🔘 Astha Vidha Shastra Karma

ASHTA VIDHA SHASTRA KARMA: 

👉🏻 Introduction:-

तच्चशस्त्रकर्माष्टविधं तद्यथा छेद्यं, भेद्यं, लेख्यं, वेध्यम्, एष्यम्, आहार्य, विस्राव्यं, सीव्यमिति ।

(Su. su. 5/3-4)

The surgical activities (sastra karmas) are of eight kinds viz, Chedya (excision), bhedya (incision), lekhya (scraping), vedhya (puncturing), eshya(probing), aharya (extracting), visravya (draining) and seevya (suturing).

1. Chedana:- excision-ectomy

2. Bhedana:- incision-otomy

3. Lekhana:- scraping

4.:Eshana:- probing

5. Aaharana:- extraction

6. Vedhana:- Puncturing-ostomy

7. Visravana:- draining

8. Seevana:- Suturing 

9. Paatana:- Breaking

10. Pracchana:-multiple incisions

11. Utpaatana:- elevation and extraction

12. Kuttana:- multiple pricking

13. Mandhana:- churning and drilling

14. Grahana:- catching

15. Dahana:- cauterization

👉🏻 Sastra karmas according to different Acharyas:-

✓ According to Sushruta--

1. Chhedana

2. Bhedana

3. Lekhana

4. Eshana

5. Aharana

6. Vedhana

7. Visravana

8. Seevana

✓ According to Charaka:-

1. Paatana

2. Vyadhana

3. Chhedana

4. Lekhana

5. Pracchana

6. Seevana

✓ According to Vagbhatta:-

1 to 8. All the 8 of Sushruta

9. Uthpaatana

10. Kuttana

11. Mandhana

12. Grahana

13. Dahana

1) Chhedana (Excision):-

👉🏻 Indications:

• छेद्या भगन्दरा ग्रन्थिः श्लैष्मिकस्तिलकालकः |

व्रणवमार्बुदान्यशश्चर्मकीलोऽस्थिमांसगम् ||

शल्यं जतुमणिर्माससङ्घातो गलशुण्डिको |

स्नायुमाससिराकोथो वल्मीकं शतपोनकः ||

अध्रुषश्चोपदंशाश्च मांसकन्द्यधिमांसकः ।

(Su. su.25/4)

• The rogas that require excision (chedhana karma) are:-

- Bhagandhara (Fistula ano) 

- Kapha grandhi (lymphadenitis)

- Tilakalam (black mole) 

- Wound (ulcers)

- Arbudas of the eyelids (benign tumours)

- Haemorrhoids (piles) warts of the skin

- Foreign body lodged in the bones and muscles

- Jatumani (birth mark pigmented patch/elevated mole)

- Mamsa sanghata, (benign tumor of palate fibromyoma)

- Galasundika (enlargement of uvula/fibrosed tonsils)

- Valtmeekam (actinomycosis or madhura foot)

- Sataponaka (a variety of rectal fistula/multiple fistula)

- Adhrusa, upadamsa (lympho granuloma venerium or inguinal lymphadenitis due to syphilis or gonorrhoca)

- Mamsasksnda adimamsa (muscular hypertrophy, myomas, gingivitis) - these diseases require excision (cutting and complete removal).

 2) Bhedana (Incision):- 

👉🏻 Indications:-

•भेद्या विद्रधयोऽन्यत्र सर्वजाद्ग्रन्थयस्त्रयः |

आदितो ये विसपश्चि वृद्धयः सविदारिकाः |

प्रमेहपिडकाः शोफः स्तनरोगोऽवमन्थकाः |

कुम्भीकानुशयी नाड्यो वृन्दौ पुष्करिकाऽलजी |

प्रायशः क्षुद्ररोगाश्च पुप्पुटौ तालुदन्तजौ |

तुण्डिकेरी गिलायुश्च पूर्वं ये च पाकिणः |

बस्तिस्तथाऽश्मरीहेतोर्मेदोजा ये च केचन ।।

(Su. su.25/6-8)

- All vidrathi (abscess) except that produced by tridosha

- Three kinds of granthi from the beginning (vataja, pittaja and kaphaja)

- The first three kinds of visarpa (erysipelas-vataja, pittaja, kaphaja)

- Antravrudhi (enlargement of scrotum-hernia),

- Vidarika (pustule in groin and axilla)

- Diabetic eruptions, diabetic carbuncle,Shopha

- Diseases of the breasts,

- Avamanthaka (a disease of the penis, suppurated veneral warts)

- Kumbhika vartma (follicular conjunctivitis/ sty)

- Anusayi (abscess of the foot)

- Nadee vrana (Sinus ulcer)

- The two kinds of vrindha (vrindh and ekavrindha- small tumour of throat)

