Salyatantra –
introductory aspects:
introductory aspects:
Sályatantra, analogous to “surgery” of modern medicine, deals with various surgical procedures. Removing foreign bodies; either of exogenous origin such as grass, sand, wood, stones, warfare materials like parts of arrow etc. or of endogenous origin such as pus, extravasated blood, dead foetus in the womb etc. comes under áalyatantra. It also deals with the diagnosis and management of inflammatory swellings and includes the description and uses of various surgical instruments and appliances. Further, it explains the mode of preparation, properties and application of various cauteries.
Divisions:
o Surgical discipline
o Orthopaedic discipline
Scope:
o Some conditions like fistula in ano can be better managed by Salyathantra techniques like ksharasutra
o Some like haemorrhoids can be managed by medicines and surgical techniques put together
o Some others like non healing ulcers can be managed by medicines alone
Orthopaedic school:
o Non surgical methods in surgical orthopaedic conditions gaining acceptance
History:
o Very popular – vedic period
o Epic of chopped off head of Daksha reconstituted with that of a goat
o Aswinee kumaras, the divine twin surgeons
o Popular till the period of Emperor Ashoka
o Later-on, suffered set back
The decline:
o Budhist ahimsa philosophy said to have accelerated the decline
o Cadeveric anatomical studies said to have been banned
o Moghul and later British invasion instrumental in the decline
Current status, renaissance and limitations:
o New syllabus, curriculum etc. helped a revival
o Students are taught western surgery
o Now para-surgical techniques gaining momentum and acceptance
o No major surgeries other than anorectal surgery done by Ayurvedic method now
The Susrutha and Caraka schools:
o Schools of Susrutha older (5th B.C.?) and gives more importance to surgical management
o Schools of Caraka gives more importance to medical management
Importance of the surgical school:
o Immediate effect
o Use of blunt instruments (yanthra), sharp instruments (shastra), caustic alkali (kshara), cautery (agni) etc.
o Blood letting (raktha mokshana), leeching (jalouka) etc. to cure a variety of diseases
o Has got its own dictum and concepts, separate from the medical school
Types of blunt instruments:
o Six types
o Swasthika yanthras – cruciform and ringed forceps of many types (extraction) – of many types resembling mouth of animals and birds
o Sandamsha yanthras – tongs (holding and extraction)
o Thala yanthras – spatula (extraction)
o Naadee yanthras – tubular instruments, scopes (scopes, extractors, dilators, speculum, finger protector, syringes, cannula, nozzles)
o Shalaka yanthras - probes
o Upayanthras – magnets, threads, cloth, stone, hammer, straps, branches of tree, nail, mouth, time, transformation, fear, pleasure
The most important instrument:
o Hand of the surgeon - Cheir
Animal faced forceps used in India in
5th Century B.C. for surgical procedures:
5th Century B.C. for surgical procedures:
Lion faced forceps, bear faced forceps,crow faced forceps
Materials used for making instruments and payana:
o Chiefly steel of varying tempers
o Payana - (3 tempers –fat, water and alkaline liquid)
o Other metals may also be used like copper, silver, gold etc.
Sterilization:
o Rakshokhna karma by fumigation
o Paayana also helps in sterilization
Fumigation:
o The technique of choice in infection and suppuration of bacterial origin
o Useful where even antibiotics fail
o Control of discharge and other signs of infection
o Special medicines like Guggulupanchapala choornam
Sharp instruments:
o Chiefly 20 types
o Mandalagra (curette), Vridhipathra (scalpel), Ulpala pathra (double edged scalpel), Ardhadhara (short bladed scalpel), sarpasya (thin bladed curved scalpel, eshani (probe/sound), vethasapathra (bamboo leaf bladed scalpel), sarari mukha (heron’s beak balded scalpel), trikurchaka (trident), kushapathra (grass leaf bladed scalpel), atamukha (bird’s beak bladed scalpel), antharmukha (semilunar bladed scalpel), Vrihi vakthra (lancet), kudari (axe shaped scalpel), shalaka (sharp probe/cataract needle), anguli shasthraka (finger blade), badisha (hook), karapathra (bone saw), karthari (surgical scissors), nakha shasthra (nail cutter), dantha lekhanaka (dental lancet), suci (needles), kurcha (needle cxluster), khaja (churner), karna vedhini (ear puncture punch), aara (punch), anushasthra (accessory sharp instruments)
Main uses of sharp instruments:
o Scraping, excision, incision, division, exploration, puncturing, drainage, tapping, venepuncture, venesection, suturing, needling (of cataract), holding, extraction, shallow pricking, abrading, blood letting by churning………….
