Sushruta Samhita Chapter 5 Agropaharaniya Adhyaya

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This text explains Sushruta Samhita Sutrasthana Chapter 5 “Agropaharaniya Adhyaya”- Assortment of supplies.

Agropaharaniya Adhyaya

We are going to now expound the chapter by title Agropharaniya – assortment of vital supplies (required for surgery), as revealed by the venerable Dhanvantari.

Trividha Karma

Three sorts of procedures
Actions (surgical actions) or procedures are of three varieties viz –

  • Purva karma – early actions (procedures accomplished earlier than the principle surgical procedure, preparation of the affected person and many others) – pre-procedures
  • Pradhana Karma – principal actions (principal process or the surgical procedure carried out on the affected person) – procedures
  • Paschat Karma – later actions (procedures accomplished / applied after the principle surgical course of) – post-procedures / post-operative procedures & comply with up.
    Learn – Chikitsa: Remedy Varieties, Ayurvedic classification

We are going to describe these in respect of every illness afterward
Observe – Purva, Pradhana and Pascat Karma are relevant for any therapy or remedy. Karma means exercise. Remedy can also be an exercise. Surgical procedure is the principle therapy process in Salya Tantra i.e., surgical science and therefore that is the principle exercise right here.

Surgical procedures are a very powerful interventions in Salya Tantra (surgical procedure)
On this science (Shalya Tantra / Surgical procedure), Sastra Karma (surgical actions) itself being the principle, solely Sastra Karmas (surgical methods) shall be described first together with the supplies required for it.
Learn – Strategies Of Surgical Coaching Elaborated In Ayurveda

Notes: – The three phases talked about above are relevant to all of the actions.
Purva Karma (pre or early actions) – are these that are essentially required for the correct conduct of the principle exercise (medicinal therapy of surgical procedure) i.e., “preparation”.
Pradhana Karma (principal actions) – are these that are the principle actions that are primarily deliberate to be carried out i.e., “the execution”. That is the precise process to be carried out – the therapy / process correct.
Paschat Karma (later actions) – are these that are accomplished after the principle exercise has been accomplished i.e., “the comply with up”.

In surgical science, these three phases are referred to as preoperative, operative and postoperative actions.
Within the context of Kaya Cikitsa (inner or common medication) whereas describing Shodhana Karma (purificatory therapies equivalent to emesis. purgation and many others.), administration of snehana (oleation) and swedana (sudations) are referred to as Purva Karma (preparatory exercise). Administration of purificatory recipes (emetic, purgative and many others) and administration of the affected person until passable purifications are achieved are referred to as Pradhana Karma (principal exercise). Taking good care of the affected person by offering him nursing, comforts, appropriate meals, relaxation and many others. after the completion of the principle exercise are referred to as Pascat Karma (protecting exercise / comply with up exercise). 
Learn – 4 Varieties Of Swedana As Per Sushruta And Vagbhata

Astha Vida Sastra Karma

Eight sorts of surgical methods

Sastra Karma – Surgical exercise (methods) are eight varieties viz,

  1. Chedya – incising, excising, eradicating
  2. Bhediya – splitting, dividing, separating
  3. Lekhya – scraping
  4. Vedhya – puncturing, piercing
  5. Esya – probing, looking
  6. Aharya – extracting, pulling out, eradicating
  7. Visravya – draining and
  8. Sivya – stitching suturing
    Learn – Sushruta’s 8 Varieties Of Surgical Procedures – Astavidha Shastra Karma

1. Purva Karma – Pre-operative actions

Agro Maharana-collection of Supplies required
The doctor (surgeon) desirous of performing any of those actions ought to accumulate the required supplies beforehand. That is referred to as as agra sangrahana i.e., beforehand assortment (assortment beforehand) of supplies. The vital supplies which have to be collected are –

