E-ISSN:2456-3110

Review Article

Ashtavidha Shastra

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 6 JUNE
Publisherwww.maharshicharaka.in

A conceptual and applied aspect of Ashtavidha Shastra Karma in Shalakya Tantra focusing on Sushruta Samhita

Shipra1*, Abhishek K2, Vijayant B3
DOI:10.21760/jaims.9.6.40

1* Shipra, Post Graduate Scholar, Dept of Shalakya Tantra, Rajiv Gandhi Government Post Graduation Ayurvedic College and Hospital, Paprola Distt Kangra, Himachal Pradesh, India.

2 Kangoo Abhishek, Post Graduate Scholar, Dept of Shalakya Tantra, Rajiv Gandhi Government Post Graduation Ayurvedic College and Hospital Paprola, Distt Kangra, Himachal Pradesh, India.

3 Bhardwaj Vijayant, HOD, Dept of Shalakya Tantra, Rajiv Gandhi Government Post Graduation Ayurvedic College and Hospital Paprola, Distt Kangra, Himachal Pradesh, India.

A vast description of Shastra and Ashtavidha Shastra Karma is given in our Samhitas, which are used for medical and surgical procedures. Most of the modern procedures can be correlated to them. As described by Acharya Sushruta there are three stages of a surgical surgery, known as Trividh Karma, that are: Poorva Karma (pre-operative measure), Pradhan Karma (operative), and Paschat Karma (postoperative measures).[1] Ashtavidha Shastra Karma falls under Pradhan Karma, which includes the main Karma or procedure. The procedures or steps that make up Ashtavidha Shastra Karmas are always the heart of surgery. From a broad perspective, Ashtavidha Shastra Karmas can be seen as the foundation of modern surgery, which may explain why both Ayurvedic and modern surgeons continue to commemorate Acharya Sushruta. Although modern surgery is always being updated and enhanced, these Shalya Karmas have not lost their luster because they are the origins of all surgeries and roots are always more essential than the branches

Keywords: Ashtavidha Shastra Karma, Sushruta, Chedana, Bhedana, Vedhana, Lekhana, Eshan, Aharan, Vistravan, Seevan.

Corresponding Author How to Cite this Article To Browse
Shipra, Post Graduate Scholar, Dept of Shalakya Tantra, Rajiv Gandhi Government Post Graduation Ayurvedic College and Hospital, Paprola Distt Kangra, Himachal Pradesh, India.
Email: 		Shipra, Abhishek K, Vijayant B, A conceptual and applied aspect of Ashtavidha Shastra Karma in Shalakya Tantra focusing on Sushruta Samhita. J Ayu Int Med Sci. 2024;9(6):255-262.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-04-17 2024-04-26 2024-05-06 2024-05-14 2024-05-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Authors state no conflict of interest. Non Funded. The conducted research is not related to either human or animals use. 13.14 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Shipra, Abhishek K, Vijayant Band Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Any device or instrument that causes injury (intentional injury caused by the surgeon during operation) to the tissue is considered Shastra. The nature of injury depends upon the type of instrument and Nature of Operation.

Surgical instruments mentioned by Sushruta for each Shastra Karma are almost similar to modern surgical instruments. Ashtavidha Shastra Karma has been explained in detail, and these principles are well accepted in the modern surgical era. These techniques are used either alone or in combination in surgical practice

Shastra Karma

Ashtavidha Shastra Karmas[2] (Operative Procedures): On the day and time having auspicious stellar constellation, Agni, Brahmana and physician should be worshipped first, then offer oblation, perform sacrificial rites and chant hymns of benediction; the patient is then given light food and made to sit east facing; after restraining him, the surgeon sitting opposite to him, insert the knife in the direction of hairs avoiding vital spots.

