ASTAVIDHA SHASTRA KARMA
Introduction :-
Shastra is derived from word sasu which means himsayam.
Any device or instrument which causes injury (intentional injury caused
by the surgeon during operation) to the tissue is considered as Shastra.
Nature of injury depends upon the type of instrument and Nature of
Operation.
Types of Shastra Karma
According to Susruta :-
According to susruta there are 8 types of Shastra Karmas :-
तच्च शस्त्रकममाऽष्टविधं ; तद्यथम- छेद्यं , भेद्यं, लेख्यं, िेध्यम्, एष्यम्, आहमयं, विस्रमव्यं,
सीव्यवमवत || su. su. 5/5
Chhedana, Bhedana, Lekhana, Vedhana, Eshana, Aaharana,
Vistravana, Seevana are the 8 type of shastra Karma.
According to Charak :-
पमटनं व्यधनं चैि छेदनं लेपनं तथम |
प्रच्छनं सीिनं चैि षवविधं शस्त्रकमा तत् || cha. Chi. 25/55
Patana, Vedhana, Chhedana, Lekhana, Prachhana, Sevana are the 6
types of Sastra karma according to Charak.
According to Vagbhata :-
उत्पमट्यपमट्यसीव्यैष्यलेख्यप्रच्छमनकु ट्टनम्
छेद्यं भेद्यं व्यधो मन्थो ग्रहो दमहश्च तवत्ियमाः || Ah. Su. 26/28
Utpatana, Patana, Sivana, Esana, Lekhana, Prachhana, Kuttana,
Chedana, Bhedana, Vyadhana, Manthana, Grahana, Dahana, etc. are
the thirteen (13) types of Shastra Karma according to Vagbhatta.
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Complications of Shastra Karma :-
हीनमवतररक्तं वतयाक् च गमत्रच्छेदनममत्मनाः |
एतमश्चतस्रोऽष्टविधे कमावि व्यमपदाः स्मृतमाः || su. su. 25/30
Vyapada There are 4 types of due to Shastra karma.
Hinachhedana
Atiriktachhedana
Tiryakachhedana
Atmachhedana
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Detailed description of different shastra Karma
Chhedana (Excision) :-
Indications :-
छेद्यम भगन्दरम ग्रवन्थाः श्लैवष्मकवस्तलकमलकाः |
व्रिित्ममाबुादमन्यशाश्चमाकीलोऽवस्थममंसगम् ||३||
शल्यं जतुमविममंससङ्घमतो गलशुवडिकम |
स्नमयुममंसवसरमकोथो िल्मीकं शतपोनकाः ||४||
अध्रुषश्चोपदंशमश्च ममंसकन्द्यवधममंसकाः | su. su. 25/3-4
The Rogas that require excision (Chhedana Karma) are Bhagandara,
Kapha granthi, Tilakalaka, Wound (Vrana), Vartmarbuda, Arsha,
Charmakilla, Asthimamsagata shalya (foreign body lodged in the
bones & muscles), Jatumani, Mamsa Samghata, Galasundika,
Putrifaction of ligaments, muscles, veins, etc., Valmikama,
Sataponaka, Adhrusha, Upadamsa, Mamsaskanda, Adhimamsa, etc.
उद्िृत्तमन् स्थूलपयान्तमनुत्सन्नमन् करििमन् व्रिमन् |
अशााःप्रभृत्यधीममंसं छेदनेनोपपमदयेत् || cha. Chi. 25/58
Vrana Which is along with veins (siras), which is having sthula edge,
which are hard and in Adhimansaja vikara like arsha ; chedana should
be done.
Chedana means cutting of body part (Vrana) & removing from the
body.
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Bhedana (Incision) :-
भेद्यम विद्रधयोऽन्यत्र सिाजमद्ग्रन्थयस्त्रयाः ||५||
आददतो ये विसपमाश्च िृद्धयाः सविदमररकमाः |
प्रमेहवपिकमाः शोफाः स्तनरोगोऽिमन्थकमाः ||६||
कु म्भीकमनुशयी नमड्यो िृन्दौ पुष्कररकमऽलजी |
प्रमयशाः क्षुद्ररोगमश्च पुप्पुटौ तमलुदन्तजौ ||७||
तुवडिके री वगलमयुश्च पूिं ये च प्रपमदकिाः |
बवस्तस्तथमऽश्मरीहेतोमेदोजम ये च के चन ||८|| su. su. 25/5-8
All Vidradhi (abcess) except that produced by tridosha.
Three Kinds of granthi from the beginning (Vataja , Pittaja &Kaphaja).
Three types of Visarpa (Vataja, Pittaja, Kaphaja).
Andravrudhi (enlargement of Scrotum –hernia).
