Shalyatantra / Surgery & Research Center
Shalakya tantra which is one of the eight classical branches of Ayurveda deals with the description and treatment of organs seated above the neck (clavicle) like Ear, Nose, Throat, Head, Eye and teeth (Dental). Department of Salakyatantra is one of the illustrious departments of Patanjali Ayurvedic hospital, a well renowned Ayurvedic health institution in world.
Aims and Objective of Shalakya tantra :-
- To treat the diseased persons with various Eyes, ENT and Head related disease.
- To prevent diseases by taking sincere effort on patient education regarding preventive aspects and life style modifications.
- To maintain the health of healthy individuals.
In Patanjali Ayurvedic hospital these (Shalakya tantra department) specialized branch again divided into three super specialized branches.
Surgical Clinics
Vedas contain many important subjects of all aspects of life, so that it would be no exaggeration to call it a key to the science, art and religion. In Vedas, Rishis took account of the whole world and whole of humanity in the manifestation of the heavenly power and knowledge. In this respect medical science (Ayurveda) is an important part of it. The knowledge of ‘ayu’ revealed according to the need of the time as appreciated by the Rishis in Vedas. With such background we have to consider the importance of Vedic surgical skill in present scenario.
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 understanding 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 outcome.
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 outcome 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
Kshara Sutra Treatment for Fistula for Fistula in Ano and Piles
Kshara Karma Therapy
Kshara is a caustic chemical, alkaline in nature obtained from the ashes of medicinal plants. It is a milder procedure compared to surgery and thermal cautery. It is the superior most among the sharp and subsidiary instruments because of performing excision, incision and scraping
It is versatile, because even such places that are difficult in approach by ordinary measures can be treated by Kshara Karma. It is more effective than the other modalities of treatment, because they can be administered both internally and externally. Kshara Karma is useful as the substitute of surgical instruments, because they can be used safely on the patients who are afraid of surgery.
- On the basis of Administration –
- Pratisaaraneeya Kshara – External application
- Paneeya Kshara – Internal application
- On the basis of Concentration – Mild, Moderate and Highly
Method of Preparation of Pratisaraneeya Teekshana Kshara –It is prepared with Apamarga Kshara (Ash of Achyranthes aspera), Sankhanabhi (conchshell) and Chitraka (Paste of Plumbago gelanica).
The PH value of Teekshna Apamarga Kshara is 13.5.
Utility / Properties of Kshara-
- Prepared Kshara, being a composite of many drugs, alleviates three doshas.
- Being white in colour it is plain. As it is made of drugs having pungent, hot, sharp, digestive property, it does cauterizing, digesting and splitting actions.
- If used in excess it can result in impotency.
- Externally it has: Cleansing, Heating, Absorbent and Scraping properties.
- Internally it destroys: Worms, Amadosha, Kapha dosha, Skin diseases, Poison and Obesity.
Indications of Pratisaraneeya Teekshna Kshara –
- Internal Haemorrhoids
- After fistulectomy
- Rectal prolapse
- After excision of pilonidal sinus
- After Incision and drainage of Anorectal abscess
Application of Pratisaraneeya Kshara in Internal Piles
I. Pre-operative
First the required instruments like Proctoscopes, Kshara, Lemon juice, Yastimadhu Taila, Allis tissue forceps, Artery forceps, etc. are kept ready with proper sterilization. The night prior to procedure, the patient is usually had light diet afterwards nil orally. The part is prepared well and gives soap water enema 2 to 4 hours prior to procedure.
II. Operative procedure
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 into the anus and internal piles bulges in. Then the pile mass should be rubbed and cleaned with cloth or a cotton swab with warm water. Then the Kshara applied over the pile mass and wait for 2 minutes or until the pile mass turns to the colour of Reddish black (Pakwa Jambu Phala Varna). After this process, the pile mass must be washed with Lemon juice to neutralize the Kshara after proper burning of piles. The same procedure should be followed in other piles also. Later the rectal pack with Yashtimadhu Taila is applied and bandaging was done and shifted to the postoperative ward.
