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Sushruta SamhitaShrira SthanaSira Vyadha Vidhi Sharira - Method of Venesection - Sushrutasamhita Sharirasthana Chapter...

Sira Vyadha Vidhi Sharira – Method of Venesection – Sushrutasamhita Sharirasthana Chapter 8

अथातः सिराव्यधविधिशारीरं व्याख्यास्यामः यथोवाच भगवान् धन्वन्तरिः ।। १ ।।

Now we shall discourse on the Sharira which treats of the method of Venesection etc. (Sira-Vyadha-Vidhi-Sharira). 1

बालस्थविररूक्षक्षतक्षीणभीरुपरिश्रान्तमद्याध्वस्त्रीकर्शितवान्तविरिक्तास्थापितानुवासितजागरितक्लीबकुशगर्भिणीनां कासश्वासशोषप्रवृद्धज्वराक्षेपकपक्षाघातोपवासपिपासामूर्च्छाप्रपीडितानाञ्च सिरां न विध्येत्, या चाव्यध्याः व्यध्याश्चादृष्टाः दृष्टाश्चायन्त्रिताः, यन्त्रिताश्चानुत्थिता इति ।। २ ।।

Persons unfit for Venesection : The vesseis (Sira) of an infant. an old man, a parched man, fatigued and emaciated with endocarditis (Ksata-ksina), a person of timid or coward disposition, a person used up with excessive drinking or sexual enjoyments or tired with the troubles of long journey, and intoxicated person, a patient who has been treated with purgatives, emetics or with Anuvasana and Asthapana measures (enemas), a man who has passed a sleepless night, an impotent (Kliba) or emaciated person, an enceinte, or one afflicted with cough, asthma, high fever, phthisis, convulsions, paralysis, thirst, epilepsy, or effects of fasting, should not be pierced or opened. Incisions should not be made into those veins (Siras) which are not fit for opening, or into the fit ones, if invisible, it should be the same with those which cannot be properly ligatured or even if ligatured cannot be raised up. 2

शोणितावसेकसाध्याश्च ये विकाराः प्रागभिहितास्तेषु चापक्वेष्वन्येषु चानुक्तेषु यथाभ्यासं यथान्यायञ्च सिरां विध्येत् || ३ ||

प्रतिषिद्धानामपि च विषोपसर्गे आत्ययिकेषु च सिराव्यधनमप्रतिषिद्धम् ॥ ४ ॥

Diseases which are amenable to acts of venesection have been described before (Sonita-Varnaniya). Venesection may be performed in the said diseases as well as in those which have not been enumerated in connection with them and also in other cases whether suppurated or unsuppurated, if such a proceeding is deemed necessary and after the application of Sneha and Sveda. Venesection should be made even in the cases declared unfit for it (such as in an infant etc.) in cases of blood-poisoning (such as snake-biteetc.) and in fatal diseases (Vidradhi etc.). 3-4

तत्र स्निग्धस्विन्नमातुरं यथादोषप्रत्यनीकं द्रवप्रायमन्नं भुक्तवन्तं यवागूं पीतवन्तं वा यथाकालमुपस्थाप्यासीनं स्थितं वा प्राणानवाधमानो वस्त्रपट्टचर्मान्तर्वल्कललतानामन्यतमेन यन्त्रयित्वा नातिगाढं नातिशिथिलं शरीरप्रदेशमासाद्य यथोक्तं शस्त्रं गृहीत्वा सिरां विध्येत् ॥ ५॥

Preliminary rules: The patient should be duly fomented (Sveda) and anointed (Sneha) with oily preparations. A liquid¹ food or diet consisting of articles which are antidotal to the bodily principles (Dosas) Yavagu (gruel) should be given to him at first. Then at the proper season (i.e., not in the rainy or winter season etc.) the patient should be brought near the surgeon and made to sit or lie down and the part to be incised upon should be bound, neither too loosely (e.g., in the extremities etc.) nor too tightly (e.g., in the head etc.) with any of the accessories, such as cloth, linen, skin, the inner fibres of a bark, creepers etc., so as not to create any pain or agitation in his mind. Then the vein should be duly opened with proper instrument (and with a careful regard to the situation of any local Marma). 5

