Agraopahrniye Adhyay - 5th Chapter of Sushruta Samhita
Sushruta is known as the father of the surgery. Acharya Sushruta wrote Sushruta samhita in which he explained about the instruments, procedures, diseases and their management. Sushruta samhita is the best textbook to have a deep knowledge about medicine and surgery. In this article we will discuss the fifth chapter of the Sushruta samhita named as a agraoparhaniye adhaya.
In this chapter there is mention of the Trividha karma (Purva, Pradhana, Pashchat karma) which is supposed to be done while performing a procedure. The eight types of shastra karma which are Chedana (Excision), Bhedana (Incision), Lekhana (Scraping), Vedhana (Puncturing), Eshyna (Probing) etc. Equipment used in the procedures, also how to incise or excise the wound, what are the precautions and techniques mentioned in this chapter.
- Purva Karma (Pre operative procedure)
- Pradhana Karma (Operative procedure)
- Paschat Karma (Post operative care)
Primacy Of the Shastra Karma
In this treatise, due to primacy of the Shasta karma, firstly the equipment are explained.
Ashtavidha Shastra Karma
- Chedana (Excision)
- Bhedana (Incision)
- Lekhana (Scraping)
- Vedhana (Puncturing)
- Eshyna (Probing)
- Aaharan (Extraction)
- Vaisravana (Drainage)
- Sevana (Suturing)
- Yanta (Blunt instruments)
- Shastra (Sharp instruments)
- Ksara (Caustics)
- Agni (Fire cautery)
- Shalaka (Probe)
- Shringa (Horn)
- Jalouka (Leeches)
- Alabu (Gourd)
- Jaumboushta (Cauterizing instrument of black stone)
- Pichu (Swab)
- Plot (Gauze)
- Sutra (Suture and ligature material)
- Patra (leaf)
- Patti (Dressing)
- Madhu (Honey)
- Ghrut (Ghee)
- Kshir (Milk)
- Taila (Oil)
On an Auspicious day and time, in Shivadi muhurta, Ashwani Nakshtra, offer prayings to the brahmins and the vaidya's with curd, yava, food and other gems. After offering prayers, give light food to the patient, Ask him to Sit in a East Direction, physicians Facing west, protecting the vital organs, use the weapon until the pus comes out. The weapon should be used once, not again and again. If the inflamed site is more, the one should not make an incision more than two or three Angula.
Qualities of a Good Incision
- Aayat (Adequate length)
- Vishal (Adequate extensibility)
- Sama (Regular and uniformly cut edges)
- Suvibhakta (well differentiated)
The correct incision is which has optimal length, optimal width, which do not have zig zag corners, do not hamper the internal structures, the one in which it does not contain pus cells etc. and the one which is excised at the correct stage.
Qualities Of A Surgeon
- Shourya (Boldness)
- Ashukriya (Swiftness in action)
- Shastra takshanya (Sharpness of his instruments)
- Asweda (No sweating)
- Avepathu (No trembling)
- Asamoah (Confidence)
Counter Excision And Multiple Excision
If in case after one incision in abscess, the pus has not excised yet or the other content is not properly cleaned, at that time another incision can be made. In the places in which you can find the pus inflammation, one should incise that point so that there will be no pus remains.
In cheeks, eyebrows, forehead, behind ears, eyelashes, lips, gums, abdomen, axilla, the Excision should be made oblique.
In hands and Legs, the excision should be in circular form (Ardhachandra akar)
In anal region or male genital organ (Medra) should be in Ardhachandrakar (Half Circular)
If the incision is not made like this, there is more pain, chronicity, and thickening of the tissues can happen.
Diseases To Be Managed Empty Stomach
- Mudagarbha (Malpresentation)
- Udar roga (Abdominal diseases)
- Arsha (Piles)
- Ashmari (Urinary Calculi)
- Bhagander (Fistula-in-ano)
- Mukha roga (Oral diseases)
Post Operative Procedure After A Surgery
After excising the foreign body from the wound, Sprinkle the cold water, Squeeze the abscess from all sides and press the wound with the help of the fingers. Wash the wound with a gauze with water and kashaya.
After that take tilakalka, madhu, Ghruta and other herbs which are to be applied with the help of gauze and that gauze is kept inside the wound.
Then cover it with help of kalka () and tie it with a cloth. After that Do Dhupana with vedanahar and rakhshogan hingulvadi gana and also chant rakshoghna mantra.
- Guggulu (Commiphora mukul)
Take all these in powder form and mix it with lavan (Salt), nimba patra (Neem leaves), and Ghruta (Ghee) and do the dhupana. The ghruta/ ghee left is used for mardana of the other vital structures.
I will do this raksha karma to avoid fear of the demons. mat y brahma deva approve this. Naga, pishach, gandharv, pitara, yaksha, rakshas etc. whoever gives you the pain, may brahma adi gods destroy them. In this earth, sky, in all directions, In your home whosoever demons live, May he gets pleased with your prayers and protects you. May all brahma rishis, deva rishis, raj rishis, mountains, seas, oceans protect you. May agni (fire) protect your tongue. May Vayu (Air) protect your life, soma protects Vyana vayu, Parjanya (Rainy season) protects your apana vayu. May electricity protects your udan vayu, indra deva protects your Satva (Mind) and manu protects your neck veins and intelligence. May sun protect your eyes, directions protect your ears, moon protects your mind and beauty, night protects your Shadow always. May water increases your semen, akasha protects your channels, prithvi protects your body, hope all this protects you and increases your lifespan, May god bless you, May Moon and Sun bless you, May vayu, agni, indra, rishi's may bless you. May you always stay healthy and Disease free.
After this mantra recitation, ask the patient to go inwards and all the dietary regime with the precautions (Post Operative instructions) is explained to them.
Time To Change The Dressing Of The Wound
You should change the dressing of the wound every 3 days and fresh dressing is to be done after washing it with the Decoction of the Sadyo Vranokta drugs. The wound should not be undressed too early. If it is undressed early, it may cause thickening of the tissue and increase the duration of healing, which increases the pain sensation at the area.
After the third day they examine the dosha, kala, strength of the person, and do the arrangement of the decoction of the herbs, local application of herbal paste, food etc. until the wound gets recovered.
Things To Be Avoided
The following things are to be avoided till the Firmness of the wound
Dressing Of The Wound According To The Season
- In early winter, winter, spring the dressing of the wound should be every third day.
- In autumn, summer and rainy season, the dressing of the wound should be on every second day.
- Ethics in emergency.
- In case of emergency, the doctor does not need to follow all these ethics but the immediate action should be taken.
Post Operative Sedation
If the patient is in severe pain after the incision then one should irrigate the part with mulethi Ghruta (Lukewarm).
This chapter told us everything about the Shastra karma, the qualities of the surgeon, how we have to incise a wound and what precautions should be taken. The preoperative operative, Operative, Post operative procedures are explained. Along with this the raksha karma is also explained.