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Sushruta SamhitaAgnikarma Vidhi Adhyaya - Thermal Cautery - Sushruta Samhita Sutrasthana Chapter 12

Agnikarma Vidhi Adhyaya – Thermal Cautery – Sushruta Samhita Sutrasthana Chapter 12

द्वादशोऽध्यायः । अथातोऽग्निकर्म्मविधिमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥

Now we shall discuss the Chapter which treats of cauteries and the rules to be observed in their us (Agni-Karma-Vidhi-adhyaya). 1

क्षारादग्निर्गरीयान् क्रियासु व्याख्यातः । तद्दग्धानों रोगाणामपुनर्भावाद् भेषजशस्त्रक्षारैरसाध्यानां तत्साध्यत्वाच्च ॥२॥

A fire (cautery) is better than an Alkali as far as its healing property is concerned. A disease burnt with fire, is cured for good and knows no recrudescence; and diseases which ordinarly baffle the skill of a surgeon or a physician, and never prove themselves amenable to medicinal or surgical remedies, are found to yield to fire (cauterisation). 2

अथेमानि दहनोपकरणानि । तद्यथा- पिप्पल्यजाशकृद्गोदन्तशरशलाकाजाम्बवौष्ठेतरलौहाः क्षौरद्रगुडस्नेहाश्च । तत्र पिप्पल्यजाशकृद्गोदन्तशरशलाकास्त्वग्गतानाम्। जाम्बवौष्ठेतरलौहामांसगतानाम् । क्षौद्रगुडस्नेहाश्च शिरास्नायुसन्ध्यस्थिगतानाम् ॥३॥

The following drugs, articles, and substances should be understood as accessories to an act of cauteristion, viz., Pippali, the excreta of goats, the tooth of a cow (Godanta), Sara, a rod, the surgical instrument known as the. Jambavausta, articles made of copper or silver, honey, treacle, oil, or any other oily substance. Out of these, Pippali, the Godanta, Sara and the rod should be (made red hot and) used in cauterising the affected part in a disease which is restricted only to the skin; similarly the surgical instrument known as the Jambavausta,, as well as the appliances made of copper or silver should be used in a disease which is seated in the flesh. Honey, treacle and oil should be boiled and employed in cauterising the disease which affects any of the veins, nerves, bones or bone joints. 3

तत्राग्निकर्म्म सर्व्वर्त्तुषु कुर्य्यादन्यत्र शरद्ग्रीष्माभ्याम्, तत्राप्यात्ययिकेऽग्निकर्म्मसाध्ये व्याधौ तत्प्रत्यनीकं विधिं कृत्वा ॥४॥

Cauterisation is admissible in all season of the years except summer and autumn; but no such distinction should be observed in cases of impending danger, when it should be practised with the help of such appliances of a contrary cooling) nature, [as wet sheets, cooling drinks and cooling plasters, etc. 4

सर्व्वव्याधिष्वृतुषु च पिच्छिलमन्नं भुक्तवतः कर्म्म कुर्वीत, मूढगर्भाश्मरीभगन्दरार्शोमुखरोगेष्वभुक्तवतः ॥५॥

In all diseases and in all seasons of the year, the patient should be fed on a diet of slimy (mucilaginous) food before actually applying the cautery; while the patient should be kept on an empty stomach before the act where the complaint would be a case of Mudhagarbha (false presentation), fistula in ano, haemorrhoids or a disease affecting the cavity of the mouth. 5

तत्र द्विविधिमग्निकर्म्माहुरेके त्वग्दग्धं मांसदग्धञ्च । इह तु सिरास्नायुसन्ध्यस्थिष्वपि न प्रतिषिद्धोऽग्निः ॥६॥

According to certain authorities the process of cauterisation may be grouped under two heads according as the skin or the flesh is cauterised. The present work does not lay any injunction against the cauterisation of any nerve, vein, bone or bone joint (as stated before ). 6

तत्र शब्दप्रादुर्भावो दुर्गन्धता त्वक्सङ्कोचश्च त्वग्दग्धे । कपोतवर्णताल्पश्वयथुवेदना शुष्कसङ्कचितव्रणता च मांसदग्धे । कृष्णोन्नतव्रणता स्रावसन्निरोधश्च शिरास्नायुदग्धे । रूक्षारुणता कर्कशस्थिरव्रणता च सन्ध्यस्थिदग्धे ॥७॥

