CRITICAL ANALYSIS OF POORVA

AND PASCHAT KARMA OF NETRA

SHASTRA CHIKITSA

PRESENTED BY GUIDED BY
Dr. MADHUMITHA S Dr. SUJATHAMMA K
FIRST YEAR PG SCHOLAR PROFESSOR & HOD
DEPT OF SHALAKYA TANTRA
SKAMCH & RC
 CONTENTS
 INTRODUCTION
 TYPES OF SURGICAL PROCEDURES
 STAGES OF SURGICAL TREATMENT
 PURVA KARMA- IN GENERAL
 MODE OF ACTION OF SNEHANA
 MODE OF ACTION OF SWEDANA, TYPE OF SWEDANA IN NETRA
 MODE OF ACTION OF VAMANA
 MODE OF ACTION OF VIRECHANA
 CRITICAL ANALYSIS OF PURVA KARMA WITH SOME DISEASE EXAMPLE
 MODERN PRE-OPERATIVE PROCEDURES
 PASCHAT KARMA- IN GENERAL
 PASCHAT KARMA- IN SHASTRA CHIKITSA
 MODE OF ACTION OF PRATISARANA
 CRITICAL ANALYSIS OF PASCHAT KARMA WITH SOME DISEASE EXAMPLE
 STERILIZATION AND DISINFECTION
 DISCUSSION
 CONCLUSION
 INTRODUCTION
 In Ayurveda, Shastra Chikitsa (surgical treatment) is a
branch that involves the use of surgical techniques and
instruments to treat various conditions.
 Poorva Karma (preparatory measures) in Shastra
Chikitsa plays a crucial role in ensuring the success and
safety of the surgical procedures.
 The preparatory phase encompasses several steps designed
to prepare the patient physically and mentally, optimize
the surgical site, and reduce the risk of complications.
 A critical analysis of Poorva and Paschat Karma in Shastra
Chikitsa is essential to understand its impact on surgical
outcomes.
 Through this analysis, the importance of Poorva Karma
can be highlighted as a foundational element in achieving
effective and safe surgical interventions in Ayurveda.
 SURGICAL PROCEDURES

“तच्च शस्त्र कर्म अष्टविधं ; छेद्यं

भेद्यं लेख्यं वेध्यं एष्यं आहार्यं
विस्राव्यं सीव्यम् इति |”
[सु. सू.
5/5]
All surgical procedures are broadly classified into eight categories:
1. Chedana: Excision-complete removal of extra growths by cutting them out.

2. Bhedana: Incision-opening of an abscess or other pathologies filled with fluids.

3. Lekhana: Scraping-removal of the superficial layer.

5. Eshana: Probing-small openings are probed to know their extent.

6. Aharana: Extraction-extracting the unnecessary parts from the body like sarkara (utpatana)

7. Visravana: Draining-inducing a discharge in skin diseases or abscess.

8. Sevana: Suturing, after operative surgery.

“तत्र अष्टविध शस्त्रकर्मणां मध्ये

नेत्रामयेषु चतुर्विधं कर्म प्रयोज्यम् ||”
[दळ्हण, सु. उ. 8/4]
 Among the eight surgical procedures, Chedana, Bhedana, Lekhana and Vyadhana are
mainly employed in Netra Rogas.
CLASSIFICATION OF NETRA ROGA ACCORDING TO
SHASTRA CHIKITSA
CHEDANA SADHYA(11) LEKHANA SADHYA(9)
 ARMA( 5 TYPES)  KUMBHIKA
 SIRA JALA  VARTMA SARKARA
 SIRA PIDIKA  POTHAKI
 ARSHO VARTMA  VARTMAAVABANDHA
 SUSHKA ARSHA  BAHALA VARTMA
 ARBUDHA  SHAYAVA VARTMA
  VARTMA KARDAMA
PARVANI
 KLISHTA VARTMA
VYADHANA SADHYA(15)  UTSANGINI
 SIROTPATA
 SIRA HARSHA
BEDHANA SADHYA(5)
 ANYATO VATA  BISA GRANTHI
 4 TYPES OF ABHISHYANDA 

LAGANA
4 TYPES OF ADHIMANTHA 
 VATA VIPARYAYA
ANJANA NAAMIKA
  KRIMI GRANTHI
PUYALASA
 SASHOPHA & ASHOPHA  UPANAHA
AKSHIPAKA
 STAGES OF SURGICAL TREATMENTS
There are three stages in surgical treatment:

PURVA KARMA: PREPARATIONS FOR SURGERY

PRADHANA KARMA: SURGICAL PROCEDURE

PASCHAT KARMA: POST-OPERATIVE CARE

PURVA KARMA
 PURVA KARMA IN GENERAL
 The early activities or the procedures done before the main surgery,
preparation of the patient etc.
 These are necessarily required for the proper conduct of the main activity.
 The physician(surgeon) desirous of performing any of these activities should
collect the required materials beforehand. This is called as “Agra
sangrahana” i.e., beforehand collection of materials.
Sl No MATERIALS TO(Materials
Agra Sangrahaniya BE COLLECTED
to be collected) IN GENERAL
Meaning

