26. SHASTRA VIDHI ADHYAYA / शास्त्रविधि अध्याय- usage of sharp instruments
Shastra means sharp surgical instrument.
SHASTRA LAKSHANA – FEATURES OF SHARP INSTRUMENTS
षड्विंशतिः सुकर्मारैर्घटितानि यथाविधि
शस्त्राणि रोमवाहिनि बाहुल्येन अङ्गुलानि षट्
सुरूपाणि सुधाराणि सुग्रहाणि च कारयेत्
अकरालानि सुध्मात सुतीक्ष्ण आवर्तिते अयसि
समाहितमुखाग्राणि नीलाम्भोजच्छवीनि च
नामानुगतरूपाणि सदा सन्निहितानि च
स्वोन्मानार्ध चतुर्थांश फलानि एकैकशो अपि च
प्रायो द्वित्राणि,युञ्जीत तानि स्थानविशेषतः
मण्डलाग्रं वृद्धिपत्रमुत्पलाध्यर्धधारके
सर्पैषण्यौ वेतसाख्यं शरर्यस्यत्रिकूर्चके
कुशास्यं साटवदनमन्दर्वक्त्रार्ध चन्द्रके किम्
व्रीहिमुखं कुठारी च शलाकाङ्गुलिशस्त्रके
बडिशं करपत्राख्यं कर्तरि नखशस्त्रकम्
दन्तलेखनकं सूच्यः कूर्चो नाम खजाह्व्यम्
आरा चतुर्विधाकारा तथा स्यत्कर्णवेधनी
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 Yantras should not be of ugly shape.
· They should be prepared from well blown – removed of impurities strong steel like iron.
· The front of their mouth. i.e – the shape edges well hammered – to make them sharp,
· having the color of the blue lotus,
· with shape in accordance with their name,
· always ready at hand for use,
· their blades- cutting edges being 1/4th, ½th or 1/8th 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.
NAMES OF SHASTRAS –
1. Mandalagra,
2. Vriddhipatra,
3. Uttpala Patra,
4. Adhyardha Dhara,
5. Sarpa Mukha,
6. Eshani,
7. Vetasa Patra,
8. Sarari Mukha,
9. Trikurchaka,
10. Kushapatra,
11. Atavadana Atimukhi,
12. Antrarvaktra, / Ardha chandraka,
13. Vrihimukha,
14. Kuthari,
15. Shalaka,
16. Anguli Shastra,
17. Badisa,
18. Karapatra,
19. Kartari,
20. Nakha Shastra,
21. Danta lekhanaka,
22. Suchi,
23.Koorcha,
24. Khaja,
25. the four kinds of Ara, and
26. Karna vedhanaka-
· are the names of the twenty six sharp instruments.
मण्डलाग्रं फले तेषां तर्जन्यन्तर्नखाकृति
लेखने छेदने योज्यं पोथकीशुण्डिकादिषु
वृद्धिपत्रं क्षुराकारं छेद भेद पाटने
ऋज्वग्रमुन्नते शोफे गम्भीरे च तदन्यथा
नताग्रं पृष्ठतो दीर्घह्रस्ववक्त्रं यथाश्रयम्
उत्पलाध्यर्धधाराख्ये भेदने छेदने तथा
सर्पस्यं घ्राणकर्ण अर्शः छेदने अर्धाङ्गुलं फलम्
गतेरन्वेषणे श्लक्ष्णा गण्डूपदमुखैषणी
भेदनार्थे अपरा सूचिमुखा मूलनिविष्टखा
वेतसं व्यधने स्राव्ये शरर्यास्यत्रिकूर्चके
कुशाटावदने स्राव्ये द्वयङ्गुलं स्यात्तयोः फलम्
1. 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.
2. 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,
· same with its tip bent backwards, long or short edge for use in deep seated swelling.
3 and 4. Utpalapatra and Ardha dhara-
lancets are for the purpose of splitting and cutting.
5. Sarpyasya- Sarpamukha- serpent bladed scalpel
· is meant for cutting
· – excision of polyps in the nose and ears
· and has an edge of half Angula.
6. Eshani- sharp probe
· meant for exploring sinuses,
· is smooth
· and shaped like the mouth of an earthworm.
b. Another kind of Eshani- probe meant for splitting,
· has its blade like a needle,
· with a slit- hole at its root.
7. Vetasapatra is for puncturing;
8. . Shararimukhi- shaped like a heron’s beak’s kind of scissors and
9. Trikuracaka – three spiked Brush like instrument are meant for draining out liquids.
10. Kushapatra- Razor resembling Blade of Kusha grass and
11. Atimukha- razor resembling the beak of a hawk are meant for draining, edge is two Angula – in length.
तद्वदन्तर्मुखं तस्य फलमध्यर्धमङ्गुलम्
अर्धचन्द्राननं चैतत्
12. Antramukha –
· is meant for draining,
· its edges – 1.5 Angula in length
· and Shaped like half moon.
