Shastra – Surgical Instruments Of Ayurveda: Astang Hriday Sutrasthana 26

Let us explore various sharp surgical instruments used in Ayurveda. This is the 26^th chapter of Ashtanga Hrudaya Sutrasthana, written by Acharya Vagbhata, son of Vaidyapathi Simhagupta. The chapter name is Shastra Vidhi Adhyaya. Shastra means sharp surgical instrument.

Shastras- sharp instruments are 26 in number.
Shastras should be prepared from skilled metal smiths, as per traditional method of preparing surgical instruments.

They should be generally six Angula (fingers breadth) long, capable  of splitting the hair/shaving, good to look at, with sharp edges, good to hold firmly;
The Shastras should not be of ugly shape. They should be prepared from  well blown – removed of impurities strong steel like iron.

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The front of their mouth. i.e – the shape edges well hammered – to make them sharp, having the color of blue lotus, with shape in accordance with their name, always ready at hand for use, their blades- cutting edges being 1/4^th, ½th or 1/8^th of their own size (total length).
Each – instrument two or three in number should be made use as suitable to the place site of operation. 1-4

Names of Shastras –
Mandalagra, Vriddhiptra, Uttpala Patra, Adhyardha Dhara, Sarpa Mukha, Eshani, Vetasa Patra, Sarari Mukha, Trikurchaka, Kushapatra, Atavadana Atimukhi, Antrarvaktra, Ardha chandraka, Vrihimukha, Kuthari,  Shalaka, Anguli Shastra, Badisa, Karapatra, Kartari, Nakha Shastra, Danta lekhanaka, Suchi, Koorcha, Khaja, the four kinds of Ara, and Karna vedhanaka- are the names of the twenty six sharp instruments.

Mandalagra Shastra

knife with round edge at its tip has its edge in the shape of nail of the index finger, to be made use of for scraping and cutting, excision, in diseases like Pothaki- cyst in the eyelid, Shundika- Tonsils etc. 5

Vridhipatra

Scalpel is shaped like a boarders knife- Razor, useful for cutting, excision, splitting, incision and tearing/ separating, it, with a straight edge, is for use in elevated – bulging swelling, the same with its tip bent backwards, long or short edge for use in deep seated swelling. 6

Utpalapatra and Ardha dhara

lancets are for the purpose of splitting and cutting. 7

Sarpyasya- Sarpamukha

serpent bladed scalpel is meant for cutting / excision of polyps in the nose and ears and has an edge of half Angula.

Eshani

sharp probe meant for exploring sinuses, is smooth and shaped like the mouth of an earthworm. 8

Another kind of Eshani- probe meant for splitting, has its blade like a needle, with a slit- hole at its root.

Vetasapatra

is for puncturing;

Shararimukhi

shaped like a heron’s beak’s kind of scissors and

Trikuracaka

three spiked Brush like  instrument are meant  for draining out liquids. 9

Kushapatra

Razor resembling blade of Kusha grass and

Atimukha- razor

resembling the beak of a hawk are meant for draining,  edge is two Angula in length.

Antramukha

is meant for draining, its edges – 1.5 Angula in length and Shaped like half moon. 10

Vrihimukha

with blade like a grain of rice,  its edge being one and half Angula in length and meant for Puncturing veins and the Abdomen. 11

Kuthari – Axe

is thick, stout, resembling a cow’s tooth, with edge of half Angula- in length  and having a wooden handle; from this the vein situated on bones should be cut keeping the handle of this Axe vertically over it. 12

Shalaka – rod

made of copper, with two edges on either side shaped like the bud of Kurabaka, meant for piercing the lens in Linganasa- Cataract couching. 13

Anguli Shastra – finger knife

is prepared so as to have an orifice.
Its  edges are sharp, half Angula in width, resembling either Vriddhipatra or Mandalagra in shape, capable of permitting the entry of the first phalange of the index finger, is tied to  the finger with thread and meant for excision and splitting of the diseases portion in diseases of the passage of the throat. 14-15

Badisha- sharp hook

with a bent blade is meant for holding enlarged Uvula, Arma- Pterygium etc.

Karapatra- saw

is meant for cutting of the bone, should have strong edge, of ten Angula- in length and width of two Angula, with fine- sharp, small teeth and with a handle to be held tight with the fist. 16

Kartari- scissors

meant for cutting tendons, threads, hairs etc, is like scissors – which is commonly used by layman.

