Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma

By Dr Renita D’Souza

Master Sushrutha has mentioned eight types of surgical techniques. 1. Chedana – excision 2. Bhedana – incision 3. Lekhana – scraping 4. Eshana – probing 5. Aaharana – extraction 6. Vedhana – puncturing 7. Visravana – draining 8. Seevana – suturing
Read – Shastra – Surgical Instruments Of Ayurveda: Astang Hriday Sutrasthana 26

Vagbhata’s surgical procedure

Master Vagbhata mentioned 6 types of surgical procedures
1. Paatana – breaking
2. Vyadhana
3. Chedana
4. Lekhana
5. Pracchana – multiple incisions
6 Seevana

Master Vaagbhata mentioned 13 types of surgical procedures
1. Chedana 2. Bhedana 3. Lekhana 4. Eshana
5. Aaharana 6. Vedhana 7. Visravana 8. Seevana 9. Uthpaatana – elevation and extraction
10. Kuttana – multiple pricking 11. Mandhana – churning and drilling 12.Grahana – holding 13. Dahana – cauterization
Read – Yantra Instruments used in Ayurveda: Ashtanga Hruday Sutrasthana 25

Chedana

Chedana – Excision Diseases that require excision – 
Bhagandara – fistula-in-ano Kapha granti – kapha origin tumors Tilakalaka – moles Vrana – wounds Vartmarbuda – benign tumours of the eyelids

Bhagandara – fistula-in-ano Kapha granti – kapha origin tumors Tilakalaka – moles Vrana – wounds Vartmarbuda – benign tumours of the eyelids

Arshas – piles Charmakeela – warts Asthimamsagam shalya – foreign body lodged in bones and muscles Jatumani – elevated mole/ pigmented patch Mamsa sanghata – benign tumour of palate/ fibromyoma Galasundi – enlargement of uvula/tumours of the throat Snayu mamsa sira kotha – putrefaction of ligaments, muscles and vein Valmeekam – actinomycosis Shataponaka – multiple fistula (variety of fistula-in-ano) Adhrusha – sore throat / quinsy Upadamsha – syphilis/ gonorrhoea Mamsakanda – muscle tumours Adimamsa – muscle tumours

Bhedana

Bedhana – Incision Diseases that require the incision

All types of vidradi (abscess) except that produced by all three doshas (tri doshaja)
3 kinds of granti (benign tumours) – Vataja, Pittaja, Kaphaja
First three types of visarpa – Vataja, Pittaja, Kaphaja Vrdya – hernia
Read –Vruddhi Causes, Types, Symptoms, Prognosis, Ayurvedic treatment

Vidarika – carbuncles
Prameha pidaka – diabetic carbuncle
Shopha – swellings Stana roga – breast diseases
Avamanthaka – a disease of penis
Kumbhika – follicular conjunctivitis
Anushahi – boils on the head Nadi vrana – sinus ulcers

Vrindha (tumours of the throat) – two kinds of vrindha – vrindha and eka vrindha
Pushkarika – a disease of the penis
Alaji – inflammation of eye
Shudra roga – minor diseases Taalu pupputa – tumours of the palate Danta pupputa – gingivitis
Tundikeri – tonsillitis
Gilayu – tonsillar abscess

Those diseases requiring excision, as mentioned above, when they attain suppuration at that stage incision or bheda is indicated. Basthi Ashmari – bladder stones Diseases produced by fat tissue
Read – Urinari calculi – Home Remedies, Ayurved Treatment, Diet, Recipes

Lekhana

Lekhana – Scraping Diseases that require scraping
4 types of rohini – vataja, pittaja, kaphaja, sannipataja Kilasa – leucoderm (Read – Vitiligo: Ayurvedic Treatment, Medicines, Herbs, Remedies) Upajihvika – swelling in the tongue Medajo dantavaidarbhyo – danta vaidarbhya (gingivitis) originated by fat tissue
Medaja granti – tumour originated by fat tissue
Medaja vartma – fat origin tumours of eyelids
Adhijihvika – adenoids
Arshas – piles
Mandala kusta – variety of skin disease
Mamsakanda – muscle tumor Mamsa unati – thickening of the muscle
Read – Charak Samhita Kushta Chikitsa – 7th Chapter

Vedhana, Eshana

Vedhana – Puncturing Diseases that require puncturing
Sira bahuvidha – viens that can be punctured in many diseases Mutra vriddi – hydrocele Udakodara – ascitis
Read – Siravyadha Method Of Bloodletting: Procedure, Precautions, Benefits

Eshana – Probing Diseases that require probing
Nadi – sinus ulcers Sa shalya vrana – wound with a foreign body inside Unmargi vrana – sinus ulcer which spread side wards
Read – Kshara Sutra application in Fistula in ano (Bhagandara)

Aharana, Visravana

Aharana – Extraction Diseases where extraction procedure is used Three kinds of sarkara (urinary gravel) – vataja, pittaja and kaphaja Danta mala – teeth tartar Karna mala – ear wax Ashmari – urinary calculus Shalya – foreign bodies present inside the body Muda garbha – abnormal presentation of the fetus Varchas nichitam gude – stools accumulated in the rectum

Visravana (Draining) Diseases that require draining procedure
Five types of vidradhi (abscess) except that caused by imbalance of all three doshas together.
Kushtani vayuh sa rujah – skin diseases of vata dosha origin associated with pain. Eka deshaja shopha – inflammatory oedema confined to one place Palyamaya – ear lobe diseases Shlipada – filariasis

Vishajushta shonitam – blood vitiated by poison Arbudani – all types of tumours
Visarpa – all types of erysipelas Grantyascha adistu – first types of granti (benign tumour) – vataja, pittaja and kaphaja Trayascha upadamsha – vataja, pittaja and kaphaja syphilis

