शस्त्रावचारणीयाध्यायः
अथातः शस्त्रावचारणीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
"Now, we shall expound the chapter on the application of surgical instruments."
"Thus said the venerable Dhanvantari."
This introduction sets the stage for discussing the application and use of surgical instruments , following the teachings of the revered Dhanvantari.
विंशतिः शस्त्राणि, तद्यथा- मण्डलाग्रकरपत्रवृद्धिपत्रनखशस्त्रमुद्रिकोत्पलपत्रकार्धधारसूचीकुशपत्राटीमुख- शरारिमुखान्तर्मुखत्रिकूर्चककुठारिकाव्रीहिमुखारावेतसपत्रकबडिशदन्तशङ्क्वेषण्य इति
||३||
"There are twenty types of surgical instruments: Mandalagra, Karapatra, Vriddhipatra, Nakhasastra, Mudrika, Utpalapatra, Arddhadhara, Suchi, Kushapatra, Ati-Mukha, Sharari-Mukha, Antarmukha, Trikurchaka, Kutharika, Vrihimukha, Arā, Vetasa-Patraka, Badisha, Danta-Shanku, and Eshani."
This shloka enumerates the twenty types of surgical instruments used in ancient surgery, listing their specific names, each with unique functions and applications in medical procedures.
तत्र मण्डलाग्रकरपत्रे स्यातां छेदने लेखने च, वृद्धिपत्रनखशस्त्रमुद्रिकोत्पलपत्रकार्धधाराणि छेदने भेदने च, सूचीकुशपत्राटी(टा)मुखशरारिमुखान्तर्मुखत्रिकूर्चकानि विस्रावणे, कुठारिकाव्रीहिमुखारावेतसपत्रकाणि व्यधने सूची च, बडिशं दन्तशङ्कुश्चाहरणे, एषण्येषणे आनुलोम्ये च, सूच्यः सीवने; इत्यष्टविधे कर्मण्युपयोगः शस्त्राणां व्याख्यातः ||४||
"Among them, Mandalagra and Karapatra are used for cutting and excising. Vriddhipatra, Nakhasastra, Mudrika, Utpalapatra, Arddhadhara are used for cutting and opening. Suchi, Kushapatra, Ati-Mukha, Sharari-Mukha, Antarmukha, Trikurchaka are used for bloodletting. Kutharika, Vrihimukha, Arā, Vetasa-Patraka are used for puncturing and so is the needle. Badisha and Danta-Shanku are used for extraction. Eshani is used for probing and directional guidance. The needle is used for suturing. Thus, the eight types of actions and uses of the instruments have been described."
This shloka categorizes and describes the various uses of the surgical instruments, emphasizing their specific functions in different types of surgical procedures such as cutting, opening, bloodletting, puncturing, extraction, probing, and suturing.
तेषामथ यथायोगं ग्रहणसमासोपायः कर्मसु वक्ष्यते- तत्र वृद्धिपत्रं वृन्तफलसाधारणे भागे गृह्णीयात्, भेदनान्येवं सर्वाणि, वृद्धिपत्रं मण्डलाग्रं च किञ्चिदुत्तानेन पाणिना लेखने बहुशोऽवचार्यं, वृन्ताग्रे विस्रावणानि, विशेषेण तु बालवृद्धसुकुमारभीरुनारीणां राज्ञां राजमा(पु)त्राणां च त्रिकूर्चकेन विस्रावयेत्, तलप्रच्छादितवृन्तमङ्गुष्ठप्रदेशिनीभ्यां व्रीहिमुखं, कुठारिकां वामहस्तन्यस्तामितरहस्तमध्यमाङ्गुल्याऽङ्गुष्ठविष्टब्धयाऽभिहन्यात् , आराकरपत्रैषण्यो मूले, शेषाणि तु यथायोगं गृह्णीयात् ||५||
"The method of holding and using the instruments will now be described. The Vriddhipatra should be held at the base of the stalk. All cutting instruments should be held similarly. The Vriddhipatra and Mandalagra should be used with the hand slightly raised for excisions. Bloodletting instruments should be held at the end of the stalk. For children, elderly, delicate individuals, fearful persons, queens, and royal offspring, the Trikurchaka should be used for bloodletting. The Vrihimukha should be held with the thumb and index finger covering the blade. The Kutharika should be held in the left hand, supported by the middle finger and thumb of the right hand. The Arā, Karapatra, and Eshani should be held at their base. All other instruments should be held as appropriate for their use."
This shloka provides detailed instructions on how to hold and use various surgical instruments, emphasizing the importance of proper technique and adjustments for different patient groups to ensure effective and safe surgical procedures.
