Sushruta Samhita Sutrasthana Chapter 9: Yogyasutriya Adhyaya (Imparting Practical Training)

The 9th chapter of Sutrasthana of Sushruta Samhita is named as Yogyasutriya Adhyaya. This chapter deals with the information on Imparting Practical Training.

अथातो योग्यासूत्रियमध्यायं व्याख्यास्यामः ।१॥
यथोवाच भगवान् धन्वन्तरिः ॥२॥

We shall now explain the chapter by name Yoga Sutriya Adhyaya – “making the student fit for surgical work” as revealed by venerable Dhanvantri.

Karmabhayasa Mahatva: Important of practical training

अधिगतसर्वशास्त्रार्थमपि शिष्य़ां कारयेत् । स्नेहादिषु छेद्यादिषु च कर्मपथमुपदिशेत् । सुबौश्रुतोऽउस्वयोग्यो भवति ॥३॥

Yogya means ‘one who is fit or expert in practical (surgical) training’. The student might have studied and understood many things and meanings of those things explained in the science after having thoroughly studied and completed his study but he or she should be made a Yogya.

He should be instructed the practical methods of medical therapies including oleation, sudation etc. and surgical therapies like excising etc. In spite of being well read and equipped with good theoretical knowledge, he becomes unfit and noncompliant for conducting surgical activities if he is not made yogya i.e. if he or she is not well equipped and well trained in practical training.

Karmabhyasa: Practical training

तत्र, पुष्पफलालाबूकालिन्दकत्रपुसैर्वारुकर्कारुकप्रभृतिषु छेद्यविशेषान् दर्शयेत्, उत्कर्तनापकर्तनानि चोपदिशेत्; दृतिबस्तिप्रसेवकप्रभृतिषु भेद्ययोग्यां; सरोम्णि चर्मण्यातते लेख्यस्य; मृतपशुसिरासूत्पलनालेषु च वेध्यस्य; घुणोपहतकाष्ठवेणुनल नालिशुष्कालाबूमुखेष्वेष्यस्यः पनसबिम्बीबिल्वफलमज्जमृतपशुदन्तेष्वाहार्यस्य ; मधूच्छिष्टोपलिप्ते शाल्मलीफलके विस्त्राव्यस्य; सूक्ष्मघनवस्त्रान्तयोर्मृदुचर्मान्त योश्च सीव्यस्य, पुस्तमयपुरुषङ्गविशेषेषु बन्धनयोग्यां ; मृदुषु मांसखण्डेष्वग्रिक्षारयोग्यं, मृदुचर्ममांसपेशीषूत्पलनालेषु च कर्णासन्धिबन्धयोग्याम् ; उदकपूर्णघटपार्श्र्वस्त्रोतस्यलाबू मुखादिषु च नेत्रप्रणिधानबस्तिव्रणबस्तिपीडनयोग्यामिति ॥४॥

Note: The physician should demonstrate the surgical methods using many materials mentioned below in the context of each procedure. The students shall practice those procedures voluntarily (after being trained thoroughly) on the same dummies.

Surgical Procedure	Materials used for demonstration by teacher (surgeon) and practice by student
Chedana – for different kinds of excision / removal after separation Utkartana – excess cutting, upward excision Parikartana – inadequate cutting, downward excision	Pushpa phala – Kushmanda Alabu Kalindaka Trapasu Ervaruka etc
Bhedana – splitting, dividing	Bellows Urinary bladder of animals Leather sac etc (Bhedana should be done after filling one of these with water or slush)
Lekhana – scraping, scarification	Broad sheet of leather with hairs
Vedhana – puncturing	Veins of dead animals and stalk of lily plant
Esana – probing, exploringn	Holes in wood pieces which has been eaten by moths, bamboo, hollow reeds (nala), pitcher gourd (alabu) etc
Aharana – extracting, pulling out	Fleshy portion of fruits of panasa, bimbi, and bilva and teeth of dead animals
Visravana – draining fluids	Wood planks of Shalmali tree which have been smeared with bee wax
Sivana – suturing, sewing, joining	Thin and thick cloth – herein the edges of the clothes are stitched together Soft skin / leather is also used
Bandhana – bandaging	Models of human body parts or dummies prepared usingn mud, cloth etc.
Agni karma – fire branding or thermal / fire cauterization and Kshara karma – alkali cauterization	Soft muscles
Karna Sandhi Bandhana – fabricating the severed ear	Soft skin, Smooth muscles Hollow stalk of lily plant
Vasti Karma – enema Vrana Vasti Karma – cleansing or washing the wounds or ulcers	By inserting a tube or spout or beak into a hole made on the side of a water containing pot Alternatively, it shall be done by inserting the same in the opening made in the mouth of a pitcher gourd – alabu

A Verse here:-

एवमादिषु मेधावी योग्यार्हेषु यथाविधि।

द्रव्येषु योग्यां कुर्वाणो न प्रमुद्यति कर्मसु ॥५॥

An intelligent student who is well versed in theory of the science is made Yogya i.e. fit or practically trained in this manner by using the things or dummies which are used for practical training described in the science for this purpose (and have been tabulated above). Such a Yogya will not falter in his actions i.e. while practicing or conducting surgical procedures.

तस्मात् कौशलमन्विच्छन् शस्त्रक्षाराग्रिकर्मसु ।

यस्य यत्रेह साधर्म्यं तत्र योग्यां समाचरेत् ॥६॥

Therefore, a student who wishes to gain expertise in using sharp or surgical instruments or in conducting surgical procedures or fire / thermal or alkali cauterization etc. should select objects similar and suitable to the act (practice and conduct) and hence become Yogya – skilled in surgical works.

इति श्रीसुश्रुतसंहितायां सूत्रस्थाने योग्यासूत्रीयो नाम नवमोऽध्यायः ॥९॥