Sl No Agra Sangrahaniya (Supplies to be collected) Which means
1 Yantra Blunt devices
2 Sastra Sharp devices
3 Ksara Caustic alkali
4 Agni Fireplace for thermal cautery
5 Salaka Steel Rods
6 Srnga Horn of animals
7 Jalauka Leeches
8 Alabu Empty Pitcher Gourd
9 Jambavoshta Piece of stone
10 Picu Items of material, swab, pad
11 Prota Lint, fabric
12 Sutra Threads
13 Patra Leaf
14 Patta Fabric / leather-based band
15 Madhu Honey
16 Ghrta Ghee
17 Vasa Muscle-fat
18 Paya Milk
19 Taila Oil
20 Tarpana Nutritive gruel manufactured from corn flour added with milk, sugar, honey
21 Kasaya Decoction of herbs / medicine
22 Lepana Anointments, ointments, pastes for utility
23 Kalka Paste of medication and many others for exterior utility
24 Vyajana Fan
25 Sitoshnodaka Cold and warm water
26 Kataha Pots, drums and many others for storage
27 Snigdha, sthira, balavantah parikarminah Affectionate, steadfast, sturdy attendants

Notes: – Dalhana the commentator describes Jambavoshta as an instrument manufactured from black stone having its entrance tip formed like Jambu phala (fruit of Eugenia jambolana). It was getting used for cauterization. Within the time of Susruta, surgical operations have been being carried out with out passable Anesthesia, therefore the need of attendants who’re sturdy, as a way to restrain the affected person from making actions through the operation.

2. Pradhana Karma

Pradhana Karma-main exercise

Subsequent, on an auspicious day, time and stellar constellation, Agni (God of fireside), Brahmana and Vaidya (doctor) must be worshipped first by providing curds, sanctified rice, meals, drinks and gems. Then, the affected person who has provided oblations, carried out sacrificial rituals, pronounced the phrase svasti (benediction), has consumed gentle to digest meals, must be made to take a seat going through east. He ought to then restrain the affected person from making any actions of the limbs and physique elements. Now the doctor / surgeon sitting reverse to the affected person – going through west, ought to insert the instrument (lancet, scalpel) within the course of the hairs (from above downwards) whereas avoiding very important spots, veins, ligaments, joints, bones and arteries, and enter deep till the pus is seen. On this means, the doctor ought to apply the instrument within the correct means, within the correct place of the physique in a single stroke after which take away the knife as soon as and shortly.
In ripened swellings despite them being large / broad (unfold deep inside), one other incision must be made at a distance of two or three angulas (finger breadths) in between.
Notes: – The above description pertains to the opening of a Vidradhi (abscess) containing pus. That is typical of inflammatory swellings. The procedures of therapy in all such circumstances can even be the identical; one Angula is 1.98 cm roughly.
Learn – Damage, Wound care Ayurvedic Cures, Medicines

Vaidyakrta Vrana guna

Options of a surgical wound

The wound (made by the surgeon) ought to have the under talked about preferrred options –

  • Ayata – lengthy
  • Visala – broad
  • Sama – even (devoid of elevation and depressions inside)
  • Suvibhakta – effectively divided (edges clearly separated) – reduce correctly by sharp instrument such that there isn’t a extreme loss (destruction) of pores and skin, muscle mass and many others and
  • Nirasraya – devoid of hole house inside

One verse right here: – 

The injuries are preferrred when they’re of enough size, enough width, clear division i.e., edges separated, absence of hole house inside and accomplished on the correct time.
Learn – Shastra – Surgical Devices Of Ayurveda: Astang Hriday Sutrasthana 26

Vaidya guna

Qualities of the Surgeon
Beneath talked about are the best qualities of a surgeon (and the surgeon having these qualities alone is eligible to conduct surgical procedure) –

  • Shaurya – braveness / boldness
  • Ashu kriya – quickness in motion
  • Shastra taikshnyam – protecting the knife and different surgical devices sharp
  • Asweda – not sweating (out of concern)
  • Avepathu – not shivering
  • Asammohasca – not turning into confused (phantasm) / the surgeon mustn’t faint on seeing the aggravation of the illness meant to be handled surgically, or by seeing the surgical course of or by seeing the wound or move of blood

Want of constructing different incision
If the wound doesn’t get cleared of pus and many others by only one incision, one other incision within the center or close to the earlier incision shall be made contemplating the situation and suitability.

