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Sushruta SamhitaYantra-Vidhi adhyaya - Appliances their Uses and Construction - Sushruta Samhita Sutrasthana...

Yantra-Vidhi adhyaya – Appliances their Uses and Construction – Sushruta Samhita Sutrasthana Chapter 7

अथातो यन्त्रविधिमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१९॥

Now Appliances, their Uses and Construction. (Yantra-Vidhi adhyaya). 1

यन्त्रशतमेकोत्तरमत्र हस्तमेव प्रधानतमं यन्त्राणामवगच्छ, (किं कारणम्? यस्माद्धस्तादृते यन्त्राणामप्रवृत्तिरेव) तदधीनत्वाद् यन्त्रकर्म्मणाम् । तत्र, मनःशरीराबाधकराणि शल्यानि, तेषामाहरणोपायो यन्त्राणि ॥२॥

we shall discuss the Chapter which treats of Surgical Surgical instruments number one hundred and one¹ in all, of which the hands is the most important, in as much as (all of them depend on the hand for their principal auxiliary) and as none of them can be handled without it; and further because all surgical operations pre-eminently require its co-operation. Any foreign or extraneous substances, which finds a lodgment in the human system and becomes painful to the body and the mind alike, is called a Salya; and surgical instruments are the means of extracting it from its seat or place where it is embedded. 2

तानि षट्प्रकाराणि । तद्यथास्वस्तिकयन्त्राणि, सन्दंशयन्त्राणि, तालयन्त्राणि, नाडीयन्त्राणि, शलाकायन्त्राणि, उपयन्त्राणि, चेति ॥३॥

According to certain authorities hundred is here indefinitely used for a large number.

(Surgical) Appliances may be divided into six different groups or types, such as the Svastika, the Sandansa, the Tala, the Nadi Yantras, and the Salakas, besides those that are called the minor or accessory appliances (Upa-yantras). 3

तत्र चतुर्विंशतिः स्वस्तिकयन्त्राणि । द्वे सन्दंशयन्त्रे । द्वे एव तालयन्त्रे । विंशतिर्नाडयः । अष्टाविंशतिः शलाकाः । पञ्चविंशतिरुपयन्त्राणि । तानि प्रायशो लौहानि भवन्ति, तत्प्रतिरूपकाणि वा तदलाभे ॥ ४ ॥

The Svastika instruments (forceps) in their turn, are divided into twenty-four sub-classes; the Sandainsa instruments (tongs) into two; the Tala Yantras into two; the Nadi Yantras (tubular) into twenty; and the Salakas (bougies) into twenty-eight; while the Upa-yantras admit of being divided into twenty five different types. These instruments are all made of iron which may be substituted for any other similar or suitable substance where iron would be unavailable. 4

तत्र, नानाप्रकाराणां व्यालानां मृगपक्षिणां मुखैर्मुखानि यन्त्राणां प्रायशः सदृशानि, तस्मात् तत्सारूप्यादागमादुपदेशादन्ययन्त्रदर्शनाद् युक्तितश्च कारयेत् ॥५॥

The mouths of these appliances are usually made to resemble those of birds and beasts and hence they should be made to resemble the mouths of some particular animal in shape, or otherwise, according to the advice of old and experienced physicians (surgeons), or according to the direction as laid down in the Sastras (Medical books of recognised authority, or according to the exigencies of the case, or after the shape and structure of other appliances used on similar occasions. 5

समाहितानि यन्त्राणि खरलक्ष्णमुखानि च ।

सुदृढानि सुरूपाणि सुग्रहाणि च कारयेत् ।।६।।

Metrical texts: Appliances should be made neither too large nor too small, and their mouths or edges should be made sharp and keen. They should be made with a special eye as to strength and steadiness, and they should be provided with convenient handles. 6

