Pr. Dr.R.B.Gogte
GFAM, AVP
Ayurveda says that no one science is perfect and one must get the help of other related sciences and give a relief to the patient in the best way without producing new complications.
Along with the knowledge of Charaka, Sus`hruta and Vaagbhat`a, I have also studied many other books on other paths. My favorite books are Surgical Anatomy by Mc.Gregor, Surgical pathology by Ellingworth, Principles of Surgery by Schwartz, Chinese Acupuncture and Moxibustionby Cheng Xinnongand Hasti Ayurveda by Paalakaapya. After practicing and teaching surgery, it appears to me that Modern Surgery is a Replica of Ayurvedic Surgery (minus changes due to anaesthesia, investigation facilities pathology, Radiology etc.). I have quoted few examples only to support my understanding
Puncture: Peritoneal Cavity
(S.Chi. 14/18)
Viddha is to dig hole or puncture. The cavity is punctured to evacuate fluid (or to insert some inert gas). By this route also fluid and blood may be administered to children. The customary site chosen is a point 1below & 1 to the left of the umbilicus. The needle can be felt to pierce first the anterior sheath of the rectus, then the post – rectussheath and peritoneum as it enters the cavity. The bowel in this situation is the small intestines. This gut is freely mobile and if encountered is displaced by the needles without injury. (A synopsis of surgical anatomy page 758, by M.C.Gregor)
Ayurveda advocates the same procedure but it is little bit at the lower and outer levels at about 5 cms. with an additional advantage of immediate entry into the peritoneal cavity by piercing the anterior rectussheath.
Abdominal Incision in Obstruction and Perforation:
S.Chi. 14/17
This is a pararectal(muscle) incision. On the left side it divides anterior rectussheath in the line of the skin cut, the rectusis pulled in words. The post. rectussheath in the line of the skin cut, fascia, transversalisand peritoneum in the line of the skin cut. This incision may be prolonged up or down or both to give access to the pelvis and ascending colon. The advantage in this incision when anaesthesia was not available was of suturing all the cut structures in one suture line. The incision is a little modification i.e. it is still below where the post rectussheath falls short and little away from the border of the rectusmuscle. It is always on the left side as the intestines are more mobile and are less liable to injury during the cutting procedures on abdominal wall. (Synopsis of Surgical Anatomy Mc.Gregor, Page 676)
S.Chi.2/56
In perforation of the G.I. tract here Ayurveda has used a non-absorbable material of animal origin. (Tongs of the big black ants) Very easy to apply in a short time and very firm. (Easy way of surgery when anaesthesia was not available) It is just like the clips used in laparoscopicsurgery. The writer himself has used it in Frogs C.I. tract, the stomach and proved it to be successful.
Peritoneal Lavage In Perforation And Peritonitis –
S.Chi.2/57
This is washing of the intestines and peritoneal cavity in perforation (G.I.tract) 1000 yr. B.C. The material used was milk.
Intra operative high volume lavageThis treatment involves extensive intra-operativelavageof the entire abdominal cavity by 1 to 1.5 L. of physiological saline or Ringers Solution, which is placed in the abdominal cavity. The viscera are manipulated so that the fluid reaches all part of the abdominal cavity to wash pus, faeces, necrotic material and then the fluid is suctioned off.
S.Chi. 14/17
Haemorrhage in Gastro intestinal tract. It may involve stomach or colon. The treatment is removal of the clotted blood /blood from G.I. tract by vomiting or by purging (modern treatment enemata)
S.Chi. 2-17
S.Chi. 2/16.17
S.Chi. 2/52
Gastro intestinal bleeding Principles of surgery. Schwartz page 1032
Gastro intestinal tract bleeding is usually divided into upper gastro intestinal (Aamaas`hayagata) and lower gastrointestinal (Pakvaas`hayagata) U.G.I. bleeding is usually from a source in the Oesophagus, stomach and duodenum, whereas LGI bleeding is usually from the colon, rectum or terminal ileum. Vomiting of blood usually represents U.G.I. bleeding proximal to the ligament of treitzwhile coffee ground vomitususually is slower rate bleeding.
Lesions below the ligament of treitzthat bleed are considered as L.G.I.
Treatment A textbook of surgical pathology ElingworthPage 248. Apart from the blood loss and resulting hypoxia, Haemorrhage into gastro intestinal tract has been thought to be harmful through absorption of products derived from extravagatedblood. It is known that blood urea level commonly rises and this has been ascribed to absorption of blood products from intestines. Though it is clear that a rise of blood urea may be a result from hypoxic renal damage. The blood is removed by stomach wash or Colonicwash.
Matress horizontal interrupted sutures
Simple stitch (interrupted) a suture formed by a single stitch inserted separately, the needle usually being passed through one lip of wound from without outwards and another from within outwards.