One verse right here: –
After figuring out the route of the sinus (channel of motion of pus) and locations of bulging, wound (incisions) could also be accomplished at these locations, in order that vitiating supplies (pus, blood and many others) do not stay inside (in muscle mass and different deeper tissues).
Learn – Nadivrana – Sinus: Varieties, Signs, Ayurvedic Remedy

Shapes of incision

Horizontal (indirect, sideward) incision – shall be accomplished in locations such because the eyebrows, cheeks, temples, brow, eyelids, lip, gums, axillae, stomach and groins.
Round incisions resembling the disc of the moon – must be accomplished by the clever surgeon on the palms and ft (extremities).
Half moon (semicircular) formed incision – shall be accomplished over the anal area and penis.
If the incisions should not accomplished within the above-mentioned means there could be a chance of chopping of veins and ligaments. There can even be extreme ache. It might take a very long time for the wound to heal and muscular sprouts will likely be fashioned.

Situations whereby surgical procedure must be accomplished on empty abdomen
Surgical treatment must be accomplished on an empty abdomen i.e., when the affected person has not taken the meals in ailments equivalent to obstructed fetus, belly enlargement, renal calculus, rectal fistula and ailments of the mouth.

Subsequent, (after incising) the knife must be taken out. The affected person must be assured and comforted by sprinkling chilly water on his face (and limbs and many others). The complete space across the incision (inside and outdoors) must be kneaded by the fingers and massaged mildly. Later the wound must be washed with decoction ready with medicine which might immediately heal the injuries or cleanse them.
The remnant kashaya (decoction) ignored within the wound shall be eliminated by utilizing sterile fabric (placing the material contained in the wound in order that it absorbs the remaining liquid – decoction). Then a wick created from the paste of tila – sesame seeds and combined with extra honey, ghee and medication. It must be neither too unctuous nor too dry must be inserted into the wound. Over this, one other thick pad of material folded into many layers is positioned over it after which tied up with a sheet of material i.e., bandage.
Then the wound is uncovered to the fumes of medication which relieves ache and destroys evil spirits i.e., micro organism, microorganisms and many others. The affected person is protected by chanting hymns which have the capability to destroy or drive away the evil spirits.
Learn – Anomalies, Defects In Fetus, Ayurvedic Remedy

3.Pascat Karma

Pascat Karma-post-operative actions

Fumigation

Subsequent, fumigation of the room, cot, garments and many others utilized by the affected person must be accomplished with the powder of Guggulu, Aguru, Sarjarasa and Gaura Sarsapa added with Lavana (saindhava lavana – rock salt), leaves of neem (Azadirachta indica) and ghee.
Rock salt, Neem leaves and ghee. Remaining ghee must be used for restoring the lifetime of the affected person (by making use of and flippantly massaging the ghee over the marma sthanas – very important organs and spots).
Learn – Dhoopana (Dhoopam, Fumigation) Blends, Advantages, Process, Mode of Motion

Raksa karma

Raksa karma-Protecting rites
A little bit amount of water is taken within the hand from water pot, sprinkled on the affected person and protecting rites carried out which is described right here: –