तत्र स्वस्तिकयन्त्राण्यष्टादशाङ्गुलप्रमाणानि, सिंहव्याघ्रवृकतरवृक्ष

द्वीपिमार्जारश्रृगालमृगैर्वारुककाककङ्ककुररचासभासशशघात्युलूकचिल्लिश्येनगृघ्रक्रौञ्चभृङ्गराजाञ्जलिकर्णावभञ्जननन्दिमुखमुखानि, मसूराकृतिभिः कीलैरवबद्धानि, मूलेऽङ्कुशवदावृत्तवारङ्गाण्यस्थिविदष्टशल्योद्धरणार्थमुपदिश्यन्ते ॥ ७ ॥

Appliances of the Svastika class should be made to measure eighteen fingers in ngth; and their mouths should be made to resemble those of lions, tigers, wolves, hyenas, bears, cats, jackals, deer, Ervarukas ( a species of deer), crows, cormorants, Kururas (a species of bird), Hasas ( a species of sparrow) vultures, falcons, owls, kites, herons, Bhrngarajas ( a species of bird), Anjalikarnas, Avabhanjanas, Nandimukhas, and such like beasts and birds. The two blades or halves of a Svastika should be welded together by means of a bolt resembling a Masura pulse (lentil) in size, and the handles should be turned inward in the shape of a mace, or an Ankusa. Appliances of this type should be used in extracting any thorn or foreign matter which may have entered into the bones. 7

सनिग्रहोऽनिग्रहश्च सन्दंशौ षोडशाङ्गुलौ भवतः, तौ त्वङ्मांसशिरास्नायुगतशल्योद्धरणार्थमुपदिश्येते ॥८॥

Sandamsas (tongs) are divided into two classes as they are soldered together with or without a bolt. They should be made to measure sixteen fingers in length, and should be used to withdraw any thorn-like substance from below the skin, flesh, veins or nerves. 8

तालयन्त्रे द्वादशाङ्गुले मत्स्यतालवदेकतालद्वितालके, कर्णनासानाड्रीशल्यानामाहरणार्थम् ॥ ९॥

The Tala Yantras which measure twelve fingers in length, may be divided into two classes as the single Tala and the double Tala. The former resemble the scales of fish in shape, while the latter, according to certain authorities, are made to resemble the entire mouth of a fish of the Bhetuli species. These Yantras are used in extracting splinters from inside the nose, ears and other external channels or passages of the body. 9

नाडीयन्त्राण्यपि अनेकप्रकाराण्यनेकप्रयोजनान्येकतोमुखान्युभयतोमुखानि च, तानि स्रोतोगतशल्योद्धरणार्थं रोगदर्शनार्थमाचूषणार्थं,क्रियासौकर्य्यार्थञ्चेति । तानि स्रोतोगतद्वारपरिणाहानि, यथायोगदीर्घाणि च। तत्र, भगन्दरार्शोर्व्वदव्रणबस्त्युत्तरबस्तिमूत्रवृद्धिदकोदरधूमनिरुद्धप्रकशसन्निरुद्धगुदयन्त्राण्यलावूश्रृङ्गयन्त्राणि चोपरिष्टाद् वक्ष्यामः ॥१०॥

The Nadi Yantras (tubular instruments like syringe’s enemas, etc. with a passage or aperture running through their entire length) are constructed in a variety of shapes and for various purposes. Some of them are open at one end, while others are open at both. These instruments are used for the purpose of extracting any shalyam that has pricked into the external canals or passages of the body, or for inspecting the seat of affection as in piles, etc., or for sucking (blood, etc. from any affected part), or simply as accessories to other surgical appliances. The length and circumference of a Nadi Yantra should be made to commensurate with those of the passage (Srota) or outlet of the human system into which it is intended to be introduced. We shall describe, later on, the types of Nadi Yantras which are to be used in connection with such diseases as fistula in ano, piles, etc. or in tumours and ulcers, in Mutravrddhi(Hydrocele) in Niruddha Prakasa (Phimosis), in Niruddha Guda (stricture of the rectum) and in ascites, as well as those to be used for the purpose of injecting anything into the urethra, the bowels, the vagina and the uterus, or are used in connection with medicated inhalation, or with those that are known as the Alabu Yantras (gourd used for cupping). 10