Table 1: Different Acharyas have considered different numbers and types of Shastra Karmas, which are as follows:

Shastra KarmaName of Shastra Karma
Acharya Charaka
(Ch.Chi 25/55)		6Patana, Vedhana, Chedena, Lepana, Prachana, Sevena [3]
Acharya Susrutha
(Su.Su 5/5)		8Chedena, Bhedena, Lekhana, Vedhana, Visravana, Eshana, Aharana, Seevena [4]
Ashtanga Hridhyem
(As.Su.26/28)		13Chedena, Bhedena, Lekhana, Vedhana, Eshana, Seevena,
Prachana, Udharana, Patana, Kuttan, Manthan, Grahana[5]
Ashtanga sangreha
(As.Su. 24/21)		12Chedena, Bhedena, Lekhana, Vedhana, Eshana, Seevena,
Prachana, Utpatana, Patana, Kuttan, Manthan, Grahana, Dahana [6]

Here, we are going to focus on Ashtavidha Shastra Karma i.e., 8 surgical procedures by Acharya Sushrutha in detail.

1. Chedana (Excision)

Chedana involves excision of part of the body/ tissue using various instruments.

Chedana should be done in Vrana that is along with veins (Siras), which have Sthula edges, which are hard and in Adhimansaja vikara.

Table 2: Shastra and Anushastra used in Chedana

1.Shastra used in ChedanaMandalagra, Karpatra, Vridhipatra, Nakhashastra, Mudrika, Utpalpatra, Ardhadhara[7]
2.Anushastra used in ChedanaTwaksar, Sphatik, Kaca(glass pieces), Nakha[8]

In modern these instruments can be correlated to the scalpel and blades.

Type of Chedana: There are three types of Chedana

1. Tiryak Chedana (Horizontal incision): Done in Shalakya Tantra in parts like Eyebrows, Cheeks, Temporal region of the head, eyelids, lips and gums.

2. Chandramandalavat (Circular excision)

3. Ardhamandalavat (Semi lunar)[9]

Table 3: Chedana Sadhya Rogas in eye, ent and mouth[10]

SNChedana Sadhya RogasModern correlation
1.In Eyes (11 in number)Parvani, 5 Aram, Sirajal, Sirapidika, Arshovartam, Shushk Arsha, Vartam ArbudaPterygium excision, Enucleation and evisceration surgery.
2.In ENT and MouthKaphaj Granthi, Ulcer Margin, Mild tumors, Adhimansa, Necrosed Tissue, Galshundika, Karna Nasa Arshas, Karna Nasa Arbuda, Dantapupput, Talupupput, Tundikeri, KanthashalukaTonsillectomy, Tonsillectomy with Adenoidectomy, Thyroidectomy - partial and total, Excision of the benign and cancerous lesions, Excision of periauricular sinuses.

Kaphaj Granthi: Granthi which is not present on Marma and which is not going to become Pakwa should be excised in Apakwa Stage and Agnikarma is done.

Galshundika: Galshundika has to be firmly handled with a Samdamsa Yantra and with Mandalagra Shastra the lower 1/3rd part should be cut by leaving the upper 2/3rd, excessive cutting causes bleeding complications and improper cutting causes complications like salivation, insomnia and aggravation of the disease. [11]

2. Bhedana (Incision)

Making an incision for opening a cavity to drain out pus, blood and removing calculus.


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Done in wounds that have pus inside but do not have an opening, have sinuses inside, or pus pocket.

Table 4: Shastra and Anushastra used for Bhedana karma

1.Shastra used for BhedanaVriddhipatra, Nakshasastra, Mudrika, Utpalpatra, Ardhadhara.[12]
2.Anushastra used for BhedanaTwaksar, Sphatika, Kacha, Kuruvind, Nakha, Agni, Kshara.[13]

Method of holding Shastra for Bhedana: Vriddhipatra and all other instruments used for Bhedan karma should be held between the Vrinta (handle) and Phala (blade). [14]

Table 5: Bhedana Sadhya Roga in eyes, ent and mouth[15]

SNBhedana Sadhya RogaModern correlation
1.Five in EyesUpnah, Krimigranthi, Anjanamika, Lagan and BisvartamLacrimal sac abscess incision and drainage, Orbital subperiosteal abscess drainage, incision and drainage of chalazion, etc.
2.In ENT and MouthKarna Nasa Dant Vidradhi (abscess), Sopha, Medoj Ostha Rog, Vrinda and Ekvrinda (tumors of throat), Tundikeri (Tonsillitis), Mukhpaka (Stomatitis), Galvidhradi, Talupupputa (tumor of the palate), Dantpupputa (Gingivitis), Gilayu (tonsillar abscess) etc.Tonsillectomy, Incision, and drainage of abscess, hematoma, etc.