1. Yantra Blunt instruments

2. Shastra Sharp instruments

3. Kshara Caustic alkali
4. Agni Thermal cautery
5. Shalaka Metal rods
6. Shrunga Horn of animals
7. Jalauka Leeches
8. Alabu Empty pitcher
9. Jambavoshta Piece of stone
10. Pichu Pieces of cloth, swab, pads

11. Prota Lint, cloth

12. Sutra Threads

13. Patra Leaf

14. Patta Cloth/leather band

15. Madhu Honey

16. Ghrita Ghee

17. Vasa Muscle-fat

18. Paya Milk

19. Taila Oil

20. Tarpana Nutritive gruels made of corn flour added
with milk, sugar, honey

21. Kashaya Decoction of herbs/drugs

22. Lepana Anointments, ointments, pastes for
application
23. Kalka Paste of drugs etc for external application

24. Vyajana Fan

25. Shitoshnodaka Cold and hot water
26. Kataha Pots, drums etc for storage
27. Snigdha, sthira, balavantah Affectionate, steadfast, strong attendants
parikarminah
"ततः प्रशस्तेषु तिथि-करण-मुहूर्त- नक्षत्रेषु
दधि- अक्षत-अन्नपान-रत्ने-अग्निं विप्रान्
भिषजच्च् आचर्यित्वा, कृत-बलि-मङ्गल-
स्वस्तिवाचनं लघुभुक्तवन्तं ................||"-[सु. सू.
5/7]
 Next, on an auspicious day, time and stellar constellation, Agni (god of fire), Brahmana and
Vaidya(physician) should be worshipped first by offering curds, sanctified rice, foods,
drinks and gems.
 Then, the patient who has offered oblations, performed sacrificial rituals, pronounced the
word ‘svasti’, has consumed light to digest foods, should be made to sit facing east.
 He should then restrain the patient from making any movements of the limbs and body
parts.
 SNEHANA
“ स्नेहसारो अयं पुरुष: प्राणाश्च
स्नेहभूयिष्ठा: स्नेहसाध्याश्च भवन्ति।
स्नेहो हि
पानानुवासनमस्तिष्कशिरोबस्त्युत्तरबस्
ति नस्य
कर्णपूरणगात्राभ्यङ्गभोजनेषूपयोज्य: ॥”
- [सु चि ३१/३]

A person is essentially composed of ‘Sneha’ and life itself is greatly sustained by Sneha. In
fact, life is maintained or cured by Sneha. Various treatments that involve Sneha are
considered essential for the body like Pana, Anuvasana etc.
 MODE OF ACTION OF SNEHANA
“स्नेहो अनिलं हन्ति मृदुकरोति देहं
मलानां विनिहन्ति सङ्गम् |”
- [च. सि. 1/7]
Sneho Anilam Hanti- As Sneha is having exactly opposite Guna to Vata Dosha, it subsides
the Vata. Sneha insist the proper functioning of Vata and this can be clearly observed through
the occurrence of Vatanulomana as the very first Samyak Snigdha lakshana. To bring doshas
which were situated in Sakha to the Kosta, ‘Vata Nigraha’ is one of the cause mentioned by
Charaka. Sneha helps in the proper Gati of Vata.

“वृध्दया विष्यन्दनात पाकात्

स्रोतोमुखविशोधनात् |शाखा मुक्त्वा मलाः कोष्टं
यान्ति वायोश्चनिग्रहात् ||”
- [च . सू. 28/33]
● Mridukaroti Deham- Snigdha and Mridu are the important properties of Sneha Dravya.
In the definition of Snigdha, Sushrutha says “Sneha Mardavakrit”. This is assessed by
Gatra Mardava.
● Malanam Vinihanti Sangam- To remove the Srotorodha is again of prime importance
regarding Sodhanartha Sneha Pana, Mala Sanga generally occurs due to Rukshata in
Kosta, Sneha overcomes this Rukshata by its Snigdha Guna and the Sanga is corrected
 MODE OF ACTION OF SWEDANA
“ स्तम्भ गौरव शीतघ्नं स्वेदनं
स्वेदकारकम् |”
- [च. सू. 22/11]
Svedana Dravya has its main actions like Stambhagna, Gauravaghna, Sitaghna and Sveda
Karakatva.
1. Stambhagna: Vayu by ruksha Guna absorbs snigdhata and so causes stambha. Svedana is
snigdha and ushna so it relieves stambha. Ushna Guna of svedana does srotoshuddhi and
amapachana and so it relieves stiffness.
2. Gauravaghna: It causes excretion of watery content of the body through sveda. Apya
Tatva or kleda is guru. Due to elimination of kleda, lightness is achieved. Svedana stimulates
muscles and nerves and so lightness is produced.
3. Sitagna: This is mainly due to ushna Guna.
4. Srotoha Su Abhiviliyate: It helps to dissolve kapha which is in a dense
stage(Grathita) stuck to the channels firmly. Further, it liquifies kapha allowing it to move
freely.
5. Khani Mardavam Ayanti: It makes the channels soften, by this vata flows in normal
direction (Anulomana).