शलाकायन्त्राण्यपि नानाप्रकाराणि, नानाप्रयोजनानि, यथायोगपरिणाहदीर्घाणि च। तेषां गण्डूपदशरपुङ्खसर्पफणवडिशमुखे द्वे द्वे एषणव्यूहनचालनाहरणार्थमुपदिश्येते। मसूरदलमात्रमुखे द्वे किञ्चिदानताग्रे स्रोतोगतशल्योद्धरणार्थम् । षट् कार्पासकृतोष्णीषाणि प्रमार्ज्जनक्रियासु। त्रीणि दर्व्याकृतीनि खल्लमुखानि क्षारौषधप्रणिधानार्थम् । त्रीण्यन्यानि जाम्बववदनानि त्रीण्यङ्कुशवदनानि षडेवाग्निकर्म्मस्वभि- प्रेतानि । नासार्बुदाहरणार्थमेकं कोलास्थिदलमात्रमुखं खल्लतीक्ष्णोष्ठम् । अञ्जनार्थमेकं कलायपरिमण्डलमुभयतो मुकुलाग्रम् | मूत्रमार्गविशोधनार्थमेकं मालतीपुष्पवृन्ताग्रप्रमाणपरिमण्डलमिति ॥११॥

The Salaka-Yantras (bougies) are of various shapes and serve a variety of purposes. The lengths and girths of these instruments should be determined according to the necessity of each individual case. Four probes or directors (salaka) in two pairs, are used for the purposes of searching (Esana) pus in a suppurated part or limb, or in connection with uplifting, cutting and thereby withdrawing a salyam from the part it has pricked into, or with a view to transfer such a body from one place to another (Calana), or for the purspoe of extracting it (Salya) from the affected part. The mouths of the two types of these directors respectively resemble those of a Gandupada (earthworm) and of a Sarapunkha (Tephrosia Purpurea, Pers) while the other two are respectively headed like the hood of a serpent and a fish hook. A couple of directors are used for the purpose of withdrawing a foreign matter (Salya) imbedded in any outer canal of the body (Srotas). The top-ends of these directors are bent down a little, and they resemble a lentil seed in size. Six types of directors or probes are used in cleansing (the pus from an affected part of the human organism) and their top-ends are fitted with caps of loose cotton. The three sorts of directors used in applying alkaline medicines, are shaped like ladles, and their mouths, resemble the cavities of little stone mortars (Khala). Of the six sorts of directors used in connection with the process of cauterisation (Agni-Karma) three are mouthed like the Jamboline fruit, while the other three are faced like a mace or a spear (Ankusa). A kind of director used in removing nasal tumours, is mounted like ate half of the kernel found in the inside of a Jujube-stone with a little dip in the middle, its lip or end having a keen or sharp edge. The ends of the type of probe used in applying Anjanas (medicated collyria) to the eyelids are wrought into two small round lobes like the Matara pulse and are blunted, while the sort of probe used in cleansing the urethra, is made round like the end of the stem of a Malati flower. 11

उपयन्त्राण्यपि रज्जुवेणिका-पट्टचर्म्मान्तर्वल्कललतावस्त्राष्ठीलाश्ममुद्गरपाणिपादतलाङ्गुलि – जिह्वादन्त – नखमुखबालाश्वकटकशाखाष्ठीवनप्रवाहणहर्षायस्कान्तभयानि क्षाराग्निभेषजानि चेति ॥१२॥

The Upa-yantras or minor surgical accessories : include such substances as rope, the Venika (braided hair), silk thread, the bark and the inner-skin of trees, creepers, linen, Asthila (stones), large oval shaped pebbles, a hammer, the palms of the hands, the soles of feet, fingers, tongue, the teeth, the nails, hair, the mane of horses, branches of trees, a magnet, alkali, fire, and medicine, and such acts as spitting, straining (kunthanam), exhilaration and intimidation. 12

एतानि देहे सर्व्वस्मिन् देहस्यावयवे तथा । सन्धौ कोष्ठे धमन्याञ्च यथायोगं प्रयोजयेत् ।।१३।।