Quality of incision: 1. Adequate in length, 2. Extensible, 3. Regular and uniformly cut edges, 4. Independent, 5. All layers are cleanly incised. [16]

Direction of incision: The incision line should be preferred in the directions of hair and along the Langer line because it heals quickly. The incision should be oblique in the eyebrow, cheeks, temple, forehead, eyelid, lip, and gum.[17]

Types of incision:

1. Gothirtha: Incision like Khur of cow (semi-circular).
2. Sarvathobadra: Circular incision to open a fistula or sinus.
3. Langlak: Langlak means “plough” used by farmers. It is a T-shaped incision.
4. Ardhalangalaka: It means half of Langlak. It is a L-shaped incision.

Complication of faulty Incision: Bhedan should be given in the exact pattern as suggested in the text; otherwise, it may lead to damage of blood vessels and nerves, severe pain, delayed wound healing and keloid formation (Maskandi). [18]

3. Lekhana Karma (Scraping)

Lekhana means to remove or to scrap out debris or unwanted tissues from the affected part.

Lekhana Karma should be done in Anuloma Gati (direction of hair follicle). If it is done in Pratiloma Gati (opposite direction of hair follicle) it will cause severe pain and bleeding.[19]

Table 6: Shastra and Anushastra used for Lekhana Karma

1.Shastra used for Lekhana KarmaMandalagra and Karpatra.[20]
2.Anushastra used for LekhanaKshara, Gojihva, Sephalikka, Nakha[21]

Table 7: Lekhana Sadhya Rogas[22]

SNLekhana Sadhya RogasModern Correlation
1.Lekhya Netra RogaUtsangini, Kumbhik Pidika, Vartam Sharkara, Vartam Avbandh, Pothaki, Bahalvartam, Shayav Vartam, Vartam Kardam, Klishta Vartam. All these diseases are vartamgata roga.Corneal Scrapping for diagnosis (corneal biopsy)
2.Lekhya Roga in ENTKarna Nasa Arsha, Soshir, Upkush, Jihwa Rog, Upjihwika (Swelling on the tongue), Adhijihwika (Adenoids), Four kinds of Rohini, Danta Vaidarbha (Gingivitis)

Lekhana is an independent procedure indicated in conditions like Shyava Vartma (oedema of eyelids) and Kardama Vartma (lid abscess) where the lid should be scraped uniformly. Shyava Vartma and Kardama Vartma present with lid oedema, discolouration, itching and secretion in the lid, suggestive of long-standing inflammatory changes in the lid due to the vitiation of Rakta. Here Lekhana is aimed to remove the vitiated blood from the affected site which is done in the form of a uniform scratch or uniform line.

In the absence of main instruments, the Lekhan should be performed with a piece of Kshauma(cloth made of the fibres of an Atasi plant), linen or a cotton pad (Pichu) or with alkaline substances such as nitrates of potash, Samudraphen, rock salt, rough leaves of trees (e.g.; Udumbara).


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For Lekhana karma, Shastra should be held at the junction of Vrunta (edge) and Vruntaphala (handle) with the hand slightly raised and Lekhana should be done multiple times.[23]

Assessment of performance of Lekhana Procedure: Sushruta has explained certain parameters to assess the proper and improper Lekhana karma.

  • a. Absence of bleeding from the site, itching, oedema and appearance of the lid like a fingernail are the characteristic features of Samyak (proper) Lekhana karma.[28]
  • b. Improperly done Lekhana methods are the result of either Ayoga (under-scraping) or Atiyoga (over-scraping).
  • c. Excessive bleeding from the site, congestion, oedema of lids, discharge, blurring of vision and inflammatory features are due to under-scraping. Features like inward rolling of lids (entropion), misdirected eyelashes (trichiasis) and discharge with pain are suggestive of over-scrapping.