तथा अध्यर्धाङ्गुलं फले
व्रीहिवक्त्रं प्रयोज्यं च तच्छिरोदरयोर्व्यधे
13. 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.
पृथुः कुठारी गोदन्तसद्दृशार्धाङ्गुलानना
तयोर्ध्वदण्डया विध्येदुपर्यस्थ्नां स्थितां सिराम्
14. 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 leeping the handle of this Axe vertically over it.
ताम्री शलाका द्विमुखी मुखे कुरुबकाकृतिः
लिङ्गनाशं तथा विध्येत्
15. 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.
मुद्रिकानिर्गतमुखं फले त्वर्धाङ्गुलायतम्
तत्प्रदेशिन्यग्रपर्वप्रमाणार्पणमुद्रिकम्
सूत्रबद्धं गलस्रोतोरोगच्छेदनभेदने
16. Anguli Shastra- finger knife
· is prepared so as to have an orifice.
· Its edges are sharp,
· with its 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.
ग्रहणे शुण्डिकार्मादेर्बडिशं सुनताननम्
17. Badisha- sharp hook with a bent blade
is meant for holding enlarged Uvula, Arma- Pterygium etc.
छेदे अस्थ्ना करपत्रं तु खरधारं दशाङ्गुलम्
विस्तारे सूक्ष्मदन्तं सुत्सरुबन्धनम्
18. 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.
स्नायुसूत्रकचच्छेदे कर्तरी कर्तरीनिमा
19. Kartari- scissors
· meant for cutting tendons, threads, hairs etc,
· is like scissors – which is commonly used by others
वक्रर्जुधारं द्विमुखं नखशस्त्रं नवाङ्गुलम्
सूक्ष्मशल्योद्धृतिच्छेदभेदप्रच्छानलेखने
20. Makhasa–
· Has cured or straight, edge,
· two bladed- shaped edge on both sides,
· nine Angula in length,
· to be made use for removing minute foreign bodies, excision, splitting and scraping.
एकधारं चतुष्कोणं प्रबद्धाकृति चैकतः
दन्तलेखनकं तेन शोधयेद्दन्तशर्कराम्
21. 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.
वृत्ता गूढदृढाः पाशे तिस्रः सूच्यो अत्र सीवने
मांसलानां प्रदेशानां त्र्यस्रा त्र्यमङ्गुलमायता
अल्पमांसास्थिसंधिस्थाव्रणानां द्व्यङ्गुलमायता
22. Soochi – needles for suturing/ swing
is of three kinds;
1) round, strong and stout;
· having – passing in through a hole in their body near its root;
2. that for use in fleshy parts
· will have three edges and
· length of three Angula,
3. for use in less fleshy places, bony joints and wounds on joints,
· with a length of two Angula.
व्रीहिवक्त्रा धनुर्वक्रा पक्वामाशयमर्मसु
सा सार्धद्व्यङ्गुला
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.
सर्ववृत्तास्ताश्चतुरङ्गुलाः
कूर्चो वृत्तैकपीठस्थाः सप्ताष्टौ वा सुबन्धनाः
स योज्यो नीलिकाव्यङ्गकेशशातेषु कुट्टने
23. Koorcha - brush with sharp spikes
· with round spikes fixed on one end,
· seven or eight in number and fastened well;
· it is used for scrapping in
· Nilika- blue patches,
· Vyangga- dark patches on the blade
· and loss of hair etc.
अर्धाङ्गुलमुखैवृत्तैरष्टाभिः कण्टकैः खजः
पाणिभ्यां मथ्यमानेन घ्राणातेन हरेदसृक्
24. 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.
व्यधनं कर्णपालीनां यूथिकामुकुलाननम्
26. Karnapali Vyadhna- instrument for puncturing the ear lobe
should have its blade in the shape of bud of Yuthika- Jasmine.
आरा अर्धाङ्गुलवृत्तस्या तत्प्रवेशा तथोर्ध्वतः
चतुरस्रा, तया विध्येच्छोफं पक्वामसंशये
कर्णपालीं च बहलाम् बहलायाश्च शस्यते
सूची त्रिभागसुषिरः त्र्यङ्गुला कर्णवेधनी
25. Ara- Awl, cutting plate
· has a round blade of half Angula below
· and four blades- edges above,
· it should be used for puncturing swellings in case of doubt whether it is ripe or urine,
· as 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.
to be continued
ANUSHASTRA – ACCESSORY INSTRUMENTS
जलौकः क्षारदहन काचोपलनखादयः
अलौहानि अनुशस्त्राणि, तान्येवं च विकल्पयेत्
अपराण्यपि यन्त्रादीन्युपयोगं च यौगिकम्
Anushastras are –
1. Jalauka – Leeches,
2. Kshara – caustic Alkalies,
3. Dahana – fire,
4. Kacha – glass
5. upala –cow dung cake
6. nakha – nail
7. stone, nail etc, which are non-metallic.