Metrical texts: These accessories should be applied to the entire body of a patient, or to any part thereof such as, the arteries, the viscera, or the joints, according to the necessities of each case to be determined by the surgeon. 13

यन्त्रकर्म्माणि तु निर्घातनपूरणबन्धनव्यूहनवर्त्तनचालनविवर्त्तनविवरणपीड़नमार्गविशोधनविकर्षणाहरणाच्ञ्छनोन्नमनविनमन- भञ्जनोन्मथनाचूषणैषणदारणर्जूकरणप्रक्षालनप्रधमनप्रमार्ज्जनानि चतुर्व्विशतिः ॥१४॥

The Functions of Surgical Instruments are striking out (Nirghatana-lit: with-drawing a salya by moving it to and fro), injection or filling, binding, up-lifting, cutting and thereby withdrawing a salya, resetting by means of a twirling motion, removing of a Salya, from one place to another, twisting, expanding, pressing, purifying of a passage, drawing off, attracting, bringing to the surface, uplifting, lowering down, applying pressure all round a part, or an organ, agitating, sucking, searching, cutting or cleaving, straightening, washing or flushing, stuffing the nose and cleansing. They number twenty-four in all. 14

स्वबुद्धया चापि विभजेद् यन्त्रकर्म्माणि बुद्धिमान् । असंख्येयविकल्पत्वाच्छल्यानामिति निश्चयः ॥ १५ ॥

Metrical texts: The intelligent surgeon shall exercise his judgment and determine the nature of the surgical operation required in each individual case, for surely the salyas requiring a surgeon’s aid are infinitely varied in their character. 15

तत्र अतिस्थूलम्, असारम् अतिदीर्घम्, अतिहस्वम्, अग्राहि, विषमग्राहि, वक्रम्, शिथिलम्, अत्युन्नतम्, मृदुकीलम्, मृदुमुखम्, मृदुपाशमिति द्वादश यन्त्रदोषाः ॥१६॥

An appliance (Yantra) which is too thick, or (made of inferior metal and hence ) not substantially made, or too short or too long, or does not admit of being easily handled and is incapable of taking in the entire Salya, or is curved, loosely fitted, or soft-bolted, or loosely tied up with cords, (should not be used in surgical operations). These are the twelve defects of a surgical instrument. 16

एतैर्दोषैर्विनिर्मुक्तं यन्त्रमष्टादशाङ्गलम् । प्रशस्तं भिषजा ज्ञेयं तद्धि कर्म्मसु योजयेत् ।।१७।।

दृश्यं सिंहमुखाद्यैस्तु गूढं कङ्कमुखादिभिः | निर्हरेत् तु शनैः शल्यं शस्त्रयुक्तिव्यपेक्षया । । १८ ।।

Metrical texts: The use of an instrument devoid of the above said defects and measuring eighteen fingers in length, is commended in surgical operations. Salyas which are manifest and visible to the naked eye, should be extracted with the instruments of the Sinhamukha (lion-mouthed) type, while those that can not be seen, should be removed with the help of the Kanka-mukhas (heron-mouthed) instruments, etc., according to the directions laid down in the Sastras (medical or surgical works of recognised authority). 17-18

निवर्त्तते साध्ववगाहते च शल्यं निगृह्योद्धरते च यस्मात् । यन्त्रेष्वतः कङ्कमुखं प्रधानं स्थानेषु सर्व्वेष्वधिकारि चैव ।।१९।।

The Kanka-mukhas are the best of all other types of instruments, inasmuch as they can be inserted and taken out without the least difficulty, are capable of drawing out a Salya with the greatest ease, and are applicable to all parts of the human body (be they an artery or a bone-joint.) 19

इति सुश्रुतसंहितायां यन्त्रविधिर्नाम सप्तमोऽध्यायः ॥७॥

Thus ends the seventh chapter of the Sutrasthana of the Susruta Samhita which treats of the shape construction and dimensions of surgical appliances.


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