Issue : 01 DOI :
INTERNATIONAL
JOURNAL
OF
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AND
RESEARCH
Volume : 02
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Abstract
Background: Acharya Sushruta, the pioneer of surgical science in Ayurveda, described Bhagna Chikitsa-a detailed
and structured approach to the management of fractures (Asthi Bhagna) and joint dislocations (Sandhi Moksha)-
centuries ago. His principles, developed through direct clinical observation, continue to hold practical relevance in
the modern orthopaedic landscape.
Objective: This review aims to explore the foundational principles of Sushruta’s Bhagna Chikitsa, understand their
physiological rationale, and assess their relevance and integration potential in contemporary fracture care.
Methods: An analytical review of classical Ayurvedic texts including Sushruta Saṃhitā, Aṣṭāṅga Hṛdaya, and
supportive Nighaṇṭu literature was conducted, along with comparison to modern orthopaedic principles. Key
therapeutic strategies, anatomical classifications, and post-fracture rehabilitation methods were identified and
interpreted in the context of biomechanics and healing physiology.
Results: Sushruta’s fourfold treatment sequence—Anchana (traction), Pidana (compression), Sankshepana
(alignment), and Bandhana (immobilisation)—provides a biomechanically sound approach to fracture management,
remarkably aligned with modern reduction and stabilisation protocols. His use of herbal formulations (Asthi-
sandhaniya dravyas) and natural splint materials reflect both clinical ingenuity and ecological adaptability. The
emphasis on diet, rest, and graded physiotherapy (mud ball, rock salt, stone lifting) reflects an early appreciation for
holistic rehabilitation.
Conclusion: Sushruta’s Bhagna Chikitsa represents not just a historical account, but a timeless clinical framework
with strong anatomical, biomechanical, and therapeutic foundations. Its integration into modern fracture care,
particularly in conservative or resource-limited settings, offers a promising, patient-centred approach for fracture
management.
Keywords : Bhagna, Laksha Churna vati, Sushruta, Integrative Fracture Management
P
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Corresponding author: Dr. Aniruddha Pawar
Article Info: Published on : 15/07/2025
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Fracture Management: A Holistic Review Of Sushruta’s Bhagna Chikitsa
Dr. Dwivedi Amarprakash
1
, Dr.Aniruddha Pawar
2
, Dr.Usman Gani Dhange
3
1
Professor, Shalya Tantra Department, D. Y. Patil School of Ayurved, Navi Mumbai, Maharashtra, India.
2
Assistant Professor, Shalya Tantra Department, D. Y. Patil School of Ayurved, Navi Mumbai, Maharashtra, India
3
P G Scholar, Shalya Tantra Department, D. Y. Patil School of Ayurved, Navi Mumbai, Maharashtra, India.
Cite this article as: - Dr. Aniruddha Pawar (2025) ; Fracture Management: A Holistic Review Of Sushruta’s Bhagna Chikitsa
;Inter.J.Dignostics and Research 2 (4) 107-114 , DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 6 0 4 1062
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Introduction :
Fractures, or the disruption of bone continuity due
to mechanical trauma or pathological weakening,
represent a significant burden in both emergency
care and rehabilitative medicine. Epidemiological
studies suggest that the prevalence rate of fractures
annually exceeds more than 178 million per year,
with incidence projected to rise due to increasing
road traffic accidents, aging populations, and
sports-related injuries
[1,2].
In classical Ayurvedic literature, fractures are
broadly explained under the term Bhagna, which
includes both bone fractures or Asthi-bhagna and
joint dislocations or Sandhi-moksha. Acharya
Sushruta has provided a detailed description of
fracture classification, pathogenesis, and holistic
management. Trauma (Abhighāta) or weakness in
Asthi dhātu (bone tissue) due to improper nutrition
or underlying disease leads to the manifestation of
fracture or dislocation. Importantly, proximity of
fractures to vital anatomical landmarks (Marma
sthāna) further determines the prognosis of bhagna.
