Surgical practices

“Surgery is the first and the highest division of the healing art, pure in itself, perpetual in its applicability, a working product of heaven and sure of fame on earth.” – Sushruta (600 BCE).

The surgical stream is traced to Dhanvantari, one of whose students Sushruta (6th century BCE) carved a name for himself in the history of science by codifying the knowledge of the school he belonged to.

Sushruta’s work – the Sushruta-samhita was revised and updated (for current knowledge) by the great Mahayana Buddhist scholar Nagarjuna in the 5^thcentury AD and by Chandradutta in the 10^th century AD. In the Buddhist period (nearly 1000 years from the 5^th century BCE to the 4^th century AD), along with Buddhism, the science of Ayurveda also spread to countries like China and Tibet.

Later authors of Sushruta-samhita also added to the contents, apart from surgery, which are found in the Appendix to the book Uttara-tantra.

Surgery

1. Intestinal Surgery

2. Absorbable Ligatures

3. Bladder Stone Removal

4. Plastic Surgery of the Nose

5. Suturing

Intestinal Surgery

Baddhagude parisravini ca

snigdhasvinnasyabhyaktasyadho

nabhervamatascaturangulamapa – haya

romarajya udararn patayitva

caturangulapramanamantrani niskrtya niriksya

baddha – gudas yan tra pra tirodhakararnasmanarn

valarn vaSpohya malajatarn va tato

madhusarpirbhyamabhyajyantral)i

yathasthanarn sthapayitva bahyarn

vranarnudarasya sivyet I

In blocked large intestine and intestinal perforation

• put the patient through fomentation and massaging
• make a 4 finger-width incision below the navel, 4 finger-width left of the hair (that stretches downward from the navel),
• extracting the intestine and checking it,
• remove stone, hair or fecal matter blocking the intestine of the patient,
• smear the intestine with honey and clarified butter,
• place the stitched intestine in its original position
• stitch the external wound of the abdomen.

Source

Sushruta-samhita, Cikitsa-sthanam, Adhyayah 14, Paragraph 17 (6^th Century BCE)

Absorbable Ligatures (Pipilika Sivanam)

Parisravinyapyevameva

salyamuddhrtyantrasravan sarnsodhya

tacchidramantrarn sarnadhaya kalapipilikabhi-

rdarnsayet daste ca tasarn kayanapaharenna

sirarnsi, tatah purvavat sIvyet, sandhanarn ca

yathoktarh karayet yastirnadhukarnisraya ca

krsnamrudasvalipya bandhenopacaret tato

nivatamagararn pravesyacarikarnupadiset

vasayeccainarn tailadronyarn sarpirdronyarn

va payovrttimiti II

Similarly, also in intestinal perforated tract – after lifting the block and cleaning the intestinal fluids, bringing together the torn intestine – have black ants bite it. On biting, remove their bodies, but not their heads. Then stitch the stomach as before; cause the union as told.

Paste a mixture of ‘liquorice’ (a Papilionaceous butterfly like plant of Asia) and black earth, secured with a bandage. Thereafter, taking the patient in an airless room, continue rest of the procedure. Make him sit in a bath of oil or bath of clarified butter. Prescribe a diet of milk.

Source

Sushruta-samhita, Cikitsa-sthanam, Adhyayah 14, Paragraph 17 (6th Century BCE)

Notes

The pincers remained in situ due to rigor mortis retaining the cut ends of the intestine in position for some time. The heads and the pincers of the ants, being organic matter, get digested in due course of time, not unlike the catgut of present-day surgery.

Bladder Stone Removal

Tatah savye parsve sevanim yavarnatrena

muktvasvacarayecchastramasmarlpramal).am

daksinato va kriyasaukaryahetorityeke, yatha

sa na bhidyate curnyate va tatha prayateta,

curnamalpamapyavasthitam hi punah

parivrddhimeti tasrnat

samastamagravaktrenadadita II

Then employ the needle on the left side leaving out only a grain of space. Some say, for the convenience of operation, employ the knife on the right side leaving out bladder-stone size space.

Make sure that the bladder stone is not broken or powdered. Even if a small quantity of particle remains, it would again grow. Therefore, remove entirely with a curved forceps.

