अष्टविधशस्त्रकर्मीयाध्यायः
अथातोऽष्टविधशस्त्रकर्मीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
“Now, we shall expound the chapter on the eight types of surgical procedures."
"As was spoken by the revered Dhanvantari.”
These introductory shlokas set the stage for a detailed discussion on various surgical techniques as taught by Lord Dhanvantari, the deity of Ayurveda and surgery.
छेद्या भगन्दरा ग्रन्थिः श्लैष्मिकस्तिलकालकः |
व्रणवर्त्मार्बुदान्यर्शश्चर्मकीलोऽस्थिमांसगम् ||३||
शल्यं जतुमणिर्मांससङ्घातो गलशुण्डिका |
स्नायुमांससिराकोथो वल्मीकं शतपोनकः ||४||
अध्रुषश्चोपदंशाश्च मांसकन्द्यधिमांसकः |५|
“The conditions requiring excision include fistula-in-ano, glandular swellings, lesions related to phlegm, infected wounds, tumors, hemorrhoids, warts, and conditions involving bone and muscle. Foreign bodies, stones or calculi, flesh accumulations, goiters, conditions involving muscles, ligaments, and veins, anthrax, and complex abscesses. Difficult-to-treat conditions, venereal diseases, flesh growths, and excessive growth of flesh.”
These shlokas list various conditions requiring surgical excision, emphasizing the need for removal of affected tissues for effective treatment.
भेद्या विद्रधयोऽन्यत्र सर्वजाद्ग्रन्थयस्त्रयः ||५||
आदितो ये विसर्पाश्च वृद्धयः सविदारिकाः |
प्रमेहपिडकाः शोफः स्तनरोगोऽवमन्थकाः ||६||
कुम्भीकानुशयी नाड्यो वृन्दौ पुष्करिकाऽलजी |
प्रायशः क्षुद्ररोगाश्च पुप्पुटौ तालुदन्तजौ ||७||
तुण्डिकेरी गिलायुश्च पूर्वं ये च प्रपाकिणः |
बस्तिस्तथाऽश्मरीहेतोर्मेदोजा ये च केचन ||८||
“The conditions requiring incision include abscesses, all types of glandular swellings, erysipelas, phlegmonous growths, diabetic boils, edema, breast diseases, and inflammatory swellings. Cysts, sinus tracts, compound abscesses, pustular eruptions, small ulcers, nasal polyps, dental abscesses, tonsillar abscesses, inflammatory throat conditions, previous abscesses, bladder stones, and any other fatty or fluid-filled swellings.”
These shlokas highlight conditions that need surgical incision, emphasizing the importance of incision for effective treatment.
लेख्याश्चतस्रो रोहिण्यः किलासमुपजिह्विका |
मेदोजो दन्तवैदर्भो ग्रन्थिर्वर्त्माधिजिह्विका ||९||
अर्शांसि मण्डलं मांसकन्दी मांसोन्नतिस्तथा |१०|
“The conditions requiring scarification include four types of ulcers, depigmentation, sublingual growths, fatty growths, dental swellings, glandular swellings, and growths on the eyelids. Hemorrhoids, nodules, flesh growths, and raised flesh.”
These shlokas emphasize the conditions that require scarification, highlighting various types of ulcers, swellings, and growths that need this surgical intervention.
वेध्याः सिरा बहुविधा मूत्रवृद्धिर्दकोदरम् ||१०||
“The conditions requiring venesection include various types of veins, dropsy (edema), and abdominal swelling.”
This shloka emphasizes conditions that require venesection (bloodletting) to relieve symptoms and treat ailments like edema and abdominal swelling.
एष्या नाड्यः सशल्याश्च व्रणा उन्मार्गिणश्च ये |११|
“The conditions requiring probing include sinus tracts with foreign bodies and wounds that have developed false passages.”
This shloka emphasizes the need for probing in conditions like sinus tracts with foreign bodies and improperly healing wounds to ensure proper treatment.
आहार्याः शर्करास्तिस्रो दन्तकर्णमलोऽश्मरी ||११||
शल्यानि मूढगर्भाश्च वर्चश्च निचितं गुदे |१२|
“The conditions requiring extraction include three types of stones, dental and ear impurities, and bladder stones. Impacted fetus, and fecal impaction in the rectum.”
These shlokas emphasize conditions that require extraction, including stones, dental and ear impurities, bladder stones, impacted fetus, and rectal fecal impaction.