Many other instruments may be designed as required for use in special operations and sites.
SHASTRA KARYA – FUNCTIONS OF SHARP INSTRUMENTS-
उत्पाट्यपाट्यसीव्यैष्यलेख्यप्रच्छानकुट्टनम्
छेद्यं भेद्यं व्यधो मन्थो ग्रहो दाहश्च तत्क्रियाः
1. Utpatana- extracting,
2. Patana- tearing / splitting,
3. Seevana- Suturing,
4. Eshana- probing,
5. Lekhana- scraping,
6. Prachehana- Scratching, incising, minute puncturing
7. Kuttana- beating, hitting, pounding
8. Chedana – excising, cutting,
9. Bhedana- breaking,
10. Vyadhana- Puncturing,
11.Manthana- Churning,
12.Grahana- holding, grasping and
13. Dahana- burning, cauterizing are the functions of sharp instruments.
SHASTRA DOSHA – DEFECTS OF SHARP INSTRUMENTS:-
कुण्ठा खण्ड तनु स्थूल ह्रस्व दीर्घत्व वक्रताः
शस्त्राणां खरधारत्वं अष्टौ दोषाः प्रकीर्तिताः
1. Kuntha – Bluntness,
2. Khanda – brokenness,
3. Tanu- thinness,
4. Sthula – stoutness,
5. Hrsava – smallness,
6. Deergha – lengthiness,
7. Vakrata – curvedness, irregular shape
8. Kharadaratva – rough edge –
are defects of sharp instruments.
SHASTRAGAHANA VIDHI:- METHOD OF HOLDING SHARP INSTRUMENTS:-
छेदभेद्य लेख्यार्थं शस्त्रं वृन्तफलान्तरे
तर्जनीय मध्यमाङ्गुष्ठैर्ग्रह्णीयात्सुसमाहितः विस्रावणानि वृन्ताग्रे तर्जन्यङ्गुष्टकेन च
तलप्रच्छन्न वृन्ताग्रे ग्राह्यं व्रीहिमुखं मुखे
मूलेषु आहरणार्थानि कृयासौकर्यतो अपरम्
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;
2. 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;
3. For Pracchanna (scorching, scratching),
· the tip of the handle should be held with the palm.
4.Vrihimukha Shastra should be held at is mouth tip;
5. for extracting,
· the instruments should be held at their root;
Others may be held in a convenient manner, as required in the operation.
SHASTRA KOSHA- INSTRUMENT WALLET:-
स्यान्नवाङ्गुलविस्तारः सुघनो द्वादशाङ्गुलः
क्षौमपत्रोर्णकौशेयदुकूलमृदुचर्मजः
विन्यस्तपाशः सुस्यूतः सान्तरोर्णस्थशस्त्रकः
शलाकापिहितास्यश्च शस्त्रकोशः सुसञ्चयः
· The instrument wallet should be 9 Angula 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.
JALAUKA- LEECHES-
जलौकसस्तु सुखिनां रक्तस्रावाय योजयेत्
Leeches should be made used of for letting out blood from happy persons
दुष्टाम्बुमत्स्य भेकाहिशवकोथमलोद्भवाः
रक्ताः श्वेत भृशं कृष्णाश्चपलाः स्थूलपिच्छिलाः
इन्द्रायुधविचित्रोर्ध्वराजयो रोमशाश्च ताः
सविषा वर्जयेत् ताभिः कण्डूपाकज्वरभ्रमाः
विशपित्तास्रनुत् कार्यं तत्र
Leeches are born in dirty water contaminated by putrifying dead bodies of fish, frog and snake or their excreta;
Indrayudha type of leeches –
1. Red, white or very black in color;
2. Chapala – very active,
3. thick and slimy,
Poisonous Jalauka -
Those which have
1. Chitra – varied lines on their back, and
2. 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.
NIRVISHA JALAUKA – SAFE LEECHES –
शुद्धाम्बुजाः पुनः
निर्विषाः शैवल श्यावा वृत्ता नील उर्ध्वराजयः
कषाय पृष्टास्ताः तनु अङ्ग्यः किञ्चित् पीतोदराश्च याः
Those
1. born in clean water,
2. which are blue,
3. round in shape,
4. having blue lines in their back,
5. rough/ hard back,
6. thin body,
7. slightly yellowish belly
· are Nirvisha- non poisonous- so can be used.
ता अपि असम्यक् वमनात् प्रततं च निपातनात्
सीदन्तिः सलिलं प्राप्य रक्तमत्ता इति त्यजेत्
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.