Strinam tu bastiparsvagato garbhasayah

sannikrstah I Tasmattasamutsangavacchastrarn

patayet atosnyatha khalvasarn mutrasravi

vrano bhavet, purusasya va mutrapraseka

ksanananmutra – ksaranam; asmarivranadrte

bhinnabastirekadhaspi na bhavati dvidha

bhinnabastirasrnariko na sidhyati II

For women, the womb is near below the bladder. Therefore for them, drop the knife (only) on the surface (of the bladder). Otherwise the bladder might get injured. For men, because of injury to the ureter, abnormal flow of urine occurs. With the exception of the injury by bladder stone surgery, there should not be any injury even once. With two incisions to the uterus, freedom from stone would never be achieved.

Source

Sushruta-samhita, Cikitsa-sthanam, Adhyayah 7, Paragraph 33 (6th Century BCE)

Etymology

1. Asma -> Asmari = Stone -> Bladder stone
2. Agra + vaktram = Front + mouth = Forceps
3. Mutra-sravi = Urine + oozer = Bladder.

Plastic Surgery of the Nose (Rhinoplasty)

Vislesitayastvatha nasikaya

vaksyami sandhanavidhirn yathavat

The method of joining of disjointed nose is described as follows –

Nasaprarnanarn prthivtruhanarn patrarh

grhitva tvavalambitasya II

Tena prarnanena hi gandaparsvadutkrtya

baddharh tvatha nasikagram I

Vilikhya casu pratisandadhlta tat

sadhubandhairbhisagaprarnattah II

The doctor should –

• take a nose sized leaf of a tree supported on the forehead
• cut the skin from the forehead in the size of the leaf
• trace on the leaf the profile of the nose and immediately
• join the skin carefully with appropriate bandage.

Susamhitarn sabhyagato

yathavannac;lfdvayenabhisamfk~ya baddhva I

Pronnamya cainamavacurnayettu

patangayastimadhukanjanaisca II

With two stalks, after checking on all sides and after tying such that the nostrils are well joined and refined, lift the nostrils; sprinkle the nose with Pathanga, liquorice and Anjana.

Safichadya sam yak picuna sitena tailena

sincedasakrttilanam I

Ghrtafica payyah sa narah sujirne snigdho

virecyah sa yathopadesam II

Covering the operated spot well with white cotton, sprinkle oil. The person should be fed repeatedly with the ghee of sesame seeds. On complete digestion, the person thus lubricated should be evacuated as advised.

Rudhafica sandhanarnupagatarn syat

tadarddhasesantu punarnikrntet I

Hinarn punarvarddhayiturn yateta sarnafica

kuryadativrddhamarnsam II

The joint would have grown stronger and closer. Cut the remaining half again. Try to grow that which is deficient, make uniform excess growth of flesh (if any).

Source

Sushruta-samhita, Sutra-sthanam, Adhyayah 16, Paragraph 27 -31 (6^th Century BCE)

Notes

During one of his battles with the British, Tipu Sultan (1793 AD), the ruler of Srirangapatna (in the present Karnataka state in South India) had, as punishment, cut the nose off of 4 Indians – Kawasajee, a Maratha and 3 other soldiers – who served in the British Army. The commanding officer of the British contingent in India chanced upon an Indian merchant who had his nose fixed after being cut as a punishment for adultery. The commanding officer traced the vaidya (doctor) from Maratha (the present Maharashtra) and had him fix the noses of his Indian soldiers.

This was reported in the Madras Gazzette of 1793.

A detailed account of the reconstruction procedure was published in the October 1794 issue of the Gentleman’s magazine published from London. Inspired by this account, an English surgeon J.C. Carpue performed two ‘Indian nose’ surgeries successfully and published his experience. A German surgeon Graefe followed Carpue’s example. Rhinoplasty thus moved from Maratha to Europe and has come back 200 years later as Plastic Surgery. This ancient type of Plastic Surgery of the nose is still popular as ‘Indian Rhinoplasty’ in modern sciences.

Suturing

Tato vranarn samunnamya sthapayitva

yathasthitam I

Sivyet suksmena sutrena

valkenasmantakasya va

Sanajaksaumasutrabhyam snayva valena va

punah I Murvaguducitanairva sivyedvellitakarn sanaih

Lifting the borders of the wound and placing it firmly, stitch with a fine thread or the fibre of the Ashmantaka grass.