स्राव्या विद्रधयः पञ्च भवेयुः सर्वजादृते ||१२||
कुष्ठानि वायुः सरुजः शोफो यश्चैकदेशजः |
पाल्यामयाः श्लीपदानि विषजुष्टं च शोणितम् ||१३||
अर्बुदानि विसर्पाश्च ग्रन्थयश्चादितश्च ते |
त्रयस्त्रयश्चोपदंशाः स्तनरोगा विदारिका ||१४||
सु(शु)षिरो गलशालूकं कण्टकाः कृमिदन्तकः |
दन्तवेष्टः सोपकुशः शीतादो दन्तपुप्पुटः ||१५||
पित्तासृक्कफजाश्चौष्ठ्याः क्षुद्ररोगाश्च भूयशः |१६|
“The conditions requiring bloodletting include five types of abscesses (excluding those of all origins), leprosy, painful vata disorders, localized edema, lymphatic diseases, spleen enlargements, blood affected by toxins, tumors, erysipelas, glandular swellings, three types of venereal diseases, breast diseases, fissures, nasal conditions, throat conditions, worm infestations in teeth, dental abscesses, and various small ailments.”
These shlokas describe the conditions that need bloodletting, focusing on abscesses, vata disorders, leprosy, tumors, venereal diseases, and various inflammatory conditions where bloodletting is considered beneficial.
सीव्या मेदःसमुत्थाश्च भिन्नाः सुलिखिता गदाः ||१६||
सद्योव्रणाश्च ये चैव चलसन्धिव्यपाश्रिताः |१७|
“The conditions requiring suturing include wounds caused by fatty tissue, deep cuts, freshly inflicted wounds, and those associated with unstable joints.”
These shlokas highlight the conditions that need suturing, emphasizing the importance of stitching for proper healing of various types of wounds and injuries.
न क्षाराग्निविषैर्जुष्टा न च मारुतवाहिनः ||१७||
नान्तर्लोहितशल्याश्च तेषु सम्यग्विशोधनम् |१८|
“The conditions not suitable for treatment with alkali, fire, or poison, nor through bloodletting, or those involving internal bleeding should be treated with proper purification methods.”
These shlokas indicate conditions that are unsuitable for aggressive treatments such as alkali, fire, poison, or bloodletting, especially those involving internal bleeding, emphasizing the need for appropriate purification methods.
पांशुरोमनखादीनि चलमस्थि भवेच्च यत् ||१८||
अहृतानि यतोऽमूनि पाचयेयुर्भृशं व्रणम् |
रुजश्च विविधाः कुर्युस्तस्मादेतान् विशोधयेत् ||१९||
“Dust, hair, nails, and loose bone fragments that remain in a wound can cause severe infection and various types of pain; therefore, these should be thoroughly cleansed.”
These shlokas emphasize the importance of thoroughly cleansing wounds to prevent infection and pain caused by foreign materials like dust, hair, nails, and bone fragments.
ततो व्रणं समुन्नम्य स्थापयित्वा यथास्थितम् |
सीव्येत् सूक्ष्मेण सूत्रेण वल्केनाश्मन्तकस्य वा ||२०||
शणजक्षौमसूत्राभ्यां स्नाय्वा बालेन वा पुनः |
मूर्वागुडूचीतानैर्वा सीव्येद्वेल्लितकं शनैः ||२१||
सीव्येद्गोफणिकां वाऽपि सीव्येद्वा तुन्नसेवनीम् |
ऋजुग्रन्थिमथो वाऽपि यथायोगमथापि वा ||२२||
देशेऽल्पमांसे सन्धौ च सूची वृत्ताऽङ्गुलद्वयम् |
आयता त्र्यङ्गुला त्र्यस्रा मांसले चाऽपि पूजिता ||२३||
धनुर्वक्रा हिता मर्मफलकोशोदरोपरि |
इत्येतास्त्रिविधाः सूचीस्तीक्ष्णाग्राः सुसमाहिताः ||२४||
कारयेन्मालतीपुष्पवृन्ताग्रपरिमण्डलाः |
नातिदूरे निकृष्टे वा सूचीं कर्मणि पातयेत् ||२५||
दूराद्रुजो व्रणौष्ठस्य सन्निकृष्टेऽवलुञ्चनम् ||२६||
“Then, raise the wound and position it properly. Stitch it with a fine thread or a fiber of the Ashmantaka tree. Also, use threads made from jute or cotton, sinew, or hair of the tail of a horse. Stitch the wound slowly and steadily. Use either a whip stitch or a mattress stitch, or other suitable techniques according to the situation. Needles should be round and two fingers wide for small areas, elongated or triangular for fleshy parts. Bow-shaped needles are suitable for joints and around bony areas. There are three types of needles: sharp, curved, and with rounded ends. They should be well-prepared and made of the stem of the Malati flower. When performing surgery, insert the needle at an appropriate distance. Pain is caused by inserting the needle from afar and improper stitching close to the edge of the wound.”
These shlokas provide detailed guidelines on the technique and tools for suturing wounds, emphasizing the importance of choosing the right thread and needle type for effective and proper healing.
