Sushruta Samhita Sutrasthana Chapter 7: Yantra Vidhi Adhyaya (Blunt Instruments and Their Usage)

This article explains Sushruta Samhita Sutrasthana Chapter 7 “Yantra Vidhi Adhyaya”- Blunt instruments and their usage.

अथातो यन्त्रविधिमध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भगवान् धन्वन्तरिः ॥२॥

We will now expound the chapter by name, ‘Yantravidi Adhyaya – chapter dealing with usage of blunt instruments’; as revealed by the venerable Dhanvantari.

Hand, the best yantra: Blunt instrument

यन्त्रशतमेकोत्तरम्;अत्र हस्तमेव प्रधानतमं यन्त्राणामवगच्छ,किं कारणं ?यस्माद्धसादृते यन्त्राणामप्रत्तिरेव तदधीबत्वाद्यन्त्रकर्मणाम् ॥३॥

Yantras (blunt instruments) are one hundred and one in number.
But please understand that ‘The Hand’ is the best and the most important one among all these yantras – the blunt instruments.

If so, then what is the reason for the hand being considered as the best yantra – the blunt instrument?

The reason is that none of the other instruments can be used without the help of the hand. One needs the hands to hold and operate each and every instrument that would be put into use. All the functions and actions of the instruments are totally dependent on the hand and how they are handled and put into use by the hands. Therefore, the hands are the best and the most important ones amongst all the blunt instruments.

Definition of Shalya

तत्र मन्ःशरीराबाधकरणि शल्यानि;तेषामाहरणोपायो यन्त्राणि॥४॥
Those things which trouble or cause pain to the body and mind are called Shalya. In simple terms Shalya means foreign body.
Yantras are the methods (and instruments) which are beneficial for removal or extraction of shalyas i.e. foreign bodies.

Yantra Bheda & Sankhya: Kinds and number of blunt instruments

तानि षट्प्रकाराणि; तद्यथा-स्वर्तिकयन्त्राणि,संदंशयन्त्राणि,तालयन्त्राणि,नाडीयन्त्रणि,शलाकायन्त्रणि,उपयन्त्रणि चेति॥५॥

The yantras – blunt instruments are of six kinds. They are –

Numbers of each type of blunt instruments

तत्र चतुर्विंशतिःस्वस्तिकयन्त्राणि,द्वे संदंशयन्त्रे,द्वे एव तालयन्त्रे,विंशतिर्नाड्चः अष्टाविंशति,शलाका,पञ्चविंशतिरुपयन्त्रणि ॥६॥
Now we shall have a look at the number of each type of the above mentioned yantras

Materials used for preparing instruments

तानि प्रायशो लौहानि,भवन्ति,तत्प्रतिरुपकाणि वा तदलाभे ॥६॥

Lohani – The yantras are generally made of lohas – metals.
Tat Pratirupani – Pratirupas i.e. substitutes for these metals i.e. those materials which are similar to these metals can also be used to make the yantras in the absence or non-availability of metals.

Face of instruments

तत्र,नानाप्रकाराणा व्यालानां मृगपक्षिणां यन्त्राणां प्रायशःसदृशानि;तस्मात्तत्सारुप्यादागमादुपशेशादन्यन्त्रदर्शनाद्युक्तितश्च कारयेत् ॥८॥

The faces of the yantras generally resemble the shapes of the faces of various kinds of wild animals, tame animals and birds. The reason may be that the faces or mouths of these animals and birds probably resemble the face or structures of the instruments. The Yantras are often named depending on the face that it has.

Hence these instruments shall be prepared following the below mentioned principles –

Qualities of instruments / customization of instruments as per need

समाहितानि यन्त्राणि खरश्लक्ष्णमुखानि च ॥
सुदृढानि सुरुपाणि सुग्रहाणि च कारयेत् ॥९॥

These instruments should be prepared, so as to conform to their size and shape.