1. A liquid food is recommended for the purpose of liquefying the blood so as to bleed easily.

नैवातिशीते नात्युष्णे न प्रवाते न चाभ्रिते। सिराणां व्यधनं कार्यमरोगे वा कदाचन ॥ ६ ॥

Metrical text: Venesection should not be performed in an extremely cold or hot, cloudy or windy day. It is forbidden to open a vein without necessity or in a healthy person. 6

तत्र व्यध्यसिरं पुरुषं प्रत्यादित्यमुखमरलिमात्रोच्छ्रिते उपवेश्यासने सक्थ्नोराकुञ्चितयोर्निवेश्य कूर्परौ सन्धिद्वयस्योपरि हस्तावन्तगूढाङ्गष्ठकृतमुष्टी मन्ययोः स्थापयित्वा यन्त्रणशाटकं ग्रीवामुष्टयोरुपरि परिक्षिप्यानेन पुरुषेण पश्चात्स्थितेन वामहस्तेनोत्तानेन शाटकान्तद्वयं ग्राहयित्वा ततो वैद्यो ब्रूयाद्-दक्षिणहस्तेन सिरोत्थापनार्थं नात्यायतशिथिलं यन्त्रणमावेष्टयेति, असृक्स्त्रावणार्थं च यन्त्रं पृष्ठमध्ये च पीडयेति, कर्मपुरुषञ्च वायुपूर्णमुखं स्थापयेत्, एष उत्तमाङ्गगतानामन्तर्मुखवर्जानां सिराणां व्यधने यन्त्रणविधिः ।। ७ ।।

The Yantrana Vidhi: The patient whose vein is to be operated upon should be made seated on a stool to the height of an Aratni (distance of the elbow from the tip of the small finger) with his face turned towards the sun. He should keep his legs in a drawn up or contracted posture resting his elbows (Kurpara) on his knee-joints and the hands with his two thumbs closed in his fists placed on (the upper ends of) his Manyas (sterno mastoid muscles). Then having cast the binding linen on the two closed fists thus placed on the neck, the surgeon should ask another man from the back side of the patient to take hold of the two ends of the cloth with his left hand having the palin turned upward, and then ask him to tie up with his right hand the bandage round the part, neither too diffusely not too tightly nor too loosely, so as to raise the vein and to press the bandage round the back for a good out-flow of blood. Then he (surgeon) should perform the operation in the desired spot, the patient having been previously asked to sit with his mouth full of air (i.e. he should confine his breathing till the surgical operation is completed). This proceeding should be adopted in opening any vein of the head, to save those which are situated in the cavity of the mouth. 7

पादव्यध्यसिरस्य पादं समे स्थाने सुस्थिरं स्थापयित्वाऽन्यं पादमीषत्संकुचितमुच्चैः कृत्वा व्यध्यसिरं पादं जानुसन्धेरधः शाटकेनावेष्ट्य हस्ताभ्यां प्रपीडयागुल्फ व्यध्यप्रदेशस्योपरि चतुरङ्गुले प्लोतादीनामन्यतमेन बद्ध्वा पादसिरां विध्येत् || ८ ||

In the case of opening a vein (Sira) in the leg, the affected leg should be placed on a level ground, while the other leg should be held in a somewhat contracted posture, at a little higher place. The affected leg should be bound with a piece of linen below its knee-joint and pressed with the hands down to the ankle. A ligature of the above kind should then be tied four fingers above the region to be incised upon. after the vein should be opened. 8

अथोपरिष्टाद्धस्तौ गूढाङ्गुष्ठकृतमुष्टी सम्यगासने स्थापयित्वा सुखोपविष्टस्य पूर्ववद् यन्त्रं बद्ध्वा हस्तसिरां विध्येत् । गृध्रसीविश्वाच्योः सङ्कुचितजानुकूर्परस्य श्रोणीपृष्ठस्कन्धेषून्नामितपृष्ठस्यावाक्शिर स्कस्योपविष्टस्य विस्फूर्जितपृष्ठस्य विध्येत् | उदरोरसो: प्रसारितोरस्कस्योन्नामितशिरस्कस्य विस्फूर्जितदेहस्य ।। ९ ।।

