शल्यतन्त्र Paper I, Part A

शल्यतन्त्र
Paper I
PART A
CHAPTER I: Introduction
 Shalya
तर मनःशरीराबाधकराणि शल्याणन … ॥ ४ ॥ (सु - सू - ७)
Shalya are those (substances) which produce troubles to the mind and body.
Shalya is derived from the roots Shal or Shval. Shal means “moving quickly” and Shval
indicates “causing pain/misery”. Therefore, Shalya is considered as the object which
moves quickly and causes pain or misery.
 Shalyatantra
Shalyatantra is one of the 8 branches of Ayurveda.
कायबालग्रहोर्ध्ङव ् गशल्यदष्ट्ं राजरा्ृषान् ।
अष्टा्ङ्गाणन तस्याहुणिणकत्सा येषु सणं िता ॥ (अ.हृ. - सू - १/५)
शल्यणमणत शल्यहरिप्रधानं तन्त्रं शल्यतन्त्रम् ॥ (सु - सू - १/७ डल्हन)

Shalyatantra is the science of Shalya which primarily deals with its extraction.
तर शल्यं नाम
ण्ण्धतृिकाष्ठपाषािपांशुलोहलोष्टाणस्ि्ालनखपूयास्रा्दष्टु व्रिान्त्तगवर्वशल्योद्धरिािं
यन्त्रशस्त्रक्षाराणननप्रणिधानव्रिण्णनियािं च ॥ (सु - सू - १/८)
Shalyatantra is the name of the branch which describes the methods of removal of
different kinds of substances, such as grass, wood, stone, sand, metal, bone, hair, nail,
pus, exudation and vitiated ulcer; the use of Ksāra and Agnikarma, as well as the
diagnosis of Vraṇa.
CHAPTER Ii: Yantra, Shastra &
Anushastra
 Yantra
 Paribhāṣā:
तर मनःशरीराबाधकराणि शल्याणन तेषामाहरिोपायो यन्त्ताणि ॥ ४ ॥ (सु - सू - ७)
Shalya are those (substances) which produce troubles to the mind and body, Yantra
are the means to extract them.
 Saṅkhyā: - 101
Yantras are 101 in number. Among them, Hasta (the hands) are considered as
Pradhānatama Yantra (most important Yantra) because without hands, other
instruments cannot be used and their application also depends upon Hasta.
 Bheda: - 6
Yantra Modern Correlation Sushruta Saṁhitā Aṣṭāṅga Hṛdaya

01) Svastika Cruciform instruments 24 24
02) Saṁdaṁsha Dissecting foceps / 2 4
Pincer-like
03) Tāla Scoop / Spatula 2 2
04) Nāḍī Tubular instruments 20 23
05) Shalākā Rod-like instruments 28 34
06) Upayantra / Accessory instruments 25 19
Anuyantra (Upayantra) (Anuyantra)
1) Svastika Yantra
a) Length: 18 angula
b) Number: 24
c) Types: i) Pashu mukha (resembling jaw of animals) = 9
ii) Pakṣi mukha (resemlbing beak of birds) = 15
d) Use: Extraction of Shalya from bones or deeper tissues.
2) Saṁdaṁsha Yantra
b) Number: 2
c) Types: i) Sanigraha (Kīla yukta – toothed)
ii) Anigraha (Kīla rahita – non-toothed)
d) Use: Extraction of Shalya from Tvacha, Māṁsa, Sirā & Snāyu.
3) Tāla Yantra
b) Number: 2
c) Types: i) Ekatāla (single scoop/blade)
ii) Dvitāla (double scoop/blade)
d) Use: Extraction of Shalya from Karṇa, Nāsā & Nāḍī.
4) Nāḍī Yantra
a) Number: 20
b) Use: Extraction of Shalya from hollow structures. Introduction of
Auṣadha Dravya into hollow structures. Dilatation of structures.
Visualization of pathological conditions.
Nāḍī Yantra Modern Correlation Number

Bhagandhara Yantra Rectal speculum 2
Arsho Yantra Rectal speculum 2
Vraṇa Yantra Syringe & irrigator 1
Basti Yantra Enema catheter 4
Uttarabasti Yantra Urethral / Uterine catheter 2
Mūtravṛddhi Yantra Cannula 1
Dakodara Yantra Cannula 1
Dhūmanetra Yantra Inhalers 3
Niruddhaprakāsha Prepuce dilator 1
Yantra
Sanniruddha Guda Rectal dilator 1
Yantra
Alabu Lagenaria vularis 1
Shṛnga Horn 1
5) Shalākā Yantra
a) Number: 28
b) Use: Rod-like instruments are numerous and their utility varies.
Shalākā Yantra Number Use

Gaṇḍūpada 2 Probing
Sarpaphaṇa 2 Retraction
Sharapuṅkha 2 Separation / Mobilization
Baḍisha 2 Extraction
Masūra dalamātra 2 Extraction of Shalya from Srotas
Kārpāsakṛtoṣṇī 6 Wound cleaning
Khalla 3 Application of Kṣāra
Jāmbava phala 3 Agnikarma
Aṅkusha 3 Agnikarma
Nāsārbuda haraṇa 1 Removal of abnormal growth from the nose
Añjana 1 Application of collyrium
Mūtramārga vishodhana 1 Clearing of urethral passage
6) Upayantra
a) Number: 25
b) Use: Accessory instruments which are used in any procedure or on any
part of the body, depending upon the requirement.
1) Rajju (Rope) Used as tourniquet