• Khara shlakshna mukhani – the faces of these instruments shall be hard and smooth,
• Sudrudha – strong,
• Surupani – good looking and
• Sugrahani – easy to handle and with good grip.

1. Svastika Yantras – cruciform instruments

तत्र स्वस्तिकयन्त्राणि-अष्टादशाङ्गुलप्रमाणानि,सिंहव्याघ्रवृकतरक्ष्वृक्षद्वीपिमार्जारश्रृगालमृगैर्वारुककाककङ्ककर रचाषभासशशघात्युलुकचिल्लिश्येनगुध्रकौञ्चभृङ्गराजाञ्चालिकर्णावभञ्चननन्दीमुखमुखानि,मसुराकृतिभिः किलैरवबद्धानि,मूलेऽङ्कुशवदावृत्तवारङ्गाणि,अस्थि विदश्ग्टशल्योद्धरणार्थमुपदिश्यन्ते ॥१०॥

Features of Svastika Yantras
Length – eighteen Angula (36cm)
Shape – of this instrument will resemble those of many animals and birds, including the face of lion, tiger, wolf, hyena, bear, panther, cat, fox, deer, megairvaruka, jackal, crow, heron, osprey, blue jay, eagle, owl, cilli – kinds of kite, hawk, vulture, pond heron, shrike, anjalikarna and avabhanjana – kinds of birds and flamingo
Nail / screw – these instruments will be fixed with a screw of the shape of a Masura (lentil)
Handle – the varanga or handle of these instruments will be bent like a goad at their root.
Benefits – these instruments are useful for extracting (pulling out) the foreign bodies lodged in the bones.

2. Samdamsa yantra – Pincers, forceps etc.

सनिग्रहोऽनिग्रहश्चसंदंशौ षोडशाङ्गुलौ भवतः त्वङूमांससिरास्नायुगतशल्योद्धरणार्थमुपदिश्येते॥१२॥

Features of Samdamsa Yantras –
Types – There are two types of Samdamsa Yantras, they are –

• Sanigraha – with a catch or lock
• Anigraha – without a catch or lock
  Length – sixteen angula (32 cm),
  Benefits – they are useful for pulling out the foreign bodies lodged in the skin, muscles, veins and ligaments.

3. Tala Yantra – instruments with flat disc at their front end

तालयन्त्रे द्वदशाङ्गुलेमत्स्यतालवदेकतालद्वितालके,कर्णनासानाडीशल्यानामाहरणर्थम् ॥१२॥
Features of Tala Yantra
Length – 12 angulas (24 cm)
Types – There are two types of tala yantras. They are –

• Eka tala – having one disc resembling the palate of the fish
• Dwi tala – having two discs resembling the palate of the fish

Benefits – They are used for removing foreign bodies from the ear, nose and sinuses.

4. Nadi Yantra: Tubular instruments

नाडीयन्त्राणि-अनेकप्रकारणि,अनेकप्रयोजनानि,एकतोमुखान्युभयतोमुखानि च,तानि स्त्रोतोगतशल्योद्धरणार्थं,रोगदर्शनार्थम् ,आचूषणार्थं,क्रियासौकर्यार्थं चेति;तानि स्त्रोतोद्वारपरिणाहानि,यथायोगदीर्घाणिच । तत्र भगन्दरार्शोव्रणबस्त्युत्तरबस्तित्तमूत्रबस्तिमूत्रवृद्धिदको दरधूमनिरुद्धप्रकशसन्निरुगुदयन्त्राण्यलाबूश्वृङ्गयन्त्राणि चोपरिष्टाद्वक्ष्यामः ॥१३॥

Features of Nadi Yantras
There are many kinds of nadi yantras and they serve many purposes and uses. Some have openings at one end only and some will have openings at both their ends.
Benefits – They are useful for –

