Siravyadhana in Parivartika – A scientific review

P a g e | 148 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION International Research Journal of Ayurveda & Yoga An International Peer Reviewed Journal for Ayurveda & Yoga ICV-70.44- ISRA-1.318 VOLUME 4 ISSUE 5 1 Assistant professor, Dept. of Shalya tantra , Sanskriti Ayurvedic Medical College & Hospital, Mathura(U.P) 2 Assistant professor, Dept. of Sharir rachana , Dhanvantari Ayurvedic Medical College & Hospital, Bareilly(U.P) 3 Assistant professor, Dept. of Shalya tantra , YET’s Shri Shiddharameshwar Ayurvedic Medical College & Hospital, Bidar(Karnataka) Corresponding Author:- Dr.Sayantan Chakraborty Assistant professor, Dept. of Shalya tantra, Sanskriti Ayurvedic Medical College & Hospital, Mathura(U.P) Article revised on 4 th May 2021 Article Accepted 23 rd May 2021 Article published 31 st May 2021 ABSTRACT: - Parivartika or paraphimosis is a very painful emergency condition. Here vitiation of Vyanvayu at Medra Charma (prepucial skin) that is why circulation of penis hampered. And then gradually Kapha And Pitta vitiation may occur and symptoms like Kandu (Itching), Daha (burning sensation), Paka, Sotha (inflammation) appears. The Siravyadhana releases the polluted Vyan Vayu as well as Pitta and Kapha that’s why Acharya Sushruta advocated this minimum invasive procedure. In modern science dorsal slit or multiple puncturing is done to reduce oedema which creates more exposure to infections. By seeing these two Sira Vyadhana (single minimum invasion) can be effective in case of Parivartika Keywords: - . Sira Vyadhana, Parivartika, paraphimosis This work is licensed under a creative attribution -Non-commercial-No derivatives 4.0 International License commons How to cite this article: Dr.Sayantan Chakraborty, Dr.Debasis Kundu, Dr.Leena Nayak “ Siravyadhana in Parivartika – A scientific review ” IRJAY, May: 2021, Vol-4, Issue- 5;148-151 ; DOI: https://doi.org/10.47223/IRJAY.2021.4502 Siravyadhana in Parivartika – A scientific review Dr.Sayantan Chakraborty 1 , Dr.Debasis Kundu 2 , Dr.Leena Nayak 3

P a g e | 149 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION INTRODUCTION: According to Acharya Sushruta Sira Vyadhana (venesection) is Ardha Chikitsa Of Shalyatantra Like Vasti Karma (medicated enema) which is half of kaya chikitsa 1 As the pure blood is one of the important factor for Bala (strength), Varna (colour), Sukha and Arogya (good health) it is our responsibility to maintain it 2 Acharya Sushruta as well as Acharya Vagbhata opines that Rakta (blood) is the main Dushya to create any disease process 3 Sira vyadhana (venesection) is one of the procedures of Rakta Mokshana (bloodletting) and being Ardha Chikitsa Of Shalya Tantra Sira Vyadhana (venesection) should be done to get faster relief. Acharya Sushruta mentioned total 700 Siras (veins) in human body 4 and he divides it into 2 categories Vedya or which can be punctured and Avedya or which cannot be punctured. In human body 98 siras 5 are Avedya and remaining’s can be puncture. According to Sushuta Medra Madhya sira can be punctured in case of Parivartika (paraphimosis) , Upadamsa (Syphilis), Sukadosha (disease affecting the genital (penis) And Sukra Roga 6 AIMS & OBJECTIVES: 1-Importance of Sira Vyadhana (venesection) in Parivartika (paraphimosis) . 2-To evaluate the specific anatomical demarcation for SiraVyadhana In Parivartika. MATERIAL & METHODS: Acharya Sushruta specifically mentioned the site of Sira Vyadhana (venesection) in Parivartika (paraphimosis). under the title of Vyadhya Siras in Sira Vyadh Vidhi Sharir Adhyaya. Other acharyas like Charaka, Vagbhata etc did not mention such type of specific site. For literary material related to Sira (veins) and Parivartika (paraphimosis) various Ayurvedic text book like Charaka Samhita, Sushruta Samhita, Astanga Hridaya etc. and some modern anatomy books like B.D. Chaurasia, surgery books like SRB’S manual of surgery, A concise text book of surgery (S.Das) and some article related to Sira Vyadhana are critically reviewed and correlated to modern terms. Disease review: Parivartika is a condition where retraction prepucial skin and a Granthi (knot) like structure hangs down from glans penis. Here due to excessive massage, pressure or trauma causes vitiation of Vata At Medra Charma ( prepuce), that cause Vedana (pain), Daha (burning sensation) and Paka (suppuration) occasionally. Then due to Kapha Prakopa Kandu (itching sensation) and hardness of the knot may be takes place 7 Parivartika can be correlated with paraphimosis. It is the condition where inability to place backs the retracted prepucial skin over glans penis 8 . Here formation of constriction band of prepucial skin over corona gland is causes obstruction of venous out flow, leads to oedema and congestion of glans penis which causes more difficulty in retracting back the prepucial skin and this cycle repeats. It is an emergency condition where the patient presents with pain & swelling of glans penis. The gangrene may form if the constriction band is not released 9 Parivartika is a disease caused by vitiation of Vata so Snehana (oleation) Swedana (sudation) is done then Avyanga by Ghrita should be done followed by Upanaha Sweda (poultice) by Vata Ghna Dravyas . Vataghna vasti may be given 10 In the treatment of paraphimosis firstly manual reduction of prepucial skin can be tried. Then multiple puncture by needle over edematous part or one dorsal slit can be made to reduce the oedema. Lastly circumcision can be done. So the main aim is to reduce the oedema. Anatomy of penis: Two corpora cavernosa (right & left)