2) Veṇikā (Thread) Suturing
3) Paṭṭa (Elongated cloth) Material for bandage
4) Charma (Leather) Material for bandage
5) Antavalkala (Inner bark of a tree) Bandaging, suturing, fracture
6) Latā (Creeper) Bandaging
7) Vastra (Cloth) Used for Pichu and Vikeshika
8) Aṣṭīlāshma (Stone) To remove Asthigata Shalya
9) Mudgara (Hammer)
10) Pāṇi & Pādatāla (Palm & Sole)
11) Aṅguli (Fingers)
12) Jihvā (Tongue)
13) Danta (Teeth)
14) Nakha (Nails)
15) Mukha (Mouth)
16) Bāla (Hair) Suturing
17) Ashvakaṭaka (Horse’s bridle) To remove Asthigata Shalya
18) Shākhā (Branch of a tree) To remove Asthigata Shalya
19) Ṣthīvana (Spitting) To remove Shalya from throat
20) Pravāhaṇa (Straining) Removal of Vāta, Mūtra, Viṭ, etc.
21) Harṣa (Pleasure) To remove stress
22) Ayaskānta (Magnets) To remove metallic Shalya
23) Kṣāra (Alkali)
24) Agni (Fire)
25) Bheṣaja (Medicine)
 Yantrakarma: - 24
1) Nirghātana (Mobilizing and then extracting)
2) Pūraṇa (Filling)
3) Bandhana (Tieing / Bandaging)
4) Vyūhana (Collecting together / Retraction)
5) Vartana (Rolling)
6) Chalana (Moving, Sliding, Transferring, Shifting)
7) Vivartana (Rotating)
8) Vivaraṇa (Dilating)
9) Pīḍana (Squeezing)
10) Mārga vishodhana (Clearing the passages)
11) Vikarṣaṇa (Splitting and then pulling)
12) Āharaṇa (Extraction)
13) Āñchana (Traction, Extension)
14) Unnamana (Elevation, Lifting upwards)
15) Vinamana (Depression, Pushing downwards)
16) Bhañjana (Bending, Breaking)
17) Unmathana (Churning)
18) Āchūṣaṇa (Suction, Aspiration)
19) Eṣaṇa (Probing)
20) Dāraṇa (Tearing, Bursting, Cracking)
21) Ṛjūkaraṇa (Straightening)
22) Prakṣālana (Cleaning, Washing, Irrigating)
23) Pradhamana (Blowing air, Insuffulating)
24) Pramārjana (Sweeping, Mopping, Cleaning)
 Yantradoṣa: - 12
तर अणतस्िूलम् असारम् अणतदीर्वम् अणतह्रस््म् अग्राणह ण्षमग्राणह ्क्रं णशणिलम्
अत्यन्त्ु नतं मृदक
ु ीलं मृदमु ख
ु ं मृदपु ाशम् इणत द्वादश यन्त्रदोषाः ॥ (सु - सू - ७/१९)
1) Atisthūla (Too thick)
2) Asāra (Weak/made from impure metal)
3) Atidīrgha (Too long)
4) Atihrasva (Too short)
5) Agrāhi (Bad grip/does not hold the objects well)
6) Viṣamagrāhi (Irregular grip/holds improperly)
7) Vakra (Asymmetrical)
8) Shithila (Loose)
9) Atyunnata (Too prominent/elevated)
10) Mṛdukīla (Loose rivets/joints)
11) Mṛdumukha (Loose at the end/soft holding part)
12) Mṛdupāsha (Loose threading/snaring power)
 Shastra
 Paribhāṣā:
शस्त्रं णह शरीर णसंसकं इणत । (चक्रदत्त)
Shastra is that which causes injury to the body.
In regard to Shalyatantra, Shastra are the sharp instruments used by the surgeon to
intentionally injure the tissue for operative purpose.
 Saṅkhyā:
1) According to Sushruta Saṁhitā = 20
2) According to Aṣṭāṅga Hṛdaya = 26
 Bheda & Prayoga:
Shastra Modern Correlation Prayoga

1) Maṇḍalāgra Circular knife Chedana & Lekhana
2) Karapatra Bone saw / Surgical saw Chedana & Lekhana
3) Vṛddhipatra Scalpel Chedana & Bhedana
4) Nakha shastra Nail parer Chedana & Bhedana
5) Mudrika Ring knife Chedana & Bhedana
6) Utpalapatra Lancet Chedana & Bhedana
7) Ardhadhārā Single edged knife Chedana & Bhedana
8) Sūchī Suturing needle Visrāvaṇa & Sīvana
9) Kushapatra Bistoury Visrāvaṇa
10) Āṭimukha Hawk bill scissors Visrāvaṇa
11) Sharārimukha Scissors Visrāvaṇa
12) Antarmukha Curved bistoury Visrāvaṇa
13) Trikūrchaka Brush Visrāvaṇa
14) Kuṭhārika Chisel Vyadhana (Asthi pradesha)
15) Vṛhimukha Trocar & Cannula Vyadhana (Māṁsa pradesha)
16) Ārā Awl Vyadhana (Kaṭhīna kaṛapāli)
17) Vetasapatra One type pf scalpel Vyadhana
18) Baḍisha Sharp hook Āharaṇa
19) Dantashaṅku Tooth-scaler Āharaṇa
20) Eṣaṇī Sharp probe Eṣaṇa
 Parts of Shastra:
1) Mūla (rear end)
2) Grīva/Phala (neck)
3) Dhārā (cutting edge / blade)
4) Vrintha (handle)
5) Pṛṣṭha (blunt edge)
6) Agra (tip)
 Shastradoṣa: - 8
तर ्क्रं कुण्ठं खण्डं खरधारम् अणतस्िूलम्
अत्यल्पम् अणतदीर्वम् अणतह्रस््म् इत्यष्टौ शस्त्रदोषाः ॥ (सु - सू - ८/९)
1) Vakra (Crooked)
2) Kuṇṭha (Blunt)
3) Khaṇḍa (Broken)
4) Kharadhāra (Rough/Serrated blade)
5) Atisthūla (Too thick)
6) Atyalpa (Too thin)
7) Atidīrgha (Too long)
8) Atihrasva (Too short)
 Shastra Pāyana:
Shastra Pāyana is the procedure of heating the blade of Shastra until red hot and
dipping it into a liquid media to increase and preserve its sharpness.
1) Kṣāra Pāyana: Shastra is dipped into Kṣāra Drava Dravya. The blade becomes
hard enough to cut through arrows, bones and other foreing bodies.
2) Udaka Pāyana: Shastra is dipped into water. The blade will be protected from
tearing or becoming damaged, and will be able to incise and excise muscles.
3) Taila Pāyana: Shastra is dipped into Taila. It is done for the purpose of
puncturing veins and cutting ligaments.
 Anushastra
 Paribhāṣā:
अनुशस्त्राणि हीनशस्त्राणि शस्त्रसदृशाणन ्ा । (सु - सू - ८/१५ डल्हन)
Anushastra are inferior Shastra which are used if Shastra is not available.
 Prayoga:
- If Shastra is not available
- In children
- If the patient not inclined to undergo surgery with Shastra
- If the patient is afraid of surgery
 Saṅkhyā: - 14
Anushastra Modern Correlation Prayoga

