पञ्चमोऽध्यायः ।
अथातोऽग्रोपहरणीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१९॥
Now we shall discuss the Chapter which treats of Preliminary measures (in connection with curative remedies of disease).¹ (Agropaharaniya adhyaya). 1
त्रिविधं कर्म्म । पूर्व्वकर्म्म, प्रधानकर्म्म, पश्चात्कर्मेति । तद् व्याधिं प्रति प्रत्युपदेक्ष्यामः ।
अस्मिन् शास्त्रे शस्त्रकर्म्मप्राधान्याच्छस्त्रकम्मैव तावत् पूर्व्वमुपदेक्ष्यामस्तत्सम्भारांश्च ॥२॥
1. Several authorities hold that acts such as fasting, administration of purgatives, etc. should be included within the preliminary measures; application of absorbent (Pacana) or healing medicinal agents, within the second or the principal measures; and the administration of tonics or restoratives within the third or the after-measure group. Others, on the contrary, lay down that measures adopted for the absorption, lubrication (pacification by the application of oily substances) or elimination of the deranged bodily humours by sweating should be grouped under the first subhead (Purva-karma), the administration of active purgatives, emetics, etc., under the second (Pradhana-karma) and the giving of rice meal, etc. to the patient under the (Pascat-karma) last; while according to others the active medicinal agents employed to cope with the deranged humours in the incubative stage of a bodily disease till the appearance of its first characteristic symptoms, should be denominated as the Preliminary measure; measures employed for the subjugation of a disease in its patent or fully developed stage as the Pradhana-karma, and measures employed to guard against the recrudescence of a disease and for the restoration of health in a patient is the sequel treatment or the Pascat-karma.
The entire course of medical treatment in connection with a disease may be grouped under three subheads, as the Preliminary measures (Purva-karma ) ; the Principal therapeutical or surgical appliances (Pradhana-karma); and the After-measures (Pascat-karma). These measures will be discussed under the head of each disease as we shall have occasion to deal with them. As the present treatise principally treats of surgical acts or operations, we shall discourse on them and their accessories at the outset. 2
तच्च शस्त्रकर्म्माष्टविधम् । तद्यथाछेद्यं, भेद्यं, लेख्यं, वेध्यमेष्यमाहार्य्यं, विस्राव्यं, सीव्यमिति । अतोऽन्यतमं कर्म्म चिकीर्षता वैद्येन पूर्व्वमेवोपकल्पयितव्यानि भवन्ति । तद्यथायन्त्रशस्त्रक्षाराग्निशलाकाश्रृङ्गजलौकालाबुजाम्बवौष्ठपिचुप्लोतसूत्रपत्रपट्टमधुघृतवसापयस्तैलत र्पणकषायालेपनकल्कव्यजनशीतोष्णोदककटाहादीनि, परिकर्मिणश्च स्निग्धाः स्थिरा बलवन्तः ॥३॥
Surgical acts or operations are divided into eight different kinds such as Incising (Chedya), Excising (Bhedya), Scraping (Lekhya), Puncturing (Vedhya), Searching or probing (Esya), Extracting (Aharya), Secreting fluids (Visravya) and Suturing (Seevya). A surgeon (Vaidya) called upon to perform any (of the eight preceding kinds) of operations, must first equip himself with such accessories as surgical appliances and instruments, alkali, fire, probe or director (Salaka), horns, leeches, gourd (Alabu), Jambavaustha (a kind of pencil shaped rod made of slate with its top-end cut into the shape of a Jamboline fruit ), cotton, lint, thread, leaves, tow (Patta), honey, clarified butter, lard, milk, oil, Tarpana (powdered wheat soaked in water), decoctions ( Kasaya), medicated plasters, paste (Kalka), fan, cold water, hot water, and cauldrons, etc., and moreover he shall secure the services of devoted and strongnerved attendants. 3
