Dr. R.B.Gogte
Obstructed Labour:
Three principles are to be kept in mind while dealing with a case of obstructed labour
Bhroon`ahatyaa (feticide) is absolutely contra-indicated in Ayurveda
A mothers life should be saved at any cost during pregnancy or during the process of labour
Usually, the obstruction is at the three places rightly described as Sus`hruta.
It means that the process of delivery is obstructed:
- At the head
- At the shoulder
- At the hip
Any manual thing done by a Vaidyas hand is to be treated as a surgical procedure rightly described as S. Su. 7/3
When a normal procedure of delivery fails usually the patient requires surgical interference. The first surgical procedure without damaging the baby in a live or dead condition is manipulation of the presenting part by the Vaidya. This may be called as internal version.
If the procedure fails then the second surgical procedure starts.
- If the obstruction is at level of the head then the crushing of skull is done in modern sciences and it is called craniotomy and the further procedure of extraction is completed. If the crushing procedure has not been done then the Vaidya has to put his finger in the orbital cavity or in the mouth and extract the body.
- If the obstruction is at the axilla then the distortion should be done at the axilla and the baby removed.
- If the obstruction is at the hip then the distortion should be done at the hip and the baby should be removed.
- For this purpose Garbhas`hanku & Man`d`alaagra S`hastra are used. Same such procedures were practiced, till recently, in modern surgery in the recent past.
Special note:
Under no condition should the dead baby be kept in the mothers womb for a longer time as it endangers the life of the mother. Inspite of our efforts to save the life of a mother during the process of labour, if she dies and if the baby is alive, without spending any time, a lower abdominal incision should be taken and the baby should be taken out. There is one controversial statement that appears in Triskandha that the incision should be taken at the outlet of the Garbhamaarga. The other postoperative treatment in case of the mother will be that of Prasoota.
In case of Retained Placenta, if the medicinal treatment like application of Aparmara, Kalalaavi or Dhoopana (smoke exposure) of vaginal area, by out casted skin of black (Krishn`a) serpent, mechanical devices like putting the hair in the mouth, fails then bimanual pressure should be given to the uterus to expel the retained placenta. If it fails it should be removed manually by the Vaidyas hand. There are no references to placenta acreta in Ayurvedic sciences.
Surgical treatment for Danta-Naad`ee
A sinus through tooth/gum/mandible / skin is usually the result carious teeth, needing removal of tooth with proper debridement and cauterizing the spot. Usually the Danta–Naad`ee develops as a sequel to Krimidanta or Danta-Pupput`a Vidradhi. Developed sinus drains from root of the tooth to skin over the mandible with a constant discharge of pus, serosanguinious nature the treatment consists of removal of a tooth with Lekhana and Agnikarma Chikitsaa on the sinus. If the bone is damaged (Asthividradhi) then scrapping of the bone should also be done.
The second condition is always difficult to give absolute health care management.
Niruddha-Prakasha:
This condition is many a times Sahaaj or sometime acquired due to adhesions of the prepusal skin to (Med`hraman`i) glans. The commonest diseases that are cause for it are Phiranga, Upadansita and repeated UTI. Other causes are unhygienic ways of keeping the prepusal skin in clean condition. Here there is narrowing of external urinary passage (Mootra Maarga) especially with regard to the level of the skin. Surgical treatment consists of dilation of the small opening by S`halaakaa, of upper diameters. If this fails the prepusal skin is excised by keeping the forceps at 12, 6, 3 and g position. This is a type of operation, circumcision , that is described in modern surgery. Such a type of condition is not prevalent in the Muslim community as the excessive skin over Med`hraman`i is excised in their infancy. This is the exact way of keeping the prepusal skin clean where there is excessive water shortage.
Bhinnakosht`ha:
This condition is usually caused by a trauma of horn of different animals over the abdomen. This results in two different conditions
- In this condition the medovarti (omentum) usually comes out through the abdominal wall and is likely to be contaminated by mud or pieces of grass.
Surgical Treatment:
The Medovarti is to be washed thoroughly with water if it is much damaged. The damaged part should first be tied with a thread at the healthy portion and the remaining damaged Medovarti (omentum) should be excised by a hot knife. Excision by hot knife controls the bleeding and also prevents infection. The remaining healthy part should be bathed with ghee and then placed in the abdomen.
The abdomen is then sutured.
- Sometimes the intestines protrude through bhinnavrana over the abdominal wall.
Surgical Treatment:
- If the intestines are not contaminated they should be put back in the abdominal cavity and the abdominal wound sutured.
- If it becomes difficult to put the intestines in the abdominal wall through the existing wound, then the wound should be extended and the intestines returned in the abdominal cavity and the wound is sutured.
- If there is damage to the intestinal wall with bhinnavrana on it, they should be sutured by a special technique called Pippilikaa S`hirograsta (by approximating the intestinal walls, the black ants, should be applied as soon as they take a bite the body of the ant is removed and the procedure is continued till all the The wound is sutured. Now in this condition the abdominal cavity and the intestine are to be cleaned by water and by milk. Intestines are to be applied ghee smear (Ghrita) and then retained in the abdominal cavity.
