A Practical Guide to Parasurgical Procedures in Ayurveda

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Ayurvedic surgery has been flourishing day-by-day and Ayurvedic surgeons have now got their due respect in the society It could only be possible by the widespread acceptability of Ksharsutra procedure especially in the management of anal fistula. Anal fistula is a difficult disease to cure by conventional surgery and Ksharsutra procedure is very much effective in the management of anal fistula.

Sushruta has explained the importance of Kshara, Agni and Raktamokshana in the management of various diseases and he has also used these procedures as substitutes of surgical procedures especially in the conditions where surgery is contraindicated. These procedures have been grouped together to be known as Parasurgical procedures. The present book deals with the details of these procedures along with description of fractures and dislocation. The practical aspects of all these procedures have been mentioned in the book. It is a must book to get the idea regarding utility of these procedures.

Dr. Praveen K. Chaudhary and Dr. K. K. Sijoria are alumni of the Shalya-Shalakya department of the prestigious Banares Hindu University at Kashi in India. Both of them have the privilege of being the disciple of honorable Prof. G. C. Prasad.

Dr. Praveen K. Chaudhary, born on 16 August 1970 at Deoband in District Saharanpur of Uttar Pradesh, did Master of Surgery in Ayurveda (M.S.) in Shalya subject in 1999. He wrote the bestseller PG. entrance books named Ayurvediya Pravesha Pariksha Digdarshika, A Comprehensive Study for Ayurvedic Competitive Examinations and Ayurveda Vrihattrayi Manjusha. The first two books were published during his tenure as a junior resident at B.H.U. at an age of 28. His career is glittering with several prizes and medals in curricular and extracurricular activities. Dr. K. K. Sijoria, a brilliant scholar from Tehsil Dabra of historical place Gwalior was born on 26 June 1951, completed his post-graduation in surgery from B.H.U. and worked as a clinical registrar in the Shalya department. Later in 1979 he joined as a lecturer in A & U Tibbia College and presently working as a reader and Head of the Deptt with an additional charge of Deputy Medical Superintendent. He received prestigious state award, from Govt. of Delhi for his valuable services.

Ayurveda is one of the most ancient systems of the medicine. It is a holistic system of medicine; it treats the patient as a whole, not merely the diseases. The original propounder of the Ayurveda was Brahma. Since then, it has served the humanity at large. There are mainly two streams of the Ayurvedic system of medicine such as Dhanavantari School of Ayurveda, which primarily deals in surgical aspects and the Atreya School, which deals in the medical aspect of the Ayurveda. In ancient time, Ayurveda was divided into eight branches or specialties. These were salya (Surgery), Salakya (Diseases of the eye, ear, nose and throat), Kayacikitsa (Medicine), Kaumarbhtya (Paediatrics, gynaecology and obstetrics), Bhutavidya (Psychiatry), Agadatantra (Toxicology), Rasayana (Geriatrics) and Vajikarana (Sexology). Among these, the Salya Tantra has been a special branch of Ayurveda owing to its definite cure capacity. It is still an important and specific branch of Ayurveda.

The practice of Salya Tantra saw many vicissitudes in its history. It was a rich science in the ancient India hut downgraded in the medieval and modern India due to some socio-political implications. In the Buddhist period, the then religious scholars demoralized Salya practice. They told the people that it involved the violence in its procedures. The surgeons were named as Asura or devil. After the independence of India, the Salya practice rushed to come back and new researches were carried out. Different treatment modalities were researched and practiced. Salya Tantra is said to be the superior among all other branches of Ayurveda owing to the following reasons - It is quick acting and result oriented (Asukriyakaranat), different types of Yantra. Sastra, Ksara and Agni are used as treatment modalities (Yantrasastraksaragni pranidhana) and it contains all therapies as mentioned in other branches of Ayurveda (Sarvatantrasamanyacca).

Salya Tantra actually flourished with the invent of new improved alkaline thread (Ksara-sutra). Ksara-sutra revolutionized the treatment of various incurable diseases such as Fistula in ano, Sinuses of varied etiology etc. Though, salya Tantra has many useful treatment modalities, yet Ksara-sutra therapy has emerged as a very specialized branch. Ksara-sutra therapy has provided a respectable status to the surgeons of Ayurveda.

The entire Salya Tantra is broadly divided into two branches as per the therapies are concern and the branches are the Surgical procedures and Para-surgical procedures. The surgical procedures are mainly performed with the help of Sastra and Yantra, while the Para-surgical procedures are accomplished with the help of Kara (alkali), Agni (heat), Srnga (horn), Alabu (gourd) and Jalauka (leeches). The former is an invasive type of treatment, while the latter is minimally invasive in nature. There are eight types of Sastrakarma e.g. Chedana, Bhedana, Lekhana, Vedhana, Esana, Aharana, Visravana and Sivana.