Vidarika (pustule in groin & axilla ), Diabetic eruptions, diabetic
Carbuncle, Shopha.
Diseases of breasts, Avamanthaka (a disease of penis, Suppurated
veneral warts)
Kumbhika Vartma (follicular Conjunctivitis)
Anusayi (abscess of the foot).
Nadee Vrana. The two kinds of Vrinda (Vrindha and ekavrindha –
Small tumor of throat)
Pushkarika (a disease of penis), Alaji(inflammation of penis).
Generally all Kshudra rogas (minor diseases)
Talupupputa (tumor of the palate)
Danta pupputa (gingivitis), Tundikeri (tonsillitis), Gilayu (tonsillar
abscess).
Those diseases which suppurate mentioned earlier (such as fistula in
ano etc under chedya rogas)
The urinary bladder due to formation of Calculus , and
Some diseases produced by fat tissue.
It is only for open the any body part .
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Qualities of Incision :-
Adequate in length.
Extensible
Regular & uniformily cut edges
Independent
All layers cleanly incised
Direction of Incision :-
वतयावछछन्द्यमल्ललमटभ्रूदन्तिेश्तकजत्रुवि |
कु वक्षकक्षमवक्षकू टौष्ठकपोलगलिङ्क्षिे |
अन्यत्र छेदनमवत्तयाक् वसरमस्नमयुविपमटनम् || Ah. Su. 29/__
It should be done in direction of hairs
Incision should be oblique in eye-brow, cheek, temple, forehead,
eyelid, lip, gum, axilla, belly, & groin.
तत्र भ्रूगडिशङ्खललमटमवक्षपुटौष्ठदन्तिेष्टकक्षमकु वक्षिङ्क्षिेषु वतयाक् छेद उक्ताः ||
su. su. 5/13
Make Oblique Incision On Bhroo, Ganda, Sankh, Lalat, Akshiputa,
Dantavestaka, Kaksha, Kukshi, Vankshana, etc.
चन्द्रमडिलिच्छेदमन् पमविपमदेषु कमरयेत् | अधाचन्द्रमकृ तींश्चमवप गुदे मेढ्रे ||
su. su. 5/14
Make incision like full moon in the upper & lower limbs.
Half moon incision in anus & penis.
Different types of incision :-
-------------------------------------------
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There are 4 types of incision according to Ashtanga hridaya.
Gothirtha
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Sarvathobadra
Ardhalangalaka
Langalaka
Complications of Improper incision :-
Injury to blood vessels & nerves
Excessive pain
Delay in wound healing
Keloid formation
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Lekhana (Scraping):-
लेख्यमश्चतस्रो रोवहडयाः दकलमसमुपवजवविकम |
मेदोजो दन्तिैदभो ग्रवन्थिात्ममावधवजवविकम |
अशमंवस मडिलं ममंसकन्दी ममंसोन्नवतस्तथम || su. su. 25/9
Four kinds of Rohini (Vataja, Pittaja, Kaphaja, Sannipataja)
Kilasa (leucoderma)
Upajihvika (Swelling on the tongue)
Danta vaidarbha of fat origin(Gingivitis)
Medaja granthi (fatty tumour)
Medaja vartma (fatty tumour of eyelid)
Adhijihvika(Adenoids)
Arsaa(haemorrhoids)
Mandalakustha (a variety of leprosy)
Mamsakanda (small tumour of muscles)
Mamsonnati (thickening of muscles)
दकलमसमवन सकु ष्ठमवन वलखेल्लेख्यमवन बुवद्धममन् | cha. Chi. 25/59
Physician who is clever should do lekhana larma in lekhana yogya kustha
like Kilasa.
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Vedhana (Puncturing) :-
िेध्यमाः वसरम बहुविधम मूत्रिृवद्धदाकोदरम् || su. su. 25/10
Siras (veins) to be punctured in many diseases.
Mutra vriddhi (enlargement of Scrotum- Hydrocele)
Jalodara (Ascitis)
दकोदरमवि सम्पक्वम गुल्मम ये ये च रक्तजमाः |
व्यध्यमाः शोवितरोगमश्च विसपावपिकमदयाः || cha. Chi. 25/57
Jalodara, Pakwa gulma, Raktaja gulma, Visarpa, &Pidika are indicated for
the Vedhana Karma.
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Esana (Probing) :-
एष्यम नमड्याः सशल्यमश्च व्रिम उन्ममर्गगिश्च ये || su. su. 25/10
Nadi (Sinus ulcers), SasalyaVrana (wound with foreign body inside),
Unmargi Vrana (Sinus Ulcer which spread sidewards) are indicated for
esana karma
सूक्ष्ममननम बहुस्रमिमाः कोषिन्तश्च ये व्रिमाः|
न च मममावितमस्तेषममेषिं वहतमुच्यते || cha. Chi. 25/80
Vrana which are having sukshma anana, which is not present in marma
sthana,which is having excessive Secreation , is indicated for esana
karma.