MushkaBheda:
This is again a type of bhinnavrana caused by trauma to the scrotal wall. One or both Mushkagranthi protrude through the wound.
Surgical Treatment:
If undamaged, the testicles should be replaced in the Mushka-Kosha and the wound is sutured. A T-shaped bandage or Utsangi Bandha should be used till the wound heals totally.
Note:
In all these conditions sutures should be removed after 7 days. The post-operative treatment for Sadyovran`a is to be given for 7 days. In case of Vran`a Dusht`i, the appropriate treatment should be given as post-operative care.
Medicinal smoke by burning particular material Dhoopan Chikitsaa should be given twice a day for 10 days to the wound of the patient along with his clothings and his rooms.
Galgan`d`a:
Surgical treatment is only indicated in medoja galgand (nodular goitre)
The treatment consists of
- Snehana and Swedana followed by an incision over the swelling. The whole Meda is removed from the swelling and on the open wound, Harataala and Manhs`hilaa is applied or Agnikarma also may be done.
Parasurgical treatment consists of Viddha Chikitsaa in the inguinal region
Note:
Galgan`d`a has no tendency to undergo suppuration but sometimes especially after a longtime, the Pittaja Galagan`d`a, may develop inflammation. All measures to control the infection should be taken. It results in ulcer formation, and should be treated as Oordhava- Jatrugata-Vran`a
Traumatic Prolapsed Eyeball:
If after a trauma the eyeball comes out with its attachment intact, then it should be replaced in orbital cavity by application of suitable fat and lotus leaf (Sneha and Kamalapatra). The rest of treatment is to be given of Bhinnavran`a with a special precaution that Pitta–Dosha should not be vitiated.
Galas`hun`d`ee:
Sometimes there is enlargement of Galas`hun`d`ee either due to Galas`hun`d`ee Paaka or Ati-Maamsaas`hana. Inflammatory Galas`hun`d`ee should be treated medically. Other types are treated surgically. The enlarged Galas`hun`d`ee is divided into three parts. A ligature is kept at the level of upper 2/3 and lower 1/3. After putting ligature lower 1/3 is cut off (Chhedana)
Gilaayu S`hastrakarma
No Gilaayu S`hastrakarma has been described in the Sus`htruta Samhitaa
Gudabhrams`ha
After doing placing back of prolapsed portion (Asthaapana) of Gudabhrams`ha, a special type of bandage called Charmabandha having a hole for passing flatus and faeces is used. Now this Bandha is of Gophan`aa or Utsangi type. The treatment is to be continued till the patient gets relief. While doing Asthaapana of Bhrams`ha, use of Chukra Taila or Mooshaka Siddha Taila is useful.
Surgical treatment for Kadara (corn):
Surgical treatment for Kadara consists of
- Excision of Kadara
- Filling the cavity by fat (Godhaamajjaa or Sneha)
- Agnikarma by Loha-S`halaakaa
Udakodara:
This is one phase (Avasthaa) of Yakrut Daalyodara. There is Sthanasams`hraya of Dosha in the abdominal cavity. As far as possible surgical treatment of removal of water is to be avoided but if the medical treatment fails, if the patient gets difficulty in respiration, if he develops severe edema; or if it is likely to develop ulceration, then Viddha Chikitsaa for removal of fluid is urgently indicated. The patient is made upright in a sitting position with an abdominal binder over the upper abdomen.
Snehana and Svedana are done over the lower abdomen, on the left side 4 fingers below and 4 fingers away from umbilicus. A trocar and canula is inserted in the abdominal cavity, the trocar is removed and the canula is kept in site till requisite amount is removed (tap). After removal of fluid, a tight abdominal bandage is to be given to prevent Vaata-Prakopa (due to the pressure of the abdominal fluid on abdominal vessels, they are more or less in a compressed condition. As soon as the fluid is removed they get relaxed and there is more pouring of blood in the vessels. It can sometimes result in hemorrhage)
Vriddhi Chikitsaa:
Wrong localization of intestines or fluids makes appearance as if the part is enlarged (more) in size. This is termed Vriddhi. The surgical treatment varies according to the type of Vriddhi
- Aantra Vriddhi In Aantravriddhi Agnikarma is done only in a reducible and inguinal type of hernia (Vankshan`astha)
Procedure:
- After doing the reduction of the hernial swelling, Agnikarma is done in the inguinal region by: Ardhendu S`halaakaa, half moon outlined metal exactly over the swelling where it appears on coughing, sneezing etc.