There is a perception in the society that Ayurveda does not have surgery; it is only a medicinal system. The so-called modern surgeons nourish this perception. However, it is very true that no modern surgeon has ever invented a single procedure out of these eight Sastrakarma. They have been practicing only these eight basic procedures even today. The same is true in case of the Yantrakarma. They have only discovered the sophisticated equipments with the synergism of physics but the basic procedures are the same as that were in the ancient time. The surgery in Ayurveda is a very broad and practical branch.

The Para-surgical procedures are the marvels of Salya practice and they can be carried out with minimal discomfort to the patients. The results are excellent and amazing. They are cheap, comfortable and carry higher treatment benefits. This branch is gaining popularity nowadays owing to its several benefits over invasive procedures.

Ksara-sutra arid ksara-karma are one of the important measures in the salya practice. Ksara is best, for it does chedana, bhedana and lekhana actions simultaneously and it can be a better substitute for Sastra. The person who afraid of instrumentation can tolerate it well. The diseases do not recur after treatment with the ksara. It is an excellent remedy to remove any type of debris from the infected wounds and use of kara results in the genesis of fresh granulation tissue in the infected wounds. In fact, treatment of infected wound especially sinuses has been revolutionized after the search of different types of ksara modifications such as ksara picu, ksara gauze, ksara varti and even ksara sutra.

In the modem medicine, Fistula-in-ano is said to be an utterly embarrassing disease owing to its recurrence even after meticulous surgery and dressing. The recurrence in cases of fistula in ano after the surgical excision is not by chance but as a rule. The surgeon of the Ayurvedic system of medicine realized this thing and they tried ksara-sutra in the management of this disease. This ksara-sutra was standardized and developed on large business scale. It was a grand success. It provided the ray of extreme hope in the frustrated patients of Fistula-in-ano. Not only it is helpful in the management of fistula-in-ano but also it is a sure shot remedy for pilonidal sinus, haemorrhoids, polyps, other infected sinuses etc. It has provided the reputation to the surgeons of the Ayurveda.

Besides ksara-sutra, some other Para-surgical measures in Ayurveda have their own importance. The one of them is the science of bloodletting. Raktamoksana is said the half of all treatments in surgery and holds a high value. Though the Susruta has given the vital status to the blood and has ordered to preserve it by any means, yet he has also reiterated that drainage of blood in measured quantity may treat several ailments. Raktamoksana can be performed by several methods such as Srnga (horn or cupping), Alabu (gourd), Jalauka (with leech), Pracchana (scarification), and Siravedha (venesection). Pracchana and Siravedhana involve instrumentation and are more invasive in nature. Pracchana is used for localized dosas while Siravedha for generalized dosas.

Srnga, Jalauka and Alabü are less invasive and are used in Vata, Pitta and Kapha predominance respectively. Srnga and Alabu work on the principle of extraction of blood by creating vacuum. Among all these method of bloodletting, the most physiological and feasible method is Jalaukavacarana. It has been practiced all over the world since a very long period. Leech injects her saliva in to the wound and this saliva is a rich source of several metabolic active chemicals. These chemicals have a wide range of activity right from producing anaesthesia to the vasodialtor and several other properties such as neogenesis, antibiotic, proteolytic, and healing actions. Use of leech has revolutionized the treatment of vascular insufficiency, other artery and venous disorders, pains, inflammations etc. Agnikarma is another important therapy in the Ayurveda. The diseases treated with Agni do not recur. There are no infections and post-operative bleeding. It can remove do? a from its root. The diseases that cannot be cured by other means can be cured by Agni. Agnikarma is performed even after astrakarma to avoid bleeding and infections.

Agnikarma is very useful in treating corns, skin diseases, warts, and it is also useful in some vatika disorders also.

Bhagna sandhana is another beautiful branch of surgical discipline in Ayurveda. By reading the literature on Bhagna, anyone can say that modern orthopaedic surgery has adopted the same principles as has been mentioned in Ayurveda. The reduction process of the fractures and dislocations is the same in modern medicine as was told by the Susruta. There are only four steps such as traction, reduction, setting and bandaging. The modern orthopaedic surgeons have adopted the same process. Nothing has been changed from the ancient times. Whatever changes we are seeing are the type of sophisticated dressing materials.

Kalupurana is a method of fracture reduction practiced in the tribes of Orisa. It is a highly effective treatment in the healing of fractures. Not only the reduction of fractures and dislocations, Ayurveda provides a wide range of medicinal and occupational therapies, pastes and other medicine to treat post-operative stiffness of the part especially the nearby joints resulted due to prolonged immobilization.

We have worked a lot on this beautiful branch of surgery in Ayurveda and found it very useful. It is our duty to tell the students and practitioners, the principles and secrets of these therapies. No such book is available in the market; therefore, we decided to frame our work in a shape of book. It will definitely provide the vital informations on this subject to the readers. There might be some mistakes escaped in the book owing to the manual work and the error in the human. The reader will forget and grasp the positive. We hope, this will prove to be a beneficial book for the readers.