तेषां नामभिरेवाकृतयः प्रायेण व्याख्याताः ||६||
"Their forms are mostly described by their names."
This shloka indicates that the shapes and forms of the surgical instruments are generally indicated by their names, making it easier to understand their design and purpose.
तत्र नखशस्त्रैषण्यावष्टाङ्गुले , सूच्यो वक्ष्यन्ते, (प्रदेशिन्यग्रपर्वप्रदेशप्रमाणा मुद्रिका, दशाङ्गुला शरारिमुखी सा च (या सा) कर्तरीति कथ्यते) |
शेषाणि तु षडङ्गुलानि ||७||
"Among them, the Nakhasastra and Eshani are eight finger-widths long. The sizes of the needles will be described later (Mudrika is the size of the first phalanx of the index finger; the Sharari-Mukha is ten finger-widths long and is also known as Kartari). The remaining instruments are six finger-widths long."
This shloka provides the specific lengths of certain surgical instruments, emphasizing that the Nakhasastra and Eshani are eight finger-widths long, while the needles' sizes will be described later. It also mentions that the remaining instruments are generally six finger-widths in length.
तानि सुग्रहाणि, सुलोहानि, सुधाराणि, सुरूपाणि, सुसमाहितमुखाग्राणि, अकरालानि, चेति शस्त्रसम्पत् ||८||
"These instruments should be easy to handle, made of good quality metal, well-sharpened, well-formed, with appropriately shaped tips, and not frightening in appearance. Such are the qualities of good surgical instruments."
This shloka describes the desirable qualities of surgical instruments, emphasizing that they should be easy to handle, made of high-quality metal, well-sharpened, well-formed, have appropriately shaped tips, and should not appear frightening. These attributes ensure the effectiveness and safety of the instruments in surgical procedures.
तत्र वक्रं, कुण्ठं, खण्डं, खरधारम्, अतिस्थूलम्, अत्यल्पम्, अतिदीर्घम्, अतिह्रस्वम्, इत्यष्टौ शस्त्रदोषाः |
अतो विपरीतगुणमाददीत, अन्यत्र करपत्रात्; तद्धि खरधारमस्थिच्छेदनार्थम् ||९||
"There are eight defects of surgical instruments: crooked, blunt, broken, excessively sharp, too thick, too small, too long, and too short. Instruments with opposite qualities to these defects should be chosen, except for the Karapatra, which should be sharp for cutting bones."
This shloka lists the eight defects of surgical instruments, emphasizing the importance of choosing instruments that possess the opposite qualities to avoid these defects. However, it notes that the Karapatra should have a sharp edge specifically for cutting bones.
तत्र धारा भेदनानां मासूरी, लेखनानामर्धमासूरी, व्यधनानां विस्रावणानां च कैशिकी, छेदनानामर्धकैशिकीति ||१०||
"There, the edge for piercing should be like a lentil, for excising it should be half a lentil, for puncturing and bloodletting it should be like a hair, and for cutting it should be half a hair."
This shloka provides guidelines on the specific shapes and sharpness of the edges of surgical instruments for different procedures, such as piercing, excising, puncturing, bloodletting, and cutting, emphasizing the precision required for each type of surgical action.
बडिशं दन्तशङ्कुश्चानताग्रे |
तीक्ष्णकण्टकप्रथमयवपत्रमुख्येषणी (गण्डूपदाकारमुखी च) ||११||
"The Badisha and Danta-Shanku have curved tips. The Eshani, primarily used for probing, should have sharp thorns or arrowhead-shaped tips (also shaped like the head of an earthworm)."
This shloka describes the specific shapes and tips of certain surgical instruments, emphasizing the curved tips for the Badisha and Danta-Shanku, and the sharp thorn or arrowhead-shaped tips for the Eshani, which is used for probing.
तेषां पायना त्रिविधा क्षारोदकतैलेषु |
तत्र क्षारपायितं शरशल्यास्थिच्छेदनेषु, उदकपायितं मांसच्छेदनभेदनपाटनेषु, तैलपायितं सिराव्यधनस्नायुच्छेदनेषु ||१२||
"Their sterilization involves three types: using alkali, water, and oil. Instruments sterilized with alkali are used for cutting arrows, extracting foreign bodies, and cutting bones. Instruments sterilized with water are used for cutting, excising, and splitting flesh. Instruments sterilized with oil are used for venesection and cutting ligaments."
This shloka describes the three methods of sterilizing surgical instruments, emphasizing the specific uses for instruments sterilized with alkali, water, and oil, corresponding to different surgical procedures such as cutting, extracting foreign bodies, and venesection.