JALAUKAVACHARANA- PROCEDURE OF APPLYING LEECHES:-
अथेतरा निशाकल्कयुक्ते अम्बसि परिप्लुताः
अवन्तिसोमे तक्रे वा पुनश्चाश्चासिता जले
लागयेद्धृतमृत्स्तन्यरक्तशस्त्रनिपातनैः
पिबन्तीरुन्नत स्कन्धाश्च्छादयेन्मृदुवाससा
1. 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.
2. should be made to stick to the body of the patient.
3. 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.
4. When it starts drinking blood by raising its shoulders, it should be covered with a soft cloth.
सम्पृक्त्वात् दुष्टशुद्धास्त्रात् जलौका दुष्ताशोणितम्
आदत्ते प्रथमं हंसः क्षीरं क्षीरोदकादिव गुल्मार्शोविद्रधीन् कुष्ठवातरक्तगलामयान्
नेत्ररुग्विषविसर्पान् शमयन्ति जलौकसः
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.
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
दंशस्य तोदे कण्ड्वां वा मोक्षयेत् वामयेच्च ताम्
पटुतैलाक्तवदनां शलक्ष्णकण्डनरूषिताम्
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.
रक्षन् रक्तमदान्भूयः सप्ताहं ता न पातयेत्
After making them vomit
· they should be protected from blood intoxication
· and should not be used again for seven days.
पूर्ववत् पटुता दार्ढ्यं संयग्वान्ते जलौकसाम्
क्लमोअतियोगान्मृत्युर्वा दुर्वान्ते स्तब्धता मदः
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,
1. it becomes lazy,
2. inactive and
3.intoxicated.
अन्यत्रान्यत्रा ताः स्थाप्या घटे मृत्स्नाम्बुगर्भिणि
लालादिकोथनाशार्थं सविषाः स्युस्तदन्वयात्
· They should be transferred from one pot to another,
· filled with good mud and water,
· in order to destroy- avoid putrefaction by saliva, excreta of leeches, because the Leeches become poisonous with such a contact.
अशुद्धौ स्रावयेत् दंशान् हरिद्रागुडमाक्षिकैः शतधौताज्यपिचवस्ततो लेपाश्च शीतलाः
When in doubt of impurity,
1. the site of the bite should be made to bleed by applying paste of Haridra (Turmeric), Guda (jaggery) and honey.
2. 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.
दुष्टरक्तापगमनात्सद्यो रागरुजां शमः
With the removal of vitiated blood,
the redness and pain subside immediately.
अशुद्धं चलितं स्थानत्स्थितं रक्तं व्रणाशये
व्यम्लीभवेत्पर्युषितं तस्मात्तत्स्रावयेत्पुनः
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.
युञ्ज्यालाबुघटिकां रक्ते पित्तेन दूषिते
तासामनलसंयोगात् युञ्ज्यात्तु कफवायुना
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.
कफेन दुष्टं रुधिरं न शृङ्गेण विनिर्हरेत्
सकन्नत्वात् वातपित्ताभ्यां दुष्टं शृङ्गेण निर्हरेत्
· 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.
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:-
गात्रं बद्ध्वोपरि दृढं रज्ज्वा पट्टेन वा समम्
स्नायुसन्ध्यस्थिमर्माणि त्यजन् प्रच्छानमाचरेत्
अधोदेशप्रविस्रुतैः पदैरुपरिगामिभिः
न गाढघनतिर्यग्भिर्न पदे पदमाचरेत्
1. The part of the body above the site, selected for bleeding should be tied tightly with a rope of leather scrap;
2. Tendons, joints, bones and vital spots are avoided and Prachanna karma (scratching, incision) by sharp scalpel done from below upwards.
3. It should not be done in horizontal direction.
प्रच्छानेनैकदेशस्थं ग्रथितं जलजन्मभिः
हरेच्छृङ्गादिभिः सुप्तमसृग्व्यापि शिराव्यधैः
1. Blood accumulated in any localized area- small area can be removed by Pracchana (scratching- incisions);
2. Blood accumulated in tumors, abscess can be removed by using leeches;
3. 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.
प्रच्छानं पिण्डिते वा स्यात् अवगाढेजलौकसः
त्वक्स्थे अलाबुघटीशृङ्गं शिरैव व्यापके असृजि
वातादिधाम वा शृङ्गजलौकोलाबुभिः क्रमात्
1. Or removal of blood by incisions is done when the blood is solidified;
2. by Leeches when it is deep seated;
3. by gourd, pot or horn when it is localized in the skin and
4. by venesection when it is pervading the entire body;
5. by using horn, Leeches, gourd for the seats of Vata and others- Doshas respectively
स्रतासृजः प्रदेहाध्यैः शीतैः स्याद्वायुकोपतः
सतोदकण्डूः शोफस्तं सर्पिषोष्णेन सेचयेत्
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.
