Dispersing controversial study of Sira Vedhan w.s.r. to Goiter

Jadhav Pooja

Sira Vedha is useful in the case of extensive vitiation of Rakta. There is much type of bloodletting methods eg. Vene puncture, application of horn, application of leeches, scarification etc. Maharshi Sushruta told in Susruta Samhita Sharir Sthana Chapter 8 Sira Vyadha Vidhi Shariram. In Galganda, It should be performed in Sira situated in Uru mool or root of thigh. But Uru Mool means “Urvi Tribhuj” or femoral tringle. In these triangle situated only one vein (femoral vein or Urvi Sira). These Sira are indicated in Sira Vedhan (Bloodletting) from Galganda. But Shusrut also says Shrarir Sthan chp.7 Sira Varna Vibhakti this are not fit for vene-section. Long saphenous vein mainly open the Saphenous opening of the femoral vein in Uru Mool or femoral triangle and bloodletting practitioners have choosing this vein for lower limb Sira Vedhan. The Long saphenous vein is safest for bloodletting in aspect first in pressure and second in long saphenous vein is larger vein of lower limb. When we choosing this vein for process of Sira Vedhan are suitable for expelled maximum amount of Infectious or cancerous substance in Galganda.

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Jadhav Pooja, Associate Professor, Department of Rachna Sharir, Mahaveer college of Ayurvedic Science, Sundra, Rajnandgaon, Chattisgarh, India.
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Jadhav Pooja, Dispersing controversial study of Sira Vedhan w.s.r. to Goiter. J Ayu Int Med Sci. 2022;7(3):64-67.
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2022-02-23

2022-02-25

2022-03-04

2022-03-11

2022-03-18

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Introduction

Ayurveda is the science of wellbeing as well as the diseases curable. The peculiarity of Acharya Sushrut in the field of treatment is Sira Vedha a type of Raktmokshan-Chiktsa (blood letting) used for healing much disease. The Sira Vedha may perform on the basis of experience and discretion, in all those disease which are curable by Raktmokshan. The properly performed treatment by Sira Vedha is said “Chikitsardh” half of the treatment described in Shalya Shastra. In Galganda that vein present at the root (base) of the thigh should be puncture.

In modern view these Galganda type of Condition’s are also called A non-neoplastic and non-inflammatory enlargement of the thyroid gland, Thyroid carcinoma.

Purpose

Acharya Sushruta told in Sushruta Samhita Sharir Sthana Chapter 8 Sira Vyadha Vidhi Shariram. In galganda, It should be performed in Sira situated in Uru Mool or root of thigh. But Uru Mool means “Urvi Tribhuj” or Femoral tringle. In these triangle situated only one vein (femoral vein or Urvi Sira). These Sira are indicated in Sira Vedhan (Blood letting) from Galganda. But Shushrut also says Shrarir Sthan chp.7 Sira Varna Vibhakti this are not fit for vene-section.

Materials and Methods

The principle Ayurvedic texts referred in this study are Sushruta Samhita, available commentaries on them and modern books such as Human Anatomy & Physiology and related websites have also been searched.

Prevalence of Goiter & Thyroidal Cancer

Goiter: U.I. data were available for 92.1% of the world’s school age children. Iodine deficiency is still. A public health problem in 54 countries. A total of 36.5% (285 million). Ranging from 10% in the W.H.O. region of the Americans as to 59.9% in the Europeans regions.

Thyroid Cancer: Thyroid cancer is the most common type of cancer (1.0%-1.5%) new cancer diagnosed each year in the USA. Increasing annual percent that in the U.S.A. was 2.4% from 1980 to 1997 and 6.61 from 1997 to 2009.

A non-neoplastic and non-inflammatory enlargement of the thyroid gland

Toxic goiter Non-toxic goiter &Diffuse goiter

Thyroid carcinoma

A. Endemic Iodine deficiency (N=150mcg/day), Most common cause in the world. B. Graves Disease (autoimmune) + Autoimmune Thyroiditis Most common causes in US Goitres can be associated with increased or decreased production of thyroid hormones May compress the trachea, esophagus, and recurrent laryngeal nerves.

A. Toxic goitre Non-Toxic goitre- determined by levels of T3, T4, TSH and clinical presentation B. Diffuse goitre; Nodular goitre; Multinodular goitre .

Thyroid carcinoma 1.5% of all cancers. A female predominance has been noted among patients who develop thyroid carcinoma in the early and middle adult years. Most thyroid carcinomas (except medullary carcinomas) are derived from the thyroid follicular epithelium There are 4 types of thyroid carcinomas: Papillary carcinoma (>85% of cases) - Most Common Follicular carcinoma (5% to 15% of cases) Anaplastic (undifferentiated) carcinoma (<5% of cases) Medullary carcinoma (5% of cases)

In Galganda, it should be performed in Sira situated in Uru Mool or root of thigh. Acharya Sushruta In Galganda very clearly consider the Sira Vedhan or bloodletting useful vein are Situated Uru Mool or femoral triangle. In Modern view this vein are femoral vein. But ‘Urvi Sira’ are contraindicated Sira for Sira Vedhan.