A burning of the skin is accompanied by a peculiar bursting or cracking sound. The skin becomes contracted and emits a fetid smell. Similarly, in a case where the flesh is burnt, (the affected part) assumes a dove colour of (blackish brown), marked by pain and a little swelling, and the incidental ulcer becomes dry and contracted. In the case where a nerve or a vein is brunt, the ulcer presents a raised (elevated) and black aspect with the stoppage of all secretions; while an ulcer incidental to the cauterisation of any of the bone joints has a parched red hue and becomes hard and rough. 7

तत्र शिरोरोगाधिमन्थयोर्भूललाटशङ्खप्रदेशेषु दहेत् । वर्त्मरोगेष्वाद्रीलक्तकप्रतिच्छन्नां दृष्टिं कृत्वा वर्त्मरोमकूपान् दहेत्। त्वङ्मांसशिरास्नायुसन्ध्यस्थिस्थितेऽत्युग्ररुजे वायावुच्छ्रितकठिनसुप्तमांसे व्रणे ग्रन्थ्यर्शोऽर्बुदभगन्दरापचीश्लीपदचर्म्मकीलतिलकालकान्त्रवृद्धिसन्धि शिराच्छेदनादिषु नाडीशोणितातिप्रवृत्तिषु चाग्निकर्म्म कुर्य्यात् ॥८॥

The regions of the eye-brows, forehead and templebones, should be cauterised in diseases affecting the head as well as in a case of Adhimantha (Ophthlmia). In diseases affecting the eyelids the eye should be covered over with a moist piece of Alaktaka (a thin pad of red pigment principally used in dyeing the feet of ladies) and the roots of the eyelashes should be duly cauterised. Cauterisation is specifically enjoined to be resorted to in cases of glandular inflammation, tumour, fistula in ano, scrofula, elephantiasis, Carmakila,, warts, Tilakalaka, hernia, sinus, haemorrhage, and on the occasion of cutting a vein or a bone joint, as well as in the event of the vital wind (Vayu) being extremely agitated and lodged in the local skin, flesh, vein, nerves and the bone-joints and giving rise to excruciating pain in and about the ulcer which in consequence presents a hard, raised and inert surface. 8

तत्र रोगादिस्थानभेदादग्निकर्म्म चतुर्धा भिद्यते; तद्यथाबलयविन्दुविलेखाप्रतिसारणानीति दहनविशेषाः ॥ ९॥

The modes of cauterisation vary according to the seat of the disease, and number four in all, viz., the Ring, the Dot, the Lateral or Slanting lines, and the Rubbing modes. 9

भवति चात्र

रोगस्य संस्थानमवेक्ष्य सम्यङ्नरस्य मर्माणि बलाबलञ्च । व्याधिं तथञ्च समीक्ष्य सम्यक् ततो व्यवस्येद् भिषगग्निकर्म ।।१०।।

Authoritative verse on the subject: A physician, after having carefully considered the seat of the disease and judiciously ascertained the patient’s strength and the situations of the Marmas (the vital parts of the patient’s) body, should resort to cauterisation with an eye to the nature of the malady and the then prevailing season of the year. 10

तत्र सम्यग्दग्धे मधुसर्पिर्ध्यामभ्यङ्गः । अथेमानग्निना परिहरेत् पित्तप्रकृतिमन्तः शोणितं भिन्नकोष्ठमनुद्धृतशल्यं दुर्बलं बालं वृद्धं भीरुमनेकव्रणपीडितमस्वेद्यांश्चेति ॥११॥

The part, after being properly cauterised, should be rubbed with an unguent composed of honey and clarified butter. A man of bilious temperament or with a quantity of bad blood lying stagnant and locked up in any part of his body, or of lax bowels, a person with any foreign substances (such as a thorn or a splinter still lodged in his body), a weak or an old man, an infant, or a man of timid disposition, or a person afflicted with a large number of ulcers, as well as a patient suffering from any of the diseases in which diaphoretic measures are forbidden, should be regarded as a subject unfit for cauterisation. 11