Shastra means sharp surgical instrument.
SHASTRA LAKSHANA – FEATURES OF SHARP INSTRUMENTS
षड्विंशतिः सुकर्मारैर्घटितानि यथाविधि
शस्त्राणि रोमवाहिनि बाहुल्येन अङ्गुलानि षट्
सुरूपाणि सुधाराणि सुग्रहाणि च कारयेत्
अकरालानि सुध्मात सुतीक्ष्ण आवर्तिते अयसि
समाहितमुखाग्राणि नीलाम्भोजच्छवीनि च
नामानुगतरूपाणि सदा सन्निहितानि च
स्वोन्मानार्ध चतुर्थांश फलानि एकैकशो अपि च
प्रायो द्वित्राणि,युञ्जीत तानि स्थानविशेषतः
मण्डलाग्रं वृद्धिपत्रमुत्पलाध्यर्धधारके
सर्पैषण्यौ वेतसाख्यं शरर्यस्यत्रिकूर्चके
कुशास्यं साटवदनमन्दर्वक्त्रार्ध चन्द्रके किम्
व्रीहिमुखं कुठारी च शलाकाङ्गुलिशस्त्रके
बडिशं करपत्राख्यं कर्तरि नखशस्त्रकम्
दन्तलेखनकं सूच्यः कूर्चो नाम खजाह्व्यम्
आरा चतुर्विधाकारा तथा स्यत्कर्णवेधनी
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 Yantras should not be of ugly shape.
· They should be prepared from well blown – removed of impurities strong steel like iron.
· The front of their mouth. i.e – the shape edges well hammered – to make them sharp,
· having the color of the blue lotus,
· with shape in accordance with their name,
· always ready at hand for use,
· their blades- cutting edges being 1/4th, ½th or 1/8th 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.
NAMES OF SHASTRAS –
1. Mandalagra,
2. Vriddhipatra,
3. Uttpala Patra,
4. Adhyardha Dhara,
5. Sarpa Mukha,
6. Eshani,
7. Vetasa Patra,
8. Sarari Mukha,
9. Trikurchaka,
10. Kushapatra,
11. Atavadana Atimukhi,
12. Antrarvaktra, / Ardha chandraka,
13. Vrihimukha,
14. Kuthari,
15. Shalaka,
16. Anguli Shastra,
17. Badisa,
18. Karapatra,
19. Kartari,
20. Nakha Shastra,
21. Danta lekhanaka,
22. Suchi,
23.Koorcha,
24. Khaja,
25. the four kinds of Ara, and
26. Karna vedhanaka-
· are the names of the twenty six sharp instruments.
मण्डलाग्रं फले तेषां तर्जन्यन्तर्नखाकृति
लेखने छेदने योज्यं पोथकीशुण्डिकादिषु
वृद्धिपत्रं क्षुराकारं छेद भेद पाटने
ऋज्वग्रमुन्नते शोफे गम्भीरे च तदन्यथा
नताग्रं पृष्ठतो दीर्घह्रस्ववक्त्रं यथाश्रयम्
उत्पलाध्यर्धधाराख्ये भेदने छेदने तथा
सर्पस्यं घ्राणकर्ण अर्शः छेदने अर्धाङ्गुलं फलम्
गतेरन्वेषणे श्लक्ष्णा गण्डूपदमुखैषणी
भेदनार्थे अपरा सूचिमुखा मूलनिविष्टखा
वेतसं व्यधने स्राव्ये शरर्यास्यत्रिकूर्चके
कुशाटावदने स्राव्ये द्वयङ्गुलं स्यात्तयोः फलम्
1. 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.
2. 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,
· same with its tip bent backwards, long or short edge for use in deep seated swelling.
3 and 4. Utpalapatra and Ardha dhara-
lancets are for the purpose of splitting and cutting.
5. Sarpyasya- Sarpamukha- serpent bladed scalpel
· is meant for cutting
· – excision of polyps in the nose and ears
· and has an edge of half Angula.
6. Eshani- sharp probe
· meant for exploring sinuses,
· is smooth
· and shaped like the mouth of an earthworm.
b. Another kind of Eshani- probe meant for splitting,
· has its blade like a needle,
· with a slit- hole at its root.
7. Vetasapatra is for puncturing;
8. . Shararimukhi- shaped like a heron’s beak’s kind of scissors and
9. Trikuracaka – three spiked Brush like instrument are meant for draining out liquids.
10. Kushapatra- Razor resembling Blade of Kusha grass and
11. Atimukha- razor resembling the beak of a hawk are meant for draining, edge is two Angula – in length.
तद्वदन्तर्मुखं तस्य फलमध्यर्धमङ्गुलम्
अर्धचन्द्राननं चैतत्
12. Antramukha –
· is meant for draining,
· its edges – 1.5 Angula in length
· and Shaped like half moon.