Following two justification of this concept

1^st Concept is why Sushruta is considering Urvi Sira in thigh.

2^nd Concept is Urvi Sira is Contraindicated Sira for Sira Vedhan. But Sushruta consider In Galganda, it should be performed in Sira Vedhan.

Modern justification of 1^st Concept

1^st Concept is why Sushruta is considered Urvi Sira in thigh.

Pressure factor: Venous pressure is less in the part of the body above the level of the heart and it is more in part below the level of the heart. Venous pressure is greater in peripheral vein than the central vein. Central vein is Superior vena cava (4.6mmHg). Pressure of jugular vein (5.1 mmHg), Pressure of dorsal venous arch of foot (13.2mmHg).

According to this concept lower extremities (peripheral) venous pressure are more in upper extremities because pressure in vein below the level of heart is more and it is less above the level of the heart. When we choose Urvi sira in arm (Upper limb) but pressure of antecubital venous pressure (7.1mmHg).

According to Sushruta favorable condition of Sira Vedhan is when proper instrumentation (puncturing) has been done, blood flow out in a stream. This should be understood as proper puncturing. Vitiated (Infected blood) flow out first when vein are punctured.

In this reasons Lower extremities vein (Urvi Sira or femoral vein) are clearly accepted than Upper extremities (Urvi Sira).

2^nd Concept is Urvi Sira is contraindicated Sira for Sira Vedhan.

Urvi Sira means femoral vein: It begins as an upward continuation of the Popliteal vein at the lower end of adductor canal, and ends by becoming continuous with the external iliac vein behind the inguinal, medial to the femoral artery.

Tributaries: It receives: Great saphenous vein, veins accompanying three deep branches of the femoral artery, in the femoral triangle.

But clinically and anatomically femoral vein is not the right vein for Sira Vedhan. Because femoral vein is direct drain the external iliac vein and external iliac vein drain direct to the IVC. In femoral triangle femoral vein is accompanied by the femoral artery. This two reason femoral vein is contraindicating vein for Siravedhan in Galganda. But we focus the long saphenous vein its formation on the dorsum of the foot, its course along the entire length of the lower limb, and its termination into the femoral vein. It contains about 10-20 valves. There one valve that lies just before the vein pierces the Cribriform fasia.

Long saphenous vein mainly open the Saphenous opening of the femoral vein in Uru Mool or femoral triangle and bloodletting practitioners have also choose this vein for lower limb Sira Vedhan.

Why Saphenous vein are useful in lower limb bloodletting for Galganda?

1^st fact- It is superficial vein in lower limb.

2^nd fact- it is easily found in Yantran Vidhi.

Yantran Vidhi in Lower Limb

The person whose vein is to be punctured is asked to sit facing east, on a seat (Stool and chair), Than puncturing the vein of the leg, one leg should be placed firmly on an even place , the other leg is slightly flexed and raised above :then the leg in which the vein is to be punctured , is wrapped with a binder below the knee, then the ankle is Kneaded by the hands, tie a band of the cloth etc. about 4 Angula above the site of puncture and then the vein of the leg be punctured.

Purpose of bloodletting in Galganda (Concept of Ayurveda and modern view)

This concept is lower extremities (peripheral) venous pressure are more in upper extremities because pressure in vein below the level of heart is more and it is less above the level of the heart. In Case of Galganda, Metastases of infected lymph drain to the thoracic duct through the Venous Channels and bloodletting is preventing method Dhusti of Rakta Dhatu. Swollen lymph nodes in the neck (cervical lymph node) are Symptoms of thyroid cancer and goiter & drain to the jugular, subclavian, bronchomidiastinal lymph

Conclusion

The peculiarity of Acharya Sushrut in the field of treatment is Sira Vedha a type of Raktmokshan Chikitsa (blood letting) used for healing much disease. Long saphenous vein mainly open the Saphenous opening of the femoral vein in Uru Mool or femoral triangle and bloodletting practitioners have choosing this vein for lower limb Sira Vedhan. The purpose of bloodletting in Galganda are mainly is prevention of Metastases of Infectious or carsinomatous substance.

Reference

1. Gerard Tortora. Text Book of Anatomy and physiology. 11th Edition.

2. A.SPIF. Golwalla Text Book of Medicine. 11th Edition.

3. BG Ghanekar. Sushrut Samhita. 2012.

4. S Suresh Babu. The Principles and Practice of Kaya Chikitsa. 11th Edition -2003

5. BD Chourasia. Text book of Anatomy. 4th edition.

Review Article

Sira Vedhan

Journal of Ayurveda and Integrated Medical Sciences