अंत ऊर्ध्वमितरथा दग्धलक्षणं वक्ष्यामः । तत्र स्निग्धं रूक्षं वाश्रित्य द्रव्यमग्निर्दहति । अग्निसन्तप्तो हि स्नेहः सूक्ष्मशिरानुसारित्वात् त्वगादीननुप्रविश्याशु दहति । तस्मात् स्नेहदग्धेऽधिका रुजो भवन्ति ॥१२॥

Now we shall describe the characteristic symptoms of the several kinds of burns other than those caused (for surgical purposes). Fire feeds both upon fatty and hard fuels, [such as oil and logs of wood etc.]. Hot or boiling oil has the property or permeating or entering into the minutest nerves and veins, and hence, it is capable of burning the skin, etc. Accordingly an ulcer incidental to such a burning (scald) is characterised by extreme pain, etc. 12

तत्र प्लुष्टं दुर्दग्धं सम्यग्दग्धमतिदग्धञ्चेति चतुर्व्विधमग्निदग्धम् । तत्र यद् विवर्णं प्लुष्यतेऽतिमात्रं तत् प्लुष्टम् । यत्रोत्तिष्ठन्ति स्फोटास्तीव्राश्चोषदाहरागपाकवेदनाश्चिराच्चोपशाम्यन्ति तदुर्दग्धम् ।

ज्वरसम्यग्दग्धमनवगाढं तालवर्ण सुसंस्थितं पूर्व्वलक्षणयुक्तञ्च । अतिदग्धे मांसावलम्बनं गात्रविश्लेषः शिरास्नायुसन्ध्यस्थिव्यापादनमतिमात्रं दाहपिपासामूर्च्छाश्च उपद्रवा भवन्ति, व्रणश्चास्य चिरेण रोहति, रूढच विवर्णो भवति । तदेतच्चतुर्व्विधमग्निदग्धलक्षणमात्मकर्म्मप्रसाधकं भवति ।। १३ ।।

Burns may be grouped under four distinct heads viz., the Plushtam, the dur-dagdham, the Samyag-dagdham and the Atidagdham. A burn characterised by the discolouring of its seat and extreme burning and marked by the absence of any vesicle or blister, is called the Plusta, from the root “plusa” to burn. A burn, which is characterised by the eruption of large vesicles or blisters, and assumes a red colour, and is characterised by excessive burning and a kind of drawing pain, and which suppurates and takes a long time to heal, is called the Dur-dagdha (bad burn or scald). A burn, which is not deep (superficial) and assumes the colour of a ripe Tala fruit, and does not present a raised or elevated aspect and develops the preceding symptoms, is called the Samyag-dagdham (fully burnt one). A burn in which the flesh hangs down, and where the veins, nerves and bones are destroyed, accompanied with fever, burning, thirst, fainting and such like disturbances, and which leads to a permanent disfiguration of the body, retarding the healing of the incidental ulcer which leaves a discoloured cicatrix even after healing, is called the Ati-dagdha (over burnt one). A physician should try to heal any of these four types of burns with the measures already laid down before. 13

भवन्ति चात्र

अग्निना कोपितं रक्तं भृशं जन्तोः प्रकुप्यति । ततस्तेनैव वेगेन पित्तमस्याभ्युदीर्य्यते ।। तुल्यवीर्ये उभे होते रसतो द्रव्यतस्तथा । तेनास्य वेदनास्तीव्राः प्रकृत्या च विदह्यते । स्फोटाः शीघ्रं प्रजायन्ते ज्वरस्तृष्णा च वर्द्धते ।।१४।।

Authoritative verses on the subject: The blood of a man is agitated and made hot by fire, and the blood thus heated tends to excite or causes it to raise the bile. And since fire and bile (Pitta) are similar in their taste, essence, effect, potency and natal factors, the effects of Pittam (burrning sensation etc.) are naturally aggravated and augmented through a contact with fire. Blisters or vesicles crop up in rapid succession and mark the seat of burning, and fever, thirst, etc., supervene. 14

