At some point of medical evolution we seem to have forgotten the basic contribution that was made by the Vedic Literature to make the documentation. After Vedas the Susruta samhita is only available text of Vedic surgical skill. Many more references are also available in other Ayurvedic texts. In different Puranas these examples are quoted in the forms of stories. Vagbhatta samhita is another milestone in this field. Our under standing of the ancient Vedic medical skill is limited due to lack of Vedic textual knowledge. In this consideration review of the Ayurvedic Literature is necessary for the better out come.
A number of examples are available in different texts about the zenith of surgical skill at that time. Susruta has taken the lead in this regard to deal with numerous surgical procedures. From incision and drainage operation of an abscess to reconstructive surgery Susruta passed a very long way. His command over all the branches of surgery is remarkable. Surgical and para surgical procedures are discussed extensively in the text. Apart from this he described surgical instruments, wound management, importance of blood in surgery and principles of plastic surgery. It can be observed from this sort of description that the Indian surgery is scientific out come of the vast manual experience of the surgical practitioners during thousands of year.
In present context when the modern surgery is on its peak, a part from simple surgical procedure, organ transplantation, surgical and Para surgical procedures on brain are very common in highly specialized centers of India and abroad. These techniques are boon for the suffering humanity.
Previously impossible operations became common with the high tech instruments and the advent of anesthesia. Transplantation of heart, kidney and liver are the landmarks of modem surgery. Anesthesia plays an important role in these operations. Especially organ transplantation, neuro surgery and plastic surgery are more dependable on anesthesia.
Millions of surgeon, physician, anesthetist, other scientist and research personnel of biosciences contribute the network of modern surgery in India and abroad. The modern surgery is progressing day by day but every science has its limitations and scope. After the invention of LASER, cryosurgery and endoscopic surgery, operations became easier and more fruitful. The governments of the different countries of the world, world Health organization and pharmaceutical business houses patronize this system. In comparison to such a big system, what is the position of Ayurvedic surgery?
And what is the utility of Ayurvedic surgery in present time? Keeping these points in mind one should discuss and reply above-mentioned questions. In reply to these questions it can be announced that Ayurvedic surgery in terms of para-surgical procedures may contribute a lot in surgical lesions. Management of fistula in ano, tumours, urolithisiasis, wound healing and application of leech are the promising features of Ayurvedic surgery.
The history of surgery in India dates back to Vedas in which transplantation of head, amputation of legs and its replacement by iron, legs have been mentioned, performed by divine twin Asvini Kumaras. Susruta Samhita is the oldest available
Application of Pratisaraneeya Kshara in Internal Piles
Mode of Action of Pratisaraneeya Kshara in Internal piles
Pratisaraneeya Kshara acts on haemorrhoids in two ways
The coagulation of protein leads to disintegration of haemoglobin into haem and globin. Synergy of these actions results in decreasing the size of the pile mass. Further, necrosis of the tissue in the haemorrhoidal vein will occur. This necrosed tissue slough out as blackish brown discharge for 3 to 7 days. The haem present in the slough gives the discharge its colour. The tissue becomes fibrosed and scar formation seen. The haemorrhoidal vein obliterates permanently and there is no recurrence of haemorrhoids.
The patient is in lithotomy position, the part is cleaned with aseptic solutions and draping was done after Local Anaesthesia / Spinal Anaesthesia. Lubricated Slit Proctoscope is to be introduced and Kshara applied at lower most all around healthy mucosa of 3 cm area of anal canal and wait for 2 minutes or until it turns to thecolour of Reddish black. After this process, the mucosa must be washed with Lemon juice to neutralizethe Kshara after proper burning of mucosa.Later the rectal pack with Yashtimadhu Taila is applied and bandaging was done and shifted to the postoperative ward.
After Kshara application in rectal prolapse, the burned part heals and anal canal become fibrosed and narrowed. Then prolapse of rectum is stopped completely.
After excision of Pilonidal sinus, the Kshara applied over the wound and wait for 2 minutes. Later neutralize with Lemon juice and pack with Jatyadi / Yastimadhu Taila. The application of Pratisaraneeya Kshara helped after excision of Pilonidal Sinus by Scraping of Pits in the surrounding tissue of the sinus, avoids the formation of unhealthy granulation tissue and helps in healing of the wound from the base.
Advantages of Kshara Therapy
The process of Kshara sutra application in the cases of sinuses has also been elaborated which is also applicable in fistula-in ano. Repeated use of Kshara sutra is necessary in the management of sinus, because single application of Kshara sutra was not found sufficient for the complete cure of the disease. So the technique of successive changes of Kshara sutra as often as necessary has also been depicted. In Susruta samhita, a comprehensive procedure including primary application and successive changes of Kshara sutra has been clearly detlned.
Many Surgical and Para surgical measures are practiced in the management of fistula- in ano. Kshara, Agni and Jalauka are three main Para surgical procedures described in Susruta Samhita.
In Susruta Samhita, bloodletting is mentioned for the management of many diseases. Shring, Alabu and Jalauka (Leech) are three main methods of blood letting. Leech application is one important method used to restore the doshic balance of body by removing the impurities from the blood.
Leeches are used to cure numerous medical and surgical conditions. After the popularization of cosmetic or plastic (reconstructive) Surgery, interest in the Lise of Leech application is increased markedly. During skin grafting or other reconstructive surgical operations, blood clotting is the main problem, which hampers the blood supply between the graft and recipient site.
Leeches have been used to maintain blood circulation to grafted tissue. The severed/injured tissue also can be saved by Leech application, Leech application therapy is known as Jalaukavacharaha (hirudotherapy) Leech application is mainly indicated in thromboangitis obliterence, acute or chronic infective or inflammatory local lesions, skin lesions, haemorrhoids etc, other indications are boils, abscess, torisillary abscess, thrombophlebitis, orchitis.