1) Tvak sāra Bamboo Chedana & Bhedana
2) Sphaṭika Crystal Chedana & Bhedana
3) Kācha Glass Chedana & Bhedana
4) Kuruvinda Ruby Chedana & Bhedana
5) Jalauka Leech Raktamokṣaṇa
6) Agni Fire Agnikarma
7) Kṣāra Alkali Kṣārakarma
8) Nakha Nails Chedana, Bhedana & Āharaṇa
9) Gojihvā Leaves of Elephantopus scaber Visrāvaṇa
10) Shephālikā Leaves of Nyctanthes arbor-tristis Visrāvaṇa
11) Shākapatra Teak leaf Visrāvaṇa
12) Karīra Sprouts Eṣaṇa
13) Bāla Hairs Eṣaṇa
14) Aṅguli Fingers Eṣaṇa
Surgical Instruments
 Proctoscope
A proctoscope is a hollow tubular instrument that is used to examine the anal cavity and
anal walls of the rectum for any evidence of hemorrhoids, polyps, tumors, etc.
It may or may not be equipped with a light source.
 Length = 7 cm (most commonly used); some varieties may be 15-32 cm
 Types: - 3
1) Slit proctoscope
2) Common proctoscope
3) Pediatric proctoscope
 Parts:
1) Obturator (inner)
2) Proctoscope sheath (outer)
 Position for Examination:

1) Left lateral position / Sim’s position
2) Knee elbow position
3) Lithotomy position
 Procedure:
The proctoscope sheath and obturator are well lubricated and held in one hand.
It is slowly inserted in the direction of the axis of anal canal, upward and forward
towards the patients’ umbilicus and in to the curve of the sacrum.
Hold the proctoscope sheath steady and slowly remove the obturator with the
other hand. Observations are made as the proctocope is slowly withdrawn.
 Probe
A probe is a rod-like instrument available in different sizes. It may be made from copper,
iron or silver. It is used to examine the depth and direction of sinus and fistula, and it is
used for Kṣārasūtra in fistula-in-ano, pilonidal sinus, etc.
 Dissecting Forceps
Dissecting forceps is used for grasping and holding structures.
 Types:
1) Plain / Non-toothed dissecting forceps: Used to hold delicate structures like
the peritoneum, vessels, bowel, nerves, tendons, etc.
2) Toothed dissecting forceps: Used to hold the skin and tough structures.
 Artery Forceps
Artery forceps is a haemostatic forceps available in various sizes.
Small or mosquito artery forceps.
Medium sized artery forceps.
Large artery forceps.
Its jaws may either be straight or curved.
 Parts:
1) Finger rings
2) Ratchet (catch, clamp, crush)
3) Shanks
4) Box joint / Box lock
5) Serrated jaws
 Use:
- To compress an artery to stem bleeding.
- Grasping tissue at the time of operation.
- Holding stay sutures.
 Allis Tissue Holding Forceps / Allis Clamp
Allis tissue holding forceps may be long (17 cm) or short (12 cm). The blades are curved
at the ends and toothed, 4 in 5 or 5 in 6 teeth.
 Parts:
1) Finger rings
2) Ratchet
3) Shanks
4) Box joint
5) Jaws / Blades with toothed ends
 Use:
- Used to hold or grasp heavy tissue, such as fascia, skin flaps, bladder wall, etc.
- It may be used to hold soft tissue, such as the breast or bowel tissue.
 Babcock Forceps
Babcok forceps has curved distal parts, forming a triangular fenestra,
which allows soft tissue to bulge out. The tip is non-traumatic with
transverse serrations.
 Parts:
1) Finger rings
2) Ratchet
3) Shanks
4) Box joint
5) Blades with curved distal parts
 Use:
To hold any part of bowel, thyroid gland, mesoappendix, uterine tubes, ureter, etc.
 Sponge Holding Forceps

Sponge holding forceps has ring-shaped ends which may be serrated or smooth on the
inncer surface. Jaws may be straight or curved.
 Parts:
1) Finger rings
2) Ratchet
3) Shanks
4) Box joint
5) Jaws with ring-shaped ends
 Use:
- Painting in surgical procedures, for blunt dissections
- To swab cavities and to mop the oozing area
 Cheatle Forceps
Cheatle forceps are kept in a container of antiseptic solution
when not in use.
 Parts:
1) Finger rings
2) Shanks
3) Box joint
4) Curved jaws
 Use:
- Used to remove sterilised instruments from boilers and formalin cabinets. They are
used to ensure that as each item is removed, others are not infected.
- Used to take out needles and scalpel blades from Lysol.
- Used to take out instruments from the autoclave drum.
 Lister’s Sinus Forceps