तेषां निशानार्थं श्लक्ष्णशिला माषवर्णा; धारासंस्थापनार्थं शाल्मलीफलकमिति ||१३||
"For sharpening them, a smooth stone of the color of lentils is used; for fixing the edges, a wooden board of Salmali wood is used."
This shloka describes the tools and materials used for maintaining the sharpness and effectiveness of surgical instruments. It emphasizes the use of a smooth stone for sharpening and a Salmali wood board for fixing the edges.
भवति चात्र-
यदा सुनिशितं शस्त्रं रोमच्छेदि सुसंस्थितम् |
सुगृहीतं प्रमाणेन तदा कर्मसु योजयेत् ||१४||
"Here, when the well-sharpened instrument can cut a hair and is well-balanced and properly handled, it should then be used in surgical procedures."
This shloka emphasizes the importance of ensuring that surgical instruments are well-sharpened, balanced, and properly handled before being used in any surgical procedures. It highlights the need for precision and skill in the preparation and use of surgical tools.
अनुशस्त्राणि तु त्वक्सारस्फटिककाचकुरुविन्दजलौकोग्निक्षारनखगोजीशेफालिकाशाकपत्रकरीरबालाङ्गुलय इति ||१५||
"The auxiliary instruments are: leather, crystal, glass, corundum, leeches, fire, alkali, nails, goat's horn, the leaf of the Shephali plant, vegetable leaves, Kari root, and the young shoots of the Balangula tree."
This shloka lists various auxiliary instruments used in surgical procedures, highlighting the diverse materials and natural elements that complement the primary surgical instruments.
शिशूनां शस्त्रभीरूणां शस्त्राभावे च योजयेत् |
त्वक्सारादिचतुर्वर्गं छेद्ये भेद्ये च बुद्धिमान् ||१६||
आहार्यच्छेद्यभेद्येषु नखं शक्येषु योजयेत् |
विधिः प्रवक्ष्यते पश्चात् क्षारवह्निजलौकसाम् ||१७||
ये स्युर्मुखगता रोगा नेत्रवर्त्मगताश्च ये |
गोजीशेफालिकाशाकपत्रैर्विस्रावयेत्तु तान् ||१८||
एष्येष्वेषण्यलाभे तु बालाङ्गुल्यङ्कुरा हिताः |१९|
"For children, those who are afraid of surgical instruments, and in the absence of surgical instruments, a wise practitioner should use the four types of auxiliary instruments: leather, crystal, glass, and corundum, for cutting and incising. For external cutting and incising, nails can be used where possible. The methods for using alkali, fire, and leeches will be described next. Diseases that affect the mouth and those that affect the eyelids should be treated by letting blood using the leaves of Shephali, and other herbs. In the absence of probing instruments, the young shoots of the Balangula tree are beneficial for probing."
These combined shlokas provide guidelines for alternative instruments and methods that can be used in the absence of traditional surgical tools or for treating specific patient groups such as children or those afraid of surgical instruments. The importance of using natural and auxiliary instruments in certain situations is highlighted to ensure safe and effective treatment.
शस्त्राण्येतानि मतिमान् शुद्धशैक्यायसानि तु |
कारयेत् करणप्राप्तं कर्मारं कर्मकोविदम् ||१९||
"A wise practitioner should ensure that these instruments are made of pure, well-
forged iron and steel, crafted by a skilled and knowledgeable blacksmith."
This shloka emphasizes the importance of using high-quality materials such as pure iron and steel for surgical instruments, and it highlights the need for these instruments to be crafted by a skilled and knowledgeable blacksmith to ensure their effectiveness and safety in surgical procedures.
प्रयोगज्ञस्य वैद्यस्य सिद्धिर्भवति नित्यशः |
तस्मात् परिचयं कुर्याच्छस्त्राणां ग्रहणे सदा ||२०||
"A physician skilled in the use of instruments always attains success. Therefore, one should always become acquainted with the handling of surgical instruments."
This shloka emphasizes the importance of a physician being skilled in using surgical instruments. It highlights that success in surgical procedures comes from a thorough understanding and familiarity with handling these tools.
इति सुश्रुतसंहितायां सूत्रस्थाने शस्त्रावचारणीयो नामाष्टमोऽध्यायः ||८||
"Thus ends the eighth chapter named 'Shastravacharaniya' in the Sutra Sthana section of the Sushruta Samhita."
This verse signifies the conclusion of the eighth chapter called 'Shastravacharaniya' in the Sutra Sthana section of the Sushruta Samhita, which discusses the application and use of surgical instruments.