A Comprehensive Guide to Ayurvedic Specialties
In Ayurveda, Bhagna refers to the loss of continuity or breaking of a bone (asthi) due to trauma. It is a major type of injury (Abhighataja Vikara) and is considered one of the Asthi Mahagada (major diseases of the bone) due to its serious nature and potential complications if not treated properly.
The management of fractures is a highly developed specialty in Ayurveda, known as Bhagna Chikitsa. The ancient seers described principles of fracture management that are remarkably similar to modern orthopedics, including traction, manipulation, immobilization, and physiotherapy.
The causes are primarily traumatic and mechanical. Classical texts provide clear lists.
Classical Reference:
अत्युच्छ्रितादवपतनं निपातो वाहनादपि ।
पतन्तामभिघातश्च भग्नं तच्च द्विधा भवेत् ॥
(अष्टाङ्ग हृदयम्, निदानस्थानम्, अध्याय २५)
Translation: "Falling from an excessive height, a simple fall, even from a vehicle, and a blow from falling objects – these are the causes of fracture. And these fractures are of two types (Sandhimukta - involving joints and Kandabhagna - shaft fractures)."
Summary of Causes (Hetu):
Abhighata (अभिघात): Direct trauma or blow from a heavy object.
Patana (पतन): Falling from a height (e.g., tree, building).
Avasanna (अवसन्न): Crushing injuries (e.g., under a vehicle or wall collapse).
Aakasmat Prapatana (आकस्मात् प्रपतन): Sudden, accidental falls on a hard surface.
Vegavadhana (वेगावधान): Sudden, forceful twisting or jerking of a limb.
For traumatic fractures, prodromal symptoms are not typically described as the event is sudden and acute. However, in cases of pathological fractures (where a bone breaks due to an underlying disease weakening it, like osteoporosis or bone cancer), the prodromal symptoms would be those of the underlying disease (e.g., pain in bones, weakness, swelling).
The texts provide very clear and accurate clinical signs to diagnose a fracture.
Classical Reference (Sushruta Samhita):
स्वस्थानाच्चलितं शूनं सवर्णं वा विवर्णताम् ।
व्रजत्यतिविवृद्धं च भिन्नं तोदभृशार्ति च ॥
न स्पृहोत्साहशक्तीनां तस्य तत्र भवन्ति हि ।
(सुश्रुत संहिता, निदानस्थानम्, अध्याय १५)
Translation: "The (limb) is displaced from its original position, swollen, discolored or of abnormal color, excessively enlarged, pierced (with broken ends), and afflicted with pricking and severe pain. In that (fractured limb), there is no desire for movement (function), enthusiasm, or strength."
Summary of Signs & Symptoms (Roopa):
1. Shula (शूल): Severe, excruciating pain.
2. Shotha (शोथ): Swelling and inflammation.
3. Vivarnata (विवर्णता): Discoloration (blue, black, red) due to bleeding.
4. Sthana Chalana (स्थानचलन): Abnormal mobility or movement at the fracture site.
5. Chipita (चिपिता): Crepitus (grating sound felt or heard on movement).
6. Vakraiva (वक्रत्व): Deformity or shortening of the limb.
7. Bala-hani (बलहानि): Loss of strength and function in the affected limb.
8. Sparshaghnata (स्पर्शाघ्नता): Loss of sensation (in severe cases with nerve damage).
This is less about diagnosis and more about the principles of treatment that bring relief. The relief (upashaya) in fracture comes from proper immobilization and bone-setting techniques.
Upashaya (What helps): Proper reduction (Samhanana), splinting with wooden planks (Kāṣṭha), and bandaging (Bandhana) to immobilize the limb brings immediate relief from pain and prevents further damage.
Anupashaya (What doesn't help): Movement, weight-bearing, and massage of the fracture site will aggravate the pain and deformity.
The pathogenesis is direct and mechanical.
1. Nidana Sevana: Exposure to the causative traumatic factor.
2. Dosha Prakopa: The impact primarily vitiates local Vata Dosha and Rakta (blood). Vata is responsible for movement, and its aggravation causes severe pain, deformity, and loss of function. The injury to tissues causes bleeding, vitiating Rakta and Pitta, leading to swelling, inflammation, and discoloration.
