Sushruta Samhita, volume 1: Sutrasthana

by Kaviraj Kunja Lal Bhishagratna | 1907 | 148,756 words

This current book, the Sutra-sthana (english translation), is the first part of this voluminous medical work. It contains a large summary of the knowledge envelopig the medical aspects of Ayurveda. Descriptions of diseases, various diets and drugs, the duties of a surgeon, surgical procedures, medical training; these are only some of the numerous s...

Chapter XXV - Eight kinds of surgical operations

Now we shall discourse on the Chapter which deals with the eight different forms of surgical operations (Ashtavidha-Shastra- Karmanya-adhyaya).

Metrical Texts:—

Bhagandara, Shlaishmika Granthi, Tilakalaka, Arvuda, Arsha, Carma-Kila, Jatumani, Mansa-Samghata, Gala-Sunthika, Valmika, Vrana-Vartma, Shataponaka, Adhrusha, Upadansha, Mansakandha, Adhimansaka, as well as ailments due to the lodgment of a foreign body in the flesh or a bone, and a sloughing of ligaments, flesh or veins are the diseases in which incision (Chedyam) should be made.


Excision (Bhedya) should be resorted to in the following diseases, viz., Vidradhis, the three types of Granthi other than the Sannipatika one, Visarpa due either to the deranged Vayu, Pitta or Kapha, Vriddhi, Vidarika, Prameha-pidaka, swellings in general, diseases affecting the mammary organs, Avamanthaka, Kumbhika, Anushayi, Nadi, the two types of Vrinda, Pushkarika, Alaji, Kshudra-roga (all minor cutaneous or pustular diseases), the three types of Puppata, Talu-puppata, and Danta-puppata; Tundukeri, Gilayu, and the diseases which are caused by suppuration in the local flesh or any soft part of the body (such as fistula in ano), as well as stone in the bladder and diseases due to a derangement of fat.[1]


The surgical operation known as scarification (Lekhya) should be resorted to in the following diseases, viz, the four types of Rohini, Kilasa, Upajihva, diseases having their seat in the deranged fat, Danta-Vaidarbha, Granthi, Vrana-Vartma, Adhi-Jihva, Arshah, Mandala, Mansa-kandi, and Mansonnati.


The Surgical operation known as Vyadhana (aspiration should be made use of in connection with a vein, or a case of Dakodara (abdominal dropsy), or Mutra-Vriddhi (hydrocele). Diseases, in connection with which the probe or the director should be used, are Nadis (sinus) and ulcers with any extraneous or foreign body lodged in their inside, and those which follow abnormal (lateral or oblique) directions.


The process known as Aharana (extraction or drawing out) should be adopted in the three types of Sharkara,[2] in drawing out any morbid matter from between the teeth or from the cavity of the ears, or in extracting any foreign matter from its seat of lodgment in the body, or a stone from the bladder, or in drawing out feces from the constricted anus, or a fetus from the uterus, (as in the case of a false presentation or difficult labour).


Secreting or evacuating measures (Sravya) should be adopted in the following diseases, viz, the five types of Vidradhi excepting the Sannipatika one, Kustha of whatsoever type, derangement of the bodily Vayu with pain in the affected region, inflammatory swellings restricted to any particular part of the body, diseases affecting the ear-lobes, Shlīpada (elephantiasis), blood poisoning, Arvuda (tumours), Visarpa (erysipelas), Granthi (glands due to any of the deranged Vayu, Pitta, or Kapha) the three types of Upadansha (syphilis), Stana-roga (inflammation of the mamme), Vidarika, Shaushira, Gala-Shaluka, Kantaka, Krimi-dantaka (worm-eaten teeth), Danta-veshta (inflammation of the gums), Upakusha, Shitada, Danta-puppata, diseases of the lips originated through the action of the deranged blood, Pitta or Kapha, and a variety of other diseases passing under the denomination of Kshudra-Roga (minor ailments).


Suturing (Sīvya) should be resorted to in the case of an open ulcer due to the action of the deranged fat after its vitiated contents (morbid matter) had been fully scraped out, as well as in the case of an uncomplicated (curable) Sadya-Vrana (wound or instant ulcer) at any of the joints which are connected with the acts of movement or locomotion.

Conditions of Suturing:—

An ulcer incidental to the application of fire (cautery), or any alkaline preparation (caustic), or treated with any poisonous drug or substance, or from whose inside the embedded Shalya (foreign matter) has not been removed, should not be sewed up without being thoroughly cleansed and purified (asepsised) inasmuch as any foreign matter, whether a hair, nail or a particle of dust or bone, lying embedded in its cavity, might set up an abnormal suppuration, accompanied by extreme pain and excessive secretion. Hence such ulcers should be thoroughly cleansed (and all foreign or indigenous morbid matter should be extracted therefrom) before being sewed up.

Mode of Suturing:—

Then having pressed the ulcer up into its proper position, it should be sutured with strings of any of the following kinds, viz. of thin cotton thread, of the fibres of the Ashmantaka tree or hemp plants, or of the Atasi, Murva or Guduci, or with strips of leather, plaited horsehair or animal sinews, into any of the officinal shapes (of suturing) known as the Gophana, Tunna-Sevani and Riju-Granthi, etc. or as suited to the shape and position of the ulcerated part. The margin of the ulcer should be gently pressed close with the fingers during suturing. A round needle to the length of two fingers’ width should be used in sewing up an ulcer occurring about any joint or in a part of the body where the flesh is thin and scanty. A needle of a triangular body (tri-hedral), and measuring three fingers’ width in length, is recommended in the case of an ulcer appearing at any fleshy part of the body. A semi-circular or bow-shaped needle should be used in a case where the seat of the ulcer would be found to be on the scrotum, or on the skin of the abdomen, or about any of the Marmas (vital parts).