तथा अध्यर्धाङ्गुलं फले
व्रीहिवक्त्रं प्रयोज्यं च तच्छिरोदरयोर्व्यधे
13. 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.
पृथुः कुठारी गोदन्तसद्दृशार्धाङ्गुलानना
तयोर्ध्वदण्डया विध्येदुपर्यस्थ्नां स्थितां सिराम्
14. 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 leeping the handle of this Axe vertically over it.
ताम्री शलाका द्विमुखी मुखे कुरुबकाकृतिः
लिङ्गनाशं तथा विध्येत्
15. 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.
मुद्रिकानिर्गतमुखं फले त्वर्धाङ्गुलायतम्
तत्प्रदेशिन्यग्रपर्वप्रमाणार्पणमुद्रिकम्
सूत्रबद्धं गलस्रोतोरोगच्छेदनभेदने
16. Anguli Shastra- finger knife
· is prepared so as to have an orifice.
· Its edges are sharp,
· with its 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.
ग्रहणे शुण्डिकार्मादेर्बडिशं सुनताननम्
17. Badisha- sharp hook with a bent blade
is meant for holding enlarged Uvula, Arma- Pterygium etc.
छेदे अस्थ्ना करपत्रं तु खरधारं दशाङ्गुलम्
विस्तारे सूक्ष्मदन्तं सुत्सरुबन्धनम्
18. 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.
स्नायुसूत्रकचच्छेदे कर्तरी कर्तरीनिमा
19. Kartari- scissors
· meant for cutting tendons, threads, hairs etc,
· is like scissors – which is commonly used by others
वक्रर्जुधारं द्विमुखं नखशस्त्रं नवाङ्गुलम्
सूक्ष्मशल्योद्धृतिच्छेदभेदप्रच्छानलेखने
20. Makhasa–
· Has cured or straight, edge,
· two bladed- shaped edge on both sides,
· nine Angula in length,
· to be made use for removing minute foreign bodies, excision, splitting and scraping.
एकधारं चतुष्कोणं प्रबद्धाकृति चैकतः
दन्तलेखनकं तेन शोधयेद्दन्तशर्कराम्
21. 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.
वृत्ता गूढदृढाः पाशे तिस्रः सूच्यो अत्र सीवने
मांसलानां प्रदेशानां त्र्यस्रा त्र्यमङ्गुलमायता
अल्पमांसास्थिसंधिस्थाव्रणानां द्व्यङ्गुलमायता
22. Soochi – needles for suturing/ swing
is of three kinds;
1) round, strong and stout;
· having – passing in through a hole in their body near its root;
2. that for use in fleshy parts
· will have three edges and
· length of three Angula,
3. for use in less fleshy places, bony joints and wounds on joints,
· with a length of two Angula.
व्रीहिवक्त्रा धनुर्वक्रा पक्वामाशयमर्मसु
सा सार्धद्व्यङ्गुला
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.
सर्ववृत्तास्ताश्चतुरङ्गुलाः
कूर्चो वृत्तैकपीठस्थाः सप्ताष्टौ वा सुबन्धनाः
स योज्यो नीलिकाव्यङ्गकेशशातेषु कुट्टने
23. Koorcha - brush with sharp spikes
· with round spikes fixed on one end,
· seven or eight in number and fastened well;
· it is used for scrapping in
· Nilika- blue patches,
· Vyangga- dark patches on the blade
· and loss of hair etc.
अर्धाङ्गुलमुखैवृत्तैरष्टाभिः कण्टकैः खजः
पाणिभ्यां मथ्यमानेन घ्राणातेन हरेदसृक्
24. 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.
व्यधनं कर्णपालीनां यूथिकामुकुलाननम्
26. Karnapali Vyadhna- instrument for puncturing the ear lobe
should have its blade in the shape of bud of Yuthika- Jasmine.
आरा अर्धाङ्गुलवृत्तस्या तत्प्रवेशा तथोर्ध्वतः
चतुरस्रा, तया विध्येच्छोफं पक्वामसंशये
कर्णपालीं च बहलाम् बहलायाश्च शस्यते
सूची त्रिभागसुषिरः त्र्यङ्गुला कर्णवेधनी
25. Ara- Awl, cutting plate
· has a round blade of half Angula below
· and four blades- edges above,
· it should be used for puncturing swellings in case of doubt whether it is ripe or urine,
· as 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.
to be continued
ANUSHASTRA – ACCESSORY INSTRUMENTS
जलौकः क्षारदहन काचोपलनखादयः
अलौहानि अनुशस्त्राणि, तान्येवं च विकल्पयेत्
अपराण्यपि यन्त्रादीन्युपयोगं च यौगिकम्
Anushastras are –
1. Jalauka – Leeches,
2. Kshara – caustic Alkalies,
3. Dahana – fire,
4. Kacha – glass
5. upala –cow dung cake
6. nakha – nail
7. stone, nail etc, which are non-metallic.