Sinuc forceps was initially designed to pack the sinus cavities, hence the name.
Its jaws may be straight or curved; serrations are confined to the tip.
 Parts:
1) Finger rings
2) Shanks
3) Box joint
4) Jaws with transverse serrated tips
 Use:
- To pack the sinus cavities
- To manipulate tissues and occlude blood vessels
- To widen the tract during Incision and Drainage (I&D)
During Drainage of sinus, sinus forceps is introduced to explore
the sinus before putting the drain. Further it may be used to
extract foreign bodies or adding medicines in sinus and fistula. It is also used to
introduce corrugated rubber drain (CRD) to drain the dead space in operations like
excision of lipoma or cyst.
 Needle Holder
Needle holder has short jaws with criss cross serrations and a central groove for
maintaining the orientation of the needle.
 Parts:
1) Finger rings
2) Ratchet
3) Shanks
4) Box joint
5) Jaws
 Use: To hold a suturing needle for closing wounds during suturing and surgical
procedures.
 Towel Clip
Towel clip is a small instrument with 4-5 inch length.
It has curved blades with pointy ends for better grasping.
 Parts:
1) Finger rings
2) Ratchet
3) Shanks
4) Box joint
5) Jaws/Blades
 Use: To fix sterile drapes in such a manner so that only the operative field is exposed
and the surrounding area is covered.
 Surgical Scissors
Scissors have one stationary and one movable blade, which may be straight or curved.
 Types:
1) Dissecting scissors (blunt tip)
2) Cutting scissors (sharp tip)
 Parts:
1) Finger rings
2) Shanks
3) Box joint
4) Blades
 Use:
- Tissue dissection or dividing
- Cutting of sutures or other surgical materials
 Scalpel
A scalpel is popularly known as “surgeon’s knife.”
 Parts:
1) Handle
2) Blade
1) Handle
- It is commonly known as BP (Bard Parker) Handle.
- It is reusable.
- It is mainly available in 2 sizes = 3 & 4
- Size 3 handle can accommodate small sized surgical blades (number 10-15).
- Size 4 handle can accommodate larger surgical blades (number 18-25).
2) Blade
- It is disposable.
- It is either made from stainless steel only or from stainless steel with
platinum coating.
 Use: For making a deliberate, controlled and clean cut into the tissue.
 Retractors
Retractors are instruments which are used to pull tissue aside to expose a surgical field.
Retraction should be gentle and injury to the underlying tissue should be avoided by
placing a sponge or gauze piece beneath the retractor.
An assistant who is retracting should be allowed to relax between surgical manoevres in
order to avoid fatigue and muscular cramps.
 Types:
1) Superficial retractors
2) Deep retractors
3) Self-retaining retractors
 Use: Traction, countertraction or both.

 Trocar & Cannula
Surgical trocar & cannula are used to perform
laparoscopic ('keyhole') surgery. They are used
to make a hole on the abdomen to provide passage
for introduction of a telescope and other hand
instruments, such as scissors, graspers, etc.
 Ryle’s Tube (Nasogastric Tube)

A nasogastric tube is a narrow-bore tube
passed into the stomach via the nose.
 Length = 105-120 cm
 Parts:
1) Base
2) Body
3) Tip
1) Base: Provided with a cork.

2) Body: It has 4 marks at: i) 40 cm – Cardio-oesophageal junction
ii) 50 cm – Body of stomach
iii) 60 cm – Pylorus
iv) 65 cm – Duodenum
3) Tip: It is blunt to avoid trauma, and has 3-4 metal beads. These are radio
opaque so radiological confirmation of location of the tip can be done. They
also facilitate passage of the tube by gravity.
 Use:
1) Diagnostic Use
- Gastric function test
- Hollander’s test
- Baid test for pseudocyst of pancreas
- Trachea-oesophageal fistula
2) Therapeutic Use
- It is used for short- or medium-term nutritional support, and also for
aspiration of stomach contents; e.g. for decompression of intestinal
obstruction.
- May be used in case of peritonitis, abdominal trauma, after abdominal
surgeries, etc.
- Used for feeding purpose in comatose patients or in case of major head and
neck injuries.
 Catheters
A catheter is a hollow, flexible tube with openings at both ends.
 Types:
1) Simple or Non-self retaining catheter: Simple rubber catheter
2) Self retaining catheter: Foley’s catheter, Malecot’s catheter, etc.
Simple Rubber Catheter
It is a non-self retaining catheter made
from India / red rubber.
This catheter is available in size 3-12, each
having 37.5 cm length.
Its tip is blunt with opening at the sides only.
 Use:
Used for bladder wash, enema, bowel wash and to temporarily drain the urine in
case of acute retention of urine. It is also used for retrograde cystourethrogram.
Foley’s Catheter
It is a self retaining catheter made from latex.
It has a balloon near the tip into which distilled
Water is infused to make it self retaining.
It is sterilized by gamma radiation.
 Use:
- To relief retention of urine.
- Used during and after any major
surgery, and in case of burns to monitor
the urine output.
- Irrigation of urinary bladder
- Hemostatic after prostatectomy
- Introduction of cytotoxic drugs while treating papillary carcinoma of the bladder.
- Catheter cholecystostomy and gastrostomy
Malecot’s Catheter
It is a self retaining catheter made from red rubber,
containing sulphur. It has a flower or umbrella shaped end.
It is never introduced per urethral route. It can be inserted
through the skin into different areas of the body.
 Use:
- Used in the drainage of different body fluids, e.g. urine, bile, pus.
- Suprapubic cystostomy, if Foley’s catheterization fails after two trials.
- Perinephric and subphrenic abscess
- Amoebic liver abscess
CHAPTER Iii: Nirjantukarana /
Sterilization
 Nirjantukaraṇa
Nirjantukaraṇa is a term to denoting the meaning of sterilization. It has not directly been
mentioned in the classical ayurvedic texts.
Ayurveda has mentioned the treatment modalities as topical (Bahirparimarjana),
systemic (Antaḥparimarjana), and surgical internventions (Shastrapranidhāna).
For a successful surgery, sterilization is essential. These methods were mentioned
sporadically in classical texts under various surgical procedures.
Āchārya Ḍalhana mentioned the physical method of sterilization of instruments before

an operation by flaming them. Further, he explained that if this method is not done, the
operation site becomes prone for infection.
Dhūpana karma (fumigation), characterized under Bahirparimarjana, has been

mentioned as a treatment in all classics of Ayurveda. This mediacated smoke creates an
aseptic environment which kills the microbes thus preventing infections.
Examples of common used Dhūpana Dravya:
- Nimba (Azadirachta indica): Its active constituent possesses insecticidal and insect
repellant action. Its fumes act against streptococcus pyogenes after 10 min of exposure,
with 100% inhibition.
- Guggulu (Commiphora mukul): Extract of guggulu have the potential action on both
gram positive and gram negative bacteria.
- Sarṣapa (Brassica campestris): It contains contrasting profile of glucosinolates which