Continuous spiral. The closure of wound by mean of one continuous thread usually by transfixing one edge of the wound
Subcuticular. A buried continuous suture in which the needle is passed horizontally under the epidermis, the cutis vera. 1871 Tabers cyclopaedicmedical dictionary.
Suturing Needles:
Straight cutting
Straight round body
Curved round body S.Su. 34/5
S.Chi. 34/5
This is the eyeless, atraumaticneedle, curved to be used for suturing the Gastro-intestinal structures, stomach, colon. The eyeless needle is the latest invention in Modern Science.
Sterilization: A process of completely removing or destroying all Micro organisms on a substance by exposure to physical or chemical agents, exposure to ionizing radiations tabers cyclopaedicMedical Dictionary. 1831.
Physical agents heat, cold, electricity,
Fumigation: Dis-infectionof rooms by gases, use of poisonous fumes or gases to destroy the organisms.
Heat- S.Su. 2, 45-46
Fumes
S.Chi. 40/19
S.Su. 19/28
C.Sha.8 / 61
Concept of hypoprotenimiaand wound healing
C. 81
C. 82
S.Chi. 81-82
It happens that many a times wounds do not heal though they are clean and aseptic. The cause is hypoprotenimia. It is also one of the causes of wound disruption. Blood transfusion plasma or protinexis given in modern surgery. Ayurveda recommends a meat diet.
Lithotomy or EdebohisPosition
S.Chi. 7/30
The patient in dorsal decubitus with hips and knees flexed and thighs abducted and externally rotated. Dorsal position, the knees and thighs drawn up, legs flexed on thighs and thighs flexed on belly, the hip raised and thigh abducted.
Left lateral position, Simsposition
18 C. C.3
A patient lies on the left side with chest, right knee and thigh drawn up; the left arm is along the back
Basti Sadyo Praan`ahara Marma
Extravasation of Urine
It only becomes Praan`ahara in trauma or during the surgery of removal of stone, if the bladder gets cut at two places resulting in extravasationof urine in abdomen. Sterile urine is extremely irritating to the peritoneum the chemical result is frequently followed by secondary infection. It also initiates bacterial peritonitis. In addition to the direct peritoneal irritation caused by hyperosmolarurine, re-absorptionof acidic metabolic acid end products and urea leads to acidosis and uraemia. (Pg. 1466 Principles of Surgery. Schwaartz)
S. Chi 7/33
I have seen such two patients one of TUR when the current jumped and resulted in intra-peritonealrupture of bladder resulting in death even when prompt treatment was given by suturing the bladder and drainage when anaesthesia was available. I have also seen another patient when the bladder was opened at two places accidentally during an operation of tubectomy. Prompt treatment was given and the patient was serious for one month but later on recovered. It was her good luck!
Think of surgery at a time when anaesthesia was not available!
Haemostasis is a must before you suture the wound
S.Su.25
S.Su. 14
S.Chi.2
A.H.Su.29/49
Haematoma impairs wound healing by providing a medium for bacterial infection (Paaka) as well as it acts as the mechanical barrier to the opposition of tissue edges. The surgeon should be fastidious in assuming; there is no bleeding before closure Schwartz. Principles of surgery 457.
Prolonged bleeding or clothing time important factor in Plastic surgery
Haematoma forming under split thickness skin grafts and prevents vascularizationand adherence, with subsequent graft failure. Similarly haematomasforming under soft tissue flaps may impair blood supply, leading to flap necrosis. Underlying disorders of coagulation (Askandi and Chirastraavi) both acquired and hereditary increase the likelihood of this complication. An increase in number of haematomasfollowing plastic surgery procedures in patients experiencing postoperative hypertension (S`heeghram) has been reported.
S.Su. 14/21
S`heegrah With forced spurts. Askandhi Prolonged clotting time. Chirastraavi Prolonged bleeding time.
S.Su. 16/14
S.Su. 16/17
Blood loss to be stopped immediately to save life
S.Su. 14/44
S.Su. 39
A.H.Su. 28/50
S.Su. 14/39, 40
S.Su. 14/36
A.H.Su. 27/43
Ligations of bleeders
S.Su. 14/40
(Cold contracts application of cold things)
S.Su. 14/39
It is a removal of a clot or slough
S.Su.14/40
Local Haemostasis:
Surgical bleeding, even when alarmingly excessive, is usually caused by ineffective local Haemostasis. The goal of local Haemostasisis to prevent the flow of blood from incised or transected blood vessels. This may be accomplished by interrupting the flow of blood to the involved area or by direct closure of the blood vessel wall defect. The technique may be classified as mechanical-digital pressure, tight bandage, direct pressure applied by mean of packs, ligationof bleeder (suturing) Sandhaaan Thermal 1. Electro cautery. Heat achieves Haemostasisby denaturationof proteins. Daaha (Ayurveda advocates this method as a last resort because, its disadvantage is that more tissue is necrosed than with precise ligature which modern medicinealso accepts. Temp is 20 to 100 M.A)
2. Extreme cooling Skandana. This is caused by dehydration and denaturationof lipid molecules. Temp is 20 to 180oC.
Chemical Agents (Bhasma) + Kashaaya Rasa + S`heet Pichchhaa Dravya
Chemical agents vary in their Haemotaticaction. Some are vasoconstrictive, while others have coagulant properties. Still others are relatively inert but possess hygroscopic properties, which increase their bulk and dig in plugging disrupted blood vessels.