In the case of opening a vein (Sira) in the arms, the patient should be asked to sit easily and fixedly with his two thumbs closed in his fists (as above). A ligature of the above-mentioned kind (rope etc.) should be tied (four fingers above the part to be incised upon and the vein is opened in the aforesaid manner. The knee-joint and the elbow should be held in a contracted or drawn up posture at the time of opening a vein in a case of Grdhrasi (Sciatica) and Visvaci, respectively. The patient should hold the back raised up and expanded and his head (and shoulders) bent down at the time of opening a vein in the back, shoulders and the Sroni (hips). He should hold his head thrust back and his chest and body expanded at the time of opening a vein in the chest or in the abdomen. 9

बाहुभ्यामवलम्बमानदेहस्य पार्श्वयोः । अवनामितमेढ्रस्य मेढ़े । उन्नामितविदष्टजिह्वाग्रस्याधोजिह्वाग्रस्याधोजिह्वायाम् । अतिव्यात्ताननस्य तालुनि दन्तमूलेषु च । एवं यन्त्रोपायानन्यांश्च सिरोत्थापनहेतून् बुद्धयाऽवेक्ष्य शरीरवशेन व्याधिवशेन च विध्यात् ।। १० ।।

He shall embrace his own body with his arms at the time of opening a vein in his sides. The penis should be drawn downward (i.e., in flaccid state) on a similar occasion in that region. The tongue should be raised up to the roof of the mouth and its fore-part supported by the teeth at the time of opening a vein in its under-surface. The patient should be told to keep his mouth fully open at the time of opening a vein in the gums or in the palate. Similarly a Surgeon should devise proper and adequate means for the purpose of raising up (distinct appearance of) a Sira (vein) and determine the nature of the bandage to be used therein according to the exigencies (i.e., the health and the kind of diseases of the patient), of each case. 10

मांसलेष्ववकाशेषु यवमात्रं शस्त्रं निदध्यादतोऽन्येष्वर्धयवमात्रं व्रीहिमात्रं वा व्रीहिमुखेन ।

अस्थनामुपरि कुठारिकया विध्येदर्धयवमात्रम् ।। ११ ।।

An incision to the depth of a barley-corn should be made with a Vrihimukha instrument (into a vein situated) in the muscular parts of the body, whereas the instrument should be thrust only half of that depth or to the depth of a Vrihi seed in other places (Vrihi here signifies Sukadhanya as well as Rakta-sali). An incision over a bone should be made with the Kutharika (small surgical axe) to the half depth of a barley-corn. 11

भवन्ति चात्र । व्यभ्रे वर्षासु विध्येत ग्रीष्मकाले तु शीतले । हेमन्तकाले मध्याहने शस्त्रकालास्त्रयः स्मृताः ।। १२ ।।

सम्यक्शस्त्रनिपातेन धारया या स्रवेदसृक् । मुहूर्त रुद्धा तिष्ठेच्च सुविद्धां तां विनिर्दिशेत् ।। १३ ।।

यथा कुसुम्भपुष्पेभ्यः पूर्वं स्त्रवति पीतिका । तथा सिरासु विद्धासु दुष्टमग्रे प्रवर्त्तते ।। १४ ।।

मूर्च्छितस्यातिभीतस्य श्रान्तस्य तृषितस्य च । न वहन्ति सिरा विद्धास्तथाऽनुत्थितयन्त्रिताः ।। १५ ।।

Memorable Verses: An opening should be effected in cloudless day in the rainy season, a cool day during the summer, and at noon in the winter season (Hemanta). These are the only three times of opening a vein. A well and successfully pierced vein bleeds in streams (almost simultaneously with the thrusting of the knife) and spontaneously stops after a Muhurta (a little while). The vitiated blood is seen first to flow out of an opened vein, like the drop of yellow pigment first coming out of a Kusumbha flower. Blood does not flow out from an incision made into a vein of an unconscious (Murcchita), much frightened, tired or a thirsty patient. An incision of a vein without proper bandaging and raising up is attended with a similar result. 12-15

क्षीणस्य बहुदोषस्य मूर्च्छयाऽभिहतस्य च । भूयोपराहणे विस्त्राव्या सापरेद्युस्त्र्यहेऽपि वा ॥ १६ ॥

रक्तं सशेषदोषन्तु कुर्यादपि विचक्षणः । न चातिप्रसुतं कुर्याच्छेषं संशमनैर्जयेत् ।। १७ ।।

बलिनो बहुदोषस्य वयःस्थस्य शरीरिणः । परं प्रमाणमिच्छन्ति प्रस्थं शेणितमोक्षणे ।। १८ ।।