अथ क्षौमपिचुच्छन्नं सुस्यूतं प्रतिसारयेत् |
प्रियङ्ग्वञ्जनयष्ट्याह्वरोध्रचूर्णैः समन्ततः ||२७||
शल्लकीफलचूर्णैर्वा क्षौमध्यामेन वा पुनः |
ततो व्रणं यथायोगं बद्ध्वाऽऽचारिकमादिशेत् ||२८||
“Then, cover the sutured wound with a linen cloth and apply powders of Priyangu, Anjana, Yashtyahva, and Rodhra all around. Alternatively, use the powder of Shallaki fruits or a linen bandage soaked in these powders. After this, bind the wound properly according to the situation and instruct the patient on the proper care.”
These shlokas provide instructions for post-surgical wound care, emphasizing the importance of covering the wound with a suitable dressing and using medicinal powders to promote healing and prevent infection.
एतदष्टविधं कर्म समासेन प्रकीर्तितम् |
चिकित्सितेषु कार्त्स्न्येन विस्तरस्तस्य वक्ष्यते ||२९||
“These eight types of procedures have been summarized here. Detailed explanations will be provided in the respective treatments.”
This shloka summarizes the eight types of surgical procedures and indicates that detailed explanations will follow in the context of specific treatments.
हीनातिरिक्तं तिर्यक् च गात्रच्छेदनमात्मनः |
एताश्चतस्रोऽष्टविधे कर्मणि व्यापदः स्मृताः ||३०||
“The four complications in the eight types of procedures are undercutting, overcutting, transverse cutting, and self-mutilation.”
This shloka highlights the possible complications during surgical procedures, emphasizing the importance of precision and care to avoid these issues.
अज्ञानलोभाहितवाक्ययोगभयप्रमोहैरपरैश्च भावैः |
यदा प्रयुञ्जीत भिषक् कुशस्त्रं तदा स शेषान् कुरुते विकारान् ||३१||
“When a physician uses surgical instruments due to ignorance, greed, false advice, improper use, fear, or delusion, it results in various complications.”
This shloka emphasizes the importance of proper knowledge, ethics, and careful use of surgical instruments to avoid complications during medical procedures.
तं क्षारशस्त्राग्निभिरौषधैश्च भूयोऽभियुञ्जानमयुक्तियुक्तम् |
जिजीविषुर्दूरत एव वैद्यं विवर्जयेदुग्रविषाहितुल्यम् ||३२||
“When a physician repeatedly uses alkali, surgical instruments, fire, and medicines improperly, one who wishes to live should avoid such a physician as they are comparable to a severe poison.”
This shloka advises patients to avoid physicians who misuse medical treatments, equating their practices to being as harmful as poison.
तदेव युक्तं त्वति मर्मसन्धीन् हिंस्यात् सिराः स्नायुमथास्थि चैव |
मूर्खप्रयुक्तं पुरुषं क्षणेन प्राणैर्वियुञ्ज्यादथवा कदाचित् ||३३||
“A physician who injures vital points, veins, nerves, or bones due to incompetence may cause instant death or severe harm to a person.”
This shloka warns against the dangers posed by unskilled physicians, emphasizing the potential for severe injury or death when vital body parts are damaged during medical procedures.
भ्रमः प्रलापः पतनं प्रमोहो विचेष्टनं संलयनोष्णते च |
स्रस्ताङ्गता मूर्च्छनमूर्ध्ववातस्तीव्रा रुजो वातकृताश्च तास्ताः ||३४||
मांसोदकाभं रुधिरं च गच्छेत् सर्वेन्द्रियार्थोपरमस्तथैव |
दशार्धसङ्ख्येष्वपि विक्षतेषु सामान्यतो मर्मसु लिङ्गमुक्तम् ||३५||
“The symptoms of serious complications include dizziness, delirium, collapse, unconsciousness, convulsions, sweating, limp limbs, fainting, upward movement of vata, severe pain caused by vata, bloody discharge resembling muscle water, and loss of sensory functions. These symptoms are generally seen when ten or more vital spots (marmas) are injured.”
These shlokas describe the severe complications that arise from injuries to vital spots, including symptoms like dizziness, delirium, collapse, unconsciousness, convulsions, sweating, limp limbs, severe pain, and loss of sensory functions.