- Pushkarika (adisease of the penis)

- Alaji (inflammation of penis)

- Generally all kshudra rogas (minor disease)

- Talupupputa (tumor of the palate)

- Danta pupputa (gingivitis)

- Tundikeri (tonsilitis)

- Gilayu (tonsillar abscess)

- Those diseases which suppurate mentioned earlier such as fistula in ano etc. under chedya rogas)

- The urinary bladder due to formation of calculus

and Some diseases produced by fat tissue

👉🏻 Incision planning-General Principles:-

1. An incision should always be planned way that it gives ready and direct access to the part to be operated upon.

2. Incision planed should allow for any change in the scope of surgery i.e. extensible in a direction which would allow for any changes in the plan of operation.

3. Cosmetically good incision is another hallmark of good surgery.

👉🏻 Method of making Good Incision:-

1. Incision should be made clearly with firm and controlled stroke of knife. The knife should be kept perpendicular to the skin

2. Incision should be made with a single firm stroke. Repeated strokes usually give rise to an incision with jagged margins.

3. If skin is loose over the operative area then it should be stretche in turn by traction as the incision is made.

4. Healing is usually good if the incision is given parallel to the crease line and across the line of pull of underlying muscles.

👉🏻 Qualities of Incision:-

- Adequate in length

- Extensible

- Regular & uniformly cut edges

- All layers cleanly incised

- Independent

👉🏻 Correct technique:-

- First decide the line & depth wanted

- Always use sharp knife

- Use the belly of the knife, except if a short stab wound is required

- Cut at one stroke

- Control bleeding

- Straight pointed blade is used only to make small incisions

- Curved blade-designed to allow smooth incision

- For minor surgical work a No: 11 blades will be ideal

- For finer work the small No 15 blades may be used.

- The physician should cut with his instrument well sharpened, should anuloma direction, avoiding vulnerable parts etc. deep enough till the pus is seen.

- The incision upto two angula (4 cm Aprox.)

- If need more space, do another insicion near 2 to 3 angulas

👉🏻 Instruments used in Incision Making:-

- Scalpel is the most important instrument.

- There are two types:

(a) Scalpel handle combined with blade

(b) Scalpel handles with detachable blade

✓ Different Methods of Holding a Scalpel:-

(1) Dinner knife position:-

- This position is used while making a long incision and when separating muscle from bone.

(2) Writing or Dissecting or Pen holding position:-

- This position is used while doing delicate and fine dissection such as during separation of a delicate structure like artery, vein or nerve or which separating the growth from surrounding

tissues.

(3) Fiddle-bow position:-

- This position is used to make incisions with minimal pressure over delicate structures. The main disadvantage of this position is that the grip is neither firm or controlled.

👉🏻 Direction of incision:-

- Should be done in the direction of hairs

- Incision should be oblique in-eye brow, cheek, temple, forehead, eyelid, lip, gum,axilla, belly & groin.

- Make incision like full moon in the upper & lower limbs.

- Half moon incision in anus & penis.

👉🏻 Counter incision:-

- Done if first incision is not enough to drain pus

ie, if the most prominent part is not the most dependent part.

👉🏻 Extension of incision:-

- Incision should be made on whichever direction the tracks lead & where ever pockets are present so that no offencive materials should be left.

- Incision should be made 2 or 3 angula deep

3) Lekhana (Scraping):-

👉🏻 Indications:-

• लेख्याश्चतस्रो रोहिण्यःकिलासमुपेजिह्निका ।

मेदोजो दन्तवैदर्भो ग्रन्थिर्वाधिजिलिका ।।

अर्शांसि मण्डलं मांसकन्दी मांसोन्नतिस्तथा ।। 

(Su.su. 25/8-9)

- Four kinds of rohini (vataja, pittaja, kaphaja, sannipataja)

- Kilasa (leucoderma)

- Danta vaidarbha of fat origin (gingivitis)

- Medaja granthi (fatty tumor)

- Medaja vartma (fatty tumor of eyelids)

- Adhijihvika (adenoids)

- Arshas (haemorhoids)

- Mandalakushta (a variety of leprosy)

- Mamsakanda (small tumor of muscles) and

- Mamsonnati (thickening of the muscle)

4) Vedhana (Puncturing):-

👉🏻 Indications:-

• वेध्याः सिरा बहुविधा मूत्रवृद्धिर्दकोदरम् । 

(Su.su. 25/10)

- Siras (veins) to be punctured in many diseases

- Mutra vrddhi (enlargement of scrotum - hydrocele)

- Jalodara (ascitis)

 5) Eshana / Yeshya rogas (Probing):-

👉🏻 Indications:-

• एष्या नाड्यःसशल्याश्च द्रणा उन्मार्गिणश्च ये ।। 

(Su.su. 25/10)

- Nadi (sinus ulcers)

- Sasalya vrana (wound with foreign body inside) 

- Inmargi vrana (sinus ulcer which spread sidewards).