A weak person, or one affected with the unusual derangement of the bodily Dosas etc., or one fainted (under operation), should not be subjected to a measure of continuous blood-letting at a time; instead of that, the vein should be opened afresh in the same afternoon or on the following day, or on the third day (as the exigency requires). An intelligent surgeon should not allow the flow of blood to an excess but should stop the flow even with a remnant of the diseased blood in the system and administer soothing internal remedies (Samsamana) for the purification of the diseased remnant. Bleeding to the quantity of a Prastha¹ measure should be deemed sufficient for a strong and adult patient, stuffed with a large quantity of the deranged Dosas (in the body). 16-18

तत्र पाददाहपादहर्षावबाहुकचिप्पविसर्पवातशोणितवातकण्टकविचर्चिकापाददारीप्रभृतिषु क्षिप्रमर्मण उपरिष्टाद् द्वयङ्गुले व्रीहिमुखेन सिरां विध्येत्, श्लीपदे तच्चिकित्सते यथा वक्ष्यते ।। १९ ।।

The vein should be incised with a Vrihimukha instrument at a distance of two fingers above the seat of the Ksipra-marma in such diseases as Padadaha, Pada-Harsa, Ava-bahuka, Cippa, Visarpa,

1. In medicinal preparations, a Prastha measure is understood to be sixty four Karsas in the case of liquids, but in cases of excreta due to emetic and purgative measures and of blood-letting, a Prastha is meant to be thirteen Palas and a half only.

Vata-rakta, Vata-kantaka, Vicarcika, Padadari, etc. The mode of opening a vein in the case of Slipada (Elephantiasis) would be described under the treatment of that disease. 19

क्रोष्टुकशिरः खञ्जपङ्गुलवातवेदनासु जङ्घायां गुल्फस्योपरि चतुरङ्गुले। अपच्यामिन्द्रबस्तेरधस्ताद्द्वचङ्गुले । जानुसन्धेरुपर्यो वा चतुरङ्गुले गृध्रस्याम् । ऊरुमूलसंश्रितानान्तु गलगण्डे । एतेनेतरसक्थि बाहू च व्याख्यातौ । विशेषतस्तु वामबाहौ कूर्परसन्धेरभ्यन्तरतो बाहुमध्ये प्लीहि कनिष्ठिकानामिकयोर्मध्ये वा । एवं दक्षिणबाहौ यकृद्दाल्ये कफोदरे च एतामेव च कासश्वासयोरप्यादिशन्ति ।। २० ।।

In Vata-rogas, such as Krostuka-sirah (Synovites), maimedness (Parngu) and lameness (Khafija), the Sira (vein of the Jangha (lower leg-calf), four fingers above the Gulpha, should be opened. In cases of Apaci (scrofula), the vein should be opened simultaneously with the appearance of the disease two fingers below the Indrabasti-marma. In a case of Grdhrasi (sciatica), the vein should be opened four fingers above or below the Janu (knee-joint). In a case of goitre. the veins attached to the roots of the Uru ( thighs) should be opened. The instructions regarding the opening of a vein in one leg shall hold good in the case of that in the other, as well as in cases of those situated in the two upper extremities (hands), but the speciality is that in a case of enlarged spleen, the vein near the Kurpara-sandhi (elbow-joint) of the left hand or that inside the fourth and the fifth fingers should be opened. Similarly in a case of Yakrddalyodara or Kaphodara, the corresponding vein in the right hand should be opened. Several authorities advise the opening of the same vein in cases of cough and asthma’ due to the action of the deranged Kapha. 20

गृध्रस्यामिव विश्वाच्याम् । श्रोणि प्रति समन्ताद् व्यङ्गुले प्रवाहिकायां शूलिन्याम् । परिवर्त्तिकोपदंशशूकदोषशुक्रव्यापत्सु मेढ्रमध्ये ।। २१ ।।

In a case of Visvaci, the same argument holds good (four fingers above or below the Kurpara-sandhi) as in a case of Grdhrasi. In a case of Pravahika (diarrhoea) attended with sula (colic), the vein within

1. Gayi holds that in cases of asthma and cough venesection should be had recourse to only when they are in a mild form two fingers width around of the pelvis (Sroni) should be opened. The vein of the penis should be opened in a case of Parikartika (D. R. – Parivartika), Upadansa, Suka-dosa and seminal disorders. 21