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Aaharana (Extraction) :-
आहमयमााः शका रमवस्तस्रो दन्तकिामलोऽश्मरी |
शल्यमवन मूढगभमाश्च िचाश्च वनवचतं गुदे || su. su. 25/11
Three kinds of Sarkara (Vataja, Pittaja, Kaphaja, Urinary gravel)
Dantamala (Tartar of teeth)
Paada Sarkara (Corns in the foot)
Karnamala (Ear wax)
Antah Shalyas (Internal foreign bodies)
Ashmari(Urinari Calculi)
Shalya (All kinds of foreign bodies)
Mudhagarbha (Abnormal presentation of Foetus)
Malasanga (Faeces accumulated in the rectum)
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Visravana (Draining) :-
स्रमव्यम विद्रधयाः पञ्च भिेयुाः सिाजमदृते |
कु ष्ठमवन िमयुाः सरुजाः शोफो यश्चैकदेशजाः || 12
पमल्यममयमाः श्लीपदमवन विषजुष्ट ं च शोवितम् |
अबुादमवन विसपमाश्च ग्रन्थयश्चमददतश्च ते || 13
त्रयस्त्रयश्चोपदंशमाः स्तनरोगम विदमररकम |
सुवषरो)शु( गलशमलूकं कडटकमाः कृ वमदन्तकाः ||14
दन्तिेष्टाः सोपकु शाः शीतमदो दन्तपुप्पुटाः |
वपत्तमसृक्कफजमश्चौष््माः क्षुद्ररोगमश्च भूयशाः || su. su. 25/12-15
Five kinds of Vidradhi(abcess) except that born from all the dosas
together.
Vataja Kustha saruja (Leprosy of vata origin having pain)
Ekdeshaja Sopha (inflammatory Oedema confined to one place)
Palyamaya (Diseases of the earlobe)
Slipada (Filariasis)
Visajusta sonita (Blood vitiated by poison )
All kinds of Arbuda (Malignant tumours)
All kinds of Visarpa
Vataja, Pittaja ,Kaphaja-Upadamsa
Stanaroga
Vidarika
Sausira
Galasaluka
Kantaka
Krimidanta
Dantavestak
Sitada
Danta pupputa
Ksudrarogas
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Seevana (Suturing) :-
Indications :-
सीव्यम मेदाःसमुत्थमश्च वभन्नमाः सुवलवखतम गदमाः |
सद्योव्रिमश्च ये चैि चलसवन्धव्यपमवितमाः || su. su. 25/16
Pralamba mamsa (a hanging cut muscle)
SudhaVranas (Clean uninfected wounds)
Diseases arising from fat such as tumours
Cut/Incised wounds (Such as tumours)
Well scraped wounds
Sadhyovrana (Traumatic wounds)
Diseases localized on moveable joints
Cut wounds on Karnapali(Earlobe), Netragola(Eyeball), Nasa, Ostha,
Kantha, Kapala, Bahu, Greeva, etc.
Deep seated wounds.
सीव्यं कु क्ष्युदरमद्यं तु गम्भीरं यविपमरटतम् |
इवत षवविधमुदिष्टं शस्त्रकमा मनीवषवभाः || cha. chi. 25/60
Vrana of Kukshi, Udara, etc.
Vrana which are deep seated are indicated for Seevana Karma.
The wounds which are caused by the vitiation of the Fat, which are
gaping, Tumour of kapha, Ear lobe, Wounds on the head, Forehead,
Sockets of the eye, ear, nose, throat, lips, neck, shoulders, abdomen,
buttocks, rectum, genitalia, scrotum, & other places which have no
movement & having excessive musculature are suitable for suturing.
Contra-indications :-
न क्षमरमविविषैजुाष्टम न च ममरुतिमवहनाः |
नमन्तलोवहतशल्यमश्च तेषु सम्यवविशोधनम् || su. su. 25/17
Kshara & Agnidagdha Vranas
Gas gangrene
Madhumehaja vranas (Diabetic ulcers)
Vankshana vranas (on groin region)
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Which places are not suitable for suturing ?
नमन्तलोवहतशल्यमश्च तेषु सम्यवविशोधनम् || su. su. 25/17
न तु िङ्क्ष्िकक्षमदमिल्पममंसे चले व्रिमन् | Ah. Su. 29/__
Wounds situated in the region of groins, axilla, chest etc. and places
which are having movement, where the musculature is less, the place
where the air is moving and the foreign bodies present in the blood,
wounds caused by poisons, chemical and thermal cautery etc. are
contraindicated for suturing.