सुरेन्द्रगोपप्रतिमं प्रभूतं रक्तं स्रवेद्वै क्षततश्च वायुः |
करोति रोगान् विविधान् यथोक्तांश्छिन्नासु भिन्नास्वथवा सिरासु ||३६||
कौब्ज्यं शरीरावयवावसादः क्रियास्वशक्तिस्तुमुला रुजश्च |
चिराद्व्र्रणो रोहति यस्य चापि तं स्नायुविद्धं मनुजं व्यवस्येत् ||३७||
शोफातिवृद्धिस्तुमुला रुजश्च बलक्षयः पर्वसु भेदशोफौ |
क्षतेषु सन्धिष्वचलाचलेषु स्यात् सन्धिकर्मोपरतिश्च लिङ्गम् ||३८||
घोरा रुजो यस्य निशादिनेषु सर्वास्ववस्थासु न शान्तिरस्ति |
तृष्णाङ्गसादौ श्वयथुश्च रुक् च तमस्थिविद्धं मनुजं व्यवस्येत् ||३९||
“Bright red blood resembling the insect 'Surendra Gopa' flows profusely when veins are injured. This causes various diseases. Complications include deformation, weakening of body parts, loss of function, and intense pain. Delayed wound healing is indicative of nerve injury. Excessive swelling, intense pain, weakness, and joint disorders are symptoms of joint injuries. Severe pain, restlessness, and swelling indicate bone injuries.”
Injuries to veins, nerves, joints, or bones can lead to severe complications like profuse bleeding, deformation, loss of function, intense pain, and delayed healing, emphasizing the need for careful treatment and management.
यथास्वमेतानि विभावयेच्च लिङ्गानि मर्मस्वभिताडितेषु |४०|
“One should carefully assess these symptoms according to their specific nature when vital points (marmas) are injured.”
This shloka emphasizes the importance of accurately evaluating the symptoms that arise when vital points are injured to ensure appropriate treatment.
स्पर्शं न जानाति विपाण्डुवर्णो यो मांसमर्मण्यभिताडितः स्यात् ||४०||
“One who does not feel touch and whose skin turns pale when the muscle marma (vital point) is injured.”
This shloka highlights the symptoms of injury to the muscle vital points, where the affected person loses sensation and their skin becomes pale.
आत्मानमेवाथ जघन्यकारी शस्त्रेण यो हन्ति हि कर्म कुर्वन् |
तमात्मवानात्महनं कुवैद्यं विवर्जयेदायुरभीप्समानः ||४१||
“A physician who harms himself while performing surgery is incompetent and should be avoided by those who wish to live.”
This shloka warns against incompetent physicians who may harm themselves during surgery, advising patients to avoid such practitioners for their own safety.
तिर्यक् प्रणिहिते शस्त्रे दोषाः पूर्वमुदाहृताः |
तस्मात् परिहरन् दोषान् कुर्याच्छस्त्रनिपातनम् ||४२||
“When the surgical instrument is applied obliquely, the complications mentioned earlier arise. Therefore, to avoid these complications, the instrument should be applied properly.”
This shloka emphasizes the importance of correctly using surgical instruments to prevent complications. Proper technique ensures safer and more effective surgical outcomes.
मातरं पितरं पुत्रान् बान्धवानपि चातुरः |
अप्येतानभिशङ्केत वैद्ये विश्वासमेति च ||४३||
विसृजत्यात्मनाऽऽत्मानं न चैनं परिशङ्कते |४४|
“Even a clever person suspects their mother, father, sons, and relatives, but they place complete trust in their physician, entrusting their life to them without any doubt.”
These shlokas highlight the immense trust and faith that people place in their physicians, often more than in their own family members, underscoring the crucial responsibility and ethical duty of medical practitioners.
तस्मात् पुत्रवदेवैनं पालयेदातुरं भिषक् ||४४||
“Therefore, a physician should care for their patient as if they were their own child.”
This shloka emphasizes the importance of compassionate care, urging physicians to treat their patients with the same love and attention as they would their own children.
धर्मार्थौ कीर्तिमित्यर्थं सतां ग्रहणमुत्तमम् |
प्राप्नुयात् स्वर्गवासं च हितमारभ्य कर्मणा ||४५||
“By performing beneficial deeds, one attains righteousness, wealth, and fame, as well as the highest honor among the noble. They also secure a place in heaven.”
This shloka highlights the rewards of performing good deeds, emphasizing that such actions lead to righteousness, prosperity, fame, and eternal bliss in heaven.
कर्मणा कश्चिदेकेन द्वाभ्यां कश्चित्त्रिभिस्तथा |
विकारः साध्यते कश्चिच्चतुर्भिरपि कर्मभिः ||४६||
“Some diseases are cured by one procedure, some by two, some by three, and others by four procedures.”
This shloka highlights the variability in medical treatments, indicating that different ailments may require a varying number of procedures for effective cure, reflecting the complexity and individualized approach needed in medical practice.
इति सुश्रुतसंहितायां सूत्रस्थानेऽष्टविधशस्त्रकर्मीयो नाम पञ्चविंशोऽध्यायः ||२५||
“Thus, ends the twenty-fifth chapter named ‘Eight Types of Surgical Procedures’ in the Sushruta Samhita, Sutrasthana.”
This marks the conclusion of the chapter, summarizing the comprehensive discussions on various surgical procedures and their respective methodologies.