(वृषणयो: पार्श्वेमूत्रवृद्धयाम् । नाभेरधश्चतुरङ्गुले सेवन्या वामपार्श्वे दकोदरे ।) वामपार्श्वे कक्षास्तनयोरन्तरेऽन्तर्विद्रधौ पार्श्वशूले च। बाहुशोषावबाहुकयोरप्येके वदन्त्यंसयोरन्तरे । त्रिकसन्ध्यिगतां तृतीयके । अध: स्कन्धसन्धिगतामन्यतरपार्श्वसंस्थितां चतुर्थके ।। २२ ।।

The vein on either side of the scrotum should be opened in a case of hydrocele (Mutra – Vruddhi). The vein four fingers below the navel and on the left side of the Sevani (suture) should be opened in a case of Dakodara (ascites). In a case of Internal abscess and colic in the sides (Pleurodynia), the vein in the region between the breast and the left armpit should be opened. Several authorities assert that in a case of Avabahuka and Bahusosa (atrophy of the hand), the vein between the Aisas shoulders) should be opened. In a case of Trtiyaka (Tertian ) fever, the vein inside the Trika-Sandhi should be opened. In a case of Caturthaka fever, a vein joined with either side of and below the shoulder-joint should be opened. 22

हनुसन्धिमध्यगतामपस्मारे । शङ्खकेशान्तसन्धिगतामुरोऽपाङ्गललाटेषु चोन्मादे । जिह्वारोगेष्वधोजिह्वायां दन्तव्याधिषु च । तालुनि तालव्येषु । कर्णयोरुपरि समन्तात् कर्णशूले तद्रोगेषु च । गन्धाग्रहणे नासारोगेषु च नासाग्रे | तिमिराक्षिपाकप्रभृतिष्वक्ष्यामयेषुपनासिके लालाट्यामपाङ्ग्याम् वा, एता एव शिरोरोगाधिमन्थप्रभृतिषु रोगेष्विति ।। २३ ।।

In a case of Apasmara, the middle vein adjacent to the joint of the jaw-bones (Hanu-Sandhi) should be opened. In a case of insanity – the vein between the temple and the edge of the scalp or those in the Apanga (tips of the eyes), the forehead or the chest should be opened.

1. Gayi holds that in cases of asthma and cough venesection should be had recourse to only when they are in a mild form.

2. Dalhana, however, differs here from the text. He says, on the authority of Vagbhata, that the opening of a vein between the temple and the edge of the sculp or those in the Apanga, the forehead and the chest should be recommended in cases of insanity only, and not in the case of Apasmara as well (as in the text). In cases of the diseases of the tongue and the teeth, the veins on the under-surface (Adho-Jihva) of the tongue should be opened. In the case of a disease of the palate, the local vein should be opened. In diseases of the ears and specially in a case of inflammatory ear-ache (Karna-Sula), the vein along the region above the ears should be opened. In diseases of the nose and specially in a case of the loss of the smelling sensation, the vein at the tip of the nose should be opened. In cases of eye-diseases, such as Timira (cataract), Aksipaka (ophthalmia) etc., as well as in diseases of the head and in Adhimantha, the veins about the nose, the forehead and the Apanga (the outer canthus of the eyes), should be opened. 23

अत ऊर्ध्वं दुष्टव्यधनमनुव्याख्यास्यामः । तत्र दुर्व्विद्धाऽतिविद्धा कुञ्चिता पिच्चिता कुट्टिताऽप्रस्त्रुताऽत्युदीर्णा अन्तेऽभिहता परिशुष्का कूणिता वेपिता अनुत्थितविद्धा शस्त्रहता तिर्यग्विद्धा अपविद्धा अव्यध्या विद्रुता धेनुका पुनः पुनर्व्विद्धा मांससिरास्नाय्वस्थि सन्धिमर्म्मसु चेति विंशतिर्दुष्टव्यधाः ।। २४ ।।

Defective Venesection: Now we shall describe the twenty kinds of defects relating to an opened vein (Dusta-vyadhana). They are as follows : Durviddha, Atividdha, Kuncita, Piccita, Kuttita, Aprasruta, Atyudirna, Ante-abhihata, Parisuska, Kunita, Vepita, Anutthita-viddha, Sastrahata, Tiryag-viddha, Apaviddha, Avyadhya, Vidruta, Dhenuka, Punpunarviddha and Marmaviddha, i.e., incised about the Siramarma, the Snayu-marma, the Asthi-marma and the Sandhi-marma. 24

