पञ्चविंशोऽध्यायः । अथातोऽष्टविधशस्त्रकर्मीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the Chapter, which deals with the eight different forms of surgical operations ( Astavidha-SastraKarmanya-adhyaya). 1
छेद्या भगन्दरा ग्रन्थिः श्लैष्मिकस्तिलकालकः । व्रणवर्त्मार्बुदान्यर्शश्चमकीलोऽस्थिमांसगम् ||२॥
शल्यं जतुमणिर्मांससङ्घातो गलशुण्डिका । स्नायुमांससिराकोथो वाल्मीकं शतपोनकः ॥ ३ ॥
अघुषश्चोपदंशाश्च मांसकन्द्यधिमांसकः ॥
Metrical Texts : Bhagandara, Slaismika Granthi, Tilakalaka, Arbuda, Arsa, Carma Kila, Jatumani, Mansa-Sanghata, GalaSunthika, Valmika, Vrana-Vartma, Sataponaka, Adhrusa, Upadamsa, Mansakandi, Adhimansaka, as well as ailments due to the lodgment of a foreign body in the flesh or a bone, and a sloughing of ligaments, flesh or veins are the diseases in which incision (Chedya) should be made. 2
भेद्या विद्रधयोऽन्यत्र सर्व्वजादः ग्रन्थयस्त्रयः ।। ४ ।।
आदितो ये विसर्पाश्च वृद्धयः सविदारिकाः । प्रमेहपिडकाः शोकः स्तनरोगोऽवमन्थकः ॥ ५ ॥
कुम्भीकाऽनुशयी नाड्यो वृन्दौ पुष्करिकाउलजी। प्रायशः क्षुद्ररोगाश्च पुप्पुटौ तालुदन्तजौ ॥ ६ ॥
तुण्डिकेरी गिलायुश्च पूर्व्वं ये च प्रपाकिणः । बस्तिस्तथाऽश्मरीहेतोर्मेदोजा ये च केचन ॥ ७ ॥
Bhedya : Excision (Bhedya) should be resorted to in the following diseases, viz., Vidradhis, the three types of Granthi other than the Sannipatika one, Visarpa either due to the deranged Vayu, Pitta or Kapha, Vrddhi, Vidarika, Prameha-pidaka, swellings in general, diseases affecting the mammary organs, Avamanthaka. Kumbhika, Anusayi, Nadi, the two types of Vrnda, Puskarika, Alaji, Ksudra-roga ( all minor cutaneous or pustular diseases), the three types of Pupputa, Talu-pupputa, and Danta-pupputa, Tundikeri, Gilayu, and the diseases which are caused by suppuration in the local flesh or any soft part of the body (such as fistula-in-ano), as well as stone in the bladder and diseases due to a derangement of fat.¹ 4-7
लेख्याश्चतस्रो रोहिण्यः किलासमुपजिह्निका । मेदोजो दन्तवैदर्भों ग्रन्थिर्वर्त्माधिजिह्निका।। अशसि मण्डलं मांसकन्दी मांसोन्नतिस्तथा । ॥ ८ ॥
Lekhya: The surgical operation known as scarification (Lekhya) should be resorted to in the following diseases, viz., the four types of Rohini, Kilasa, Upajihva, diseases having their seat in the deranged fat, Danta-Vaidarbha, Granthi, Vrana-Vartma, Adhi-Jihva, Arsa, Mandala, Mansa-kandi, and Mansonnati. 8
वेध्याः शिरा बहुविधा मूत्रवृद्धिर्दकोदरम् । एष्या नाडचः सशल्याश्च व्रणा उन्मार्गिणश्च ये।। ९ ।।
Vyedhyana: The Surgical operation known as Vyedhyana (aspiration) should be made use of in connection with a vein, or a case of Dakodaram (abdominal dropsy), or Mutra- Vrddhi (hydrocele). Diseases, in connection with which the probe or the director should be used, are Nadis (sinus) and ulcers with any extraneous or foreign body lodged in their inside, and those which follow abnormal (lateral or oblique) directions. 9
1. Granthi (gland), Galaganda ( goitre) Vrddhi ( scrotal tumour) Apaci ( scrofula) and Arbuda (tunour) are the fat-origined diseases contemplated as instances.