Nakhashastra

Has curved or straight edge, two bladed- shaped edged on both sides, nine Angula in length, to be  made use for removing minute foreign bodies, excision, splitting and scraping. 18

Danta lekhanaka- dental lancet

has one edge four Angulas, Shaped like a knot on one side, is meant for scrapping the tartar on the teeth. 19

Soochi – needles

for suturing/ swing is of three kinds; round, strong and stout; having a hole in their body near its root; that for use in fleshy parts will have three edges and length of three Angula, for use in less fleshy places, bony joints and wounds on joints, with a length of two Angula. 20

Vrihimukha Soochi- curved needle

is bent like a bow, meant for use- sewing/ suturing of intestines, stomach and vital spots and two and half Angula in length. 21

Koorcha – brush

with sharp spikes with round spikes fixed on one end, for seven or eight number and fastened well; it is used for scraping in Nilika- blue patches, Vyanga- dark patches on the blade and loss of hair etc.22

Khaja- churner

has blade of half Angula in  length and is of round shape, with eight spikes- fixed in it meant for removing the vitiated blood from the nose by churning with the hands. 23

Karnapali Vyadhna

instrument for puncturing the ear lobe should have its blade in the shape of bud of Yuthika- Jasmine. 24

 Ara- Awl

cutting plate has a round blade of half Angula below and four blades- edges above, it should bee used for puncturing swellings in case of doubt whether it is ripe or unripe, and also – the earlobe which is thick. In case of thick earlobe, a needle, hollow in three parts of it, three Angula in length is best for puncturing. 25-26

Anu Shatra – Accessory instruments

Anushastras are –
Jalauka – Leeches,
Kshara – caustic Alkalies,
Dahana – fire,
Kacha – glass,
Upala –cow dung cake,
Nakha – nail
Stone, nail etc, which are non-metallic.
Many other instruments may be designed as required for use in special operations and sites. 27

Shastra Karya – functions of sharp instruments

Utpatana- extracting,
Patana- tearing / splitting,
Seevana- Suturing,
Eshana- probing,
Lekhana- scraping,
Pracehhana- Scratching, incising, minute puncturing,
Kuttana- beating, hitting, pounding,
Chedana –  excising, cutting,
Bhedana- breaking,
Vyadhana- Puncturing,
Manthana- Churning,
Grahana- holding, grasping and
Dahana- burning, cauterizing  are the functions of sharp instruments.28

Shastra Dosha – defects of sharp instruments

Kuntha – Bluntness,
Khanda – brokenness,
Tanu- thinness,
Sthula – stoutness,
Hrsva – smallness,
Deergha – lengthiness,
Vakrata – curved, irregular shape
Kharadaratva – rough edge – are defects of sharp instruments.29

Method of holding sharp instruments

 Shastragrahana Vidhi:- Method of holding sharp instruments:-

For Chedana (cutting), Bhedana (breaking) and Lekhana (scraping),  the instrument should be held in Vrunta phalantara- between round woods handle and the edge, with the help of index, middle fingers and the thumbs, carefully;
For Visravana (draining), it should be held at the tip of the round wooden handle with the help of the index finger and the thumb;
For Pracchanna (scorching, scratching), the tip of the handle should be held with the palm.
Vrihimukha Shastra should be held at its mouth tip;
For extracting, the instruments should be held at their root;
Others may be held in a convenient manner, as required in the operation. 30-32

 Shastra Kosha- instrument wallet

The instrument wallet should be 9 Angula in width, 12 Angula in length.
It should be made from jute, leaves, wood, silk, inner bark of trees or soft leather.
It should be endowed with threads, well stitched with compartment for instruments, which should be kept wrapped in wool;
Its mouth closed and held tight with a rod- acting like a bolt and pleasing to look at. 33-34

Jalauka- leeches

Leeches are born in dirty water contaminated by putrefying dead bodies of fish, frog and snake or their excreta;
Indrayudha type of leeches –
Red, white or very black in color;
Chapala – very active,
Thick and slimy,

Poisonous Jalauka

Those which have
Chitra – varied lines on their back, and
Urdhvaraji – which are very hairy are Savisha- poisonous and so should be rejected.
If used, they produce itching, ulceration, fever and giddiness – These ailments are to be treated with drugs which mitigate poison, pitta and blood. 35-36 ½