तत्र या सूक्ष्मशस्त्रविद्धाऽव्यक्तमसृक् स्रवति रुजाशोफवती च सा दुर्विद्धा, प्रमाणातिरिक्तविद्धायामन्तः प्रविशति शोणितं शोणितातिप्रवृत्तिर्वा साऽतिविद्धा, कुञ्चितायामप्येवम्, कुण्ठशस्त्रप्रमथिता पृथुलीभावमापन्ना पिच्चिता, अनासादिता पुनः पुनरन्तयोश्च बहुशः शस्त्राभिहता कुट्टिता, शीतभयमूर्च्छाभिर- प्रवृत्तशोणिता अप्रस्स्रुता, तीक्ष्णमहामुखशस्त्रविद्धा अत्युदीर्णा, अल्परक्तस्त्राविण्यन्तेविद्धा, क्षीणशोणितस्यानिलपूर्णा परिशुष्का, चतुर्भागासादिता किञ्चित्प्रवृत्तशोणिता कूणिता ।। २५ ।।

Their definitions: The vein in which an act of venesection is unattended with a satisfactory outflow of blood owing to its being incised with an extremely slender instrument and is marked by an extremely painful swelling in consequence thereof, is called Durviddha (badly incised). The vein in which the incision becomes more than measurement and no blood comes out properly or enters an internal channel or excessive bleeding owing to the largeness of the incision, is called Atividdha (over-incised). An opened vein in which the incision has been made in a curving manner and is attended with the foregoing results, is called Kuncita (crooked or contracted ). An incised vein presenting a flattened or thrashed appearance on account of its being opened with a blunt knife (Kuntha-Sastra) is called Piccita (thrashed). The vein at the sides of which incisions have been successively made, instead of in its body, is called Kuttita (lacerated). An incised vein, unattended with any bleeding owing to the patient’s fright, coldness or loss of consciousness, is called Aprasruta (unbleeding). A vein with a large incision in its body made with a sharp and flat-edged instrument, is called Atyudirna (improperly wideincised). An opened vein in which blood oozes out in small quantity is called Anteabhihata (struck in the interior). An opened vein in an anaemic patient (marked by a total absence of bleeding and) stuffed with Vayu (lit., as if the flow has been dried up by the Vayu), is called Parisuska (dried up). A vein opened but to a quarter part of the proper length and attended with a scanty outflow of blood, is called Kunita (partially incised). 25

दुःस्थानबन्धनाद् वेपमानाया: शोणितसम्मोहो भवति सा वेपिता । अनुत्थितविद्धायामप्येवम्। छिन्नाऽतिप्रवृत्तशोणिता क्रियासङ्गकरी शस्त्रहता । तिर्यक्प्रणिहितशस्त्रा किञ्चिच्छेषा तिर्यग्विद्धा | बहुश: क्षता हीनशस्त्रप्रणिधानेनापविद्धा । अशस्त्रकृत्या अव्यध्या । अनवस्थितविद्धा विद्रुता, प्रदेशस्य बहुशोऽवघट्टनादारो हव्यधा मुहुर्मुहुः शोणितस्त्रावा धेनुका । सूक्ष्मशस्त्रव्यधनाद् बहुशो भिन्ना पुनः पुनर्विद्धा। मांसस्नाय्वस्थिसिरासन्धिमर्मसु विद्धा वा रुजां शोकं वैकल्यं भरणञ्चापादयति ।। २६ ।।

A vein which trembles owing to its being bandaged at a wrong place and from which blood does not flow out in consequence, is called vepita (quivering). A vein incised without being previously properly raised up and attended with a similar result (i.e., absence of blood), is called Anutthita-viddha. A vein is fully cut and attended with excessive bleeding and inoperativeness of the organ is called Sastrahata (knifecut). A vein incised with an instrument applied slantingly and (consequently) not fully opened, is called Tiryag-viddha (obliquely incised ). A vein incised several times and ( every time ) with an improper instrument, is called Apaviddha (wrongly incised ). A vein unfit for opening (i.e., whose opening has been forbidden in the sastras), is called Avyadhya (unfit for opening ). A vein opened carelessly and hastily is called Vidruta (erratic). A vein bleeding again and again owing to its being repeatedly pressed and successively opened, is called Dhenuka. A vein variously cut owing to its being pierced into the same part with an extremely slender-pointed instrument is called Punah punarvidha (repeatedly incised). If a vein in the Mansa-marmas, Snayu-marmas, the Asthi marmas the Sira-imarmas or the Sandhi-marmas be opened, it is called Marma-viddha and in such cases severe pain, Oedema (Sofa) deformity or (even) death may be the result. 26