आहार्य्याः शर्करास्तिस्रो दन्तकर्णमलोऽश्मरी । शल्यानि मूढगर्भाश्च वर्च्चश्च निचितं गुदे ।। १० ।।
Aharya: The process known as Aharana (extraction or drawing out) should be adopted in the three types of Sarkara,¹ in drawing out any morbid matter from between the teeth or from the cavity of the ears, or in extracting any foreign matter from its seat of lodgment in the body, or a stone from the bladder, or in drawing out feces from the constricted anus, or a foetus from the uterus, (as in the case of a false presentation or difficult labour). 10
साव्या विद्रधयः पञ्च भवेयुः सर्व्वजागते । कुष्ठानि वायुः सरुजः शोफो यश्चैकदोषजः ।।११।।
पाल्यामयाः श्लीपदानि विषजुष्टञ्च शोणितम् । अर्बुदानि विसर्पाश्च ग्रन्थयश्चादितस्तु ये ।। १२ ।।
त्रयस्त्रयचोपदंशाः स्तनरोगा विदारिका । शौषिरो गलशालूकं कण्टकाः कृमिदन्तकः ।।१३।।
दन्तवेष्ट: सोपकुश: शीतादो दन्तपुप्पुटः । पित्तासृक्कफजाश्चौष्ठयाः क्षुद्ररोगाश्च भूयशः ।।१४।।
Sravya : Secreting or evacuating measures ( Sravya) should be adopted in the following diseases, viz, the five types of Vidradhi excepting the Sannipatika one, Kustha of whatsoever type, derangement of the bodily Vayu with pain in the affected region, inflammatory swellings restricted to any particular part of the body, diseases affecting the ear-lobes, Sleepada (elephantiasis), blood poisoning, Arbuda (tumours), Visarpa (erysipelas), Granthi (glands due to any of the deranged Vayu, Pitta, or Kapha) the three types of Upadamsa (syphilis), Stana-roga (inflammation of the mammae), Vidarika, sausira, Gala-saluka, Kantaka, Krmi-dantaka (worm-eaten teeth), Danta-vesta (inflammation of the gums), Upakusa, Sitada, Dantapupputa, diseases of the lips originated through the action of the deranged blood, Pitta or Kapha, and a variety of other diseases passing under the denomination of Ksudra-Roga ( minor ailments). 11-14
1. Such as urinary calculi, calcareious deposits on the teeth, and Pada-Sharkara.
सीव्या मेदः समुत्थाश्च भिन्नाः सुलिखिता गदाः । सद्योव्रणाश्च ये चैव चलसन्धिव्यपाश्रिताः ।। १५ ।।
Sivya : Suturing (Sivya) should be resorted to in the case of an open ulcer due to the action of the deranged fat after its vitiated contents (morbid matter) had been fully scraped out, as well as in the case of an uncomplicated (curable) Sadyovrana (wound or instant ulcer) at any of the joints which are connected with the acts of movement or locomotion. 15
न क्षाराग्निविषैर्जुष्टा न वा मारुतवाहिनः । नान्तर्लोहितशल्याश्च तेषु सम्यग् विशोधनम् । । १६ ।।
पांशुरोमनखादीनि चलमस्थि भवेच्च यत् । । १७ ।।
अहृतानि यतोऽमूनि पाचयेयुर्भृशं व्रणम् । रुजश्च विविधाः कुर्य्युस्तस्मादेतान् विशोधयेत्।।१८ ।।