4. Vedhana (Puncturing or Paracentesis)

Vedhana means puncturing or removal of fluids

Table 8: Shastra and Anushastra used in Vedhana

1.ShastraKutharika, Vrihimukha, Aara, Vetaspatra and Suchi.[24]
2.AnushastraKareera[25]

Method of Vedhana: Kutharika should be held in the left hand, the stroke is given on it by the middle finger of the other hand (right hand) released after holding it with the thumb.[26]

Acharya Sushruta has explained 15 Vedhya Sadhya Vyadhis.[27]

Table 9: Vedhya Sadhya Vyadhis in eyes, ent and mouth

SNVedhya Sadhya VyadhisModern co-relation
1.In eyes and entPuyalasa, VPKR Abhishayand, VPKR Adhimantha, Sashoph Akshipak, Ashoph Aakshipaka, Anytovaat, Vatprvaya, Siroutpat, SiraharshaAnterior chamber paracentesis

Paracentesis (Anterior chamber paracentesis (ACP) is a surgical procedure done to reduce intraocular pressure (IOP) of the eye. The procedure is used in the management of glaucoma and uveitis. It is also used for clinical diagnosis of infectious uveitis.

5. Eshana Karma (Probing)

Table 10: Shastras and Anushastras used for Eshana

1.ShastraEshani[28]
2.AnushastraAnguli, Baaala, Kareera[29]

Method of holding probe: Eshani should be held at its base.[30]

Indications:

  • Nadi Vrana (Sinuses)
  • Sasalya Vrana (wound with foreign body inside)
  • Unmargi Vrana - ulcers those which follow abnormal (lateral or oblique) directions[37]
  • In modern co-related to: Bowman’s probe: in congenital dacryocystitis to open up the nasolacrimal duct and lacrimal sac probing.[31]

6. Aharana Karma (Extraction)

Table 11: Shastras and Anushastras used for Aharana

1.ShastraBadisa and Dantasanku[32]
2AnushastraNakha, Anguli[33]

Indications:

  • Karnamala (impacted wax)
  • Dant Sharkara (tartar of teeth),
  • Dantamala (tartar)
  • Krimi Danta (Dental Caries)
  • Kapalika

7. Visravana Karma (Bloodletting or Draining of Pus)

Indications:

  • Five types of Vidradhi (abscess),
  • Ekadeshaja Sopha (localized inflammatory swelling),
  • Visajusta Sonitha,
  • All kinds of Arbuda,
  • Vataja Pittaja Kaphaja Granthi,
  • Vataja Pittaja Kaphaja Upadansa
  • Saushira,
  • Galashaluka,
  • Kantaka, Krimidant (Tooth Caries),
  • Dantavestak,

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  • Sitada,
  • Upakusha,
  • Dantapupputa,
  • Disorders of lips caused by Pitta, Rakta and Kapha[34]

Table 12: Shastras and Anushastras used for Visravana

1.ShastrasSuci, Kushapatra, Atimukha, Sararimukha, Antarmukhaand, Trikurchka.[35]
2.AnushastrasJalouka, Nakha[36]

Method of holding Shastra: Should be held at its tip.[37]

  • Visravana in Vidarika: In Apakwa Vidarika either Jalouka or Prachanna done.
  • Visravana in Upadamsha: Jalouka or Sira Vyadha to be done, Sira Vyadha done at Medhra Madhya. In Alpa Dosha Jalouka can be done, in deep-seated Doshas Sira Vyadha advisable.

8. Seevana Karma (Suturing)

It means suturing with help of different types of needles and threads.

Seevana Karma i.e., suturing one of prime surgical procedures and has great importance as success of surgery depends on careful apposition and wound healing.

Indication:

  • Pralamba Mamsa (a hanging cut muscle)
  • Sudha Vranas (Clean uninfected wounds)
  • Diseases arising from fat such as tumors
  • Cut/Incised wounds (Such as tumors)
  • Well-scraped wounds
  • Sadhyovrana (Traumatic wounds)
  • Diseases localized on moveable joints
  • Karnapali
  • Cut wounds on (Earlobe), Netragola (Eyeball), Nasa, Ostha, Kantha, Kapala, Bahu, Greeva, etc.
  • Deep-seated wounds.[38]