Stana roga – diseases of breast Vidarika – diabetic carbuncles Sausira – tooth sinus
Gala shalooka – epiglottitis Kantakah – inflammation of tongue Krimidantaka – dental caries
Danta veshta – gingivitis
Upakusha – ulcerative gingivitis
Shitada – spongy gums
Danta pupputa – gingivitis Pitta asrk kaphaja oshtayah – inflammation of lips caused by imbalanced pitta, blood and kapha Shudra roga – minor diseases
Read – Home Remedy For Gum Swelling And Bleeding Gums

Indications for suturing

Sevana – Suturing Diseases that require suturing
Medah samuthasch – diseases of fat origin Bhinna – cut/ incised wound Sulikhita gadah – well scarped wounds Sadhyo vrana – traumatic wound Chala sandhi vyapasrita – wounds located in movable joints

Contraindications for suturing

Shara agnidagdha vranas – wounds caused by alkali and fire
Visha dushta – wound caused by poisonous bite
Maruta vahi vrana – gas gangrene Reference – (Ashtanga Hrdaya 29/51) Vankshana vrana – wounds over the groin region Kaksha vrana – wounds in axilla Alpa mamsa – wounds less fleshy Chale vrana – wounds that which are movable

Materials for suturing

Materials used in ancient times for Suturing

Reference – Shushrutha sutra sthana – 25/20, 21 Ashmataka valkala – suture made of ashmataka tree bark Shana – jute Kshouma – silk Vaala – hair Murva guduchi tana – fibres of murva and guduchi plant Read – Chanchu – Jute: Corchorus fascicularis Uses, Dose, Research

Type of Suture

Reference – Sushrutha sutra sthana 25/21, 22 1. Vellitaka 2. Gophanika 3. Tunnasevani 4. Rujugranti 5. Any kind suitable to the site of injury Read – Wound Healing – Ayurvedic Home Remedy For Wound Pain And Itching

Needles

Types and Qualities of ancient Needles used in Surgery

Reference – Shushrutha sutra sthana 25/23, 24

In ancient period master Sushrutha has mentioned 3 types of suchi (needles) based on the site of injury. 1. Vrutta – round needle

Features –  Length – 2 angula This type of needle is used to suture the area where there is less muscle tissue. 2. Needle with 3 angula long and having 3 edges (tryasra). This type of needle is used to suture broad and fleshy area of injury. 3. Dhanurvakra – needle curved like bow. This type of needle is used for suturing vital pionts (marma), Phala kosha (scrotum) and abdomen (udara).

General features of Suturing Needles- Theekshnaagra – tip of the needle should be sharp Susamahitha – manufactured evenly

Malati pushpa vrunta aagra parimandala – hind tip resembling stalk of malati flower and round.
Read – Diseases Due To Pathological Muscle Tissue – Mamsa Pradoshaja Rogas

Suturing method

Ancient method of Suturing
Reference – Su. Su 25/20 – 26

The wound should be elevated and placed in normal position. Then suturing should be done using the suitable suturing material and needle. Suturing should be done neither very far nor very close. If the sutures are far apart it will give rise to pain in the edges of the wound and if very near edges will get torn.

After suturing – After suturing, the wound should be sprinkled with – powder of priyangu, anjana, licorice and rodhra or shallaki phala churna – powder of shallaki fruit or Ash of linen cloth Then it should bandaged appropriately. Patient is advised to follow suitable regimen.

Complications

Shastra Karma Vyapat (Complications of surgery)

There are four kinds of complications that can occur in 8 types of surgical procedure. 1. Hina cheda – inadequate cutting 2. Atirikta cheda – excess cutting 3. Tiryak cheda – oblique cutting 4. Atmana – cutting own body

Shastrakarma Vyapat lakshana (symptoms of complications) Reference – Shushruta sutra sthana 25/34, 35

Following are the common symptoms that occur when vital points, joint, veins, tendons and bones are injured especially the vital points.
Brhma – giddiness
Pralapa – incoherent speech
Patanam – fainting
Pramoha – delusion
Vicheshtana – loss of body activities
Samlayana – Lying down unconsciously

Ushnata – increase of body temperature
Srastangata – weakness of body parts
Murchana – unconscious
Urdvavata – gasping

Tivra rujo vatakrtascha – severe pain due to vata imbalance
amsodakaabham rudhiram cha gacheth – the blood resembles as if mixed with muscle tissues. Common symptoms of injury to sense organs and marma points.
Read – Bleeding Disorders: Ayurveda Treatment, Diet, Home Remedies

Features of injured parts

Features when specific parts are injured during surgical procedure Reference – Su.Su 25/36-40

Injury to veins –
Profuse bleeding which resembles the color of indragopa (cochineal insect) Vata gets aggravated giving rise to many diseases.

Injury to ligaments – Kaubjya – Shortening Debility of body parts and inability to perform thier functions Severe pain Healing of the wound takes long time
Read – Local Pichu Treatment For Painful Joints, Ligaments And Muscles

Injury to the Joints – Increase of swelling Severe pain In joints there is loss of strength, splitting pain, oedema and loss of function.
Read – Sandhi Shareera: Study of Bone Joints As Per Ayurveda

Injury to the bones – Severe pain day and night Finds no comfort in any posture constantly Thirst Body debility, oedema and pain
Read – Asthi Shareera – Definition, Anatomy, Types Of Bones

Injury to marmas (vital spots) The above symptoms together with symptoms pertaining to the particular injured vital spot will be present. Injury to the vital spots of muscles – loss of touch sensation, paleness of the body.

Click to Consult Dr Renita D’Souza