Again slowly do a winding stitch with

• hemp

• linen or silk

• sinew

• hair

• fibre of murve creeper

• fibre of the medicinal plant coccvlus cordifolius or

• thread.

Sivyedgophanikam vaspi sivyedva

tunnasevanim I Rjugranthimatho vaspi yathayogarnathapi va

Make cow horn shaped stitches or wound suture or straight knot; or stitch as appropriate.

Source

Sushruta-samhita, Sutra-sthanam, Adhyayah 25, Slokah 20-22 (6^th Century BCE)

Notes

Murva – the fibers drawn from this creeper are used for making bowstrings. This is indicative of the strength of this fiber used as a stitching material.

Blunt Surgical Instruments (Yantra)

Yantrani satprakarani tadyatha

svastikayantrani, sandarnsayantrani

talayantrani nadi-yantrani salakayantrani

upayantrani ceti II

Controlling blunt instruments are of six types. They are swastikas, forceps, scoops, tubulars, probes and minor instruments.

Tatra caturvirnsatih svastikayantrani dye

sandarnsayantre dye eva talayantre

vimsatirnadyah astavirnsatih salakah

paficavirnsatirupayantrani II

There are 24 swastikas, 2 forceps, only 2 scoops, 20 tubular instruments, 28 probes and 25 minor instruments.

Source

Sushruta-samhita, Sutra-sthanam, Adhyayah 7, Paragraphs 5 and 6 (6^th Century BCE)

Etymology

Yam = To control

Yantram= A controlling instrument

Svastikam: Cross shaped

Sam + damsah: One that bites well = forceps

Talah = Palm leaf = Scoop

Nadi = Tubular

Salaka = To stir = Probe

Surgical Instruments – Forceps

Svastikayantrani – astadasangulapramanani,

siIhhavyaghravrkatarak~vrk~advlpimaIjarasrgaJa-

mrgairvarukakakakai1kakuraraca~abhasasasaghat –

yuliikacillisyenagrdhrakrauficabhrilgaraja-

fi j alikarnavab hafij ananan dim ukham u khan i ,

masurakrtibhih kllairavabhaddhani,

mulesnkusa – vadavrttavarangani,

asthivida~tasalyoddharal).arthamupadisyante II

Kaka-yantra – Crow faced

Kanka-yantra – Heron faced

Kurara -yantra – Osprey faced

Casa-yantra – Blue jay faced

Chilli-yantra – Bengal kite faced

Syena-yantra – Hawk faced

Briga raja-yantra – Large bee faced

Anjalikarna-yantra – Horned owl faced

Avabajananandimuka-yantra – Broken bull faced

Instruments bound by lentil sized nails, like the elephants held at the base by the goad (ankusha), are advised for biting and lifting thorns (foreign bodies).

Source:

Sushruta-samhita, Sara-sthanam, Adhydyah 7, Paragraph 10 (6^th Century BCE)

Osprey = Large fish-eating bird with a dark back and whitish head.

Curlew = Water bird with a long thin beak that curves downwards.

Western Reference

Some analogous modern instruments are lion forceps, dental hawk, bill forceps, mouse teeth forceps, crocodile forceps, bulldog, volsella or tweezer, bone forceps and dental forceps.

Surgical Instruments – Surgical Probes

Salakayantrani api nanaprakarani

nanaprayojanani yathayogaparinahadirghani ca

Probes are also of different types and are of different applications. They are joined, circular or lengthy.

Tesarn gand upadasarpaphanasarapunkha-

badisarnukhe dye dye

etanaYyUhanacalanaharal)arthamupa-disyete I

Of these probes with face like earthworm, head of the snake, the base of the arrow and a hook – each of these – are of two shapes. These are advised for probing, arranging, moving, and extracting.

Masuradalamatramukhe dye kificidanatagre

srotogatasalyoddharanartham sat

karpasakrtosnisani prarnarjanakriyasu I

Probes which are bent and have a grain-sized face are two in numbers. These are advised for lifting of thorn or any foreign body gone into the alimentary canal.

Trini darvyakrtini khallamukhani,

ksarausadhaprani-dhanartharn I

There are 6 cotton headed probes, for cleaning tasks.

Trinyanyani jarnbavavadanani

trinyankusavadanani

sadevagnikarmasvabhipre-tani

For the application of alkaline and medicines, there are three ladle-shaped and mortar-faced probes.