“तैरस्य ग्रतिथः श्लेष्मा स्रोतः

स्वभिविलीयते |खानि मार्दवमायान्ति ततो
वातानुलोमता ||”
-[च. चि. 17/72]
TYPE OF SWEDANA IN NETRA
“ किञ्चित् स्तोकेन पित्तेन संसृष्टे
द्रवस्वेदो योज्यः |”
-[अ. स. सू. 26/15,comm.]
“सर्वरोगनिदानोक्तैः हितैः कुपिता
मलाः |आचक्षुष्य विशेषेण प्रायः
पित्तानुसारिणः ||”
-[अ. स. उ. 11/2]
As pitta is the main dosha involved in the causation of Netra rogas, Drava sweda will help in
such condition.
MODE OF ACTION:
• Brings more blood to the area where it is applied.
• Reduces joint stiffness and muscle spasm.
 MODE OF ACTION OF VAMANA KARMA

“ तत्र उष्ण तीक्ष्ण सूक्ष्म व्यवायि

विकाशिनी औषधानि स्वविर्येण
हृदयमुप्येत्य सोक्ष्म्यात्
व्यवायित्वात् च धमनिर् अनुसृत्य
स्नेहेन मृदुकृत्य अन्तःशरीरे
स्वेदोष्मणा
आद्रर्दारुवद्विष्यन्ने
स्थुलानुस्त्रोतोभ्यह् सकलमपि
दोषसंघात उश्नियात् विष्यन्दयति |
 Vamana Dravya Vyavayi, Vikashi, Ushna, Tikshna & Sukshma Guna Enters Hridaya

Udana Vayu Vamana Through Dhamini

Upward circulates all over the body
stimulation movement Vega

Agni & Vayu MB Due to Sukshma Guna,

Pred. & its enters in Sthula &
Prabhava Sukshma Srotases

Dosha Due to Anupravana Due to Tikshna and Due to Agneya Guna,

Amashaya Bhava, Dushita Dosha, Ushna Guna, Dosha Dosha vilayana in
pravesha Atisukshma rupa not Chedana & Bhedana Srotases
adhere to any region
How Vamana works in Netra Rogas ??
● Even though Vamana is contraindicated in Netra rogas like timira, it is indicated in some
of the disease conditions like Vartma rogas.

“ प्रायेण सर्वे नयनामयास्तु भवन्ति

अभिष्यन्द निमित्तमूलाः |
तस्मात् अभिष्यन्द उदीर्यमाणं उपाचरेत्
आशु हिताय धीमान् ||”
- [सु. उ. 6/5]
● Abhishyanda is the main causative factor for all eye diseases. It can spread through
circulation as it involves Rakta.
● So treating this disease properly is important.
● As told in the mode of action of Vamana due to Sukshma Guna the aushadha reaches
sthula and anu srotas in our body which says it reaches the blood vessels present in our
eyes and removes the dosha’s adhered to it thereby subsiding the inflammatory condition
“ तेषां श्लेषमाश्रयत्वात इति
श्लेष्मस्थानाश्रयत्वात श्लेष्म
प्रत्यनीकं चिकित्समाह् |
उदिर्णवेदनम् नेत्रं राग शोथ समन्वितम्
घर्ष निस्तोद शूलाश्रु युक्तमानम्
अन्वितम् विदुः ||”
- [यो. र. -नेत्र
]
 All the 76 diseases of the eye can be produced by untreated Abhishyanda, as it settles in
Kapha (sleshma asraya) of the eye.
 This kaphaasraya produces ama lakshanas like pain, swelling, redness and foreign body
sensation in eye.
 So, to remove this kapha dosha, Vamana is a ideal treatment.
 MODE OF ACTION OF VIRECHANA KARMA
1. Removal of Systemic Toxins: - Virechana is part of the Panchakarma therapies designed to
eliminate toxins (Ama) and imbalanced doshas (especially Kapha and Pitta) from the body.
● By clearing these systemic toxins, the therapy create a cleaner internal environment, which
is essential before any localized treatment.
2. Balancing the Doshas: Virechana targets Pitta dosha as well as pitta associated with kapha.
The predominant dosha causing Netra roga is pitta, for the Apakarshana of pitta, virechana is
the best line of treatment.
“सर्वरोगनिदानोक्तैः हितैः कुपिता मलाः |
आचक्षुष्य विशेषेण प्रायः
पित्तानुसारिणः ||” सिराभि : उर्ध्वं
प्रसृता नेत्र अवयवम् आश्रिताः |वर्त्म
सन्धिं सितं कृष्णं दृष्टिं वा सर्वमक्षि
वा |रोगान् कुर्युः......||
-[अ. स. उ. 11/2]
Indication of Vamana and Virechana:
“ तत्र उत्कृष्टे श्लेष्मणि पित्त
संसृष्टे वा तत्स्थानगते वा पित्ते अनिले
वा श्लेष्मोत्तरे वमनं आचरेत् |
पित्ते तु विरेकं श्लेष्मसंसृष्टे वा
तत्स्थानगते वा श्लेष्मणि इति ||”
- [अ. स. सू. 27/4]
 Kapha prakopa in its own sthana
 Kapha combined with pitta in a small quantity
 Excessive utklesha of kapha
 Vata or pitta lodging in the sites of kapha
 Pitta alone or pitta along with kapha or pitta in kapha sthana , then go for virechana.
IMPORTANCE OF VAMANA AND VIRECHANA