Many other instruments may be designed as required for use in special operations and sites.
SHASTRA KARYA – FUNCTIONS OF SHARP INSTRUMENTS-
उत्पाट्यपाट्यसीव्यैष्यलेख्यप्रच्छानकुट्टनम्
छेद्यं भेद्यं व्यधो मन्थो ग्रहो दाहश्च तत्क्रियाः
1. Utpatana- extracting,
2. Patana- tearing / splitting,
3. Seevana- Suturing,
4. Eshana- probing,
5. Lekhana- scraping,
6. Prachehana- Scratching, incising, minute puncturing
7. Kuttana- beating, hitting, pounding
8. Chedana – excising, cutting,
9. Bhedana- breaking,
10. Vyadhana- Puncturing,
11.Manthana- Churning,
12.Grahana- holding, grasping and
13. Dahana- burning, cauterizing are the functions of sharp instruments.
SHASTRA DOSHA – DEFECTS OF SHARP INSTRUMENTS:-
कुण्ठा खण्ड तनु स्थूल ह्रस्व दीर्घत्व वक्रताः
शस्त्राणां खरधारत्वं अष्टौ दोषाः प्रकीर्तिताः
1. Kuntha – Bluntness,
2. Khanda – brokenness,
3. Tanu- thinness,
4. Sthula – stoutness,
5. Hrsava – smallness,
6. Deergha – lengthiness,
7. Vakrata – curvedness, irregular shape
8. Kharadaratva – rough edge –
are defects of sharp instruments.
SHASTRAGAHANA VIDHI:- METHOD OF HOLDING SHARP INSTRUMENTS:-
छेदभेद्य लेख्यार्थं शस्त्रं वृन्तफलान्तरे
तर्जनीय मध्यमाङ्गुष्ठैर्ग्रह्णीयात्सुसमाहितः विस्रावणानि वृन्ताग्रे तर्जन्यङ्गुष्टकेन च
तलप्रच्छन्न वृन्ताग्रे ग्राह्यं व्रीहिमुखं मुखे
मूलेषु आहरणार्थानि कृयासौकर्यतो अपरम्
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;
2. 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;
3. For Pracchanna (scorching, scratching),
· the tip of the handle should be held with the palm.
4.Vrihimukha Shastra should be held at is mouth tip;
5. for extracting,
· the instruments should be held at their root;
Others may be held in a convenient manner, as required in the operation.
SHASTRA KOSHA- INSTRUMENT WALLET:-
स्यान्नवाङ्गुलविस्तारः सुघनो द्वादशाङ्गुलः
क्षौमपत्रोर्णकौशेयदुकूलमृदुचर्मजः
विन्यस्तपाशः सुस्यूतः सान्तरोर्णस्थशस्त्रकः
शलाकापिहितास्यश्च शस्त्रकोशः सुसञ्चयः
· The instrument wallet should be 9 Angula 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.
JALAUKA- LEECHES-
जलौकसस्तु सुखिनां रक्तस्रावाय योजयेत्
Leeches should be made used of for letting out blood from happy persons
दुष्टाम्बुमत्स्य भेकाहिशवकोथमलोद्भवाः
रक्ताः श्वेत भृशं कृष्णाश्चपलाः स्थूलपिच्छिलाः
इन्द्रायुधविचित्रोर्ध्वराजयो रोमशाश्च ताः
सविषा वर्जयेत् ताभिः कण्डूपाकज्वरभ्रमाः
विशपित्तास्रनुत् कार्यं तत्र
Leeches are born in dirty water contaminated by putrifying dead bodies of fish, frog and snake or their excreta;
Indrayudha type of leeches –
1. Red, white or very black in color;
2. Chapala – very active,
3. thick and slimy,
Poisonous Jalauka -
Those which have
1. Chitra – varied lines on their back, and
2. 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.
NIRVISHA JALAUKA – SAFE LEECHES –
शुद्धाम्बुजाः पुनः
निर्विषाः शैवल श्यावा वृत्ता नील उर्ध्वराजयः
कषाय पृष्टास्ताः तनु अङ्ग्यः किञ्चित् पीतोदराश्च याः
Those
1. born in clean water,
2. which are blue,
3. round in shape,
4. having blue lines in their back,
5. rough/ hard back,
6. thin body,
7. slightly yellowish belly
· are Nirvisha- non poisonous- so can be used.
ता अपि असम्यक् वमनात् प्रततं च निपातनात्
सीदन्तिः सलिलं प्राप्य रक्तमत्ता इति त्यजेत्
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.