दग्धस्योपशमार्थाय चिकित्सा संप्रवक्ष्यते । प्लुष्टस्याग्निप्रतपनं कार्य्यमुष्णं तथौषधम् ।। शरीरे स्विन्नभूयिष्ठे स्विन्नं भवति शोणितम् । प्रकृत्या ह्युदकं शीतं स्कन्दयत्यति शोणितम् । तस्मात् सुखयति ह्युष्णं न तु शीतं कथञ्चन ।। १५ ।।

Now I shall describe the course of medical treatment to be adopted for the cure of burns. Hot and dry fomentations, as well as warm plasters should be applied to a burn of the Plustami type, and a course of hot food and drink should be likewise prescribed for the patient. The blood becomes thin when the body is diaphorised by means of warm fomentations, and water, in virtue of its natural cooling properties, tends to thicken the blood. Hence warm fomentations or applications exercise curative virtues in the case of a burn of the foregoing type, and water or cold applications produce the contrary effect.¹ 15

शीतामुष्णाञ्च दुर्दग्धे क्रियां कुर्य्याद् भिषक् पुनः । घृतालेपनसेकांस्तु शीतानेवास्य कारयेत् ।।१६।।

Both warm and cold measures are to be adopted in the case of a burn of the Dur-dagdha type, the medicinal remedies consisting of cold applications and unguents of clarified butter. 16

सम्यगूदग्धे तुगाक्षीरीप्लक्षचन्दनगैरिकैः । सामृतैः सर्पिषा स्निग्घैरालेपं कारयेद् भिषक् ।।

1. By arresting the radiation of the incarcerated heat and thereby favouring the elevation of the local temperature and the increase of the burning sensation.

2. Cold applications and cooling measures should be resorted to in the case of a deep and excessive burn, while the contrary should be held as the correct remedy in the case of a slight and superficial one.

ग्राम्यानूपौदकैश्चैनं पिष्टैर्मासैः प्रलेपयेत् । पित्तविद्रधिवच्चैनं सन्ततोष्माणमाचरेत् ।।१७।।

A plaster composed of Tugaksiri, Plaksa, Candana, Gairika, and Amrta (Guduci), pasted together with clarified butter, should be applied over a burn of the Samyag-dagdha type, or the flesh of domestic or aquatic or amphibious animals should be pasted and plastered over the affected part. A burn of the present type, marked by excessive burning, should be medicinally treated in the same manner as a case of bilious abscess (Pitta-vidradhi). 17

अतिदग्धे विशीर्णानि मांसान्युद्धृत्य शीतलाम् । क्रियां कुर्य्याद् भिषक् पश्चाच्छालितण्डुलकण्डनैः ।। तिन्दुकीत्वक्कपालैर्वा घृतमिश्रैः प्रलेपयेत् । गुडूचीपत्रैर्वा छादयेदथवौदकैः ।। व्रणं क्रियाञ्च निखिलां कुर्य्याद् भिषक् पित्तविसर्पवत् ॥१८ ।।

In the case of a burn of the Ati-dagdha (over-burnt) type, the loose or the dangling integuments (skin) and flesh should be removed, and cold applications should be made over the ulcer. Then the affected part should be dusted over with pulverised Sali rice, or a plaster composed of the pulverised skin of Tinduki and clarified butter pasted together, should be applied over its surface. The affected part should be covered over with the leaves of Guduci, or of lotus, or other aquatic plants, and all measures and remedial agents, indicated in the case of a bilious erysipelas, should be resorted to in the present instance as well. 18

मधूच्छिष्टं समधुकं रोध्रं सर्जरसं तथा । मञ्जिष्ठां चन्दनं मूर्व्वा पिष्ट्वा सर्पिर्विपाचयेत् । सर्व्वेषामग्निदग्धानामेतद्रोपणमुत्तमम् ।।१९।। स्नेहदग्धे क्रियां रूक्षां विशेषेणावचारयेत् ।। २० ।।

A plaster composed of bee’s wax, Madhukam, Rodhra Sarjarasa, Manjistha, (red) Candana and Murva pasted together and boiled with

1. Several authorities prescribe Tinduki bark and human cranium powdered together and mixed with clarified butter, while others prescribe a decoction of Tinduki bark.

clarified butter should be regarded as beneficial to burns of all types to promote rapid healing.