“ बुद्धिप्रसादं बलमिन्द्रियाणां
धातुस्थिरत्वं ज्वलनस्य दीप्तिं |
चिराच पाकं वयसः करोति संशोधनं सम्यक्
उपास्यमानम् ||”
- [अ. स. सू. 27/63]
 PURVA KARMA IN VYADHANA SADHYA VYADHI
“ स्निग्धस्विन्नस्य तस्याथ काले
नातिउश्न शीतले |..... ||”
- [सु. उ. 17/57]
 Patient should be subjected to Snehana and Svedana.
 VATAJA ABHISHYANDA AND ADHIMANTHA
“ पुराण सर्पिषा स्निग्धो स्यन्द अधिमन्थ
पीडीतो |.....||”
- [सु. उ. 9/3-4]
Guna's of Purana gritha:
Rasa- Katu, Tikta
Veerya- Sheetha
 Sneha administered internally reaches to srotamsi and acts as a solvent to remove the
obstruction by dissolving dosha in it, resulting in the removal of srotorodha, which is one
of the important steps in the samprapti vighatana as the katu rasa present in purana ghrita is
having the property of removing kledata.
 PITTAJA ABHISHYANDA AND ADHIMANTHA

“ आमपाचनस्यस्नेहपूर्वक सिरामोक्षणं |”
- [सु . उ 10/8]
Tiktaka ghrita is mentioned by acharya vaghbhata which tells the pittahara karma of Snehana.
 EFFECT ON INTRAOCULAR PRESSURE BY
GHRITA PANA
● Remove obstructions of trabecular meshwork by pigments, RBC, glycosaminoglycans,
amorphous materials, extra cellular lysosomes, plaque like materials and proteins etc. and
removes the deposition in the juxtra canalicular spaces by its Srotovishodhana property.
● It improves pore density & size in the inner wall endothelium of schlemn’s canal by its
Rasayana property.
● Ghrita will reduce thickening, sclerosis of trabecular meshwork with faulty collagen
tissues & widening of intra trabecular spaces by its Srotovishodhana property.
KAPHAJA ABHISHYANDA AND ADHIMANTHA
स्नेहपान – “तिक्त द्रव्य साधित प्रातः प्रशस्तं
घृतम्।तेन स्निग्धस्य त्र्यहात् सिरामोक्षणम् ||”
- [सु. उ. 11/3, comm.]
 As tikta rasa is having the property of removing the kandu, it is given in Kaphaja
Abhishyanda and Adhi Mantha and it does the dosha utkleshana so that it can be removed
by raktamokshana.
स्वेदन-
 It helps to dissolve kapha which is in a dense stage(Grathita) stuck to the channels firmly.
Further, it liquifies kapha allowing it to move freely.
RAKTAJA ABHISHYANDA AND ADHIMANTHA
● Sneha Pana – Koumbha Sarpi
“ घृतस्य महति मात्रा पीता”
- [सु उ 12/9]
स्वेदनं –
“ रुजायां चाप्यतिभृशं स्वेदाच मृदवो
हिताः।”
- [सु. उ. 12/8]
● To subside the pain due to vata avruta in raktaja abhishyanda , Sneha Pana in large
quantity is given followed by mridu sweda to prepare for raktamokshana.
 SIROTPATA (EPISCLERITIS)
● Sneha Pana with gavya gritha.
● It helps to subside the pain present in sirotpata.
● The ghee saturates the cells in the body with excess fat, which causes the cells to flush out
the extra fat and this also leads to the flushing out of toxins along with the fat which in
turn subsides the inflammation.
 SASHOPHA AND ASHOPHA AKSHIPAKA(UVEITIS)
“स शोफ च आशोफश्च द्वौ पाकौ प्रकीर्थितौ।
स्नेह स्वेदोपपन्नस्य तत्र विध्वा सिरां भिषक्।।”
- [सु. उ. 12/38]
 After Pana, the Ghrita gets absorbed into the systemic circulation.
 Due to Chakshushya properties, it has an affinity towards ocular tissues and due to
its lipid soluble property crosses blood ocular barriers.
 By active and passive transport the ingredients of the Ghrita crosses the cell
membranes and reach the targeted tissue.
 Due to the anti-inflammatory property it reduces the symptoms.
 PUYALASA( DACROCYSTITIS)
“शोणितमोक्षणं च स्नेहस्वेदपूर्वकमेव |”
- [सु. उ. 13/45, comm.]
To avoid the formation of fistula or sinus, snehana is given as a Purva karma to
raktamokshana
Swedana- To bring down the inflammatory signs, Avaguntana type of sweda is indicated
 LEKHANA SADHYA ROGA
"नव ये अभिहिता लेख्याः सामन्यस्तेषु
अयं विधिः |स्निग्ध-वान्त-विरिक्तस्य
निवातातपसद्मनि ||सुखोदकप्रतप्तेन वाससा
सुसमाहितः |स्वेदयेत् वर्त्म निर्भुज्य
वाम- अन्गुष्टानगुलिस्थितं ||"
[सु. उ. 13/3-4]
Preparation of the patient: Snehana, Vamana and Virechana for the elimination of doshas.
Swedana should be done with a cloth pad dipped in luke-warm water.
Why Vamana?
 The active principle of Vamana Dravya taken orally is absorbed from the stomach into
circulatory system, where from it is circulated to all over the body.
 On reaching at the site of lesion(Dosha Sanghata), which is at the cellular level, it breaks
the nexus of Dosha and brings back the toxic substances thus released into the stomach,
wherefrom they are expelled out of the body by the action of vomiting.
Why Virechana ?
 Because of the Vikasi Guna present in the virechana Dravya it moves in the Sukshma and
anu srotas.
 Due to ushna Guna, the dosha sanghata is liquified(vishyandana).
 Action of Tikshna Guna is to break the mala and dosha in microform.
 Due to Sukshma Guna by reaching in micro channels, disintegrates endogenic toxins,
which are then excreted through micro channels.
“सुसमाहित इन्थ्यानेन यथा दृशो पीडा न
स्यात् तथा स्वेदयेत् इति द्योत्यते।”
- [सु. उ. 3/3-4, comm.]
● To combat the pain present in the disease and also to remove the kledata, swedana is given
as a Purva karma to lekhana chikitsa.
 BHEDANA SADHYA VYADHI
BISA GRANTHI(Edema of eyelids) AND LAGANA(Chalazion)