Needles of these three shapes should be so constructed as to be fitted with sharp points capable of being handled with the greatest ease, having a girth equal that of the stem of a Malati flower.

The needle should not be pricked into a part too near, or too remote from the fissure, or the mouth of an ulcer, as there might be the danger of the suture being broken off (at the least pressure or movement) in the first instance and of genesis of pain in the second. An ulcer, thus properly sutured, should be covered over with cotton and dusted over with a pulverised compound consisting of the powders of Priyangu, Anjana, Yasthyahva and Rodhra, or with the ashes of a burnt piece of Kshauma cloth, or with the powders of the Shallaki fruit. Then the ulcer should be properly bandaged, and measures and rules regarding the regimen of diet, and conduct previously laid down in the chapter on the nursing of an ulcer-patient (Ch. XIX.) should be adopted and observed.

The eight kinds of surgical operations have thus been briefly described. They will be dealt with later on in the Chikitsita.

Defective Surgical Operations:—

These eight forms of operations may be attended with dangers of four different kinds such as those arising from an insufficient or over performance, or from the slanting or oblique deviation (of the knife or the instrument), or from an act of self-injury on the part of the physician.

A physician (surgeon) making a wrong operation on the body of his patient either through mistake, or through the want of necessary skill or knowledge, or out of greed, fear, nervousness or haste, or in consequence of being spurned or abused, should be condemned as the direct cause of many new and unforeseen maladies. A patient, with any instinct of self-preservation, would do well to keep aloof from such a physician, or from one who makes a wrong or injudicious application of the cautery, and should shun his presence just as he would shun a conflagration or a cup of fatal poison.

On the other hand, a surgical operation, carried to excess, (or a surgical instrument inserted deeper than what is necessary, is attended with the danger of cutting or destroying a vein, ligament, bone, joint, or any vital part of the body.[3] A surgical operation by an ignorant surgeon brings about, in most cases, the instantaneous death of the patient, or consigns him to the pangs of a life-long death.

The symptoms which generally manifest themselves in connection with the injudicious hurting of any of the five vital parts or principles of the body (such as the joints, bones, veins, ligaments, etc.) are vertigo, delirium, loss of bodily functions, semi-insensibility (comatose state), incapacity of supporting oneself, cessation of mental functions, heat, fainting, looseness of the limbs, difficult respiration, excruciating pain or pain peculiar to the deranged Vayu, secretion of blood or a thin watery secretion like the washings of meat from the injured part, or the organ, with coma or inoperativeness of all the senses. A vein* (Shira) any way severed or injured is attended with a copious flow (hemorrhage) of deep red blood, resembling the hue of the cochineal insect, from the ulcer; and the deranged local Vayu readily exhibits all its essential characteristics, and ushers in diseases which have been enumerated under that head in the chapter on the description of blood.)

Similarly, an injured ligament gives rise to a crookedness or bending of, as well as to a gone feeling in the injured limb or organ, attended with pain and loss of function, and the incidental ulcer takes a long time to heal.

An abnormal increase in the local swelling, together with an excruciating pain, loss of strength, breaking pain in the joints, and in-operativeness of the affected part, mark the wounding of a flexible or immovable joint. Similarly, in the case where a bone is hurt or injured in the course of a surgical operation, the patient is tormented with indescribable pain, day and night, and finds no comfort in any position whatsoever. Pain and swelling specifically mark the affected locality, and thirst and inertness of the limbs add to the list of his sufferings.

A case of any injured Sira-Marma (vital venal or arterial combination or plexus) exhibits the same symptoms which characterise the hurting of a single vein, as previously described. Loss of actual perception (anesthesia), and a yellowish colour of the skin mark the case where the injury is confined to the vital principle of the flesh.

A patient, who is discreet, and is not in a special hurry to end his earthly sojourn, would do well to shun the presence of a bungling, unskilful surgeon, who can not even keep himself unhurt in the course of a surgical operation.

The evils, which attend the oblique insertion of a surgical instrument, have been described before; and accordingly care should be taken not to leave any room for the occurence of those evils in connection with a surgical operation.

The patient, who may mistrust his own parents, sons and relations, should repose an implicit faith in his own physician, and put his own life into his hands without the least apprehension of danger; hence a physician should protect his patient as his own begotten child. A surgical case may yield to a single incision, or may require two, three, four or more than that number to effect a cure. By doing good to humanity with his professional skill, a physician achieves glory, and acquires the plaudits of the good and the wise in this life, and shall live in Paradise in the next.


Thus ends the twenty-fifth Chapter of the Sutrasthana in the Sushruta Samhita which treats of the eight forms of Surgical operations.

Footnotes and references:


Granthi (gland), Galaganda (goitre), Vriddhi (scrotal tumour) Apachi (scrofula) and Arvuda (tumour) are the fat-origined diseases contemplated as instances.


Such as urinary calculi, calcareous deposits on the teeth, and Pada-Sharkara.


Other than the one situated in any of the abovesaid vital parts of the body.

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