I’m performing this protecting ceremony as a way to destroy the witch referred to as Kritya and for eradicating the concern of Raksasa (evil spirits). This will likely be permitted by Lord Brahma.
“Could Nagas, Pisacas, Gandharvas, Pitas, Yaksas and Raksasas who hassle you shall be destroyed by Lord Brahma and different Gods. The nisacaras (evil spirits) which roam round on the earth, sky and in all instructions and the raksasas (evil spirits) which keep within the open house and in homes shield you by being happy by your prayers. Many Brahmarshis, Devarsis and Rajarsis, the mountains, all rivers and oceans shield you. Could Agni (God of fireside) shield your tongue and Vayu (God of wind) shield your prana (life). Could Soma (Moon God) shield your vyana vata and Parjanya (wet clouds / God of rain) shield your apana vata. Could Vidhyut (God of lightning) shield your udana vata. Could Stanayitnava (clouds, God of clouds) shield your samana vata.
Could Lord Balapati Indra shield your power, and Manu the veins of your neck and mind, Gandharva your wishes and needs and Lord Indra your thoughts. Could Lord Varuna shield your consciousness, oceans (Lord of oceans) your umbilical area, Solar your eyes, the instructions (quarters) your ears, Candra (moon god) your thoughts, Naksatras (stars) your kind *magnificence) and the Nisa (nights) shield your shade.

Could Apah (waters) shield your semen, Aushadhis (medicinal crops) your hairs (physique hairs), Akasa (sky, house) the orifices and hole areas inside your physique and Vasundhara (earth) your physique. Let Vaisvanara (hearth god) shield your head, Lord Vishnu your valour, Purusa shresta / Purushottama your masculinity / virility (penis), Lord Brahma your atma (soul) and Dhruva (pole star) your eyebrows.
All of the Gods talked about above dwell in your physique and at all times shield you continuously. Could you get hold of a protracted life (by their grace). Could Lord Brahma at all times bestow goodness to you. Could all Gods bestow goodness on you. Could Solar and Moon do good to you. Could Narada and Parvata, Agni, Vayu and different Gods along with Lord Indra bestow good on you.
Could this protecting hymn created by Lord Brahma bestow you with all the nice and supply longevity, let all of your troubles subside and also you stay free from sorrow at all times, Svaha!”
 “By this sacred hymn revealed within the Vedas, which wards off sorcery and ailments, you’ve gotten been protected by me; could you attain lengthy life”.

After performing the protecting ritual, the affected person must be taken into his home (particular chamber) and suggested to stick to the routine (of weight loss program and different actions).
Learn – Daiva Vyapashraya Chikitsa – Divine Therapies of Ayurveda

Vranitopasana

Vranitopasana-care of the wounded
Then on the third day, the bandage must be eliminated, (wound cleaned with decoctions, the wick of drugs inserted, and tied once more with bandage of material, in the identical means as accomplished earlier). The dressing shouldn’t be eliminated in haste on the second day itself. By eradicating the bandage in haste on the second day the wound develops hardness, heals after a very long time and produces extreme ache.
Afterwards (after the third day) contemplating the situation of the Dosas (of the wound), season, power of the sufferers and many others. the wound must be handled with decoctions, functions of pastes, bandaging, appropriate meals and actions.

With a need of getting fast aid, it (wound) ought to by no means be made to heal in a rush when the dosas are nonetheless inside. If accomplished so, even slight violations of routine produce elevation inside and provides rise to many abnormalities.

Sanskrit Versus

 Some verses right here: –
Therefore, the wound which is clear each inside and outdoors must be made to heal. Even after therapeutic, the affected person ought to keep away from indigestion, bodily train, copulation, pleasure, anger and concern till the wound is totally healed and the affected person attains firmness.

 The clever doctor ought to take away the bandage after three days in Hemanta (dewy, early winter), Sisira (late winter), Vasanta (spring) seasons and after two days in Sarat (autumn), Grisma (summer season) and Varsa (wet) seasons.
In emergency ailments (attributable to suppuration in wounds or there may be risk to life resulting from extreme bleeding from the injuries), this process needn’t be adopted strictly by the doctor and coverings that are urgently required must be accomplished, simply as salvaging a home which has caught hearth.
That ache, which is produced by the knife, troubles the physique of the affected person drastically; and will get subsided by utility of lukewarm ghee boiled with Yastimadhu (Glycyrrhiza glabra, licorice).

Thus, finish the Fifth chapter by title Agropaharaniya – in Sutra Sthana of Susruta Samhita.

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