JALAUKAVACHARANA- PROCEDURE OF APPLYING LEECHES:-
अथेतरा निशाकल्कयुक्ते अम्बसि परिप्लुताः
अवन्तिसोमे तक्रे वा पुनश्चाश्चासिता जले
लागयेद्धृतमृत्स्तन्यरक्तशस्त्रनिपातनैः
पिबन्तीरुन्नत स्कन्धाश्च्छादयेन्मृदुवाससा
1. 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.
2. should be made to stick to the body of the patient.
3. 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.
4. When it starts drinking blood by raising its shoulders, it should be covered with a soft cloth.
सम्पृक्त्वात् दुष्टशुद्धास्त्रात् जलौका दुष्ताशोणितम्
आदत्ते प्रथमं हंसः क्षीरं क्षीरोदकादिव गुल्मार्शोविद्रधीन् कुष्ठवातरक्तगलामयान्
नेत्ररुग्विषविसर्पान् शमयन्ति जलौकसः
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.
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
दंशस्य तोदे कण्ड्वां वा मोक्षयेत् वामयेच्च ताम्
पटुतैलाक्तवदनां शलक्ष्णकण्डनरूषिताम्
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.
रक्षन् रक्तमदान्भूयः सप्ताहं ता न पातयेत्
After making them vomit
· they should be protected from blood intoxication
· and should not be used again for seven days.
पूर्ववत् पटुता दार्ढ्यं संयग्वान्ते जलौकसाम्
क्लमोअतियोगान्मृत्युर्वा दुर्वान्ते स्तब्धता मदः
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,
1. it becomes lazy,
2. inactive and
3.intoxicated.
अन्यत्रान्यत्रा ताः स्थाप्या घटे मृत्स्नाम्बुगर्भिणि
लालादिकोथनाशार्थं सविषाः स्युस्तदन्वयात्
· They should be transferred from one pot to another,
· filled with good mud and water,
· in order to destroy- avoid putrefaction by saliva, excreta of leeches, because the Leeches become poisonous with such a contact.
अशुद्धौ स्रावयेत् दंशान् हरिद्रागुडमाक्षिकैः शतधौताज्यपिचवस्ततो लेपाश्च शीतलाः
When in doubt of impurity,
1. the site of the bite should be made to bleed by applying paste of Haridra (Turmeric), Guda (jaggery) and honey.
2. 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.
दुष्टरक्तापगमनात्सद्यो रागरुजां शमः
With the removal of vitiated blood,
the redness and pain subside immediately.
अशुद्धं चलितं स्थानत्स्थितं रक्तं व्रणाशये
व्यम्लीभवेत्पर्युषितं तस्मात्तत्स्रावयेत्पुनः
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.
युञ्ज्यालाबुघटिकां रक्ते पित्तेन दूषिते
तासामनलसंयोगात् युञ्ज्यात्तु कफवायुना
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.
कफेन दुष्टं रुधिरं न शृङ्गेण विनिर्हरेत्
सकन्नत्वात् वातपित्ताभ्यां दुष्टं शृङ्गेण निर्हरेत्
· 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.
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:-
गात्रं बद्ध्वोपरि दृढं रज्ज्वा पट्टेन वा समम्
स्नायुसन्ध्यस्थिमर्माणि त्यजन् प्रच्छानमाचरेत्
अधोदेशप्रविस्रुतैः पदैरुपरिगामिभिः
न गाढघनतिर्यग्भिर्न पदे पदमाचरेत्
1. The part of the body above the site, selected for bleeding should be tied tightly with a rope of leather scrap;
2. Tendons, joints, bones and vital spots are avoided and Prachanna karma (scratching, incision) by sharp scalpel done from below upwards.
3. It should not be done in horizontal direction.
प्रच्छानेनैकदेशस्थं ग्रथितं जलजन्मभिः
हरेच्छृङ्गादिभिः सुप्तमसृग्व्यापि शिराव्यधैः
1. Blood accumulated in any localized area- small area can be removed by Pracchana (scratching- incisions);
2. Blood accumulated in tumors, abscess can be removed by using leeches;
3. 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.
प्रच्छानं पिण्डिते वा स्यात् अवगाढेजलौकसः
त्वक्स्थे अलाबुघटीशृङ्गं शिरैव व्यापके असृजि
वातादिधाम वा शृङ्गजलौकोलाबुभिः क्रमात्
1. Or removal of blood by incisions is done when the blood is solidified;
2. by Leeches when it is deep seated;
3. by gourd, pot or horn when it is localized in the skin and
4. by venesection when it is pervading the entire body;
5. by using horn, Leeches, gourd for the seats of Vata and others- Doshas respectively
स्रतासृजः प्रदेहाध्यैः शीतैः स्याद्वायुकोपतः
सतोदकण्डूः शोफस्तं सर्पिषोष्णेन सेचयेत्
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.
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