Suture material: Acharya Sushruta has worked with many natural different types of suture materials both vegetative and animal origin which are either absorbable or non-absorbable like thin cotton thread,

fibres of Ashmantak tree, hemp plants, Atasi, Murva or Guduchi, silk threads, horse hairs and Snayu.[39]

Types of Suchi (Needle)[40]

1. Round: Length - 2 Angula - Used where there is less Mamsa and Sandhis
2. Triangular: Length - 3 Angula - Used in broad places
3. Curved

Seevana indication:

1. Abhighataj Ostha Prakop
2. Kanthshaluk
3. Galganda etc

In the case of an uncomplicated Sadyo Vrana it is mentioned that the wound should be sutured on the same day.

Contraindications for Seevana: Acharya Sushruta mentioned that the wounds affected by Agni, Kshara, Visha, wounds that emit Marutha (gas gangrene), and wounds that have blood or foreign body inside should not be sutured. In these cases, the wound should be cleaned and the dust, hairs, nails and bone pieces be removed. If they are not removed from the wound, they cause severe suppuration of the wound along with different types of pain.[41]

Type of Seevana: Su.Su.25/21-22: Four methods of suturing techniques are described in Sushruta Samhita and other ancient Ayurvedic texts.

1. Vellitaka: Continuous type. This is achieved by suturing continuously along the length of the wound rapping the wound edges inside it.

2. Gophanika: Interlocking or blanket-type suturing. The wounds, shaped like footprints of crow, are sutured with Gophanika type of suturing.

3. Tunnasevani: Zig zag type or subcuticular.

4. It is done as like as the torn-up garments are sutured.

5. Rijugranthi: Straight and interrupted type. This type of suturing thread is inserted from two edges of the wound and the knot is tied. This is an interrupted type of suturing.[42]

Seevana Vidhi

Wound edges should be slightly raised, approximated, and then sutured.


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Acharya Sushruta explain that during suturing, if the bite is taken at very near of edge the margin may tear and result in wound dehiscence and if the suture is taken very far from the margin there may be tension suture which causes very much pain at the operative site.

So, the needle should be passed neither very far nor very near the margins of the wound. In modern correlation to Lobuloplasty, Eyelid suturing.[43]

Discussion

The Ashta Vidha Shastra karma is being implemented in various forms in Modern Surgery even today. Sushruta has given clear instructions on surgical procedures but the references are scattered. The term Chedana in Ayurvedic classical texts and the term ‘excision’ used in modern surgical textbooks have the same meaning i.e. Chedana means an abnormal or diseased part should be excised from the normal body part.

In all available references, the term Bhedana has been used in comparison to incisions but there are other references where the typical incisions also have been indicated under the heading Chedana Karma like, Tiryak, Chandramandal and Ardhamandalavat Chedan. According to Sushruta, the incision line should be preferred in the line of hair that heals quickly.

Lekhana Karma should be done in Anuloma Gati (direction of hair follicles). If it is done in Pratiloma Gati (opposite direction of hair follicles) it will cause severe pain and bleeding. Sushruta indicates Vyadhan Karma which can be considered as tapping.

Acharya Sushruta gave the appropriate definition for a probe that it is a slender surgical instrument for exploring the depth or direction of a wound, sinus etc. He not only told us about the incisions but also about how a particular instrument should be held in hand during the surgical procedure, which we are practising even today.

Talking about the incisions he said that incisions should be taken from above to downwards, avoiding damage to Marmas, Sira, Snayu, Asthi, Sandhi and Dhamni, it shows that these are important structures and should be avoided during surgery to avoid the permanent loss of the function of any part of the body.

The 8 types of surgical procedures like Chedana, Bhedana, Lekhana, Aharana, Vyadhana, Sravana, Esana and Seevana are the basis of any surgical technique and this has remained unchanged. All surgical procedures are bound by these 8 varieties. There may be conflict on the numbers of surgical procedures by some authors but the procedures are unchanged. These surgical procedures are still in use these days.

Conclusion

Ashtavidha Shastra Karmas mustn't be the eight surgical procedures; rather these are the eight basic principles of all the surgical procedures which can be used for any surgery. These Karmas contain a short but full description of all the surgeries. Every surgical procedure comprises either one or more of them.

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