[3]
These include procedures such as Bhagna
sthāpanā (realignment), Bandhana by using
splinting using organic materials like bark, cloth, or
grass etc, and adjuvant oral administration of
promoting bone healing formulations such as
Laksha, Ashwagandha, Guggulu, and various
medicated ghrita preparations
[4,5].
Similarly modern orthopaedics categorises fractures
based on anatomical location, pattern, and extent of
displacement, guided primarily by radiological
imaging. Although surgical stabilization and
internal fixation have revolutionized fracture care,
complications such as delayed union, malunion,
and infection remain concerns. Moreover, limited
access to high-cost surgical care in many rural
settings highlights the need for a safe, conservative,
and evidence-based alternative management.
[6]
This review article aims to bridge the perspectives
of traditional Ayurvedic and modern biomedical
approaches to fracture management. Drawing from
classical textual sources and recent clinical studies,
we outline the integrative potential of Bhagna
Chikitsā in the current orthopaedic stream.
2. Methods / Sources of Evidence :
This review complies data from both classical
Ayurvedic texts and contemporary biomedical
literature to examine the multifaceted approach to
the diagnosis and management of fractures
(Bhagna).
2.1 Ayurvedic Literary sources -
Primary Ayurvedic content was extracted from
original Sanskrit reference books, particularly:
The Sushruta Saṃhitā, considered the
authoritative text on surgical and traumatic
conditions—especially Bhagna and
Sandhimoksha—with comprehensive detail
on types, symptoms, prognostic features,
and stepwise therapeutic strategies.
[7]
The Aṣṭāṅga Hṛdaya of Vāgbhaṭa, which
outlines medicinal formulations (yogas),
dietary do's and don'ts (pathya-apathya),
and practical procedures relevant to fracture
healing.
[8]
Additional insights were drawn from the
Bhaiṣajyaratnāvalī and classical Nighaṇṭus
(Ayurvedic lexicons), which catalogue a
wide range of Asthi-sandhāna dravyas-
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herbal and mineral substances known for
bone-regenerative properties—such as
Lakṣā (Laccifer lacca), Śankha bhasma,
Godanti, Guggulu, and Asthiśṛṅkhalā
(Cissus quadrangularis).
[9,10]
All texts were reviewed using standard Hindi and
English commentaries (e.g., Dalhaṇa, Hemādri) to
ensure doctrinal accuracy and contextual
interpretation. Where needed, cross-verification
through modern Ayurvedic research journals (e.g.,
AYUSHDHARA, AYU JOURNAL) was performed.
2.2 Biomedical Literature Review :
Modern scientific evidence was obtained from:
Peer-reviewed journals indexed in PubMed,
Scopus, and Google Scholar, using
keywords such as:“Fracture management,”
“Bone healing,” “Ayurveda in
orthopaedics,” “Bhagna Chikitsa,” and
“Integrative trauma care.”
Authoritative orthopedic texts such as
Rockwood and Green's Fractures in Adults,
which detail fracture classification, healing
biology, surgical and conservative
management.
[11]
Current research articles and clinical
reviews on fracture healing mechanisms—
including osteoblast differentiation, callus
formation, and the effects of herbal/mineral
supplements on bone density and
remodeling.
[12,13]
Global trauma statistics and burden of
disease data from the World Health
Organization (WHO) and Centers for
Disease Control and Prevention (CDC).
[14,15]
Inclusion criteria for selected biomedical
literature:
Articles in English, published between 2000
and 2024
Clinical trials, observational studies, meta-
analyses, or review articles focused on
fracture healing, complications (non-union,
malunion), and conservative/non-surgical
interventions
Reports involving integrative or alternative
medical strategies in musculoskeletal or
orthopaedic rehabilitation
2.3 Clinical Experience and Contextual
Integration:
Where applicable, the review incorporates field
insights from licensed Ayurvedic physicians and
traditional bone-setters (e.g., Bhagna Vaids) in
India. Practices that reflect textual wisdom or
represent region-specific innovations (e.g., Droni,
Kusha-bandhana, oil fomentation) were compared
with published case reports and observational
studies.
[16]
These sources were used cautiously,
with emphasis on triangulation—ensuring
consistency, historical grounding, and evidence for
safety and efficacy.