• Extracting the impacted shalya – foreign bodies from within the channels and minute pores of the body
• To view and observe the abnormalities in these srotas – channels and pores
• To suck the vitiated fluids like blood, pus etc from the channels, tissues or organs
• For convenience in other surgical and medical activities
  Circumference – The circumferences of these instruments are of the size of the channels.
  Length – Their lengths are made as per need and convenience (for effective use).
  Examples –
• Bhagandhara Yantra – rectal speculum, curette scope, used in fistula in ano
• Arso yantra – proctoscope / anal speculum
• Vranyantra – syringe and irrigator used for washing ulcers
• Basti Yantra – enema bag, nozzle and tube / enema syringe
• Niruddhaprakasa Yantra – prepuce or urethral dilator, used in treating phimosis
• Sanniruddhaguda Yantra – rectal dilator / bougie, used to dilate constricted rectum
• Alabu yantra – hollow pitcher gourd, used for aspiration
• Srnga Yantra – horn of cow etc animals, used for bloodletting through aspiration
  They will be described further on.
  Other examples –
  Uttara Vasti Yantra – rubber ball vaginal douche
  Dakodara yantra – trocar and cannula for tapping ascitic fluid
  Dhuma / dhauma yantra – inhaler, respirator – used for inhalation therapy

5. Shalaka Yantra: Rod like instruments

शलाकायन्त्राण्यपि नानाप्रकाराणि,नानाप्रयोजनानि,यथायोगपरिणाहरिणाहदीर्घाणि च,तेषां गण्डूपदसर्पफणशरपुङ्खव्बबडीशमुखेद्वे द्वे,एषणव्यूहनचालनाहरणार्थमुपदिश्येते: मसूरदलमात्रमुखे द्वे किंचिदानताग्रे स्त्रोतोगतशल्योद्धरणार्थं;षट् कार्पासकृतोष्णीषाणि प्रमार्जनक्रियासु;त्रीणि दर्व्याकृतीनि खल्लमुखानि क्षारौषधप्रनिधानार्थं,त्रीण्यन्यानि जाम्बववदनानि,त्रीण्यङ्कुशवदनानि,षडेवाग्रिकर्मस्वभिप्रेतानि;नासार्बुदहरणर्थमेकं कोलास्थिदलमात्रमुख खल्लतीक्ष्णौष्ठं;अञ्जनार्थमेकं कलायपरिमण्डलमुभयतोमुकुलाग्रं मूत्रमार्गविशोधनार्थमेकं मालतीपुश्पवृन्ताग्रप्रमाणपरिमण्डलमिति॥१४॥
Features of Shalaka Yantras – rod like instruments

Shalaka Yantras is of many types and serves many purposes and uses.

Length and thickness – as found suitable for the purpose for which they are designed and function which they serve.

Note – Salaka Yantras comprises a wide array of instruments which include probes, dilators, urethral and uterine sounds, scoops, swab sticks, branding rods, collyrium rods etc.

6. Upa Yantras: Accessory instruments

उपयन्त्राण्यपि-रज्जुवेणिकापट्टचर्मान्तर्वल्कललतावस्त्राष्ठीलाश्ममुद्ररपाणिपादतलाङ्गुलिजिह्वादन्तनखवालाश्वकटकशाखाष्ठीवनप्रवाहणहर्षायसस्कान्तमयानि क्षाराग्रिभेषजानि चेति ॥१५॥
एतानि देहे सर्वस्यिन देहस्यवयवे तथा।
संधौ कोष्ठे धमन्यां च यथायोगम् प्रयोजयेत्॥१६॥