Nirvisha Jalauka – non-poisonous leeches

Those born in clean water, which are blue, round in shape, having blue lines in their back, rough/ hard back, thin body, slightly yellowish belly are Nirvisha- non poisonous- so can be used. 37-38

Even these, when they do not vomit the sucked blood fully,  when  they are applied frequently, and when they are inactive even after getting into water, should be considered as blood intoxicated and should be rejected. 39

Leech therapy

 Jalaukavacharana– procedure of applying leeches:-

The leech that are kept for short time in water containing paste of turmeric / grain washed water (Avantisoma) / buttermilk should be made comfortable by putting back in pure water.
Should be made to stick to the body of the patient.
The leeches are attracted to the desired part of the body, by rubbing the part with ghee, mud, breast milk / blood or by making a wound with a sharp instrument.
When it starts drinking blood by raising its shoulders, it should be covered with a soft cloth.

Thus stuck up, the leech will suck only the vitiated blood first from the mixture of vitiated and un-vitiated blood, just like the swan sucks the milk from a mixture of milk and water. 40-42

Application of Leeches mitigates diseases such as,
Gulma – Tumors of the abdomen,
Arsha – Haemorrhoids,
Vidradhi – Abscess,
Kushta – skin diseases,
Vatarakta – gout,
Galamaya, Netraruk – diseases of the neck and eyes,
Visha – poison,
Visarpa- herpes etc.

When pricking pain or itching develops at the site of the bite, the leech should be removed; they are then made to vomit the sucked blood by touching their mouth with salt and oil or by gentle rubbing in the direction of their mouth after smearing fine rice flour over them. 43

After making them vomit they should be protected from blood intoxication and should not be used again for seven days.

After proper vomiting, the Leech regains its previous activity and becomes strong;
By too much of vomiting it becomes very weak or may even die;
If vomiting is improper, it becomes lazy, inactive and intoxicated. 44

They should be transferred from one pot to another, filled with good mud and water, in order to avoid putrefaction by saliva, excreta of leeches, because the Leeches become poisonous with such a contact. 45

अशुद्धौ स्रावयेत् दंशान् हरिद्रागुडमाक्षिकैः ॥४६॥

शतधौताज्यपिचवस्ततो लेपाश्च शीतलाः।

When in doubt of impurity, the site of the bite should be made to bleed by applying paste of Haridra (Turmeric), Guda (jaggery) and honey.
Later a piece of cloth soaked in Shata Dhauta Ghrita or cooling pastes prepared from drugs of cold potency should be applied – over the site.

With the removal of vitiated blood, the redness and pain subside immediately. 47

The vitiated blood, displaced from its site and accumulating in the interior of the wound becomes greatly sour by stagnating overnight; hence it should be expelled out again. 48

A gourd or pot (cupping method) should not be used to remove the vitiated blood when the blood is vitiated by pitta, for they are associated with fire. It would further aggravate Pitta. They should be used in case of vitiation by kapha and Vata imbalance. 49

The blood vitiated by Kapha should not be extracted by using a sucking horn (Shrunga) because of thickness of the blood, whereas blood vitiated by Vata and pitta should be removed by the sucking horn. 50

Shrunga is good for Vata and Pitta imbalance and not indicated in Kapha.

Ghata is good for Vata and Kapha but not for Pitta.

Pracchana – incising to produce bleeding

The part of the body  above the site, selected for bleeding should be tied tightly with a rope or leather strap;
Tendons, joints, bones and vital spots are avoided and Prachanna karma (scratching, incision) by sharp scalpel done from below upwards.
It should not be done in horizontal direction.

Blood accumulated in any localized area- small area can be removed by Pracchana (scratching- incisions);
Blood accumulated in tumors, abscess can be removed by using leeches;
Blood that has produced loss of sensation- at the site of accumulation by using the sucking horn (shrunga) etc gourds or pot (Ghata) and
that which is soared all over the body by venesection. 55

Or removal of blood by incisions is done when the blood is solidified; by Leeches when it is deep seated; by gourd, pot or horn when it is localized  in the skin and by venesection when it is  pervading the entire body; by using horn, leeches, gourd for the seats of Vata and others- Doshas respectively.54 ½

After the bleeding procedure, the site of bleeding should be covered with cooling paste.
This will reduce the pain, itching and oedema at the site.
The area should  be bathed with warm ghee. 55

Thus ends the chapter- Shastra Vidhi- the 26^th  in Sutrasthana in Astangahridaya.