3. Ayurvedic Management of Bhagna (Fracture)
— Sushruta’s Protocols and Rationale :
Acharya Sushruta describes a structured and
stepwise protocol for the treatment of Bhagna
based on the type, location, displacement, and
complications of the fracture. These steps-anchana
(traction), pidana (compression), sankshepana
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(alignment), and bandhana (immobilization) are
physiologically sound and closely parallel modern
orthopedic principles.
3.1 Foundational Principles of Bhagna Chikitsa :
Acharya Sushruta has mentioned and outlined a
four-steps protocol for the management of fractures
(Bhagna): Anchana (traction), Pidana
(compression or moulding), Sankshepana (precise
approximation), and Bandhana (immobilization).
Similarly, in modern orthopaedics fracture
management emphasizes the same chronology i.e -
restore length, correct alignment, obtain fragment
contact, and lastly stabilize then joint before
definitive fixation or casting .
[17,18]
Anchana
involves the gentle application of traction to the
injured limb. By counteracting muscular spasm and
separating overlapping fragments, traction
facilitates accurate reduction while minimizing
soft-tissues injury. Sushruta’s description
anticipates today’s use of skin or skeletal traction as
a preparatory step for long-bone fractures or for
temporary fracture care when surgery is
delayed.Once length is restored, Pidana—the
judicious use of manual pressure—addresses any
residual depression or elevation of bone fragments.
This manoeuvre is comparable to closed
manipulation performed under anaesthesia in
current practice; it restores anatomical contour and
reduces the risk of angular deformity, thereby
optimizing the surface for callus formation.The
third stage, Sankshepana, focuses on bringing the
realigned fragments into direct contact. Sushruta
advises individual handling of bone ends to achieve
precise apposition, a concept that mirrors the
modern principle that stable bone-on-bone contact
accelerates consolidation and lowers the incidence
of delayed union.Finally, Bandhana secures the
reduction. Sushruta recommends splints fashioned
from the bark of trees such as Ashwatha, Palāśa,
and Bamboo, selected for their firm yet slightly
concave inner surfaces that cushion the limb. He
also stipulates periodic re-bandaging based on
climatic conditions to prevent skin maceration—
guidance strikingly similar to modern cast checks
and bivalving protocols. The underlying goal is the
same: provide sufficient rigidity to prevent
displacement while permitting the micro-movement
essential for healthy secondary bone healing.Taken
together, this quadripartite approach-traction,
reduction, approximation, and immobilisation-
illustrates a timeless surgical framework rooted in
close clinical observation. Its enduring congruence
with present-day fracture management underlines
both the practical wisdom of classical Ayurvedic
surgery and its potential value in integrative
musculoskeletal care.
 [19]
The basic principle of
Bhagna Chikitsa has been mentioned in Table No 1
Step
Description
Modern Rationale
Anchana
Gentle traction to
elongate the limb
and reduce muscular
pull
Prevents overlapping
of fragments,
minimizes spasm
Pidana
Compression of the
elevated part to
restore contour
Similar to
manipulation under
anaesthesia (MUA)
Sankshepana
Approximation of
fragments into their
natural anatomical
position
Ensures contact for
callus formation
Bandhana
Splinting using tree
bark (Ashwatha,
Vata, Palasha, etc.)