have biocidal action on different pathogens including bacteria and fungi. Fumigation with
Sarṣapa is effective against nematodes.
- Elā (Elettaria cardmomum): It contains volatile oils which have antimicrobial and
antifungal action.
- Haridrā (Curcuma longa): It exhibits the fumigant activity against beetles and insect.
Haridra itself act as antibacterial agent and also having antifungal activity
- Jaṭāmāṁsī (Nardostachys jatamansi): It contains essential oil with antimicrobial action.
- Tulasī (Ocimum sanctum): Extracted essential oils such as chavicol, euginol, linalool,
camphor and some biologically active constituents that are insecticidal, nematicidal and
fungicidal.
Āchārya Sushruta described the Rakṣoghna Dhūpa containing Sarṣapa, Nimba patra, etc.
which has been told to use for wound management.
Āchārya Charaka described 32 Lepa and Pradeha in 3rd chapter of Sūtra Sthāna for the
management of skin infections. He also described the Mahākaṣāya like Kuṣṭhaghna,
Kaṇḍūghna, Kṛmighna, Viṣaghna for the same. These are used in infective conditions for
Sharīrparimarjana, both internal and external.
Āchārya Sushruta also described the Mishraka Gaṇa like Arkādi gana, Elādi gaṇa, Paṭolādi
gana, Āragvadhādi gaṇa, which are used for disinfection.
In the description of Dinacharya, Ā. Sushruta has recommended some plants for the
purpose of Dantadhāvana, such as Nimba, Karañja, etc. which are disinfectants,
therefore preventing accumulation of microorganisms in the oral cavity.
In Aṣṭāṅga Hṛdaya, Uttara Sthāna, chapter 1, it is described to tie Kṛmihara Dravya like
Hiṅgu, Vachā, Sarṣapa, Brāmhī, Jīraka, etc. on the door, bed, around the neck or limbs of
an infant to protect the newborn child from infections.
 Sterilization
Sterilization is the process of completely freeing an article, a surface or a medium of all
microorganisms by removing or killing them.
In surgery, sterilization has prime importance. Without sterilization, complications such
as infections, impaired wound healing, etc. are likely to occur.
Disinfection describes a process that eliminates most or all pathogenic microorganisms,

except bacterial spores, on inanimate surfaces.
Asepsis is the absence of bacteria, viruses, and other microorganisms.
Antisepsis is the prevention of infection by inhibiting or arresting the growth and

multiplication of infectious agents.
Decontamination is the process of removal of contaminating pathogenic microorganisms

from articles by either sterilization or disinfection.
Sanitization is the process of chemical or mechanical cleansing, applicable in public

health systems.
Bacteriostasis is a condition where the multiplication of the bacteria is inhibited without

killing them.
Bactericidal is the action of killing bacteria.

 Methods of Sterilization:
1) Physical
2) Chemical
1) Physical Methods of Sterilization

a) Heat
b) Radiation
c) Filtration
a) Heat
i) Dry Heat = Flaming, Hot air oven
ii) Moist Heat = Heating below 100° C, Heating at 100° C (boiling),
Heating at 120° C (autoclaving)
Flaming is used in sterilization of inoculating loops or wires, forceps

points, spatulas, etc.
Hot air oven is an electrical device used for sterilization of glassware,

forceps, scissors, scalpels, syringes, swabs, dressings, etc.
Temperature = 160° C
Duration = 1 hour
Heating below 100° C is used for pasteurization of milk.

Temperature = 71.7° C
Duration = At least 15 seconds, not longer than 25 seconds
Heating at 100° C is the process of immersing objects into boiling water.

It kills most pathogenic organisms and is used for sterilization of
syringes, injection needles, suture needles, knives and other surgical
instruments.
Duration = 10 minutes
Autoclaving is the process of sterilization by using saturated steam

under pressure. It has high penetrating power and is used to sterilize
syringes, needles, linen, masks, etc.
Pressure = 20 pounds per square inch
Duration = 20 minutes
b) Radiation
i) Non-ionizing = Infrared, Ultraviolet
ii) Ionizing = Gamma rays, X-rays, Cosmic rays
Infrared radiation is used for sterilization of syringes.

Ultraviolet radiation is used for entryways, hospital wards, OT, etc.
Gamma rays are used for syringes, swabs, catheters, sutures, IV infusion
set, blood donor transfusion set, scalp vein set, scalpels, etc.
c) Filtration
Filtration through several different types of filters, including the modern
membranes filters (Milipore filters), is an efficient way of removing
larger particals and bacteria from liquids that cannot be treated by other
means.
2) Chemical Methods of Sterilization

a) Gases: Formaldehyde, Ethelyne oxide
b) Aldehydes: Formaldehyde
c) Alcohol: Ethyl alcohol
d) Dyes: Flavin, Acriflavin
e) Halogens: Chlorine, Iodine
f) Surface active: Detergents
CHAPTER IV: Sangyaharana /
Anaesthesia
 Sangyāharaṇa
Sangyāharaṇa is the process of inducing a loss of sensation or reducing awareness.
It is used to make a surgical procedure tolerable or even painless, and to console or
distract the patient.
Ancient methods of Sangyāharaṇa include:

1) Madyapāna
Drinking of alcoholic preparations reduces the patient’s awareness leading to decreased
pain perception. It has been described for surgical procedures such as extraction of
Shalya or to relieve pain during labor. Mātuluṅga svarasa & Madya can be used for eye
operations according to Ā. Vāgbhaṭa.
2) Shantavaitva
It is the process of consoling and distracting the patient before, during or after a surgery
with sweet words and joyful conversations, as well as the use of fomentation or
application of pressure on the root nerves to reduce pain.
3) Āptairdrudha Grahitasya
Family members should console the patient by holding and caressing.
4) Vedanā Sthāpana Dravya

