Krityakritya-Vidhi-Madhyayam – 23rd Chapter of Sushruta Samhita

Abstract

Acharya Sushruta is the main listed author of Sushruta Samhita which treats and addresses the aspects of Medicine and has impressive chapters on Surgery. In 1907, in the ancient Indian Epic, The Mahabharata named Bhishagratna told that Susruta is one of their sons in ancient Vishvamitra. Ayurveda is a divine science which has been created and formulated by the creator and which is leant by Gods and Sages. Acharya Sushruta stands for iconic legend in the surgical part of medicine. Sushruta Samhita, Charak Samhita and Ashtanga Sangraha come under Brihat Trayis which means the greatest Trio of Ayurveda. Acharya Sushruta is known as the “Father of Surgery”.

Sushruta is the Devotee of Divodasa, king of Kasi. Divodasa was the avatar of Lord Dhanwantari. Divodasa Dhanwantari taught Ayurveda to Sushruta and special texts. Sushrut and Dhanwantri lived in the period of Ramayana. Susruta provides the details of the preservation of the dead body. He also says that surgical procedures such as Excision and Suturing should not be practised on the human body, instead practise first on Flowers, Fruits and Toys. Sushruta was very popular for conducting Rhinoplasty. There are 46 chapters in ayurveda which deal with fundamental principles and various topics of Sutra Sthana has explained various types of Kshara (Alkali) and Jalouka (leech application). In this topic, we will discuss the prognosis of Ulcers and Curable and Incurable Wounds in this chapter.

Introduction

Sushrutaa Samhita is an ancient Sanskrit Text which is both verses on Surgery and Medicine. It discusses the various measures which cure the diseased individual and further preserve the health of the healthy person. The entire script is written in Sanskrit Language, which is divided into 2 parts. The First Sthana is composed of 5 Sthanas and the Second Part is the separate volume ‘Uttaratantra’. Shalya and Shaarira are two aspects which are mentioned in Sushruta Samhita. Shalyantantrum is mostly discussed in Sushruta Samhita, which talks about weapons and arrowheads to remove foreign objects from the body which includes major and minor procedures. It has 6 sections known as Sthana, which has multiple chapters known as Adhyayas, which are 186 Adhyayas under various Sthanas.

Sthana – Number Of Adhyayas

1. Sutrasthana – 46
2. Nidana Sthana – 16
3. Sharirasthan – 10
4. Chikitsa Sthan -40
5. Kalpasthan -08
6. Uttaratantra – 66

TOTAL – 186

1. Sukhsadhya Vrana (Curable Wounds)

Wounds which are easily curable in persons, that are young, Strong, Energetic and self-controlled, these four qualities are found in a single patient and the treatment of this wound is easily curable.

• If the person has all four qualities then the wound is easily curable.
• The fresh growth of tissues heals easily and in a determined person, the sharp instruments used will not reach or damage the veins and tendons.
• A person who has strong willpower does not suffer from pain which is caused due to troublesome treatment.
• A person of truthfulness does not feel pain in the vexatious process.

2. Krichsadhya Vrana (Difficulty In Cure)

The Suitable four Gunas (young, energetic, self-controlled and energetic) are not found in Old, Emaciated, Asthenic and Timid persons.

3. Sukhropniya Vrana (Easily Treated Wound)

Here In this formula, those places have been counted where the wound gets easily treated and cured such as on the Buttocks, Rectum (Anus), Genital Organs, Forehead, Cheeks, Lips, Back, Ears, Scrotum, Abdomen and inside the lining of mouth get easily cured.

4. Dushchikitsya Vrana (Difficult To Treat)

On the eyes, nose, temporal region, ear and abdominal raphe, Loins, chest, Axillae and on breast bone where there is the discharge of blood and gas, the sinus exudes froth and has a foreign body inside is difficult to cure.

• When pus is eliminated in an upward direction which is located on the border of hair, near the roots of nails, various vital spots and bones of the foreleg and the wound which is situated on the perineal raphe and pelvic bone near the coccyx are difficult to cure.