Nasasrbudaharanartharnekam

kolasthidalamatrarnukham khallatiksnaustharn

There are three other rose-apple-faced probes; three spear-faced. These 6 are opined in cauterization.

Afijanarthamekarn kalayaparimandala-

mubhayato mukulagrarn I

For the removal of tumor from the nose, a probe with face like a split hip bone and with sharpened lip is advised.

Miitramargavisodhanarthamekam

malatIpupavrntagrapramaQaparimaQ Ialamiti

For applying medicine, one that has the circumference of a seed and has bud like face on either side is advised.

For cleaning the urinary tract, a probe with circumference of the size of the tip of the jasmine stalk is advised.

Source:

Sushruta-samhita, Sutra-sthanam, Adhyayah 7, Paragraph 14 (6^th Century BCE)

Etymology

Ksara = corrosive = alkaline.

Surgical Cutting Instruments

Virnsatih sastrani tadyatha –

mandalagrakarapatra – vrddhipatra-

nakhasastra – mudrikotpalapatrakarddha-

dharasuci- kusapatratirnukha-

sararimukhantarmukhatrikflrcaka – kutharika-

vrihirnukharavetasapatraka – badisa

dantasankvesanya iti II

There are twenty sharp instruments like this –

1. Mandala-agra = Circular fronted
2. Kara-patra = Hand-leaf
3. Vriddhi-patra = Razor
4. 4. Nakha-shastra = Nail like instrument
5. Mudrika = Ring like
6. Utpala-patraka = Lotus leaf
7. Ardha-dhara = Single edged
8. 8. Kusha-patra = Grass leaf
9. Ati-mukha = Ati beak like
10. Sharari-mukha = Sharari beak like
11. Antar-mukha = Curved in
12. Tri-kurcaka = Three bristled
13. Kutharika  = Axa
14. Vrihi-mukha = Rice faced
15. Ara = Spokes
16. Vetasa-patraka = Rattan like
17. Badisa = Hook
18. Danta-sanku = Tooth cone
19. Eshani = Probes

Sushruta-samhita, Sutra-sthanam, Adhyayah 8, Paragraph 3 (6^th Century BCE)

Surgical Instruments – Needles

Deseslpamarnse sandhau ca suci vrttasnguladvayam

Ayata tryangula tryasra rnarnsale capi pujita II

Dhanurvakra hita marmaphalakosodaropari I

Ityetastrividhah suclstiksnagrah susarnahitah II

In areas of minimal flesh and joints, needles that are round and of two finger-width length and in fleshy parts three-cornered needles of three finger-width length are required.

In the vital parts, scrotum and abdomen, needle curved like a bow is appropriate. Thus these three types of sharp pointed needles are brought together.

Source

Sushruta-samhita, Sutra-sthanam, Adhyayah 25, Slokah 23, 24 (6^th Century BCE)

Pockets of Knowledge

Surgeon Jivaka

The oldest operation we know of is trepanning, making a hole in the skull. It is said that Jivaka (the royal physician of King Bimbisara) once opened a man’s skull and removed a centipede from inside the man’s head. The man recovered.

Pathologists say he might have removed a dog tapeworm which sometimes lodges in the human brain.

Reiki: India —> Japan —-> India

The concept of Reiki originated in India, but it was rediscovered by Dr. Mikao Usui in Japan in the late 19^th century. Dr. Usui was a Shingon Buddhist priest and a physician. He read about an ancient healing art in an 1100 year old Buddhist Manuscript and made a brief synthesis of the essence of this seven level Tantric teaching as Reiki.

Thai Massage: India —–> Thailand —> India

“With Thai massage the effects are immediate, you feel significantly rejuvenated and energized after the very first session,” says Anne Perry, a Thai bodywork expert. “Repeated sessions have actually cured chronic back pain, bur most importantly, they seem to inspire people to do more work, live healthier lives and take up what they really love to do.”

“Thai massage is a little bit like dance, it involves a lot of postures like yoga. It’s not strenuous as long as you do it right,” she says.

“There’s evidence, in some form, of it being practiced 2,500 years ago in India. And I am honored to be able to bring the tradition back to India, the country of its origin. Thai massage finds similarities with marma chikitsa, and probably travelled to Southeast Asia with Monastic Buddhism before being integrated with their medical and herbal systems. In Thailand, they honor the fact that it came from India.”