“स्वेदयित्वा बिसग्रन्त्थि
छिद्राण्यस्य निराश्रयम्। पक्वं भित्वा
तु शस्त्रेण सैन्धवेन अवचूर्णयेत।।”
- [सु उ 4/5]
 To bring the pakva Avastha of doshas from apakva state in case of Bisa granthi and
Lagana, swedana is helpful.
ANJANANAAMIKA(EXTERNAL HORDEOLUM)

“ स्विन्नां भिन्नां विनिष्पीड्य भिषक्

अञ्जननामिकाम् |”
- [सु. उ. 14/6]
• In case of Anjanamika the glands will open up, ducts will be cleared and the obstruction
is removed by swedana karma which in turn reduces the inflammation .

“दाह तोदवती ताम्रा पिडका वर्त्मसंभवा |

म्रद्वी मन्दरुजा सूक्ष्मा ज्ञेया सा
अञ्जननामिका ||”
- [सु उ. 3/15]
KRIMI GRANTHI (BLEPHARITIS)
“ सम्यक् स्विन्ने कृमिग्रन्थो भिन्ने
स्यात् प्रतिसारणम् |त्रिफला तुत्थ कासीस
सैन्धवैश्च रसक्रिया||”
- [सु. उ. 14/5]
“ सम्यक् स्विन्ने इति लोचनोचित
स्वेदस्विन्ने |”
- [सु. उ. 14/8, comm.]
 A warm compress encourages blood flow to a particular area by dilating blood vessels in
the area where heat is applied.

“ कृमिग्रन्थि करीषेण स्विन्नं भित्वा

विलिख्य....|”
- [अ.ह्र्. उ. 11/6-7]
“ संस्नेह्य पत्रभङ्गेच स्वेदयित्वा
यथासुखम् |आपाकात् विधिनोक्तेन
पञ्चभेद्याम् उपाचरेत् ||सर्वेषु तेषु
विहितं विधानं स्नेहपूर्वकं |.......||’’
- [सु. उ. 14/10-11]
 So generally in all 5 types of Bhedana Sadhya rogas, Snehana and Svedana should be
done in the beginning to bring them to pakva Avastha so that it can be removed by
Bhedana karma .
 CHEDANA SADHYA ROGA
ARMA (PTERYGIUM)
“ स्निग्धं भुक्तवतो हि अन्नं उपविष्टस्य
यत्नतः |संरोष्येत तु नयनं भिषक्
चूर्णेस्तु लवणे ||’’
[सु. उ. 15/3]
 Snigdha bhojana is given to tolerate the pain which will be seen in Chedana karma as
snehana is having the property of gurutva.
“ संरोषयेत अर्मशिथिलिकरणाय
संक्षोभयेत् |”
- [सु. उ. 15/3, comm.]
 Nayana samrosana is done by application of lavana churna for loosening the arma.
 PREOPERATIVE EVALUATION AND
PREPARATION FOR ANAESTHESIA AND
SURGERY
● The ultimate goal of preoperative medical assessment is to reduce the patient’s surgical
and anesthetic perioperative morbidity or mortality, and to return him to desirable
functioning as quickly as possible.
● A history and physical examination, focusing on risk factors for cardiac and pulmonary
complications and a determination of the patient’s functional capacity, are essential to any
preoperative evaluation.
● Laboratory investigations should be ordered only when indicated by the patient’s medical
status, drug therapy, or the nature of the proposed procedure and not on a routine basis.
● Proper consultations with appropriate medical services should be obtained to improve the
patient’s health.