- In a case of non-reducible of a inguinal type, (Vankshan`astha) incision should be taken on the opposite great toe on the proximal phalynges, extending from angle of nail bed to the proximal crease followed by Agnikarma
- One more point for the same purpose has been described in Ayurveda located at paritotemporal sutureline (note: 1&2 are the proved facts and the third no common
Mootravriddhi:
In Mootravriddhi, Viddha Chikitsaa has been advised. Now this Viddha is to be done on the lateral side of Sivani on the side where Mootravriddhi is to be located after doing Snehana and Svedana locally. All the fluid is tapped by using trocar and canula. After removal of fluid a tight bandage is applied to prevent Vaata-Prakopa (Please refer to pathology under heading Udakodara)
Medovriddhi:
After doing Snehana and Svedana a bilateral incision is to be taken lateral to the Sivani (Rufae). The whole Meda is removed and cavity is dressed by Harataala and Manhs`hilaa. Harataala and Manhs`hilaa are to be used till the wound heals.
Raktaja and Pittaja Vriddhi:
Treatment is nothing but incision and drainage if it undergoes suppression. Post operative treatment consists of all Pittaghna Vran`a–Upachaara both externally and internally.
Kaphaja and Vaataja Vriddhi:
These are to be treated medically still if they undergo suppressive changes treatment of Baahya Vidradhi is to be given.
Bhagandara:
In a surgical treatment more consideration is given to the type of Naad`eevran`a namely Chandraardha, Chandra–Chakra and Sarvatobhadra instead of taking into consideration the type of Dosha. The two types of Naad`eevran`a are not to be described in the main:
Gotirthaka where Naad`eevran`a is of zigzag nature
Kharjurupatraka where there is one single main nadi with multiple branching. This variety we get in S`hataponaka Bhagandara. These two varieties are to be derived from the types of incisions that have been described earlier.
Treatment:
The treatment mainly consists of excision of whole fistulas tract. Before doing procedure of excision Eshan`akarma is to be done to confirm the type of Bhagandara. Types of excisions for this type of fistulas are namely as follows:
- Laangalaka Plough
- Aardhalaangalaka half plough
- Sarvatobhadra
- Gotirtha
- Kharjurpatra
Now these Bhagandara_s are of two types
- Avachina
- Paraachina
In case of Paraachina Bhagandara (blind internal) usually Ksharkarma and Agnikarma are indicated. In case of Antar Bahirmukha. Bhagandara, usually the Kshaarsootra is indicated. Kshaarkarma and Agnikarma could be done in any type of Bhagandara where Kapha and Vaata predominates. All the Chheda_s and Naad`eevran`a_s are illustrated elsewhere.
As`hmaree:
In case of As`hmaree , Ayurveda takes it as a neat a fatal operation. But by keeping the As`hmaree as it is, it also may take the life of the patient. So to do a surgery on bladder located Bastistha As`hmaree is like taking a chance to save the life of a patient. The patient is given lithotomy position and a para-periurethral incision is taken on the left or right perineal region by keeping one finger in the rectum. By putting the other hand over the lower abdomen the stone is brought down in such a way, so as to it could be fixed by the finger in the rectum. Now the incisions taken over the bladder, which is divided of the peritoneal line and the whole stone is removed by As`hmaree Nirharan`a Swastica Yantra. The bladder should not be opened at two places as it results in death of the person. As Savarn`a Prades`ha of Basti is damaged (resulting into contamination of the abdomen by the extravasated urine which is the cause for death and thats why it is described as Sadyopraan`ahara Marma. This death time may occur immediately or in 15 days. While taking the incision over the bladder one is to take care in not injuring the rectum, uterus in case of a female which is exactly behind it and S`hukravaha Dhamanyaa and Baahya Mootramaarga). After removal of the stone bladder it should be irrigated well. The stone should be removed completely without leaving behind any particle, which may again form the As`hmaree. After removal of the As`hmaree, there remains a Vran`a, which drains the urine called Mootravaahi Naad`ee Vran`a. Normally it heals naturally in 7 days. If it does not, Agnikarma should be done
Baddhodara:
These are the varieties of Udara Roga. Charaka has rightly said that these two conditions should only be treated by Dhanvantari i.e. a surgeon.
Sus`hruta advises a left lateral lower paramedian incision (Four Angula_s below and lateral to umbilicus) now this incision was the correct incision, which facilitates when anaesthesia was not available. According to modern science also the intestines in the left iliac fossa are very free to move and secondly there is no posterior rectur sheath four finger below umbilicus. This was the easiest place to enter the abdominal cavity in a single stab incision.
Chhidrodara:
After opening the abdominal cavity look for the site of perforation if any evidence of foreign body there to remove it and suture the intestinal wound by applying the black ants [Pipilikaa S`hirograsta]. As soon as they take the bite, keep the head as it is and remove the body. This is the first kind of non-absorbable suturing material that has been used for the first time in Ayurveda in the history of surgery. Close the wound, as in Baddhodara. After this operation a special dietary regime has been advised by Ayurveda. It consists of milk and Maamsrasa to be used in proportion of one part of soup or milk with 3 parts of water.
Then two: Two [equal parts].
Then three: One
Then full milk.
Last updated on March 2nd, 2021 at 09:42 am