भवन्ति चात्र |

सिरासु शिक्षितो नास्ति चला ह्येता: स्वभावतः । मत्स्यवत् परिवर्त्तन्ते तस्माद् यत्नेन ताडयेत् ।। २७ ।।

अजानता गृहीते तु शस्त्रे कायनिपातिते । भवन्ति व्यापदश्चैता बहवश्चाप्युपद्रवाः ।। २८ ।।

लेपनैरपि। स्नेहादिभिः क्रियायोगैर्न तथा यान्त्याशु व्याधयः शान्तिं यथा सिराव्यधश्चिकित्सार्द्ध सम्यक् सिराव्यधात् ।। २९ ।।

प्रकीर्त्तितः । शल्यतन्त्रे यथा प्रणिहितः सम्यग् बस्तिः कायचिकित्सिते ॥ ३० ॥

Memorable Verses : Practice ( even) does not give the necessary skill in surgical operation of the veins etc., as they are naturally unsteady and changing like fishes. Hence a vein should be opened with the greatest care. An opening into the body, made by an ignorant and unskilful surgeon, is attended with the aforesaid dangers and many other distressing symptoms. An act of venesection, properly performed. gives more speedy relief than that derived from the application of medicated oil & cover of plaster as well. Venesection (bleeding) properly performed is half of the treatment described in Salyatantra (surgery) like the application of Basti-karmas (enematic measures) in Kaya Chikitsa (therapeutics). 27-30

तत्र स्निग्धस्विन्नवान्तविरिक्तास्थापितानुवासितसिराविद्धैः परिहर्त्तव्यानि – क्रोधायासमैथुनदिवास्वप्नवाग्व्यायामयानाध्ययनस्थानासनचंक्रमणशीतवातातपविरुद्धासात्म्याजीर्णान्याबललाभात्, मासमेके मन्यन्ते । एतेषां विस्तरमुपरिष्टाद् वक्ष्यामः ।। ३१ ।।

A man medically anointed (Sneha-karma), diaphorised (Sveda), vomited (Vamana), purged (Virecana), or treated with both the Bastikarmas (Anuvasana and Asthapana) or bled shall forego anger, physical labour, sexual intercourse, sleep in the day time, excessive talking. physical exercise, reading or driving etc., sitting on his haunches, standing frequent ramblings, exposure to cold, winds and the sun, hardly digestible, uncongenial and incompatible food until the strength is perfectly restored or, according to some authorities, for a month. These subjects will be fully dealt with later on Aturopadravachikitsa, ch. – 39). 31

भवतश्चात्र | जलौकाभिः सिराविषाणतुम्बैस्तु अवगाढं यथापूर्वं निर्हरेद् अवगाढे जलौका: स्यात् प्रच्छन्नं पिण्डिते हितम् । पदैस्तथा । दुष्टशोणितम् ||३२||

सिराऽङ्गव्यापके रक्ते श्रृङ्गालाबू त्वचि स्थिते || ३३ ||

Memorable Verses: The vitiated blood incarcerated in any part of the body should be abstracted there from by scarifying it, by cupping it with a Sira (pipe), a horn, a gourd, or leeches, or by the opening of a vein respectively, according to the density of the blood (Others assert that) leeches should be applied in the case of the (vitiated) blood being confined deep into the body, scarification with a surgical instrument should be made in the case of clotted blood, with a pipe in the case of extensive vitiation of the blood through-out the body and with a horn or a gourd in the case of the deranged blood having been seated in the skin. 32-33

इति सुश्रुत संहितायां शारीस्थाने शिराव्यधविधिशारीरं नामाष्टमोऽध्यायः ॥ ८ ॥

Thus ends the eighth Chapter of the Sharira Sthana in the Susruta Samhita which treats of venesection.


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