Conditions of Suturing: An ulcer incidental to the application of fire (cautery) or any alkaline preparation (caustic), or treated with any poisonous drug or substance, or from whose inside the embedded salya (foreign matter) has not been removed, should not be sewed up without being throughly cleansed and purified (asepsised) inasmuch as any foreign matter, whether a hair, nail or a particle of dust or bone, lying embedded in its cavity, might set up an abnormal suppuration, accompanied by extreme pain and excessive secretion. Hence such ulcers should be throughly cleansed (and all foreign or indigenous morbid matter should be extracted therefrom) before being sewed up. 16-18
ततो व्रणं समुन्नम्य स्थापयित्वा यथास्थितम् । सीव्येत् सूक्ष्मेण सूत्रेण वल्केनाश्मन्तकस्य वा । ।१९ । ।
शणजक्षौमसूत्राभ्यां स्नाय्वा बालेन वा पुनः । मूर्व्वागुडूचीतानैर्वा सीव्येद् वेल्लितकं शनैः ॥ २० ॥
सीव्येद् गोफणिकां वाऽपि सीव्येद् वा तुन्नसेवनीम् । ऋजुग्रन्थिमथो वाऽपि यथायोगमथापि वा ।। २१ ।।
देशेऽल्पमांसे सन्धौ च सूची वृत्ताऽङ्गुलद्वयम् । आयता त्र्यङ्गुला त्र्यम्रा मांसले चापि पूजिता ||२२||
धनुर्वक्रा हिता मर्म्मफलकोषोदरोपरि । इत्येतास्त्रिविधाः सूचीस्तीक्ष्णाग्राः सुसमाहिताः।।२३।।
Mode of Suturing: Then having pressed the ulcer up into its proper position, it should be sutured with strings of any of the following kinds, viz. of thin cotton thread, of the fibres of the Asmantaka tree or hemp plants, or of the Atasi, Murva or Guduci, or with strips of leather, plaited horse-hair or animal sinews, into any of the officinal shapes (of suturing) known as the Gophana, Tunna-Sevani and Rju-Granthi, etc. or as suited to the shaped and position of the ulcerated part. The margin of the ulcer should be gently pressed close with the fingers during suturing. A round needle to the length of two fingers’ width should be used in sewing up an ulcer occurring about any joint or in a part of the body where the flesh is thin and scanty. A needle of a triangular body (tri-hedral), and measuring three fingers’ width in length, is recommended in the case of an ulcer appearing at any fleshy part of the body. A semi-circular or bow-shaped needle should be used in a case where the seat of the ulcer would be found to be on the scrotum, or on the skin of the abdomen, or about any of the Marmas (vital parts). 19-23
कारयेन्मालतीपुष्पवृन्ताग्रपरिमण्डलाः।। २४ ।।
Needles of these three shapes should be so constructed as to be fitted with sharp points capable of being handled with the greatest ease, having a girth equal that of the stem of a Malati flower. 24
नातिदूरे निकृष्टे वा सूच कर्म्मणि पातयेत् । दूराद् रुजो व्रणौष्ठस्य सन्निकृष्टेऽवलुञ्चनम् | ॥ २५ ॥
अथ क्षौमपिचुछन्नं सुस्यूतं प्रतिसारयेत् । प्रियङ्गञ्जनयष्ट्याह्नरोघ्रचूर्णैः समन्ततः ।।२६ ।।
शल्लकीफलचूर्णैर्वा क्षौमध्यामेन वा पुनः । ततो व्रणं यथायोगं बद्धवाचारिकमादिशेत् ॥ २७ ॥
The needle should not be pricked into a part too near or too remote from the fissure, or the mouth of an ulcer, as there might be the danger of the suture being broken off (at the least pressure or movement) in the first instance and of genesis of pain in the second.