Shāla, Kaṭphala, Kadamba, Padmaka, Tumba, Mocharasa, Shirīṣa, Vañjula, Elavāluka,
Ashoka, Bhaṅga, Ahiphena, etc.
5) Mantras
Certain Mantras or rituals were performed before conducting an operation which also
might have a soothing or even hypnotic effect on the patient.
6) Bandha
Jalandhara Bandha in case of tooth extraction.
 Anesthesia
Anesthesia is the loss of sensation with or without loss of consciousness.
It is a state of controlled, temporary loss of sensation or awareness that is induced for
medical purposes. It may include analgesia, paralysis, amnesia, and unconsciousness.
Anesthesiologists use a wide variety of drugs, in multiple combinations, in order to

ensure that patients remain comfortable, relaxed and free of pain during surgery or
other procedures. Drugs administered by anesthesiologists are categorized as follows:
1) Local & Regional anesthetics: Block transmission of nerve impulses without
causing unconsciousness. Local anesthesia numbs just a small area of tissue where a
minor procedure is to be done. Regional anesthesia numbs a larger (but still limited)
part of the body.
2) General anesthetics: Bring about a state of unconsciousness.
3) Analgesics: Relieve pain of patients before, during or after surgery.
4) Sedatives: Bring about relaxation/calmness in a patient and reduce anxiety; higher
doses can also be used to induce sleep.
5) Muscle Relaxants: Work to paralyze skeletal muscles in order to facilitate
intubation or surgery.
While only certified anesthesiologists can administer certain types of anesthesia, such
as general, epidurals and spinals, some physicians/surgeons can apply local anesthetics
without the presence of an anesthesiologist.
 Types of Anesthesia:
1) Local Anesthesia (LA)
2) Regional Anesthesia (RA)
3) General Anesthesia (GA)
4) Monitored Anesthesia Care (MAC)
1) Local Anesthesia (LA)

Local anesthesia, also called local anesthetic, is a one-time injection of an
anesthetic to numb a small area of the body.
Local anesthetics work by preventing the nerves in the injected area from
communicating sensations to the brain.
It is used for procedures such as performing a skin or breast biopsy, repairing a
broken bone, stitching a deep cut, tooth extraction, etc.
LA is mainly of 2 types:
i) Topical / Superficial Anesthesia:
It is defined as superficial loss of sensation in mucus membrane or skin
produced by topical application of local anesthetic solutions, ointmens, gels or
sprays. It reversibly blocks nerve conduction near the site of administration by
targeting free nerve endings in the dermis or mucosa thereby producing
temporary loss of sensation in a limited area.
It is commonly used in laryngoscopy, bronchoscopy, cystoscopy, urethral
dilatation, etc.
ii) Injection / Infiltration Anesthesia:
In this type of anesthesia, a local anesthetic solution is injected subcutaneously
to numb the surrounding area of the injection site.
It is used in minor operations such as excision of lipoma, polyp, dermoid cyst,
tooth extraction, etc.
2) Regional Anesthesia (RA)

Regional anesthesia is the injection of a local anesthetic around major nerves
or the spinal cord to block pain from a large region of the body, such as a limb.
Regional anesthesia provides muscle relaxation as well as postoperative pain
relief since its numbing effects can last 8 to 12 hours, depending upon the
dose. This reduces the need for pain medicine after surgery, as well as other
side effects of surgery, such as nausea. If necessary, the patient may also be
given a mild sedative to help relax or sleep during surgery.
Types of regional anesthesia are:

i) Axillary Nerve Block: Local anesthetic is injected around the nerve
that passes through the axilla (armpit) from the shoulder to the arm to
numb the feeling in the arm and hand. Typically used for surgery of the elbow,
forearm, wrist, or hand.
ii) Interscalene Nerve Block: Local anesthetic is injected around the nerve
block in the neck used to numb the shoulder and arm. Typically used for
surgery of the shoulder and upper arm.
iii) Femoral Nerve Block: Local anesthetic is injected around the nerve block in
the upper thigh/groin area to numb the leg from the knee to the hip. Typically
used from surgery of the upper leg, hip or knee.
iv) Ankle Block: Local anesthesia is injected around the ankle to block the five
nerve branches that supply sensation to the foot. As the name indicates, used
for surgery of the ankle, foot or toes.
v) Bier Block: Local anesthetics are injected intravenously to numb a limb,

typically the arm, and then a tourniquet is applied to prevent the anesthetic
from leaving the area. Typically used on surgeries of hand or arm that last less
than an hour.
vi) Epidural anesthesia & Spinal block: Epidural and spinal anesthesia can be
used for most surgeries below the navel. In order to get an epidural or spinal
anesthesia, an IV must first be inserted since these procedures require the
patient to be properly hydrated. Both epidural and spinal anesthesia use a
local anesthetic to numb the area where the needle is inserted. Depending on
the type of surgery, patients may also be placed under general anesthesia or a
mild sedative that allows them to relax and/or sleep.
Epidural anesthesia is administered in the lower back/lumbar region using a
special needle that is inserted between the vertebrae of the spinal column into
the epidural space around the spine. Once in place, a small catheter is placed
into the epidural space via the needle, and then the needle is removed, leaving
the catheter in place. Local anesthetics and narcotics are then given through
the catheter. The procedure usually takes 10 to 25 minutes. Because an
epidural uses a catheter, pain medicine can continue to be administered to
provide post-operative pain relief if needed.
Types of Procedures: Typically used for labor, cesareans (c-sections) and
surgeries of the colon and gastrointestinal tract.
Spinal Anesthesia is administered in the lower back/lumbar region using a

spinal needle that is inserted between the vertebrae of the spinal column into
the dural membrane, which covers the spine and nerve roots. Once in place,
medicines including a local anesthetic and sometimes a narcotic are given
through the needle, and then the needle is removed. The entire process
usually takes anywhere from 5 to 20 minutes.
Types of Procedures: Typically used for gynecologic (e.g. hysterectomies) and
urologic (e.g. prostate) surgeries, as well as surgeries of the lower extremities
(e.g. knee surgery).
3) General Anesthesia (GA)

General anesthesia places the entire body, including the brain, into a state of
unconsciousness during which the patient has no awareness and feels nothing,
and will remember nothing of the surgical experience.
General anesthesia is administered by injection or through a breathing mask,
or sometimes both. In order to control the breathing, patients are intubated.
The tube is inserted after the anesthesia is given and removed as the patient is
waking up and breathing adequately. Upon awakening from anesthesia,
patients may experience disorientation and/or a mild sore throat from the
intubation.
Laryngeal Mask Airway (LMA): When possible, the anesthesiologist will use a
Laryngeal Mask Airway device instead of intubation because it is quicker and
causes less discomfort for the patient. An LMA is a tube with an inflatable cuff
that is inserted into the pharynx.
4) Monitored Anesthesia Care (MAC)