ततः प्रशस्तेषु तिथिकरणमुहूर्त्तनक्षत्रेषु दध्यक्षतान्नपानरत्तैरग्निं विप्रान् भिषजश्चार्च्चयित्वा, कृतबलिमङ्गलस्वस्तिवाचनं लघुभुक्तवन्तं प्राङ्मुखमातुरमुपवेश्य, यन्त्रयित्वा, प्रत्यङ्मुखो वैद्यो मर्म्मशिरास्नायुसन्ध्यस्थिधमनीः परिहरन्ननुलोमं शस्त्रं निदध्याद् आ पूयदर्शनात्, सकृदेवापहरेच्छस्त्रमाशु च। महत्स्वपि च पाकेषु द्वयङ्गुलं त्र्यङ्गुलान्तरं वा शस्त्रपदमुक्तम् ।। तत्रायतो विशालः समः सुविभक्तो निराश्रय इति व्रणगुणाः ॥४॥
Then under the auspices of blissful astral combinations, etc., and having propitiated the Brahmanas and the physicinas, with gifts of curd, sun-dried rice, cordials and gems, etc., and having made offerings to the gods and uttered benediction, etc., the surgeon should commence his work. The patient should be given light food (before the act), and made to sit with his face turned towards the east. His limbs should be carefully fastened (so as to guard against their least movement during the continuance of the operation). Then the surgeon, sitting with his face towards the west, and carefully avoiding the vital parts (Marmas), Veins, nerves (Snayus), joints, bones and arteries of the patient, should insert the knife into the affected part along the proper direction till the suppurated part would be reached and swiftly draw it out. In case of extended suppuration, the part opened (length of incision) should be made to measure two or three finger’s widths in length. An incision (Vrana) which is wide, extended, equally and evenly divided, should be deemed the best. 4
भवतश्चात्र ।
आयतश्च विशालश्च सुविभक्तो निराश्रयः । प्राप्तकालकृतश्चापि व्रणः कर्म्मणि शस्यते ॥ ५ ॥ शौर्य्यमाशुक्रिया शस्त्रतैक्ष्ण्यमस्वेदवेपथु । असम्मोहश्च वैद्यस्य शस्त्रकर्म्मणि शस्यते ॥६॥
Authoriatative verses on the subject: An incision which is wide, extended, well divided, does not involve any vital part, etc. of the patient, and is well-matured as regards time, is the best of its kind.¹ Courage, light handedness, non-shaking, non-sweating, sharp instruments, self confidence and self command are what should be possessed by a surgeon engaged in opening a boil or an abscess. 5-6
एकेन वा व्रणेनाशुध्यमानेनान्तरा बुद्धयावेक्ष्यापरान् व्रणान् कुर्य्यात् ॥७॥
1. Certain commentators interpret the couplet as follows: A boil or an abscess which is wide, extended, well defined in its shape, equally suppurated in all its parts and does not involve any vital part of the body is the fittest thing for a surgeon’s knife-Tr.
Two or three incisions should be made if a single opening does not seem large enough for the purpose. 7
भवति चात्र
यतो यतो गतिं विद्यादुत्सङ्गो यत्र यत्र च तत्र तत्र व्रणं कुर्य्याद् यथा दोषो न तिष्ठति ।। ८ ।।
Authoritative verse on the subject : The knife (lancet) should be freely used wherever a fissure, sinus, or a cavity would appear in a boil, so as to ensure a complete flowing out of the pus accumulated in it. 8
तत्र भ्रू- गण्ड – शङ्ख – ललाटाक्षिपुटौष्ठ-दन्तवेष्ट- कक्ष-कुक्षिवङ्गणेषु तिर्य्यक् च्छेद उक्तः ॥९॥
Lateral (tiryak) incisions should be made in regions of the eyebrows, temple, forehead, cheeks, eyelids, lower lip, gums, armpits, loins, belly and the groins. 9
चन्द्रमण्डलवच्छेदान् पाणिपादेषु कारयेत् । अर्द्धचन्द्राकृतींश्चापि गुदे मेढ्रे च बुद्धिमान् ।। १० ।।
An incision made in the region of the hand or root should be made to resemble the disc of the moon, while those about the anus and the penis should be made semi-circular (half-moon) in shape. 10
अन्यथा तु शिरास्नायुच्छेदनमतिमात्रं वेदना चिराद् व्रणसंरोहो मांसकन्दीप्रादुर्भावश्चेति ॥११॥
Authoritative verse on the subject: An incision in any of the abovesaid regions not made as directed, may give rise to extreme pain, prolonged granulation (healing) and condylomatous growths in and about the ulcer, owing to an inadvertent cutting of the local veins, or nerves. 11