● The preoperative preparation involves procedures that are implemented based on the
nature of the expected operation as well as the findings of the diagnostic workup and the
preoperative evaluation.

● Surgical procedures and administration of anesthesia are associated with a complex stress
response that is proportional to the magnitude of injury, total operating time, amount of
intraoperative blood loss and degree of postoperative pain.
 ● Decreasing the stress response to surgery and trauma is the key factor in improving
outcome and lowering the length of hospital stay as well as the total costs of patients care.

The following primary goals of preoperative evaluation and preparation have been identified:
● Documentation of the conditions for which surgery is needed.
● Assessment of the patient’s overall health status.
● Uncovering of hidden conditions that could cause problems both during and after surgery.
● Perioperative risk determination.
● Optimization of the patient’s medical condition in order to reduce the patient’s surgical
and anesthetic perioperative morbidity or mortality.
● Development of an appropriate perioperative care plan.
● Education of the patient about surgery, anesthesia, intraoperative care and postoperative
pain treatments in the hope of reducing anxiety and facilitating recovery.
● Reduction of costs, shortening of hospital stay, reduction of cancellations and increase of
patient satisfaction.
 THE HISTORY
● The history is the most important component of the preoperative evaluation. The history
should include a past and current medical history, a surgical history, a family history, a
social history (use of tobacco, alcohol and illegal drugs), a history of allergies, current
and recent drug therapy, unusual reactions or responses to drugs and any problems or
complications associated with previous anesthetics.
● A family history of adverse reactions associated with anesthesia should also be obtained.
● In children, the history should also include birth history, focusing on risk factors such as
prematurity at birth, perinatal complications and congenital chromosomal or anatomic
malformations and history of recent infections, particularly upper and lower respiratory
tract infections.
 LABORATORY WORK UP
● Lab tests should be ordered based on information obtained from the history and physical
exam, the age of the patient and the complexity of the surgical procedure.
● Routine laboratory tests in patients who are apparently healthy on clinical examination
and history are not beneficial or cost effective.
● A clinician should consider the risk-benefit ratio of any ordered lab test.
 DRUG HISTORY
● A history of medication use should be obtained in all patients.
● Especially, the geriatric population consumes more systemic medications than any other
group.
● Numerous drug interactions and complications arise in this population and special
attention should be paid to them.
● Generally, administration of most drugs should be continued up to and including the
morning of operation, although some adjustment in dosage may be required (e.g.
antihypertensives, insulin).
● Some drugs should be discontinued preoperatively.
● The use of medications that potentiate bleeding needs to be evaluated closely, with a risk-
benefit analysis for each drug and with a recommended time frame for discontinuation
based on drug clearance and half-life characteristics.
PHYSICAL EXAMINATION
● The physical examination should build on the information gathered during the history.
● At a minimum, a focused preanesthesia physical examination includes an assessment of
the airway, lungs and heart, with documentation of vital signs.
● Unexpected abnormal findings on the physical examination should be investigated before
elective surgery.
 AIR CONDITIONING IN OT’S
IMPORTANCE
Air conditioning is extremely important in the OT as it helps in controlling the temperature,
humidity and sterile filtration.
Proper air conditioning is helpful in the prevention and treatment of diseases.
The factors determining the need for air conditioning in hospital facilities are:
a. The need to restrict air movement within and between various departments.
b. The specific requirements for ventilation and filtration to dilute and remove contaminants
in the form of airborne microorganisms, viruses, odour, hazardous chemicals &
radioactive substances.
c. Different types of temperature and humidity requirements for various areas.
d. Permit accurate control of environmental conditions.
e. Control of air quality and air movement.
Operating Room Air Conditioning Requirements
 The primary task of the ventilation system in an operating room is to provide an
acceptable indoor climate for personnel and patients to remove odour, released anaesthetic
gases and to reduce the risk of infection in the operating area.
 The greatest amount of bacteria found in operating rooms comes from the surgical team
and is a result of their activity during surgery.
 During an operation most members of the surgical team are in the vicinity of the operating
table, creating the undesirable situation of concentrating contaminants in this highly
sensitive area.
  Studies of operating room air distribution systems and various air delivery systems
indicate that these are the most effective methods for air movement pattern in operation
theatres for limiting the cone of contaminants to an acceptable level.
 The total heat production per hour caused by the staff, operation room lighting and
equipment may be about 2 KW or 17550 kcal/h.
Operating Room Ventilation
 To maintain oxygenation for 10 persons in the operating room, a volume of about 28 m3
of air will be required per hour.
 15 to 20 air changes/hr should be sufficient for comfort, to ensure pressurization in the
operation room and to maintain considerable control of airborne microorganisms in an
operation room of the size of about 40 sqm, if an average surgical team is involved.
 Another study shows that bacteriological contamination of the air is markedly reduced by
the use of ultra clean air filters.
 Airborne contamination in operating room is mainly derived from the personnel in the OT
and their activities.
 The number of individuals present, ventilation and airflow implements the bacterial count
in OT.
 Proper design and ventilation of OT is the most important means of controlling airborne
infection in OT.
HAND HYGIENE
PASCHAT KARMA
 PASCHAT KARMA IN GENERAL
● Acharya Sushrutha has explained Raksha Karma as one of the paschat karma to keep
the operated site sterile, infection free and healthy, by following rakshavidhaana i.e.
protocols of sterilization.