An ulcer, thus properly sutured, should be covered over with cotton and dusted over with a pulverised compound consisting of the powders of Priyangu, Anjanam, Yastyahva and Rodhra, or with the ashes of a burnt piece of Ksauma cloth, or with the powders of the Sallaki fruit. Then the ulcer should be properly bandaged, and measures and rules regarding the regimen of diet, and conduct previously laid down in the chapter on the nursing of an ulcer-patient (Ch. XIX.) should be adopted and observed. 25-27
एतदष्टविधं कर्म्म समासेन प्रकीर्त्तितम् । चिकित्सिते तु कार्त्स्येन विस्तरस्तस्य वक्ष्यते ॥ २८ ॥
The eight kinds of surgical operations have thus been briefly described. They will be dealt with later on in the Chikitsita. 28
हीनातिरिक्तं तिर्य्यक् च गात्रच्छेदनमात्मनः । एताश्चतस्रोऽष्टविधे कर्म्मणि व्यापदः स्मृताः ।। २९ ।।
Defective Surgical Operations: These eight forms of operations may be attended with dangers of four different kinds such as those arising from an insufficient or over performance, or from the slanting or oblique deviation (of the knife or the instrument), or from an act of self-injury on the part of the physician. 29
अज्ञानलोभाहितवाक्ययोगभयप्रमोहैरपरैश्च भावैः । यदा प्रयुञ्जीत भिषक् कुशस्वं तदा स शेषान् कुरुते विकारान् ॥ ॥ ३० ॥
तं क्षारशस्त्राग्निभिरौषधैश्च भूयोऽभियुञ्जानमयुक्तियुक्तम् । जिजीविषुर्दूरत एव वैद्यं विवर्ज्जयेदुग्रविषाग्नितुल्यम् ।।३१ ।।
A physician (surgeon) making a wrong operation on the body of his patient either through mistake, or through the want of necessary skill or knowledge, or out of greed, fear, nervousness or haste, or in consequence of being spurned or abused, should be condemned as the direct cause of many new and unforeseen maladies. A patient, with any instinct of self-preservation, would do well to keep aloof from such a physician, or from one who makes a wrong or injudicious application of the cautery, and should shun his presence just as he would shun a conflagration or a cup of fatal poison. 30-31
तदेव युक्तं त्वति मर्म्मसन्धीन् हिंस्यात् सिराः स्नायुमथास्थि चैव । मूर्खप्रयुक्तं पुरुषं क्षणेन प्राणैर्वियुञ्जयादथवा कथञ्चित् ||३२||
On the other hand, a surgical operation, carried to excess, (or a surgical instrument inserted deeper than what is necessary is attended with the danger of cutting or destroying a vein, ligament, bone, joint, or any vital part of the body. A surgical operation by an ignorant surgeon brings about, in most cases, the instantaneous death of the patient, or consigns him to the pangs of a life-long death. 32
भ्रमः प्रलापः पतनं प्रमोहो विचेष्टनं ग्लानिरथोष्णता च स्रस्ताङ्गता मूर्च्छनमूर्द्धववातस्तीव्रा रुजो वातकृताश्च तास्ताः ।।३३।।
मांसोदकाभं रुधिरञ्च गच्छेत् सर्व्वेन्द्रियार्थोपरमस्तथैव । दशार्द्धसङ्ख्येष्वपि हि क्षतेषु सामान्यतो मर्म्मसु लिङ्गमुक्तम् ॥ ३४ ॥
सुरेन्द्रगोपप्रतिमं प्रभूतं रक्तं स्रवेद् वै क्षततश्च वायुः । करोति रोगान् विविधान् यथोक्ताश्छिन्नासु भिन्नास्वथवा सिरासु ||३५ ।।
The symptoms which generally manifest themselves in connection with the injudicious hurting of any of the five vital parts or principales of the body (such as the joints, bones, veins, ligaments, etc.) are vertigo, delirium, loss of bodily functions, semi-insensibility (comatose state), incapacity of supporting oneself, cessation of mental functions, heat, fainting, looseness of the limbs, difficult respiration, excruciating pain or pain peculiar to the deranged Vayu, secretion of blood or a thin watery secretion like the washings of meat from the injured part, or the organ, with coma or inoperativeness of all the senses. A vein’ (Sira) any way severed or injured is attended with a copious flow (haemorrhage) of deep red blood, resembling the hue of the cochineal insect, from and ulcer; and the deranged local Vayu readily exhibits all its essential characteristics, and ushers in diseases which have been enumerated under that head in the chapter on the description of (blood.) 33-35
कौब्ज्यं शरीरावयवावसादः क्रियास्वशक्तिस्तुमुला रुजश्च । चिरावणो रोहति यस्य चापि तं स्नायुविद्धं पुरुषं व्यवस्येत् ||३६ ||
