In this type for the external application Vamsha Lochana, Gairika, Plaksha and Guduchi are made into paste and then mixed with Ghee and used.Flesh of the animals of dry, marshy and aquatic places are mixed and triturated well and then used for the external application. If there is continuous burning sensation of the local part or all over the body then one has to treat according to the line of treatment of Pittaja Vidradhi.

The treatment adopted in case of Pittaja Vidradhi are :

1. The paste prepared by sugar, laja, Yastimadhu, Sariva triturating with milk can be used for external application. In case of non-availability of Sariva one can use Ksheerkakoli, Chandana and Usheera. Even the Ghee prepared with warm or cold decoction of above said drugs along with milk and cane juice or Jeevaneeya group drugs with sugar can be used for Parisheka.

2. Application of paste prepared by Yastimadhu triturating with milk andmixed with Ghee has to be employed after washing the wound with decoction prepared by Ksheeri Vruksha like Vata, Udumbara and aquatic plants like Prapaundarika etc. then bandaging is to be done. But in case of Dagdha vrana bandaging can be avoided.

3. The Ghee prepared out of Propaundarika,. Manjista, Yastimadhu, Usheera, Padmaka and Turmeric powder boiled with milk can be used in healing the wound. The Grita prepared by the leaves of Ksheera Vidari, Prishnaparni, Manjista, Lodhra, Chandana and Vata can be used as good healing agent. Even barkof plants can be used.

4. Karanjadya ghrita can also be used in Samyak Dagdha Vrana. Honey and Ghee mixed together can also be used for application.

Treatment Of Atidagdha Vrana

According to sushruta in the case of a burn of a Ati-dagdha type, the loops or dangling integuments (skin) and flesh should be removed, and cold applications should be made over the ulcer. Then the affected part should be dusted over with pulverized Sali rice, or a plaster composed of the pulverized skin of Tinduki and clarified butter pasted together should be applied over its surface. The affected part should be covered over with the leaves of Guduchi or lotus, or other aquatic plants.

So first debridement of charred muscles should be done and then all the cold measures should be employed. Paste prepared out of powder of Shali rice and decoction of bark of Tinduka, which is mixed with milk, can be applied. Then the wound should be covered with leaves of Guduchi and Padmaka. Remaining things are to be followed according to the line of treatment of Pittaja Visarpa.

Later the cold application which is prepared out of Kaseru, Shrinagataka,Kamal, and Bhadra musta and the mud with lotus all triturated together and mixed with Ghee can be done. This paste has to be applied over the cloth, which covers the wound.

The paste prepared by the Sugandhika, Bala, Lamajjakatruna, Chandana, Mukta, Mani and Gairika triturated with milk and mixed with Ghee can be applied. The paste of Propaundarika, Yastimadhu, Ksheera Vidari, Manjista, Padmaka, Chandana and Uthpala Sariva can be used for external application. Parisheka can be done with decoction of vatadi group of medicines and Seka should be done with the Ghee prepared out of same medicines and cold honey with water and sugar with cane juice. Gavyadi Grita can also be employed in Atidagdha Vrana.

Equal quantity of Yavabhasma and Tila Bhasma are mixed with Atasi taila or Tila taila, and then Malahara should be prepared and applied as Lepa. Yava bhasma is mixed with the equal quantity of Tila taila and applied as Lepa.

As an immediate treatment in Atidagdha vrana the honey should be applied and then powder of Yava should be sprinkled over that. It will cool the burning sensation. Tila, which is triturated with butter, prepared by Mahish dugdha and applied over the part, which reduces burning sensation and pain. Root of Jalapippali is to be triturated with water and applied.

Pathyapthya – Do’es and Don’ts in Dagdha Chikitsa

It helps wound to heal rapidly in one who takes boiled old rice or bland, warm semi-solid diet in small quantities and meat of wild animals. Tanduliyaka, Jeevanthi, Sunishannaka, Vastuka, tender Raddish, Brinjal, Patola and Karvellaka should be fried in Ghee and mixed with Dadima, Amalaki, Salt and other substances with similar properties are taken with Mudgha and mutton soup.
The fried and powered gram, medicated gruel and Kala Mustha should also be taken for drinking purpose boiled and coolwater can be made use.