Asian Journal of Modern and Ayurvedic Medical Science (ISSN 2279-0772)
Vol.1,no.1, July 2012.[
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Research Paper
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Role of Anushastra karma (Para surgical procedure) in Wound management
Anil Kr. Tripathi1, S. J. Gupta2, S.C. Varshney3
,Amit Vaibhav4
Declaration
T
he Declaration of the authors for publication of Research Paper in
Asian Journal of Modern and Ayurvedic Medical Science (ISSN 2279-0772)
W
e
Anil Kr. Tripathi1, S. J. Gupta2, S.C. Varshney3
,Amit Vaibhav4
the authors of the research paper entitled
Role of Anushastra karma (Para surgical procedure) in Wound management
declare that ,
W
e
take the responsibility of the content and material of our paper as We ourself have written it and also have read the manuscript of our paper carefully. Also, We hereby give our consent to publish our paper in ajmams , This research paper is our original work and no part of it or it’s similar version is published or has been sent for publication anywhere else.We authorise the Editorial Board of the Journal to modify and edit the manuscript. We also give our consent to the
publisher of ajmams to own the copyright of our research paper.
Received june 3 , 2012 ; accepted june 25 , 2012 , published july 1 , 2012
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Abstract :
Wound is big trouble to patient and doctor both since time immemorial. Surgical practice moving around wound and related things in all the pathies. Ayurveda also give their prime attention in wound management. Sushruta elaborated sixty procedures (Shasti-Upakrama) to manage different kinds of wounds. These sixty procedures grossly consist of medical therapy, Pancha-karma therapies, surgical therapies, Para- surgical therapies and mantra therapy too. In this paper we elaborate especially all the para-surgical procedure in wound management.
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KEYWORDS
:
Wound, Shasti-Upakrama, Para- surgical therapies.
Introduction-
Shalya Tantra
is one of the important branches of Ayurveda in which surgical and parasurgical techniques has described for management of various diseases. Vrana (wound) is one of them which have been managed by human being from starting of civilization. Under the circumstances the first thing which the men came across was the injury from different sources which caused him the Vrana (wound). Vrana is seen as debilitating and scaring disorder usually seen affecting the human being at any age. Vrana is the most important and widely described chapter of Shalya Tantra.
Sushruta
– The father of surgery has scientifically classified it in a systemic manner whose wealth of clinical material and the principles of management are valid even today. Classification of traumatic wounds, Shuddha Vrana, Nadi Vrana, Sadhya Vrana, Dagdha Vrana etc., their prognostic evaluation and management in the form of sixty upakramas which are from Apatarpana to Rakshavidhana, insistence on primary suturing in clean wounds, avoidance of sepsis and excision of extruded omentum and careful suturing of intestinal perforation in the management of perforating abdominal wounds, etc. are remarkable for their modern outlook.
Sisty procedure consist of
Apatarpana, Alepa, Parisheka, Abhyanga, Sveda, Vimlapana, Visravana, Snehana, Vamana Virechana, Upanaha, Pachana, Chedana, Bhedana, Darana, Lekhana, Eshana, Aharana, Vyadhana, Vyavana, Sivana, Shandhana, Pidana, Shonitasthapan, Nirvapana, Utkarika, Kashaya, Varti, Kalka, Avachurnana, Rasakriya, Taila, Sarpi, Dhupana, Utsadana, Avasadana, Mridukarma, Darunakarma, Ksharkarma, Agnikarma, Krushnakarma, Pandukarma, Pratisarana, Romasajanana, Romapaharana, Basti, Uttarbasti, Bandhana, Patradana, Krimighna, Nasya, Shirovirechana, Vishagna, Brihana, Kavala, Dhuma, Madhusarpi, Yantra, Ahara and Raksavidhana
. In this series there are many included in anushastra karma (para-surgical procedure).
Anushastra Karma
means surgical procedure performed by non surgical items or instruments in absence of surgical instruments. Acharya Sushruta described different Anushastra, these are twakasara (bamboo bark), sphatika, Kancha (led), kuruvind, jalauka (leech), agni (flame), kshara (alkali), nakha (nails), goji (gajawa), shephalika (harasringar leave), shaka patra (sagaun leave), Kareera, bala (hair) and anguli (finger) etc (Su. Su 8/15). Kshara karma, agnikarma, jalaukawacharana are three most important anushastra karma which are included in shasti upakrama and come across in wound management.
Anushastras
are effectively used in management of different surgical conditions. It is equally useful to diagnose the different types of sinuses and fistulas (Su. Chi.-1/41). For the diagnosis of Nadi Vrana (sinus), Shalya yukta vrana (wound with foreign body), Unmargi vrana (fistula) and utsangi vrana (wounds with cavity), now a days we used generally different kind of probes (eshani). In place of probes we can use Bal anguli (kid’s fingure) or kareer naal. These two are counted under anushastra by Sushruta.
Role of different Anushastra Karma in wound management
1.
Role of Kshar Karma in wound management-
Kshar
is a medicament obtained from ash of different plants. Kshar is best among shastra and anushastras. Pratisaraniya kshar are mainly used in wound management. It is mainly used for vrana shodhana (debridment) The ushna and tikshna properties are helpful in wound debridement.
a.