Schwartz, Principles of Surgery
Khadira hygroscopic. Lodhra Gel formation, Apaamaarga Kshaara Clot breaking (Bhasma) is being used by this author and has borne good results.
Replacement of blood is a must if the blood loss is more
S.Su.14/36
S.Su. 14/9
S.Su. 14/30
Ayurveda advocates oral blood of different animals as rabbit, buffalo etc. Modern science advocates I.V. Blood transfusions. Blood has been described as a vehicular organ that perfuse all other organs. It provides transportation of oxygen to satisfy the bodys metabolic demands and removes the by-product carbon dioxide. Blood also transports chemical nutrients and waste products from metabolic activity Haemotaticgovernors including hormones, coagulation factors, and antibodies are carried to and from appropriate sites within the fluid portion of the blood. Red blood cells, with their oxygen carrying capacity, white blood cells, which function in body defense processes and platelets, which contribute to the Haemotaticprocess, comprise the formed elements.
This proves the Paanchabhautikatva of blood
Principles of surgery SchwarthzPage 111
Treatment of traumatic wounds
According to Ayurveda all traumatic wounds are to be sutured as it helps quick healing of a wound with some contraindications.
A.H.Su. 29/49
S.Chi. 1/15
All postoperative and deep wounds are to be sutured
S.Su. 25/17
A.H.Su. 49/51
S.Chi 1.45
C. Chi. 25/65
Contra indications of suturing
Wounds in mobile zones, suspected foreign body, pus or Haemorrhage inside
Wounds created by wild animals
Tracheostomy, of lungs opening outside, 3 wounds contaminated with chemicals and of burns
Ayurveda also states that if the muscles are cut they are also to be Re-sutured. 4 Post-operative wounds after doing the surgery, for obstruction, perforation, removal of cysts etc. are to be sutured.
S.Chi. 2/56-61
Wound healing has been described throughout recorded history. Empirically, the ancients recognized that foreign bodies and dead tissues must be removed from wounds. They knew that cleanliness prevents infection and pus required drainage Wound elixirs such as honey decreased wound suppuration (hyopertonicglucose is bactericidal) and fresh open wounds could be closed primarily using hairs, cloth or insert jaws.
Principles of surgery, Schwartz p. 279
Suturing Materials in Ayurveda
S.Su. 25-20-21
Non-absorbable. Hairs threads derived from cotton, silk, jute and tendrils of climbers heads of black big ants.
Absorbable Snaayuprataana muscle or facial strips
Mechanical wound closure
The materials used for wound closure are much less important than the technique of closure. Basically sutures may be classified as absorbableand non-absorbable. The absorbable are synthetic such as poly-glycolic acid or biologic such as catgut (Snaayuprataana), which is plain or chromium treated. They are absorbed and will not be nidusfor late infection. Non-absorbable sutures are used on the skin because they are less reactive and allegedly provide a better appearing scar. Any woven suture is more prone to infection than a smooth suture because bacteria can become entrapped in the interstices a woven suture and are not destroyed by normal host response.
Principles of Surgery Schwartz
Secondary Suturing of the wound
A.H.Su. 29/56
In doing secondary suturingthe edges of the ulcer/wound should be scraped till it bleeds and then the suturing should be done. In delayed primary closure. Delay in closure is indicated to prevent infection in those wounds where there is significant bacterial contamination, foreign bodies or extensive tissue trauma. In the open wound being prepared for delayed primary closure, angiogenesisproceeds to provide enhanceblood supply and needed oxygen. Leukocytes are attracted to destroy and remove bacteria. (This is only possible when there is free bleeding from scraped edges of old wound)
280 principles of surgery Schwartz
When to remove sutures
Sutures are to be removed on the seventh day as the treatment for traumatic Wound or operate wound is only for seven days, modern science says the same.
A.S.U.31
Varieties of suturing
- Mattress
- Subcuticular
- Simple stitch
Interrupted S. Su. 25 / 21-22 - Spiral continuous
Pr. Dr.R.B.Gogte
Ex – Professor and H.O.D. Department of Shalya,
Tilak Ayurved Mahavidyalaya and Hospital, Pune.
Last updated on March 3rd, 2021 at 07:23 am