मूढगर्भोदरार्शोऽश्मरीभगन्दरमुखरोगेष्वभुक्तवतः कर्म्म कुर्वीत ॥१२॥
In a case of artificial or instrumental parturition, in ascites, in piles, in stone, in the bladder, in fistula in ano, and in diseases affecting the cavity of the mouth, the patient operated on should be kept on an empty stomach (before the act). 12
37
ततः शस्त्रमवचार्य्य, शीताभिरद्भिरातुरमाश्वास्य, समन्तात् परिपीड्याङ्गुल्या, व्रणमभिमृद्य, प्रक्षाल्य कषायेण प्लोतेनोदकमादाय, तिलकल्कमधुसर्पिः प्रगाढाम् औषधयुक्तां वर्त्ति प्रणिदध्यात्। ततः कल्केनाच्छाद्य नातिस्निग्धां नातिरुक्षां घनां कवलिकां दत्त्वा वस्त्रपट्टेन बघ्नीयात् वेदनारक्षोघ्नैर्धूपैर्धूपयेत् रक्षोघ्नैश्च मन्त्रैः रक्षां कुर्वीत ॥१३॥
Then sprays of cold water should be dashed over the face and the eyes of the patient to relieve the pain and the sense of exhaustion incidental to the operation. The sides of the incision should be firmly pressed (so as to ensure a good outflow of the accumulated pus) and the margins of the wound should be rubbed with the fingers (so that they may have a level surface and be of uniform structure throughout). Then the wound should be washed with an astringent decoction (of Nimba, Triphala, etc.) which should be wiped and made thoroughly dry with a piece of clean linen. then a lint plug (Varti) plastered over with the (paste) Kalka or sesamum, honey and clarified butter, and soaked in disinfectant (lit: purifying medicines such as Ajagandha, etc.) should be inserted deep into the cavity of the wound. After that, a poultice made of officinal substances should be applied over it and the whole should be bound up with thick layers of tow (Kavalikassuch as the leaves and bark of the Indian figtree etc.) which are neither too irritant nor too cooling in their effect; and finally scraps of clean linen should be wound round them. The limb, [or the affected part] should be subsequently fumigated with the fumes of pain-killing (anodyne) substances and also with those of drugs which are supposed to ward off all malignant spirits (from the bedside of the patient).! 13
ततो गुग्गुल्वगुरुसर्ज्जरसवचागौरसर्षपचूर्णैर्लवणनिम्बपत्रव्यामिश्रैराज्ययुक्तैर्धूपयेत् । आज्यशेषेण चास्य प्राणान् समालभेत् ॥१४॥
Then it should be fumigated with the drugs, known as Guggulu, Vaca, white mustard, Saindhava and the leaves of the Nimba tree, soaked in clarified butter. The residue of the clarified butter [dripped down and collected from the fumigating compound described above], should be rubbed over the region of the heart and other vital parts of the patient. 14
1. Even the bedsheets, etc. of the patient should be fumigated as above. This foreshadows the germ theory of the modern days.
उदकुम्भाच्चापो गृहीत्वा प्रोक्षयन् रक्षाकर्म्म कुर्य्यात्, तद् वक्ष्यामः ।।१५।।
कृत्यानां प्रतिघातार्थं तथा रक्षोभयस्य च । रक्षाकर्म्म करिष्यामि ब्रह्मा तदनुमन्यताम् ।।१६।।
नागा: पिशाचा गन्धर्व्वाः पितरो यक्षराक्षसाः । अभिद्रवन्ति ये ये त्वां ब्रह्माद्या घ्नन्तु तान् सदा ।।१७।।
पृथिव्यामन्तरीक्षे च ये चरन्ति निशाचराः । दिक्षु वास्तुनिवासाश्च पान्तु त्वां ते नमस्कृताः । ।१८ ।।
पान्तु त्वां मुनयो ब्राह्मया दिव्या राजर्षयस्तथा । पर्व्वताश्चैव नद्यश्च सर्व्वाः सर्वेऽपि सागराः ।।१९।।
अग्नी रक्षतु ते जिह्वां प्राणान् वायुस्तथैव च । सोमो व्यानमपानं ते पर्ज्जन्यः परिरक्षतु । ॥ २० ॥
उदानं विद्युतः पान्तु समानं स्तनयिलवः । बलमिन्द्रो बलपतिर्मनुर्मन्ये मतिं तथा । ॥ २१ ॥
कामांस्ते पान्तु गन्धर्व्वाः सत्त्वमिन्द्रोऽभिरक्षतु । प्रज्ञां ते वरुणो राजा समुद्रो नाभिमण्डलम् ॥ २२ ॥
चक्षुः सूर्य्यो दिशः श्रोत्रे चन्द्रमाः पातु ते मनः । नक्षत्राणि सदा रूपं छायां पान्तु निशास्तव ॥ २३ ॥