Types of suture :-
………सीव्येिवे ल्लतकं शनैाः ||
सीव्येद्गोफविकमं िमऽवप सीव्येिम तुन्नसेिनीम् |
ऋजुग्रवन्थमथो िमऽवप यथमयोगमथमवप िम || su. su. 25/21-22
According to Sushruta there are 4 types of Suturing :-
o Vellitaka
o Gophana
o Tunna-sevani
o Rju-Granthi
………सीव्येिवे ल्लतकं शनैाः ||
सीव्येद्गोफविकमं िमऽवप सीव्येिम तुन्नसेिनीम् |
ऋजुग्रवन्थमथो िमऽवप यथमयोगमथमवप िम || su. su. 25/21-22
According to Astanga Samgraha there are 4 types of Seevana karma according
to it’s shape are Gophanika , Tunna-sevani , Vellitaka , Rju-Granthi.
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VELLITAKA SEEVANA :-
That stitches which are similar to vellitaka bandh is known as Vellitaka
Seevana.
Mostly used in Shakhagata Vrana.
They are corelated with Continuous suture.
GOPHANIKA SEEVANA :-
As the Bandages are rapped around Gophana bandha in the same way
Stitches are taken in Gophana Seevana.
Mostly this are used in vistruta vrana.
They are corelated with Continuous blanket suture (Mattress Suture)
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TUNNA – SEVANI :-
As the Tailor takes repeated stitches to get the corner of torn cloth without
cutting thread in the same way Sutures are taken in Tunna-Sevani.
They are corelated with subcuticular suture.
RJU – GRANTHI :-
After taking stitches the thread is cut & again stitches are taken at some
distance.
They are corelated with Interrupted suture.
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How to make suturing :-
ततो व्रिं समुन्नम्य स्थमपवयत्िम यथमवस्थतम् |
सीव्येत् सूक्ष्मेि सूत्रेि िल्के नमश्मन्तकस्य िम ||२०||
शिजक्षौमसूत्रमभयमं स्नमय्िम बमलेन िम पुनाः |
मूिमागुिूचीतमनैिमा सीव्येिवे ल्लतकं शनैाः ||२१||
सीव्येद्गोफविकमं िमऽवप सीव्येिम तुन्नसेिनीम् |
ऋजुग्रवन्थमथो िमऽवप यथमयोगमथमवप िम ||२२||
देशेऽल्पममंसे सन्धौ च सूची िृत्तमऽङ्गुलियम् |
आयतम त्र्यङ्गुलम त्र्यस्रम ममंसले चमऽवप पूवजतम ||२३||
धनुिािम वहतम ममाफलकोशोदरोपरर |
इत्येतमवस्त्रविधमाः सूचीस्तीक्ष्िमग्रमाः सुसममवहतमाः ||२४||
कमरयेन्ममलतीपुष्पिृन्तमग्रपररमडिलमाः | su. su. 25/20-25
Then having pressed the ulcer up into its proper position , it should be
sutured with strings of any of the following kinds ,viz.of thin cotton
thread, of the fiberss of the Asmantaka tree or hemp plants, or of the
Atasi,Murva or Guduchior with strips of leather , paited horse hair or
animal sinews, into any of the officinal shapes of suturing known as
Gophana, Tunna-sevani & Rju-Granthi ,etc. or as suited to the shaped &
positionof the ulcerated part.
The margin of the ulcer should be gently pressed close with the fingers
during suturing.
Around needle to the length of two finger’s width should be used in
sewing up an ulcer occurring about any joint or in a part of body where
flesh is thin & scanty.
A needle of a triangular body & measuring three fingers width in length
is recommended in the case of an ulcer appearing at fleshy part og body.
A semi – circular or bow – shaped needle should be used in a case where
seat of ulcer would be found to be on the scrotum, or on the skin of
abdomen, or about any of the Marmas.
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कमरयेन्ममलतीपुष्पिृन्तमग्रपररमडिलमाः | su. su. 25/25
Needles of these three shapes should be so constructedas to be fitted
with sharp points capable of being handledwith the greatest ease,
having a girth equal that of stem of a Malati flower.
नमवतदूरे वनकृ ष्टे िम सूचीं कमावि पमतयेत् |
दूरमद्रुजो व्रिौष्ठस्य सवन्नकृ ष्टेऽिलुञ्चनम् || su. su. 25/25
The needle should not be pricked into a part too near or too far from the
fissure, or mouth of ulcer , as there might be the danger of suture being
broken off in the first instance and genesis of pain in the second.
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