Monitored Anesthesia Care (MAC) is the intravenous administration of mild
sedatives to help a patient relax and relieve anxiety during minor procedures
that do not require general anesthesia. These procedures, such as biopsies and
colonoscopies, typically require the injection of a local anesthetic to numb the
surgical site.
CHAPTER V: Trividha karma
णरण्धं कमव पू्क

व मव प्रधानकमव पिात्कमेणत ॥ (सु - सू - ५/३)
Trividha Karma consist of:
1) Pūrvakarma (Pre-operative)
2) Pradhānakarma (Operative)
3) Pashchātkarma (Post-operative)
1) Pūrvakarma
Pūrvakarma are the pre-operative procedures which are to be followed.
Ācharya Ḍalhana has described the term Agropaharṇīya as the preparation of the patient
along with collecting all the required materials needed for the surgical procedure.
Preparation of the patient is done by Ekadashopakrama:

1) Apatarpaṇa (fasting)
2) Ālepa (application of ointment)
3) Parisheka (pouring of liquid)
4) Abhyaṅga (oil massage; Bahir Snehana)
5) Svedana (sudation)
6) Vimlāpana (softening)
7) Upanāha (application of poultice)
8) Pāchana (digestives)
9) Visrāvaṇa (blood letting)
10) Snehapāna (drinking oil; Abhyantara Snehana)
11) Shodhana (Vamana & Virechana - emesis & purgation)
Upakaraṇa Sambandha:
The materials required for the procedure should be collected. These include:
Yantra, Shastra, Kṣāra, Agni, Shalāka, Shṛṅga, Jalauka, Ālābū, Jambvauṣṭha (a cauterizing
instrument made from black stone, with its tip resembling Jambuphala), Pichu (cotton
cloth/gauze), Prota/Plota (cloth/swab), Sūtra (thread), Paṭṭa (band-like cloth, tape),
Vikeshikā (kind of compression garment), Madhu, Ghṛta, Vāsa, Paya, Taila, Tarpaṇa, Kaṣāya,
Ālepana kalka, Shītāmbu, Uṣṇodaka, Kaṭāha (pots)
Additionally, Parikarmiṇa / Parichāraka (attendant) who is affectionate (Snigdha), steadfast
(Shtira) and strong (Balavanta) should be present.
Nirjantukaraṇa: Sterilization of Sthāna, Upakaraṇa, Rogī and Shastravaidya is also included

under Pūrvakarma.
2) Pradhānakarma
Pradhānakarma is the main operative procedure. According to Sushruta Saṁhitā, there are
8 main surgical procedures, known as Aṣṭavidha Shastrakarma.
1) Chedana (Excising, Removing)

2) Bhedana (Dividing, Separating)
3) Lekhana (Scrapping)
4) Vyadhana (Puncturing, Piercing)
5) Eṣaṇa (Probing, Searching)
6) Āharaṇa (Extracting, Pulling out)
7) Visrāvaṇa (Draining)
8) Sīvana (Suturing)
Refer to the subsequent chapter for detailed description.
Shastravaidya Guṇa:
शौयवमाशणु क्रया शस्त्रतैक्ष्णण्यमस््ेद्ेपिु ॥
असम्मोहि ्ैद्यस्य शस्त्रकमवणि शस्यते ॥ (सु - सू - ५/१०)
Required qualities of a Shastravaidya (surgeon):
1) Shaurya / Nirbhayatva (boldness / courage)
2) Āshukriyā (light handed & quick in action)
3) Shastrataikṣnya (equipped with sharp instruments)
4) Asveda (no perspiration during the procedure)
5) Avephathu (no trembling during the proedure)
6) Asammoha (not becoming stupefied, confused or unconscious
during the procedure)
3) Pashchātkarma
Pashchātkarma is the post-operative procedure which is to be followed.
1) The patient should be sprinkled with cold water.
2) Pressure should be applied with fingers around the wound to squeeze it.
3) The site is irrigated with Kaṣāya (Pariṣeka). The remaining liquid on the wound
should be mopped by Plota (swab).
4) The wound should be fumigated (Dhūpana) with Vedanāshāmaka & Rakṣoghna

Dravya. Dhūpana may be done with Guggulu, Aguru, Sarjarasa, Vachā, Gaura Sarṣapa,
Lavaṇa, Nimbapatra and Ajāghṛta.
5) Then the wound is packed with Pichu (gauze) which should neither be too wet, nor
too dry, but thoroughly soaked in Tila kalka & Madhu-Sarpi.
6) Kalka is applied over the site and is covered by a thick layer of Kavalikā (bandage).
7) Recitation of Mantra should be done to reassure the patient and for protection
against Nāga, Pishacha, Rakṣasa, etc.
8) The patient should follow Pathyāhāra-vihāra according to the condition.
9) On the third day after Pradhānakarma, the applied dressing is removed and
Steps 3-8 are repeated.
During Hemanta, Shishira and Vasanta Ṛtu, dressing should be changed every 3rd day.
During Sharada, Grīṣma and Varṣa Ṛtu, dressing should be changed every 2nd day.
10) If there is severe pain due to the surgery, lukewarm Ghṛta with Yaṣṭīmadhu
should be applied before fixing the new dressing.
CHAPTER Vi: Astavidha Shastra karma
According to Sushruta Saṁhitā, there are 8 main surgical procedures, known as Aṣṭavidha
Shastrakarma.
1) Chedana (Excising, Removing)
2) Bhedana (Dividing, Separating)
3) Lekhana (Scrapping)
4) Vyadhana (Puncturing, Piercing)
5) Eṣaṇa (Probing, Searching)
6) Āharaṇa (Extracting, Pulling out)
7) Visrāvaṇa (Draining)
8) Sīvana (Suturing)
Shastrakarma Vyāpat
1) Hīna (Inadequate) E.g.: Hīna Chedana
2) Atirikta (Excessive) E.g.: Atirikta Visrāvaṇa
3) Tiryak (Irregular) E.g.: Tiryak Sīvana
4) Ātmagatra (Accidental) E.g.: Ātmagatra Bhedana
These complications occur if the surgeon uses improper instruments either due to
ignorance, greediness, being instigated by the enemy, or out of fear, confusion or due to
other impairing factors.
1) Chedana Karma
Chedana karma is the surgical procedure in which a particular part of the body is removed. It
may range from excising small structures, like a skin wart or a mole, up to amputation of a
whole limb.
Shastra: Maṇḍalāgra, Karaptara, Vṛddhipatra, Nakha shastra, Mudrika, Utpalapatra,