"निशाचरेभ्यो रक्ष्यस्तु नित्यमेव अक्ष

आतुरः |रक्षाविधाने उददिष्टेः यमैहि
सनियमेस्त्तथा ||"
- [सु. चि. 1/132]
• In post operative measures the area should be properly irrigated and then Lepa of
medications should be applied followed by bandaging.
 Acharya sushrutha also explained mantradi uchharana to protect the area from infections.
 He told that Mantrouchhrana of praising lord Brahma, Vishnu, Maheshwara,
Panchamahabhutas, Deva, Raja and Gandharva's makes patient happy and painless and his
lives can be saved thus.
 PASCHAT KARMA IN SHASTRA CHIKITSA
 Paschat karma ensures the healing and recovery of the patient after a surgical procedure.
 The principles of post-operative care in Shastra chikitsa focus on restoring balance in the
body, preventing complications, and ensuring that the surgical wound heals properly.
IMPORTANCE OF PASCHAT KARMA
1.HEALING AND RECOVERY
● After a surgical procedure, the body needs time and support to heal.
● Paschat karma involves various therapies, diet, and lifestyle modifications that promote
the regeneration of tissues, reduce inflammation and enhance the body’s natural healing
processes.
2. PREVENTING INFECTIONS AND COMPLICATIONS
● Just as in modern surgery, preventing infection is essential.
● The ancient texts prescribe the use of medicinal plants, antiseptic oils, and herbal
kashayas to clean wounds and prevent infections.
3. BALANCING DOSHAS
● Surgery can disturb the balance of the doshas(vata, pitta and kapha) in the body.
● Paschat karma involves treatments and dietary regimens that help restore the doshic
balance, preventing further diseases or complications that could arise from an imbalance.
4. PROPER WOUND HEALING(VRANA ROPANA)
● Specific herbal treatments and ointments are prescribed to promote wound healing.
● The use of vrana ropana Dravya like haridra and nimba are recommended for their anti-
inflammatory and anti-infective properties.