The eight surgical procedures:
Chedana - excision
o Bhedana - Incision
o Vedhana - Puncturing
o Lekhyam – abrasion, scraping
o Eshana - exploration
o Aahanrana - extraction
o Visravana - drainage
o Seevana – suturing
Holding of instruments:
o For drainage – at the tip of the handle
o Lancet – handle covered by palm
o Extraction – at the base
Anaesthesia, analgesia:
o Drugs not available
o Alcohol used in those who took it
o Analgesia attained by fomentation after external use of fat
Procedure in steps:
o Poorva karma (pre operative protocol)
Necessary arrangements, preparation of the room, staff and the patient etc.
o Pradhana karma (operative procedure)
o Paschima karma (post operative procedures)
Resuscitation of the patient, wound toilet etc.
Experimental surgery:
o The eight surgical procedures done experimentally in similes of vegetables etc.
Marmas – the vital points:
o 107 types vs. 3 types
o Structural complexity
o Where life ‘passes through’
o Chinese acupressure/acupuncture
o Surgical implications
o Anatomical (mamsa, sira, snayu, asthy and sandhy) and traumatological (death span freom time of injury) Classification
o Marma therapy
Kshara – the caustic alkali:
o Definition
o Importance
o Properties
o Action
o Types
o Method of preparation
o Complications
o Ksharasoothra
Management of burns/scalds:
o Plushtam
o Durdagdham
o Samyak dagdham
o Athidagdham
Management of fractures and dislocations:
o Types
o Principles
o Reduction
o Immobilization
o Reabilitation
o Immediate management
o Later management
o Medicines that promote bone healing
Bandages:
o Indications
o Contraindications
o 15 Types (based on location): capsular, figure of 8, loose bandage, eye bandage, soica bandage, ascending spiral, four tailed, chest bandage, finger bandage, cephalic bandage, arm sling, T- bandage, twin bandage, circular bandage and five tailed bandage
o Benefits
Wound management principles:
o Susrutha consider all therapies based on ulcer
o Sadyo vrana, dushta vrana
o The sixty therapies
o Vrana gandha
o Vrana srava
o Regimen
Ulcer, its types and management:
o Dushta vrana
o Vrana shodhana
o Vrana ropana
Concepts:
o Vranasopha
o Shatkriyakala
o Paka
o Kshathoshma
o Raktha as the fourth dosha
o Regimen – high protein, sex, alcohol, mindset
o Emergency surgery
Shatkriyakala:
o Samchaya - accumulation
o Prakopa – excitation
o Prasara - spread
o Sthanasamshraya - localisation
o Vyakthy - manifestation
o Bheda – incurability
Blood letting:
o Benefits
o Types -
o Siravyadha(for systemic illnesses, varicose veins) , Pracchanna (for local complaints), Shringa (for hypoasthesia, numbness), Alabu (numbness), Jaloukavacharana (deep seated and indurated conditions): medicinal and non medicinal - poisnous
o Indications: Skin pathologies, local swellings, oedema, blood borne conditions, pathologies not amenable to management with usual protocol
LEECHING – back in vogue:
o Medicinal, poisnous
o Indications
o Contra indications
o Benefits
o Procedure
o Current state in India
Current applications
of leech therapy:
of leech therapy:
o Plastic and Reconstructive surgery
o Reducing venous congestion (stagnation), promoting microcirculation, anticoagulant/thrombolitic effect, anti ischemic effect
o Improving haematopoietic cell formation
o Promoting healing
o Improving angiogenesis
o Improvement of antigenic expressions like endothelial cells, cytokine release, extracellular matrix interactions
o Collagen reorganization
o Improving role of fibroblasts in healing
o Formation of pseudoblastema during healing (rudimentary protoplasm)
o Decompressing venous congestion during re-plantation plastic surgery of the ear, with no venous repair mandatory
o In the revascularization of the amputated segment
o Anti-inflammatory effect - osteoarthrosis
o Immune-stimulating and immune-modulating effects
o Anti-stress, adaptogenic effects
o Anesthetic, analgesic effect
o Bacteriostatic and bactericidal effect
o Anti edematous effect
o Improvement of endo-cellular gaseous exchange
o Prevention of abnormal intersystem interactions (ex. auto-immune diseases)
Plastic & reconstructive surgery:
o Ancient rhinoplasty
o Otoplasty
Impacted foreign bodies:
o Methods to identify and remove impacted foreign bodies
Wound management:
the short 7 therapies:
the short 7 therapies:
o Vimlapana (To compress)
o Avaseka (blood letting)
o Upanaha (poultice)
o Patana (external use of drugs which helps opening up of abscess etc)
o Shodhana (emesis, purgation etc.)
o Ropana (healing by ropana varthy, kalka etc)
o Vaikrithapaha (prevention of complications)
Some clinical conditions:
o Bhagandara – fistula in ano
o Pitaka - abscesses
o Naadee vrana - sinuses
o Bhanga – fractures and dislocations
o Arshas – piles
o Marmakhatha – shock due to assault
o Kodha – gangrene
o Grandhy - Benign tumors
o Arbuda – malignant tumors
o Sira grandhy – varicose veins
o Ashmary - Urolithiasis
(courtesey)
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