Ashtavidha Shastra Karmiyadhyaya - 25th Chapter of Sushruta Samhita
Ashtavidha Shastra Karmiyadhyaya is the 25th chapter of Sushruta Samhita which explains the Eight kinds of various Surgical operations. Acharya Sushruta is famous for surviving ancient treatises of medicine in the foundation of Ayurveda. Susrhuta was an ancient Indian Surgeon who lived in 1000-800 BC. He is the main source of knowledge about surgery in the Ancient time. It has 120 surgical instruments and 300 procedures and these are classified into 8 categories. Astanga Sangraha, Charak Samhita, and Sushruta Samhita are collectively referred to as the Brihat Trayis, or "Greatest Trio of Ayurveda." In this article, we are going to discuss the various explanations that are explained in this chapter and about various procedures done in surgery.
An old Sanskrit text called the Sushruta Samhita contains poems on both surgery and medicine. It explains the numerous treatments that can be used to treat the sick person and maintain the health of the healthy person. Sanskrit, which is broken up into two pieces, is used to write the whole script. The Second Part is the distinct volume "Uttaratantra," and the First Sthana is made up of 5 Sthanas. In the Sushruta Samhita, two aspects are mentioned: Shalya and Shaarira. The Sushruta Samhita, which talks about weapons and arrowheads to remove foreign items from the body and contains big and minor procedures, is where Shalyantantrum is mostly covered. It consists of 186 Adhyayas divided into 6 Sthanas, each of which comprises many chapters called Adhyayas. The concept of Shalya Tantra (surgical science) explains various operations such as Rhinoplasty (remarking the nose) and Lithotomy (it is a surgical incision in the hollow organs).
Sthana—Number Of Adhyayas
There are eight udara rogas, eight types of suppression of urine, eight defects of breast milk, eight defects of semen, seven types of leprosy, seven diabetic boils, seven types of erysipelas, six types of diarrhoea, six types of udavarta, five types of gulma, five disorders of spleen, five types of cough, five types of dyspnea, five types of hiccup, five types of thirst, five types of vomiting, five types of anorexia, five head diseases, five heart disorders, five types of anaemia, five types of insanity, four types of epilepsy, four eye diseases, four ear diseases, four types of coryza, four mouth diseases, four diseases of grahani, four types of intoxication, four types of fainting, four types of wasting, four types of impotency, three types of swelling, three types of vitiligo, three types of internal haemorrhage, two types of fever, two types of wounds, two types of contractures, two types of sciatica, two types of jaundice, two types of ama, two types of vatarakta, two types of piles, one urustambha, one coma, one type of mahagada, twenty groups of krimis, twenty types of prameha, twenty types of yonivyapat. Thus forty eight disease syndromes have been mentioned in this context.
- Sutrasthana - 46
- Nidana Sthana - 16
- Sharirasthan - 10
- Chikitsa Sthan - 40
- Kalpasthan - 08
- Uttaratantra - 66
- TOTAL - 186
1. Chedya Rogas (Diseases which require excising)
The disease which can be treated with excision (removing or cutting) are-
- Fistula in ano
- Pigmented moles
- Palatine inflammatory
- Excessive granulation of tissue
- Sataponaka (a rectal fistula type)
- Ulceration in Penis
2. Bhedya Rogas (Diseases requiring incision)
These diseases require an incision which is open during cutting as follows-
- The abscess which involved tridoshas
- Axillary and inguinal lymphadenitis
- Diabetic eruptions (carbuncles)
- Abscess present in the foot
- Inflammation of penis
- Tonsillar abscess
- Small tumour in the throat region
- Calculus in the Bladder Region
- Diseases of the Adipose tissue
- Tumour of the palate
3. Lekhana Rogas (Diseases which require Scraping)
These diseases are treated with Scraping as follows-
- Swelling on the region of the tongue
- Diseases of the Eyelids
- Thickening of the muscles
4. Vedhya Rogas (Diseases which require Puncturing)
These diseases require Puncturing as follows-
- Venepuncture of the veins
5. Eshya Rogas (Diseases which require probing)
These diseases which are treated with probes are as follows-
- Foreign Body
6. Aharya Roga (Diseases that require extract)
The diseases which require removal are as follows-
- Three types of Sharkara (urinary gravel, Foot corn and vesical calculus)
- Dental Tartar
- Sordes of the teeth
- Ear wax
- Obstructed labour
- Faecal scybala
- Various foreign body
7. Sravya Rogas (Diseases which require draining)
There are various diseases which are treated with Draining of waste products such as pus and blood as follows-
- Localised inflammatory oedema
- Diseases of the ear lobe
- Benign Tumour
- All kinds of Granthi (cysts and tumours)
- Sinus in the tooth
- Inflammation of the tongue
- Porous gums
- Hypertrophy of gums
- Spongy gums and suppurative gingivitis
- Inflammation of the lips
8. Sivya Rogas (Diseases which require Suturing)
- The diseases that arise from fat (tumours)
- The diseases that have been cut
- Which has been scraped
- The various traumatic wound
- The diseases of movable variety
9. Contraindications Of The Suturing
- Diseases (wounds) that are caused due to Alkali, Fire and Poison further emit the air (gas form) from inside.
- Those who have blood and various foreign bodies should be sutured.