P a g e | 150 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION goes parallel upto glans penis. These two muscles are bounded by a fibrous envelop tunica albuginea. Ventrally another erectile tissue comes parallel to corpora cavernosa, and then its terminal part expanded to form conical glans penis. Throughout its whole length it carries the urethra which is surrounded by a fibrous sheath. The skin covers the penis which is loosely connected with the fascial sheath of the organ. The skin is folded at the neck which covers the glans penis, called prepuce or foreskin. On the under surface of this skin there is a median fold, called frenulum 10 Superficial fascia covers the penis superficially which is continuous with superficial fascia of abdomen and it contains superficial dorsal vein of the penis. Deep layer of superficial fascia called deep fascia of penis, surrounds all the three erectile tissue and it contains deep dorsal vein, dorsal artery, and dorsal nerves 11 The Deep artery which supplies corpora cavarnosum. The dorsal artery supplies glans penis, distal part of corpus spongiosum, prepuce and the frenulum. Artery to the bulb of penis supplies the bulb. Superficial external pudendal artery which is a branch of femoral artery supplies to skin and fascia of penis 12 Superficial dorsal vein drains the prepuce and penile skin. Deep dorsal vein drains the blood from corpora cavernosa and glans penis 13 DISCUSSION: In the Samprapti (Pathogenesis) we can see that the pain, Paka (suppuration) and hardness, Kandu (Itching) is due to Vata, Pitta and Kapha vitiation respectively. As we know in case of Tridosha vitiation Sira Vyadhana (venesection) can be done. Acharya Sushruta and Acharya Vagbhata advised Medra Madhya Sira Vyadhana (venesection) in case of Parivartika . The prominent superficial dorsal vein situated on the dorsal aspect of the penis is most suitable for Sira vyadhana (venesection) . 14 On the other hand the main aim is to reduce oedema. Main venous drainage of prepucial skin is superficial dorsal vein which drains the blood from penile skin and prepuce. In case of Parivartika or paraphimosis there is venous congestion and oedema takes place and patient unable to place back the retracted, oedematous prepucial skin. So if Sira Vyadhana is done in this vein oedema will be reduced gradually. By this procedure the patient gets relief with minimum invasion and exposure. CONCLUSION: So from the above discussion it is very much logical and may be effective procedure of Sira Vyadhana (venesection) in case of Parivartika . And by this procedure the patient can gets relief with minimum invasion and exposure Dorsal slit

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