The Science of Treating Fractures
Hi! My name is Anand. I come from Trichur in Kerala. Unfortunately, my life is far from happy right now! I was involved in a bad bike accident and ended up with a couple of fractured bones. Since then I have been in bed, bandaged and immobilized. There is also a long process of rehabilitation ahead. The next few months are definitely not going to be easy.
Unable to move, I decided to do some reading up on fractures. My main aim was to try and figure out when I could finally get out of bed and move on with my life. During my research, I stumbled upon the fact that orthopaedic medicine existed in ancient India and that Ayurveda is pretty effective in treating fractures. In fact my home state Kerala, excelled in treating orthopaedic problems through Ayurveda. I was surprised. I know it’s silly, but somehow I always thought of fractures and orthopaedic treatments as ‘modern’!! Anyway, I am so amazed at the fact that our forefathers and ancient vaidyas were able to set, mend, repair and rehabilitate broken bones that I thought I would share this knowledge with you.
Bhagna or Fractures
Sushruta, one of the greatest and oldest Ayurvedic practitioners, was the pioneer in treating fractures. Ayurveda’s term for fractures is bhagna. Bhagna literally means breach or break in the movement or continuity of bones. The Sushruta Samhita – Sushruta’s all encompassing medical treatise – lays down in great detail the kinds of fractures and how they can be managed effectively. Apparently, the principles of fracture management laid down by Sushrutha sometime in 1st BC are the same as that followed in the 21st century world by modern medicine. That was truly a mind boggling discovery!
The treatise recognises 12 kinds of fractures and six kinds of dislocations. The bone fractures are classified into Karkataka, Aswakarana, Churnitam, Picchitam, Asthichallita, Kandabhanga, Majjanugatam, Atipatitam, Vakra, Chinnam, Patitam and Sputita. These terms are used to describe the severity or kind of fracture. For example, Chinnam refers to incomplete fractures, while Kandabhanga is complete spinal fracture. Majjanugatam is impacted fracture and Atipatitam is complete compound fracture.
Given the lifestyle of the times, Sushruta detailed the causes of fractures as falls, beatings, blows, excessive movements, pressure and bites or attacks from wild animals. However, as in modern medicine, Ayurveda too recognises that trauma is the root cause for any bone injury. The Samhita also points out that the fracture can either be at the joint of the bone (sandhighata) or in places other than the joint (asandhigata). I found this particularly interesting because I have both sandhigata and asandhigata fractures!
Of course, there were no handy X-ray machines in those days to find out the exact nature of the fracture. But Sushruta used physics to develop excellent diagnostic tools that vaidyas could use to treat fractures. He studied the shape and structure of the bones to find out how force could impact them. This led him to conclude that trauma will make cartilages bend, long bones will break and flat bones will crack. Smaller bones will fragment when force is applied on them. He also described clinical features that an Ayurveda practitioner can use to diagnose fracture. These include pain, inflexibility of limb, swelling, crackling sound on movement, and discomfort in any position. The diagnostic tools were so well detailed that a fracture could be diagnosed just by touch and feel of the injured area.
Asthibhagna or Fracture Management
The traditional system of fracture management in Ayurveda is known as Asthibhanga. Reading the various features of fracture management made me realise once again the techniques of today are the same as that used all those centuries ago. The Samhita explains it in rather succinct terms. Basically, it states one should rise up the slipped/repressed bone (Unnamanna), press down the elevated one (Vinammana), retract the excessively thrown out bone and pull out that which is moved below. Setting, splinting, bandaging and pain alleviation are an important part of fracture management in Ayurveda. In modern times, rehabilitation includes physiotherapy. In the ancient times, patients were made to undergo massages with medicated oils.
The splints used for immobilizing fractures were obtained from the bark of trees like papal, banyan and bamboo. Once the splint was in place, the wound was bandaged. Interestingly, the bandages were changed depending on the season. They were changed every three days in summers, once a week in winters and every five days during the monsoons. Each time the bandages were changed, the fracture was gently bathed in a decoction of drugs which included ghee, juice of gooseberries, rice flour etc. This decoction was meant to reduce pain and swelling.
Herbs played an important role in fracture management. Gooseberries, oatstraw and comfrey were commonly used to help heal fractures and aid rehabilitation. Guggul and kutki were prescribed to remove toxins and purify the bones. Oil massages were recommended to ensure that the bones returned to their original shape. Fracture management in Ayurveda also imposes certain restrictions. Salty, pungent, alkaline and sour foods are forbidden. Patients are advised to avoid the heat of the sun and any form of physical exercise.
From diagnosis to rehabilitation, Ayurveda has covered every aspect of treatment as far as fractures are concerned. As I read more and more about the details given in the ancient texts, I can only wonder at the wisdom of our ancestors!