- But these wounds must be purified well so as must remove all the accumulations from the wound.
10. Precautions Before The Suturing
- Sand, Hair and Nails or some leftover pieces that are left or moving inside the wound, when not removed cause excessive suppuration which leads to many types of pains in the body.
- So, it must be carefully removed and the wounds must be cleared well
11. Sivana Vidhi- Sivana Sutra ([Procedure of suturing and its materials)
- The wounds must be elevated (raised slightly) must be placed higher than the normal position and must be sutured with the below-mentioned things- with the thin bark of (Asmantaka, Flax, jute and linen), Fine threads, Horse Hair, with the fibre of Murva and Guduchi, with ligaments.
- There are two types of suture materials that are absorbable and non-absorbable suture. In Absorbable sutures, Catgut Suture is the best. In Nonabsorbable sutures, Nylon is a commonly used material for sutures.
12. Types Of Sutures
- Gophanika (reinforcing suture)
- Tuna Sevani (Draining suture)
- Ruju Granthi (interrupted suture)
13. Type Of Needles And Their Location
- The round needles (cylindrical and straight) should be 2 Angula in length and should be sutured in that part of the body that has less muscle mass and the sutures over the bony joints.
- In the fleshy regions of the body, which have more muscle mass the suture must be Triangular (which has three borders and the straight needles).
- The needle of 4 Angulas is considered Ideal.
- For suturing on the Vitals parts of the body on the Scrotum and abdomen a curved bow is used.
- In sutures, three types of needles are used which should have sharp points so that they should be made as the Hind Tips should be round which resemble a stalk of Malti flowers.
14. Distance Between Sutures
- While using the needle (suturing the edges of the wound), the sutures must not be very far or very near (from one pinhole to another).
- If the punctures are far, they give rise to pain at the edge of the wounds, and if it is very near it gets torn.
15. Postoperative-Care Of Suturing
- After the process of suturing is done, the wound must be covered with the cotton linen cloth which must be sprinkled with the Powder of Priyangu, Anjana (Sauviranjana), Yashti and Rodra and the fruits of Shallaki which must be bandaged properly along with the food activities to be advised.
16. Shastra Karma Vyapat (Complication Of Surgery)
In the eight kinds of surgical operations, there are 4 complications that might occur-
- Hina Cheda (inadequate cutting)
- Atirikta Cheda (excess cutting)
- Tiryak Cheda (Oblique cutting)
- Atmana Cheda (accidental trauma)
17. Loss Of Improper Procedures Of Surgery
- The Physician performs various surgical operations improperly (bad instruments) due to ignorance, greed, provoking phrases, Confusion and many more factors that lead to various diseases.
- The person who has a desire for life, must reject the treatment and use Cautery, various sharp instruments, thermal cauterization and medications in an improper manner.
- The instruments that are made by foolish physicians produce a severe type of pain in the vital points, Joints, ligaments and bones which can cause severe loss of life.
18. Shastrakarma Vyapat Lakshana
- Loss of Activity of the various body parts
- Increase in the temperature of the body
- Weakness in parts of the body
- Vata doshas which is abnormally moving in the upward direction
- Increased expiration
- Severe pain by vata doshas
- The blood that flows out causes the cessation of the sense organs.
- When all five (Vital spots, Joints, veins, tendons and bones) are injured
- When all the veins are cut or torn there will be a large amount of bleeding from the wound, the blood resembles Indragopa (the cochineal insect which is bright red in colour)
- This aggravation of Vata doshas leads to many types of diseases.
19. Symptoms Of Injury To Ligaments Include
- Injuries to the ligaments
- Hunchback type of deformity
- Weakness in the parts of the body
- Severe Excruciating pain
- Loss of functions
- Inability to perform the actions
20. Symptoms Of Movable And Immovable Joints
- oedema has greatly increased
- Severe pain
- Loss of strength of joints
- Splitting pain and oedema in the small joints
- Loss of functions of joints
21. Symptoms Of Cuts In The Bones Include
- Severe pain in the body constantly
- No comfort in any postures
- Weakness of the body
22. Symptoms Of Injury To The Vital Spots Relating To The Muscles Include
- Loss of Sensation of Touch
- Anaemic in the colour of the parts of the body
The Physician who causes injury to the patient while performing various activities should be considered as a mean fellow and the intelligent person who wants to live a long life must avoid these Quack Surgeons who kill the life of the patient.
23. Aturva Visava (Faith Of Patient)
- Although the patient might question his own mother, father, son, and other relatives, he responds to the doctor's faith and submits to him, not suspecting him.
- The doctor gains money with his effective treatment-
- even life in paradise, tremendous respect from the wise
Acharya Sushruta is famous for surviving ancient treatises of medicine in the foundation of Ayurveda. Susrhuta was an ancient Indian Surgeon who lived in 1000-800 BC. He is the main source of knowledge about surgery in the Ancient time. It has 120 surgical instruments and 300 procedures and these are classified into 8 categories. The concept of Shalya Tantra (surgical science) explains various operations such as Rhinoplasty (remarking the nose) and Lithotomy (it is a surgical incision in the hollow organs). In this article, we discussed the various types of Sutures, the procedure of Sutures and the Wiseful act of the Physician in this chapter in detail.