Pratisaraniya Kshar
in wound management-
There are so many conditions where partisaraniya kshar help in wound management. Sushruta clearly mentioned those conditions- utsanna mansan (wound with elevated margin and base i.e. wound with hypergranulation tissue), kathinan (wound having hard consistancy), Kandu yukta (wound with severe itching), Chirotthitan (chronic wounds) and those wounds are not cleansed easily are purified without any difficulty i.e. help in wound bed preparation. Pratisaraniya kshar also help in bursting (Darana karma) the large pus pockets having no opening especially in those where one cannot perform surgical intervention, like wounds in children, elder patient, weak patient, panic patients, ladies and wounds over sensitive and vital portion (Su. Chi.-1/34-35).
b.
Ksharambu
in wound management-
Ksharambu
is liquid form of kshar. Sushruta mentioned a condition of wound where flies are attracting over wound and lays allot of maggots (krimi). These maggots engrave the wound surface and leads to painful inflammation. Those wounds which are generally exposed to flies, easily managed by irrigation with ksharambu (Su. Chi.1/121).
c.
Kshar Sutra & Kshar Varti
in wound management-
Sinus (nadi vrana) and fistulas (bhagandara) are kind of wounds which are difficult to treat. This is because of its undermined edge and unexposed infective site and difficult debridement. These conditions are treated by both method, surgical (chhedana-lay opening) and parasurgical (kshar sutra & kshar varti). Sushruta mention that nadi vrana present in emaciated, weak, anxious patient and present over vital portion treated by Kshar sutra but not by surgery (chhedana). Fistula (bhagandara) is also treated by kshar sutra in same manner. Kshar varti is another cleansing agent which treats nadi vrana effectively described in all Ayurvedic texts.
2.
Role of Agni Karma in wound management-
Agni karma
is second important anushastra karma which is described by all the acharyas. There are so many tools for agni karma like pippali, goat stool pellets, teeth of different animals, shalaka (probes) and snehapadartha (ghee, tail, guda, honey). Valaya, bindu, vilekha and pratisarana are types of dahana (agni karma).
Sushruta
descried many conditions related to wounds where agnikarma is indicated. Wounds with urine secretion, wounds related to stone and its surgery, wounds with blood discharge, and wound on traumatic joints are treated by agnikarma successfully. Beside this wounds where hypergranulation tissues are present, wound margin and surface become hard, surrounding skin loosed their sensation and nadivrana (sinuses) are also managed by agnikarma.
3.
Role of Jalaukawacharana in wound management-
Jalaukawacharana
(leech application) third foremost important anushastrakarma illustrated by many authors. Jalaukavacharana is a method of Raktamokshana (blood-letting). Raktamokshana have two methods- shastrakrita and ashastrakrita. Shastrakrita further have two methods- siravedha and pracchana. Ashastrakrita having shringa, jalauka, alabu and ghati. Jalaukawacharana is generally applied in initial phase of wound progress. Rakta mokshana reduces the pain and suppress the suppuration of premature swelling. Wound with inflammation, hardness, reddish black in colour, tenderness and uneven surface are treated by rakta mokshana. Inflammation with poisonous in origin is specially treated by leech application and secreting (Pracchana).
Mridukarma
is also an upakrama to treat the wound with hardness, less granulation tissue and vitiated by vata. It is generally performed by Raktamokshana. Leech can be used for raktamokshana.
4.
Role of Anguli & Kareeranala in wound management-
Finger is also an anushastra used in many places. Vimlapana is a process where a mild massage done by anguli, palm and bamboo stem. It is performed to subside swelling with hardness and mild pain.
Small figures specially children’s are also used in wound management. It is indirectly helpful in wound management. We can use kids figure and kareera nala t
o diagnosis of Nadi Vrana (sinus), Shalya yukta vrana (wound with foreign body), Unmargivrana (fistula) and utsangivrana (wounds with cavity).
5.
Role of Patra (leaf) in wound management-
Shephalika (harsringar patra)
and shaka patra (Sagauna) are kinds of rough leaf described under anushastras. Wound with hardness, elevated and round margins, bursting frequently and hard hyper granulation tissue are effectively treated by lekhana (scratching) karma. Lekhanakarma is performed by shstras i.e. mandalagra and karapatra. In absence of instruments one can use kshauma, plota, pichu, samudraphena, yavakshara, rock salt and rough leaves like shephalika etc.
6.
Role of Bala (hair) in wound management-
Bala
(hair) is also illustrated under the heading of anushastras. Seevana karma (Suturing) is applied to manage fresh wound for fast healing. There are so many kinds of suturing material described by Sushruta i.e. kshaumasutra, snayu, bala (hair) of different animals like horse and different plant’s fibre. In this way hairs are also helpful in management of wound
Summary and conclusion-
Vrana (wound) is very vast subject of shalya tantra. There are so many kinds of wounds. Anushastra are equally important in wound management to shastrakarma. Kshara are widely described in wound management at different places of texts. PratisarniyaKshara is use in debridement of chronic wounds. Ksharasutra is applied to control sinuses and fistulas, whereas ksharambu use to clean to those wound which are liable to maggots infestation. Agnikarma employ on those wounds which are hard and discharging in nature. Jalauka or leech application is play active role to subside the suppuration. Beside these three anushastra rough leave, anguli, kareera and bala are also use in wound management. Kid’s figure and kareeranala are use in diagnosis of different wounds which ultimately help in wound management.
References-
1.
Astanga Hridaya: Hindi commentary by Tripathi Brahmanand, Chowkhamba Sanskrit Pratisthana, Delhi, India, Sutra Sthana26:35-46(2003)
2.
Astanga Sangraha- Hindi commentary by Changani G. S, Chowkhamba Sanskrit Sansthana, Varanasi, India, 13th edition, Sutra Sthana:35/ 5-13(1999)
3.
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