Immobilisation—key
for union, matches
POP concept
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3.2 Integrated therapeutic modalities in Bhagna
:The ancillary Therapeutic Measures used in the
management of Bhagna have been mentioned in table
2 along with its modern interpretation and probable
Ayurvedic rationale. Table No. 2
Therapy
Details
Ayurvedi
c
Rationale
Modern
Interpreta
tion
Parisheka
(irrigation)
Continuous
sprinkling of
medicated
liquids (e.g.,
Nyagrodhadi
decoction,
Panchamula-
siddha-
dugdha,
Chakra taila)
Alleviates
pain,
reduces
inflammat
ion,
pacifies
Vata
Cooling,
analgesic,
anti-
inflammato
ry
Lepa
(plaster)
Application
of pastes like
Manjishthadi
lepa
Reduces
swelling
and pain,
aids
healing
Herbal
poultices
with anti-
inflammato
ry and
regenerativ
e potential
Medicated
Oils
Gandha
Taila,
Bhagnasand
hana Taila,
Chakra
Taila
Promote
Asthi-
dhatu
poshan,
strengthen
healing
Shown in
studies to
enhance
osteogenes
is
Asthisandha
niya Yogas
Laksha
Guggulu,
Ashwagandh
a, Pravala
Bhasma,
Sudha
Bhasma
Enhance
callus
formation
and union
Contain
calcium,
flavonoids,
adaptogens
—aid bone
repair
3.3 Salutatory recommendations (Pathya-Apathya)
Pathya (Wholesome): Milk, ghee, meat
soup (mamsa rasa), Shali rice
Apathya (To Avoid): Salt, sour/pungent
foods, excessive exertion, sun exposure,
sexual activity
These restrictions are intended to pacify Vata, reduce
inflammation, and provide anabolic nourishment.
Protein-rich and lipid-based diets are aligned with
modern fracture healing guidelines requiring high
protein, calcium, and vitamin D intake.
3.4 Rehabilitation Measures (Physiotherapy in
Ayurveda) Sushruta prescribes gradual
mobilization post-fracture union using:
Mud ball holding (Mṛitapinda)
Rock salt (Lavana dharana)
Stone weights (Pāṣāṇa dharana)
This graded weight training mirrors modern
physiotherapy protocols, starting from passive to
active resistance exercises to restore muscle tone and
joint mobility.
[20]
4. Clinical Implications
The Ayurvedic approach to Bhagna Chikitsa, as
detailed by Acharya Sushruta, offers a time-tested,
biomechanically sound, and clinically adaptable
framework for fracture management. Its continued
relevance is evident not only in its structural logic but
also in its therapeutic versatility, especially in contexts
where access to advanced surgical care may be
limited. The four foundational principles i.e Anchana
(traction), Pidana (compression), Sankshepana
(alignment), and Bandhana (immobilisation) are the
essential pillars of modern orthopaedics, highlighting
the deep empirical insight embedded in classical
surgical literature. The use of splints made from
natural materials, the timing of re-bandaging based on
seasonal variation, and the emphasis on repositioning
before immobilisation underscore Sushruta’s
pragmatic understanding of wound biomechanics,
pressure care, and tissue perfusion issues still central
to current fracture care protocols. Of particular
significance is Sushruta’s emphasis on post-union
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physiotherapy, as seen in his recommendation of mud
ball, rock salt, and stone lifting (Sushruta Samhita,
Chikitsasthana 3/70). This graduated approach to
muscle strengthening and joint mobility restoration
resonates with the principles of modern
physiotherapy. It supports the idea that recovery does
not end with union but must be followed by
progressive rehabilitation to achieve functional
restoration. Additionally, the pharmacological arm of
Bhagna Chikitsa through drugs like Laksha,
Asthishrinkhala, Ashwagandha, Guggulu etc
showcases potential for integrative rehabilitation
management. Several of these herbs have
demonstrated anabolic, osteogenic, and anti-
inflammatory effects in both classical observations
and preliminary modern research which can be seen in
various drug clinical trials conducted such as use of
Laksha Churna Vati in the management of Avran
Kand Bhagna.
[21]
5. Conclusion :
In the context of contemporary fracture management
by conventional Ayurvedic modalities of Bhagna,
when applied with authentic approach can reduce
dependence on surgical interventions, lower
hospitalisation costs, and minimise complications
such as infection. A synergistic, integrative model that
combines modern diagnostic tools and fixation
techniques with Ayurvedic internal medications,
external therapies, and structured rehabilitation
protocols offers a promising, patient-centered
approach fracture management. To strengthen this
integrative framework, further research is essential
particularly in the form of randomised controlled
trials, radiographic outcome studies, and
biomechanical evaluations of traditional splinting and
herbal formulations. Ultimately, this review
underscores the scope, strengths, and evolving
evidence base of Bhagna Chikitsa, and advocates for
its thoughtful integration into modern orthopaedic
practice for safer, holistic, and accessible fracture
management.
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