II. Post operative
Patient is allowed to orally with sips of liquids and liquid diet after 4 to 6 hours of procedure. Later Patient is advised for Pancha Valkala Kwatha / Triphala Kwatha Sitz bath for 10- 15 minutes to relieve the pain and swelling. Triphala Guggulu & Gandhaka Rasayana 2 BDS for 10 days. Analgesics and Antibiotics if necessary.
Histopathological examination of slough material in blackish brown discharge reveals the presence of necrosed haemorrhoidal tissue.
Mode of Action of Pratisaraneeya Kshara in Internal piles
Pratisaraneeya Kshara acts on haemorrhoids in two ways
- It cauterizes the pile mass directly because of its corrosive nature.
- It coagulates protein in haemorrhoidal plexus.
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.
Application of Pratisaraneeya Kshara in after fistulectomy
In small low anal fistulas, first excise the fistula tract followed by application of Kshara and wait for 2 minutes. Later neutralize with Lemon juice and pack with Yastimadhu Taila. It is helpful for quick healing and avoids recurrence of fistula tract.
In high level fistulas, excision of fistulous tract was done partially followed by application of Kshara. Later Kshara Sutra is applied in remaining fistulous tract at anal sphincteric area. The excised fistulous tract heals completely with help of Kshara and remaining fistulous tract was cut by Kshara Sutra ligation. So that patient can be cured at less time and pain.
In this technique, after excision of fistulous tract and applying Kshara, leads to debridement of the fibrous tissue and at the same time remaining wound will be healed by its Scraping and Healing property of Kshara. In the mean time the Kshara sutra ligation at sphincteric area of fistulous tract leads to cutting and debridement and drainage of fistulous tract at the same time preserving continence of anal canal.
Application of Pratisaraneeya Kshara in Rectal Prolapse
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 the colour of Reddish black. After this process, the mucosa must be washed with Lemon juice to neutralize the 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.
Application of Pratisaraneeya Kshara in Pilonidal Sinus
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
- Postoperative pain is mild in intensity
- No bleeding
- Minimum hospitalization – one day care
- No scope for recurrence
- No stricture formation
- Complications of Kshara Therapy
Bleeding – Negligible
- Pain – Mild to moderate pain – relieved by hot sitz bath and oil enema.
- Discharge – Blackish brown discharge will be occur 5 to 7 days postoperatively.
- Anal stricture – Improper technique
- Recurrence – Improper technique
Bhagandara (Fistula in ano) is a disease, which is described, in various ancient medical texts. Bhagandara was recorded as the most notorious disease for the treatment point of view. Fistula in ana is a disease, which takes place in the perineal part and ano-rectum. The fistulae are invariably preceded by ano -rectal abscess.
The treatment of fistula in ano has always been a great problem, both for the patient as well as for the surgeon. This is due to the high recurrence rate. A number of management techniques are described by a number of authors, but all these described techniques are not satisfactory therefore these techniques are discarded. The systemic use of anti- microbial agent is very limited to the earlier stage of peri anal abscess. It is well accepted that fistula in ano is a surgical disease, for that reason, a lot of preference has been given to surgical! operative approaches. Even despite the fact that it has high recurrence rate. Considering the problems in the management of fistula in ano, postoperative complications and recunence, the para-surgical procedure Kshara-Sutra (medicated thread) is re-practiced for the management of fistula in ano successfully by the Ayurvedic practitioners.
The Kshara sutra therapy is an age old known effective therapy, the efficacy of which has been reputable and acknowledged in the medical world for the treatment of fistula in ano. Every Ayurvedic scholar knows that this therapy is mentioned in Susruta Samhita in the chapter of Visarpa Nadi Stana roga chikitsa. Where it is mentioned as an alternative treatment of Nadi Vrana (sinuses) in emaciated and poor nourished weak persons where surgical procedure is not indicated.
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 detuned.
Para Surgical Procedures
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.
Blood Letting and Leech Application
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.
Traditional Surgery Packages & Tariff
- Piles : Rs.10,000/-
- Fistula : Rs.10,000/- (If Fistula is long in length after 10 days Rs. 200/- per day)
- Fissure : Rs.8,000/-
- Ksharkarma : Rs.4000/-
- Agnikarma : Rs.200/- per day
- Leech Therapy : Rs. 200/- per day