Below mentioned are the important Upa Yantras –

• Rajju – ropes
• Venika – thread wound in 3 strings, plait
• Putta – leather or cloth sheath
• Charma – leather,
• Antar valkala – thin inner layer of tree barks
• Lata – creeper
• Vastra – cloth
• Asthila asma – hard stones
• Mudgara – mortar / hammer
• Panitala – palm
• Padatala – sole
• Anguli – fingers
• Jihva – tongue
• Danta – teeth
• Nakha – nails
• Mukha – mouth
• Vala / bala – hairs
• Avakataka – bridle of horse
• Sakha – tree branches
• Shyvana – spittle / spittoon or act of spitting
• Pravahana – straining
• Harsa – joy, excitement
• Ayaskanta – magnet
• Ksara – caustic alkali
• Agni – fire
• Bhesaja – medicine / drug / herb
  These upa yantras are very beneficial in many procedures and can be administered all over the body and body parts, organs, joints, gut, and blood vessels as and when needed.

Yantra Karma: Functions of the instruments

यन्त्रकर्माणी तु-निर्घातनपूरनबन्धनव्यूहनवर्तनचालनविवर्तनविवरण पीडनमार्गविशोधनविकर्षणाहरणा च्छनोन्नमनविनमनभञ्जनोन्मथनाचूषणैषणर्जुकरणप्रक्षलन प्रधमनप्रमार्जनानि चतुर्विंशतिः ॥१७॥

There are in total twenty-four Yantra karmas i.e. functions of blunt instruments. They are as below mentioned –

स्वबुद्ध्या चापि विभजेह्यनत्रकर्माणि बुद्धिमान् ।
असंख्येयविकल्पत्वाच्छल्यानामिति निश्चयः ॥१८॥
The foreign bodies are of innumerable kinds. Therefore, an intelligent physician may carry out the actions of the instruments, using his own intelligence (make choice of instruments as per convenience of usage in a given condition using his skill and intelligence).

Yantra Doshas: Defects of the Instruments

तत्र अतिस्थुलम्,असारम्,अतिदीर्घम्,अतिह्रस्वम्,अग्राहि,विषमग्राहि,वक्रं शिथिलम्,अत्युत्रतम्,मृदुकीकं,मृदुमुखं,मृदुपाशम्,-इति द्वादश यन्त्रदोषाः॥१९॥

There are in total of twelve yantra doshas i.e. defects of instruments. They are as below mentioned –

Prashasta Yantra: Ideal blunt instrument

एतैर्दोषैर्विनिर्मुक्तं यन्त्रमष्टादशाङ्गुलम् ।प्रशस्तं भिषजा ज्ञेयंतद्धिकर्मसु योजयेत् ॥२०॥

A yantra having the below mentioned features shall be considered as ideal and should be used in surgical activities –

• Devoid of the above mentioned twelve dosas – defects
• Has a length of 18 angula – 36 cm

दृश्यंसिम्हमुखाद्यैस्तु गूढं कङ्कमुखादिभिः ।
निर्हरेत शनैः शल्यं शास्त्रयुक्तिव्यपेक्षया॥२१॥

Visible Shalyas – foreign bodies should be removed by pulling them out slowly by using instruments like Simhamukha Yantra – lion faced forceps etc. Invisible Shalyas – foreign bodies which are invisible should be pulled out slowly by using Kanka mukha (heron beak forceps) etc. Both procedures should be done in accordance to what has been directed in the treatises.

Kanka Mukha Yantra: The Master instrument

निवर्तते साध्ववगाहते च शल्यं निगृह्योद्धरते च यस्मात् ।
यन्त्रेष्वतः कङ्कमुखं प्रधानं स्थानेषु सर्वेष्वधिकारि चैव॥२२॥
Kanka Mukha Yantra i.e. Heron-bill forceps is said to be the chief and best instrument amongst all the yantras – blunt instruments. Below mentioned are the reasons –

Sthaneshu sarveshu Adhikari – it is the master i.e. best for work at all the places of the body

इति श्रीसुश्रुतसंहितायं सुत्रस्थाने यन्त्रविधिर्नाम् सप्प्तमोऽध्यायः ॥७॥
Thus ends the Seventh chapter by name Yantra Vidhi- In Sutra Sthana of Susruta Samhita.