3. Dushya: The main tissue affected is the Asthi Dhatu (bone tissue). Mamsa (muscle), Snayu (ligaments/tendons), and Siras (blood vessels) are also damaged.
4. Srotas: Asthivaha Srotas (channels carrying bone tissue) and Raktavaha Srotas (channels carrying blood) are obstructed.
5. Agni: No significant role in acute trauma, but Asthi Dhatvagni (metabolic factor of bone tissue) is crucial for the healing phase.
6. Udbhava Sthana: Site of injury.
7. Vyaktasthana: Site of injury (the fractured bone).
8. Roga Marga: Abhyantara (internal) as the bone is a deep tissue, but the manifestation is Bahya (external).
Samprapti Ghataka Summary:
Dosha: Vata (~90%), Pitta, Rakta
Dushya: Asthi, Mamsa, Snayu, Sira
Srotas: Asthivaha, Raktavaha
Srotodushti Prakara: Sanga (obstruction)
Agni: Asthi Dhatvagni Mandya (in healing phase)
Utsarga: Ama production from immobility can occur, complicating healing.
Classical Reference:
काण्डभग्नं सन्धिमुक्तं विद्धं अस्तिप्रभेदितम् ।
पिच्चितं अतिपिच्चितं च श्लक्ष्णं चेति च तद्विधम् ॥
(सुश्रुत संहिता, निदानस्थानम्, अध्याय १५)
Types:
1. Kandabhagna (काण्डभग्न): Fracture of the shaft of a long bone.
2. Sandhimukta (सन्धिमुक्त): Dislocation of a joint (often grouped with fractures).
3. Viddha (विद्ध): Punctured or perforated fracture.
4. Asthi Prabhedita (अस्थिप्रभेदित): Comminuted fracture (shattered into multiple pieces).
5. Picchita (पिच्चित): Crushed fracture.
6. Atipicchita (अतिपिच्चित): Severely crushed fracture.
7. Shlakshna (श्लक्ष्ण): Greenstick fracture (incomplete fracture, common in children).
Modern Correlation: Bhagna directly correlates with fractures in modern medicine. The types described by Sushruta align with modern classifications like simple, compound, comminuted, greenstick, and displaced fractures.
Lab Investigations:
Radiography (X-Ray): The primary and gold-standard investigation to confirm the diagnosis, locate the fracture line, see the type of fracture, and assess the alignment after reduction. CT scans may be used for complex joint fractures.
Blood Tests: Not for diagnosing the fracture itself, but to:
Rule out infection (Total Leukocyte Count - TLC, ESR, CRP) in compound fractures.
Check hemoglobin levels if significant blood loss is suspected.
Assess calcium, vitamin D, and Alkaline Phosphatase levels if a pathological fracture is suspected (e.g., osteoporosis).
5. Chikitsa Sutra (Line of Treatment)
The Ayurvedic management is systematic and happens in stages:
1. Reduction (Samhanana / Peedana): Bringing the fractured ends back into alignment. This is done through traction and counter-traction.
2. Immobilization (Bandhana / Plaster): Using splints made of light wood, bark, or other materials (now often replaced with plaster of Paris casts) to hold the reduction in place. The texts emphasize that the splint should not be too tight or too loose.
3. Oral Medication (Bheshaja):
Anti-inflammatory & Analgesic: Yogaraja Guggulu, Mahayogaraja Guggulu, Singh-nada Guggulu to reduce pain and inflammation (Vata and Rakta).
Bone Healers (Asthi Sandhanaka): The most crucial medicines. Laksha Guggulu, Pravala Pishti, Mukta Pishti, and compounds containing Laksha (Laccifer lacca), Hadjod (Cissus quadrangularis), and Ashwagandha (Withania somnifera).
4. Diet (Ahara): A diet rich in calcium, protein, and nutrients that support bone healing. Milk, ghee, sesame seeds, and bone broth are highly recommended.
5. Rehabilitation (Paschat Karma): After removal of the splint, medicated oil massage (Snehana), fomentation (Swedana), and physiotherapy are essential to restore strength, movement, and function to the muscles and joints.
This comprehensive approach ensures not just the union of the bone but the complete functional recovery of the patient.