रेतस्त्वाप्याययन्त्वापो रोमाण्योषधयस्तथा । आकाशं खानि ते पान्तु देहं तव वसुन्धरा । ॥ २४ ॥
वैश्वानरः शिरः पातु विष्णुस्तव पराक्रमम् । पौरुषं पुरुषश्रेष्ठो ब्रह्मात्मानं ध्रुवो ध्रुवौ ॥ २५ ॥
एता देहे विशेषेण तव नित्या हि देवताः। एतास्त्वां सततं पान्तु दीर्घमायुरवाप्नुहि ॥ २६ ॥
स्वस्ति ते भगवान् ब्रह्मा स्वस्ति देवाश्च कुर्व्वताम् । (स्वस्ति ते चन्द्रसूर्य्यां च स्वस्ति नारदपर्व्वती) स्वस्त्यग्निश्चैव वायुश्च स्वस्ति देवा सहेन्द्रगाः ॥ २७ ॥
पितामहकृता रक्षा स्वस्त्यायुर्वर्द्धतां तव । ईतयस्ते प्रशाम्यन्तु सदा भव गतव्यथः । ॥ २८ ॥ इति स्वाहा ।
एतैर्वेदात्मकैर्मन्त्रैः कृत्याव्याधिविनाशनैः । मयैवं कृतरक्षस्त्वं दीर्घमायुरवाप्नुहि || २९ ।।
And the floor of the chamber should be washed and sprinkled over with drops of water previously kept in a (new) pitcher for the purpose. The rites of protection from the influences of baneful spirits, should then be performed by reciting the Mantra which runs as follows: “I am about to practise the prophylactic incantation for guarding thy person against the malignant influences of Raksas and conjured demonesses, and may the god Brahma be graciously pleased to approve of its performance. May the Gods and deities and ministers of grace disperse and confound the hosts of wrathful Nagas (celestial serpents), Pisacas, Gandharvas and Pitrs that might be maliciously disposed to strike thee in thy sickly confinement. May the spirits, which stir abroad in the night and roam about in the sky and on earth, defend thy person in recognition of thy fervent devotion to them. May the concourse of Brahma-begotten sages (such as Sanaka, etc.) the saintly and canonised kings (Rajarsis) in heaven and the sacred mounts, streams and oceans of the earth protect thee from evil. May the fire-god guard thy tongue; the wind-god protect thy breath; and the Moon-god, Parjanya, Vidyut (lightning) and the spirit of the clouds preserve the healthy coursings of those vital winds in thy organism which are respectively known as Prana Vyana, Apana, Udana and Samana Vayu. May Indra, the presiding deity of all physical energies, keep the bodily strength immaculate. May Manu defend the two side tendons at the nape of thy neck, as well as thy faculty of intellect; the Gandharvas, thy faculty of desire; Indra, thy fortitude; Varuna, thy faculty of cognition; the Ocean, thy region of umbilicus; the Sun-god, thy eyes; the Quarters of the Heaven, thy ear; the Moon-god, thy mind; the Stars, thy complexion; the Night, thy shadow; the Water, thy vigour; the Ausadhis, thy hair; Infinite Ether, the space which is imprisoned in thy body; Vasundhara, thy body; Vaisvanara, thy head; Visnu, thy moral courage; Purusottama (the foremost of beings), thy energy of action (dynamical action of purposes); Brahma, thy self; and Dhruva (immutable being), thy eyebrows. May these divinities, which perpetually reside in thy body, ensure thy safe continuance in being and may thou enjoy a long life through their grace. May the gods such as, Brahma, etc., confer blessings on thy head. May the Sun, the Moon, the twin sages Narada and Parvata, the fire-god, the wind, and the other celestial helpmates of Indra, bring thee good. May the prophylaxis devised by Brahma keep thee from evil. May thou be spared to witness the return of many a long and happy year on earth. May such abnormal physical phenomena as drought, deluge, ecessive downpour of rain, and excessive germination (or wholesale extinction of such vermin as) rats, mosquitoes, flies which invariably portend evil and mortality in a community, as well as bloody feuds among kings, abate and cease. May thou be relieved of all pain and misery. We close the prayer with a “Svaha” (obeisance). The present Vedic mantra exercises an occult power in relieving ailments which are due to the malignant influences of conjured up she-devils. May thou acquire a long life through the protective energy of the prophylactic prayer (lit: incantation) now read by me. 15-29