In the case of a burn from boiling oil, clarified butter or such like substances should be externally applied and all measures which promote dryness of the part (Ruksa) should be adopted without the least hesitation. 19-20

अत ऊर्ध्वं प्रवक्ष्यामि धूमोपहतलक्षणम्। श्ववसिति क्षौति चात्यर्थमत्याधमति कासते ।। चक्षुषोः परिदाहश्च रागश्चैवोपजायते ।

सधूमकं निश्वसिति प्रेयमन्यन्न वेत्ति च। तथैव च रसान् सर्व्वान् श्रुतिश्चास्योपहन्यते ।। तृष्णादाहज्वरयुतः सीदत्यथ च मूर्च्छति । धूमोपहत इत्येवं श्रृणु तस्य चिकित्सितम् ॥ २१ ॥

Now we shall describe the symptoms which become manifest in a person [whose nostrils and larynx] are choked with smoke. The respiration becomes laboured and hurried and the abdomen is distended accompanied by constant sneezing and coughing. The eyes look red and seem as if burning. the patient breathes out smoke and fails to catch any other smell than that of it. The sense of hearing is considerably affected; the sense of taste becomes inert; fever, thirst and a burning sensation supervene; and the patient drops down utterly unconscious. 21

सर्पिरिक्षुरसं द्राक्षां पयो वा शर्कराम्बु वा । मधुराम्लौ रसौ वापि वमनाय प्रदापयेत् ।। वमतः कोष्ठशुद्धिः स्याद् धूमगन्धश्च नश्यति । विधिनानेन शाम्यन्ति सदनक्षवथुज्वराः ।। दाहमूर्च्छातृडाध्मानश्वासकासाश्च दारुणाः । मधुरैर्लवणाम्लैश्च कटुकैः कवलग्रहैः ॥ सम्यग्गृह्णातीन्द्रियार्थान् मनचास्य प्रसीदति । शिरोविरेचनं तस्मै दह्याद् योगेन शास्त्रवित् ।। दृष्टिर्विशुध्यते चास्य शिरोग्रीवञ्च देहिनः । अविदाहि लघु स्निग्धमाहारञ्चास्य कल्पयेत् ॥ २२ ॥

Now hear me discourse on the course of medical treatment to be adopted in the case of one over-powered with smoke. Emetics in the shape of clarified butter mixed with sugarcane juice or milk saturated with the juice of grapes, or lumps of sugar-candy dissolved in an adequate quantity of water, or any acid potion slightly sweetened, should be administered to the patient. The contents of the stomach are speedily discharged by vomiting; the distension of the abdomen is removed; the smell of smoke in the breath is mitigated, and the accompanying fever with (its concomitants) of sneezing, languor, thirst, cough, laboured breathing etc. is abated, and the patient is restored to consciousness. Gargles having a sweet, saline, acid or pungent (katu) taste restore the sense-perception of the patient, and gladden his mind. Medicated snuffs in adequate quantities should be administered by a well-read physician to such a patient, whereby his head, eyes and neck would be able to resume their normal functions. And a course of diet, which is light, emollient and not acid in its reaction, should be prescribed. 22

उष्णवातातपैर्दग्धे शीतः कार्यो विधिः सदा । शीतवर्षानिलैर्दग्ध उष्णं स्निग्धञ्च शस्यते ।

तथातितेजसा दग्धे सिद्धिर्नास्ति कथञ्चन ।। २३ ।।

Cooling measures or application should be prescribed or made in the event of any part of the body being scorched by excessive heat, or by being exposed to a draught of hot and parched wind. Similarly, hot and emollient measures of applications should be resorted to where any part of the body has become frozen or shrivelled by snow or cold winds. A person struck by lightning should be regarded as beyond the pale of medicine. 23

इति सुश्रुतसंहितायां सूत्रस्थानेऽग्निकर्म्मविधिर्नामद्वादशोऽध्यायः ॥१५॥

Thus ends the twelth Chapter of the Sutrasthana in the Susruta Samhita which treats of Cauteries and the rules to be observed in their use.

1. Additional texts: Where the scorching would be found to be considerably extensive; otherwise such measures as lubrication with medicated unguents etc. should be adopted in a case where the patient is picked up alive.


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