6) Aharana (Extraction):-

👉🏻 Indications:-

• आहार्याः शर्करास्तिस्रो दन्तकर्णमलोऽस्मरी ।

शल्यानि मूढगर्भाश्च वर्चश्च निचितं गुदे ।।

(Su.su. 25/ 11)

- Three kinds of sarkara (vataja, pitaja, kaphaja- urinary gravel)

- Dantamala (tartar of the teeth)

- Paada sarkara(coms in the foot)

- Karnamala (ear wax)

- Antah shalyas (Internal foreign bodies)

- Asmari (urinary calculii)

- Shalya (all kinds of foreign bodies)

- Mudha garbha (abnormal presentation of foetus)

- Mala sanga (faeces accumilated in the rectum)

7) Visravana (Draining):-

👉🏻 Indications:-

• स्राव्या विद्रधयः पञ्च भवेयुः सर्वजादृते ।

कुष्ठानि वायुः सरुजः शोफो यश्चैकदोषजः ।।

पाल्यामयाः श्लीपदानि विषजुष्टश्च शोणितम् । 

अर्बुदानि विसर्पाश्च ग्रन्थयश्चादितश्च ते ।।

त्रयस्त्रयश्चोपदंशाः स्तनरोगा विदारिका । 

सुषिरो गलशालूकं कण्टकाः कृमिदन्तकः ।।

देन्तवेष्टः सोपकुशः शीतादो दन्तपुप्पुटः । 

पित्तासृक्कफजाश्चौष्ठ्याः क्षुद्ररोगाश्च भूयशः ।।

(Su.su. 25/12-15)

- Five kinds of vidradhi (abscess) except that born from all the dosas together.

- Vataja kustha sa ruja (leprosy of vata origin having pain)

- Ekadesaja sopha (inflammatory oedema confined to one place)

- Pali amaya (diseases of the earlobe)

- Shlipada (filariasis)

- Visha justa sonita (blood vitiated by poison)

- All kinds of arbuda (malignant tumors)

- All kinds of visarpa (erysepelas)

- The first three kinds of grarithi (vataja, pittaja and kaphaja-benign tumor)

- Three kinds of upadamsa (vataja, pittaja. kaphaja- syphillis)

- Stanaroga (diseases of the breast)

- Vidarika (pustule in groin and axilla)

- Sausira (small sinus of the tooth)

- Gala saluka (epiglotitis)

- Kantaka (jihvakantaka/ inflammation of tongue)

- Krimidanta (caries of the teeth)

- Danta vesta (gingivitis)

- Upakusa (ulcerative gingivitis)

- Sitada (spongy gums/scurvy)

- Danta pupputa (gingivitis)

- Ostha kopa arising from pitta, rakta and kapha (inflammation of the lips)

- Ksudra rogas (minor diseases)

8) Seevana (Suturing):-

👉🏻 Indications:-

• सीव्या मेदः समुत्थाश्च भिन्नाः सुलिखिता गदाः । 

सद्योव्रणाश्च ये चैव चलसन्यिव्यपाश्रिताः ।।

(Su.su. 25/16)

- Pralamba mamsa (a hanging cut muscle)

- Suddha vranas (clean uninfected wounds)

- Diseases arising from fat such as tumors etc

- Cut Incised wounds (such as tumors etc)

- Well scrape wound

- Sadyo Vrana (traumatic wound)

- Diseases localised on moveable joints

- Cut wounds on karnapali (ear lobe), sira's (head), netra gola (eye ball), nasa, oshtha, kantha, kapola, Ooru, bahu. greeva, and udara

- Vitpaatita vrana (deep seated wound)

👉🏻 Contraindication for suturing:-

- Kshara and agnidahaya vranas

- Pavana vai vranas (gas gangrene)

- Madhumehaja vranas (diabetic ulcers)

- Kakshaha vranas (tension wounds)

- Alpa mamsa yuktha vranas (gaping wounds)

👉🏻 Seevanam / suturing:-

- Sutures or stitches are the materials used to close a wound

- Used in an attempt to improve and speedy healing

- Used to close skin, internal tissues, organs and blood vessels

- Suture material may be absorbable and non absorbable

👉🏻 Suturing - Introduction:-

1. To produce accurate apposition with minimal dead space

2. Avoid suturing in septic conditions

3. Suture should not be put neither too far nor too near.

👉🏻 Types of suture:-

1. Continuous suture (Vellitak)

2. Interrupted suture (Ruju granthi)

3. Blanket or button hole suture (Gofanika)

4. Matress suture

5. Buried subcuticular suturing (Tunnasevani)