ततः कृतरक्षमातुरमागारं प्रवेश्याचारिकमादिशेत् । ततस्तृतीयेऽहनि विमुच्यैवं बघ्नीयाद् वस्त्रपट्टेन, न चैनं त्वरमाणोऽपरेधुर्मोक्षयेत्, द्वितीयदिवसे परिमोक्षणाद् विग्रथितो व्रणश्चिरादुपसंरोहति, तीव्ररुजश्च भवति । अत ऊर्द्ध दोषकालबलादीनवेक्ष्य कषायालेपनबन्धाहाराचारान् विदध्यात् । न चैनं त्वरमाण: सान्तर्दोषं रोपयेत्, स ह्यल्पेनाप्यपचारेणाभ्यन्तरमुत्सङ्गं कृत्वा भूयोऽपि विकरोति ॥३०॥
Then having protected the body of the patient with the recitation of the above Vedic Mantra, the surgeon shall see his patient taken to his own chamber, and prescribe the proper course of medicine and diet according to the exgencies of each case. The old bandage should be loosened on the third day of the operation, when the wound or the ulcer should be washed, and a fresh bandage should be wound round as before. The bandage should not be loosened on the day following the lancing of a boil, as such a measure might give rise to a sort of excruciating pain and formation of knots in the wound and retard the process of granulation (healing). On the third day, the surgeon (Vaidya) should prescribe the proper medicated plaster, diet, etc. after fully considering the strength of the patient, the nature of the disease, and the then prevailing season of the year. A wound should not be tried to be healed up, as long as the least morbid matter, or pus remains in its inside, as it would lead to the formation of fresh cavities in the surrounding healthy tissues, and ultimately to a recrudescence of the disease. 30
भवन्ति चात्रतस्मादन्तर्बहिश्चैव सुशुद्धं रोपयेद् व्रणम् । रूढे ऽप्यजीर्णव्यायामव्यवायादीन् विवर्ज्जयेत् ।।
हर्ष क्रोधं भयञ्चापि यावत् स्थैर्य्योपसम्भवात् ॥ ३१ ॥
हेमन्ते शिशिरे चैव वसन्ते चापि मोक्षयेत् । त्र्यहाद् द्व्यहाच्छरद्ग्रीष्मवर्षास्वपि च बुद्धिमान् ॥ ३२ ॥
अतिपातिषु रोगेषु नेच्छेद् विधिमिमं भिषक् । प्रदीप्तागारवच्छीघ्रं तत्र कुर्य्यात् प्रतिक्रियाम् ॥ ३३॥
The authoritative verses on the subject: Accordingly a wound or an ulcer should be made to heal up after the perfect purification of both of its inside and exterior has been fully brought about. Even after the healing of the wound the patient should studiously avoid all sexual connections, indigestive viands, fatiguing physical. exercises and indulgence in emotions of grief or fright, or in ecstasies of joy, until the cicatrix has acquired enough toughness. The dressings and bandages should be untied and changed every third day in winter, in spring and in the season of Hemanta, and on each alternate day in summer and in the rains. But a physician ( surgeon) should not be guided by these rules in cases where there would be reasons to apprehend imminent danger, and in such cases the wound or the ulcer, like a house in flames, should be checked as speedily as possible. 31-33
या वेदना शस्त्रनिपातजाता तीव्रा शरीरं प्रदुनोति जन्तोः । घृतेन सा शान्तिमुपैति सिक्ता कोष्णेन यष्टीमधुकान्वितेन ॥ ३४ ॥
Clarified butter boiled with Yastimadhu, and applied tepid to a wound, incidental to a surgical operation, is sure to allevitate the excruciating pain that is usually experienced in such an affected part. 34
इति सुश्रुतसंहितायां सूत्रस्थानेऽग्रोपहरणीयो नाम पञ्चमोऽध्यायः ॥५॥ Thus ends the fifth chapter of the Sutrasthana in the Susruta Samhita which treats of Preliminary measures.