1. Other than the one situated in any of the abovesaid vital parts of the body.
Similarly, an injured ligament gives rise to a crooked ness or bending of, as well as to a gone feeling in the injured limb or organ, attended with pain and loss of function, and the incidental ulcer takes a long time to heal. 36
शोफातिवृद्धिस्तुमुला रुजक्ष बलक्षयः पर्व्वसु भेदशोफौ। क्षतेषु सन्धिष्वचलाचलेषु स्यात् सन्धिकर्म्मोपरतिश्च लिङ्गम् ॥ ३७॥
घोरा रुजो यस्य निशादिनेषु सर्व्वास्ववस्थासु न शान्तिरस्ति । तृष्णाऽङ्गसादौ श्वयथुश्च रुक् च तमस्थिविद्धं पुरुषं व्यवस्येत् ||३८ ।।
An abnormal increase in the local swelling, together with an excruciating pain, loss of strength, breaking pain in the joints, and inoperativeness of the affected part, mark the wounding of a flexible or immovable joint. Similarly, in the case where a bone is hurt or injured in the course of a surgical operation, the patient is tormented with indescribable pain, day and night, and finds no comfort in any position what-soever. Pain and swelling specifically mark the affectedlocality, and thirst and inertness of the limbs add to the list of his sufferings. 37-38
यथास्वमेतानि विभावयेयुर्लिङ्गानि मर्म्मस्वभिताडितेषु । स्पर्शं न जानाति विपाण्डुवर्णो यो मांसमर्म्मण्यभिताडितः स्यात् ।।३९ ।।
A case of any injured Sira-Marma (vital venal or arterial combination or plexus) exhibits the same symptoms which characterise the hurting of a single vein, as previously described. Loss of actual perception (anaesthesia), and a yellowish colour of the skin mark the case where the injury is confined to the vital principle of the flesh. 39
आत्मानमेवाथ जघन्यकारी शस्त्रेण यो हन्ति हि कर्म्म कुर्व्वन् । तमात्मवानात्महतं कुवैद्यं विवर्ज्जयेदायुरभीप्समानः ।।४० ।।
A patient, who is discreet, and is not in a special hurry to end his earthly sojourn, would do well to shun the presence of a bungling, unskilful surgeon, who can not even keep himself unhurt in the course of a surgical operation. 40
तिर्य्यक प्रणिहिते शस्त्रे दोषाः पूर्व्वमुदाहृताः । तस्मात् परिहरन् दोषान् कुर्य्याच्छस्त्रनिपातनम् ।।४१ ।।
The evils, which attend the oblique insertion of a surgical instrument, have been described before; and accordingly care should be taken not to leave any room for the occurence of those evils in connection with a surgical operation. 41
मातरं पितरं पुत्रान् बान्धवानपि चातुरः । अप्येतानभिशङ्केत वैद्ये विश्वासमेति च ॥ ४२ ॥
विसृजत्यात्मनात्मानं न चैनं परिशङ्कते। तस्मात् पुत्रवदेवैनं पालयेदातुरं भिषक् ॥ ४३ ॥
धर्मार्थो कीर्त्तिमत्यर्थं सतां ग्रहणमुत्तमम् । प्राप्नुयात् स्वर्गवासञ्च हितमारभ्य कर्म्मणा ॥४४ ॥
कर्म्मणा कश्चिदेकेन द्वाभ्यां कश्चित् त्रिभिस्तथा । विकारः साध्यते कश्चिच्चतुर्भिरपि कर्म्मभिः ॥ ४५ ॥
The patient, who may mistrust his own parents, sons and relations, should repose an implicit faith in his own physician, and put his own life into his hands without the least apprehension of danger; hence a physician should protect his patient as his own begotten child. A surgical case may yield to a single incision, or may require two, three, four or more than that number to effect a cure. By doing good to humanity with his professional skill, a physician achieves glory, and acquires the plaudits of the good and the wise in this life, and shall live in Paradise in the next. 42-45
इति सुश्रुतसंहितायां सूत्रस्थानेऽष्टविधशस्त्रकर्मीयो नाम पञ्चविंशोऽध्यायः ।। २५ ॥
Thus ends the twenty-fifth Chapter of the Sutrasthana in the Susruta Samhita which treats of the eight forms of Surgical operations.