5. Krichsadya Vrana (Difficult To Cure Wounds)

The wounds which are seen in Skin diseases (Kushtha)and diabetes are difficult to cure.

6. Yapya Vrana (Manageable Wounds)

The wounds which are produced by below-mentioned conditions are considered as Yapya (Can be manageable but can not be completely cured)

• Paraphimosis
• Phimosis
• Rectal stenosis
• Alimentary tract ulcer
• Glandular swelling
• Maggots
• Urinary gravel disease
• Enlarged prostate
• Dental tartar
• Cavities in the lungs
• Glandular swelling
• Gingivitis
• Painful retention of urine
• Tumour of wounds
• Any type of diabetes
• Rhinitis

7. Difficulties During Lack Of Treatment

Due to Lack of treatment, the curable disease becomes incurable, and when they are incurable, if not treated well, these diseases can destroy the life of a person.

8. Yapya Lakshanas (Manageable Symptoms)

• Yapya diseases are those which are under control with the help of Treatment.
• But the person can get killed if there is withdrawal of medications immediately.
• Relievable diseases (Yapya disease) sustain the health of patients if treatment is available, and if the treatment is stopped it may kill the patient as the house is supported with the pillars placed properly, if it is removed it gets collapsed.

9. Asadhya Vrana (Incurable Wounds)

We will discuss the incurable wounds and the presenting features mentioned below-

• Wounds which are elevated like a ball
• Discharging exudation in excess
• Perforations which are formed inside
• The network of ligaments resembles a silk cloth
• The wound is filled with a pus discharge and is associated with pain
• Associated with pain
• Wounds which are exuding blood and discharge which are thin, cold and slimy
• Wounds which are alimentary canal occur black and yellow in colour or the discharge is of urine, faeces and wind
• The wound of the alimentary canal secretes pus and blood from both orifices i.e. mouth and anal opening
• Complicated cases such as loss of taste, indigestion, dyspnoea and cough
• The Traumatic Wounds which exude fat, bone marrow and brain matter, get cures but the wounds which are produced by the aggravation of Doshas which also exudes fat and muscles are incurable wounds

10. Prognosis Of Wounds

• The wounds which vitiate and destroy all the tissues which are not present in a vital spot and are devoid of veins and joints is an incurable feature.
• The wounds get slowly involving the Dhatus (tissues) one after the other which is not possible to cure just as a large tree.
• The diseases which are stable, increase and invade all the tissues gradually nullifying the potency of the medicines just like nullifying the power of expiatory hymns.
• The wound which has the above features is easily curable, is not rooted firmly as a new plant and can be easily pulled out.

11. Suddha Vrana (Clean Wound)

The wound is said to be clean with the below-mentioned features-

• Which is not affected by tridoshas
• Whose edges of wounds are blue in colour
• The small eruptions with granulations are even
• Not associated with pain and exudation

12. Rohati Vranam (Healing Wound)

The wound which is similar to the margins of pigeons (grey coloured) is non-progressive and is surrounded by epithelium.

13. Rudha Vrana (Healed Wound)

Rudha Vrana whose edges are healed and do not have knots in the muscle, does not have swelling around it, not associated with pain.

• The wound has the same colour as the surrounding skin which is known as Samyak Rudha Vrana (properly healed wound)

Recurrence Of Wounds

The healed wounds become torn with the aggravation of Doshas, with indulging in Physical activities, Indigestion and in anger, fear.

Conclusion

Ayurveda is a divine science which has been created and formulated by the creator and which is leant by Gods and Sages. Acharya Sushruta stands for iconic legend in the surgical part of medicine. Sushruta Samhita, Charak Samhita and Ashtanga Sangraha come under Brihat Trayis which means the greatest Trio of Ayurveda. Acharya Sushruta is known as the “Father of Surgery”. In this article, we discussed the various types of wounds and the clinical features which are explained in this chapter!