5. STRENGTHENING THE IMMUNE SYSTEM

● After surgery, the immune system may be weakened.
● Paschat karma involves rejuvenating therapies(rasayana), which enhance immunity and
help the body regain strength and vitality.
6. MENTAL AND EMOTIONAL WELL-BEING
● The holistic approach of ayurveda includes mental and emotional health, which is
important during recovery.
● Post-surgical care may also involve Manasa chikitsa(psychological care), yoga and
meditation to ensure a balanced state of mind and reduce stress or anxiety.
7. DIET AND LIFESTYLE ADJUSTMENTS(PATHYA-APATHYA)
● Diet is a critical component of paschat karma.
● Foods that are easily digestible and nutritious are prescribed, while foods that can increase
ama(toxins) or aggravate the doshas are avoided.
● Proper rest and avoidance of strenuous activities are also emphasized to aid recovery
8. MONITORING AND FOLLOW-UP
● Continuous monitoring of the patient’s progress, wound condition and overall health is
essential.
● This allows the practitioner to make adjustments to the treatment plan as necessary and
prevent any potential post-surgical complications.
 MODE OF ACTION OF PRATISARANA
● The probable mode of action of Pratisarana, it has Vrana Shodana and Ropana actions.
● Local rise in temperature initiates function of Bhrajaka pitta which leads to Twak
Prasadana.
● Dosha Vilayana: Clears kapha dosha due to Gharshana
● Increase in blood circulation: Blood vessels get dilated, which increases blood
circulation and promotes healing.
● Srotomukha Vishodhana: Does evacuation and cleansing of the secretory passages.
 PASCHAT KARMA OF ARMA CHEDANA
 PRATISARANA- The operated part should be rubbed gently with churna of Yavanala,
trikatu and saindhava lavana.
 PARISEKA- The wound should be cleaned with sterilized gauze and honey; washed with
cold water and lukewarm ghee.
 VRANA BANDHANA- Bandaging should be done after applying the honey and ghee.
 SITA PRADEHA- The cooling medicaments like satadhatu ghrita should be applied to
head and sole of the feet.
PASCHAT KARMA OF LINGANASA(CATARACT)
 The eye should be lubricated with ghrita and bandaged with cloth.
 Thereafter the patient should be made to lie supine in room free from disturbing agencies
like dust, smoke, wind etc. and patient should avoid udagara, kasa, kshavathu, sheetavana,
utkampana during the period.
POST-OPERATIVE COMPLICATIONS AND THEIR MANAGEMENT
 The main complications of shastra karma are raga, Sopha, arbudha, sucking pain, squint,
Adhi Mantha etc.
 Management of complications include Lepas and Seka.
 STERILIZATION AND DISINFECTION
○ Infection control practices essentially consist of cleaning,
disinfection and sterilization of equipments and
environment, hand hygiene practices, preoperative
preparation of patient and antibiotic prophylaxis for
procedures.
○ Cleaning, disinfection and sterilization are essential to
ensure that medical and surgical equipments do not transmit
infectious pathogens to patients.
○ Cleaning is the physical removal of organic material or soil from the objects and is a
prerequisite for disinfection or sterilization.
○ It is usually done by using water with or without detergents. Generally, cleaning is
designed to remove rather than to kill microorganisms.
 STERILIZATION
 Sterilization is defined as a process that destroys or eliminates all forms of microbial life
including spores and is carried out in hospitals and clinics by physical or chemical
methods.
 Sterilization is intended to convey an absolute process.
 Steam under pressure, dry heat, ethylene oxide (ETO) gas are the common methods used,
while newer methods include hydrogen peroxide gas plasma, low-temperature
sterilization technologies and liquid chemicals.
 DISINFECTION
 Disinfection is a process that eliminates many or all pathogenic microorganisms without
removal of bacterial spores.
 Unlike sterilization, disinfection is not sporicidal.
 In practice, instruments are usually disinfected by liquid chemicals.
 Some disinfectants may kill spores with prolonged exposure time and these are called
chemical steriliants.
 Postoperative infections can be either of endogenous or exogenous origin.
 Factors associated with transmission of infective material exogenously in hospitals and
clinics include presence of shedders of pathogenic microorganisms amongst the hospital
personnel, use of inadequately sterilized equipment, contaminated environment and
grossly contaminated surfaces.
 DISCUSSION
● Through Purva Karma the toxins are channelized and collected for easy removal at
Pradhana Karma stage.
● Important Purva Karma techniques regularly used across the Panchakarma are Pachana,
Snehana and Swedana.
● They prepare the body for detoxification and revitalization.
● Sushrutha emphasizes the significance of gathering all the supplies required for the
operation and for post-operative care.
● Patient preparation, anaesthesia and sterilization, etc. are included in Purva karma.
● A unique procedure known as Raksha Karma was also presented by Acharyas.
● According to ayurveda before surgery, Mantras should be repeated; the only goal of
Raksha Karma is to ensure the patient’s success.
● Acharyas have also stressed the importance of collecting a complete history, performing a
comprehensive physical examination, and performing many assessments before surgical
procedures.
● The severity of pain, appetite, bowel movements, overall health and length of the disease,
etc. should be considered before surgical procedure.
● Following practice can be considered as preoperative measures in Ayurveda survey:
 Cleansing, preparation and special preparation.
 Spraying or washing the irritated area with liquids.
 Abhyanga and Sweda karma
 Sneha Pana and arrangement of operative theatres
 Complete examination should be performed after taking a correct medical history
 The anaesthetist should be alerted, and information should be left for him with regard to
important aspects of the patient’s medical history, physical examination, and the type of
surgery planned, as well as any sort of patient’s history of adverse medication reactions.
 Documentation, patient consent or family member consent in case of critical surgery.
 According to Ayurveda philosopher for a safe and painless recovery, a proper, normal
preoperative procedure is crucial.
 Purva Karma such as Pachana, Deepana, Swedana and Snehana etc. offer advantages in
surgical treatment.
 Maintenance of aseptic condition and patient comfort, etc. also comes under the heading
of Purva Karma.
● Raksha Karma which is carried out to eradicate the fear of Rakshas, was also stated by
Acharya Sushrutha. The main goal of this procedure is to strengthen the patient’s
psychologically.
● The surgeon and his assistant must provide thorough care after completing the Sastra
Karma until the patient is fully recovered.
● Bandaging, application of medicinal Lepa, dressings, diet adjustments and rest etc. are
recommended as post operative measures.
● The dressings should be changed and bandage clothing should be sterilized and
fumigated for early healing or recovery.
● Since the immediate post-operative time is crucial, the patient should be closely
monitored.
● Surgeon should take care of anaesthetic recovery and stitches need to be examined on
regular basis.
● The complete course of antibiotics and pain killers recommended for early recovery of
patient.
 CONCLUSION
● Pre-surgical and post-operative procedures are crucial for the patient’s complete relief.
● Postoperative care is especially important for the patient’s optimal recovery and
rehabilitation.
● Paschat karma improves healing process and boost up the efficacy of Pradhan Karma.
● The patient’s care and precautionary measures are major components of Paschat Karma.
● On the whole Preoperative and postoperative measures are essential for the successful
completion of surgical practice.
● And to be more successful in ayurvedic surgical practice it is good to integrate with
modern pre and post-operative procedures which is going to give a better result.
THANK
YOU