Ardhadārā shastra
Anushastra: Tvak sāra, Sphaṭika, Kācha, Kuruvinda, Nakha, Agni, Kṣāra
Yogya:
- Bhagandara (fistula-in-ano) - Kaphaja Granthi (glandular swelling)
- Tilakālaka (mole) - Arbuda (tumor)
- Vraṇa Vartma / Nāḍī Vraṇa - Arshas (piles)
- Charmakīla (skin warts) - Asthi-Māṁsagata Shalya
- Jatumaṇi (hemangioma) - Galashuṇḍikā (uvulitis)
- Necrosis of Snāyu, Māṁsa and Sirā - Valmīka (Madura foot)
- Shataponaka Bhagandara - Adhruṣa (palatine inflammatory swelling)
- Māṁsakaṇda (keloid) - Adhimāṁsa
2) Bhedana Karma
Bhedana karma is the surgical procedure to divide or seperate tissue to open a structure for
achieving effective drainage or for adequate removal of underlying structures.
Shastra: Vṛddhipatra, Nakha shastra, Mudrika, Utpalapatra, Ardhadārā shastra
Anushastra: Tvak sāra, Sphaṭika, Kācha, Kuruvinda, Nakha, Agni, Kṣāra
Yogya:
- Vidhradhi (abscess) - Granthi (Vātaja, Pittaja, Kaphaja)
- Visarpa - Vṛddhi (hydrocele)
- Vidārika (axillary/ inguinal lymphadenitis) - Prameha piḍaka (carbuncles)
- Shopha - Stanaroga
- Avamanthaka - Kumbhīka (diseases of eyelids)
- Anushayī (scalp inflammation) - Vṛnda (throat tumors)
- Puṣkarikā & Alajī - Kṣudra Roga
- Tālu Danta puppuṭa - Tuṇḍikerī (tonsillitis)
- Gilāyu (pharyngeal swelling) - Bastigata Ashmarī (vesical calculus)
3) Lekhana Karma
Lekhana karma is the surgical procedure to remove tissue by scrapping.
Shastra: Maṇḍalāgra, Karapatra, Vṛddhipatra
Anushastra: Kṣāra, Gojihvā, Shephālikā patra, Nakha
Yogya:
- Rohiṇī (diphtheria) - Medaja Granthi
- Kilāsa (leucoderma) - Upajihvikā (sulingual inflammatory swelling)
- Dantavaidarbha - Adhijihvikā (adenoids)
- Arshas - Maṇḍala Kuṣṭha
- Māṁsa kanda & Māṁsa unnata
4) Vyadhana Karma
Vyadhana karma is the surgical procedure to puncture or pierce a structure.
Shastra: Kuṭhārika, Vṛhimukha, Ārā, Vetasapatra, Eṣaṇī, Kushapatra
Anushastra: Tvak sāra, Karīra
Yogya:
- Mūtravṛddhi (hydrocele) - Pakva Raktaja Gulma
- Dakodara (ascitis) - Visarpa
5) Eṣaṇa Karma
Eṣaṇa karma is the surgical probing procedure.
Shastra: Eṣaṇī
Anushastra: Karīra, Bāla, Aṅguli
Yogya:
- Nāḍī vraṇa
- Sashalya vraṇa
- Unmārgī vraṇa
6) Āharaṇa Karma
Āharaṇa karma is the surgical procedure to extract a structure from the body.
Shastra: Baḍisha, Dantashaṅku
Anushastra: Nakha, Aṅguli
Yogya:
- Mūtra Sharkarā - Danta mala
- Ashmarī - Karṇa mala
- Shalya - Mūḍhagarbha
- Gude Varcha Nichita (accumulated faeces in the rectum)
7) Visrāvaṇa Karma
Visrāvaṇa karma is the surgical procedure to drain liquid from a particular site.
Shastra: Kushapatra, Āṭīmukha, Sharārimukha, Antarmukha, Trikūrchaka, Sūchī
Anushastra: Jalauka, Gojihvā, Shephālikā, Shākapatra
Yogya:
- Vidhradhi - Kuṣtha
- Ekadeshaja Shopha - Pālī roga (diseases of the earlobe)
- Shlīpada - Viṣajuṣṭa Shoṇita (blood vitiated with toxins)
- Arbuda - Visarpa
- Granthi - Upadaṁsha
- Stanaroga - Vidārikā
- Suṣira (porous gum) - Galashālūka (pustules in the axillary region)
- Kṛmidanta (dental caries) - Dantaveṣṭa (gum hypertrophy)
- Upakusha (gingivitis) - Shītada (spongy gum)
- Danta puppuṭa - Pittaja, Raktaja & Kaphaja Oṣṭha roga
- Kṣudra roga
8) Sīvana Karma
Sīvana karma is the surgical suturing procedure.
Shastra: Sūchī
Anushastra: Bāla
Required Materials for Sīvana:

- Sūkṣma sutra (fine thread)
- Ashmantaka valka (bark of Ashmantha)
- Shaṇa (thread of Shaṇa)
- Kṣaumasūtra (silk thread)
- Snāyu (tendons)
- Bāla (hairs)
- Mūrva (fibres of Mūrva)
- Guḍūchī (fibres of Guḍūchī)
Yogya:
- Diseases which arise from Meda which have been incised and scrapped.
- Sadyovraṇa
- Vraṇa located around movable joints.
- Repair of wounds on the head, ear, nose, sides of the neck, lups, arms, legs, abdomen, anal
canal, genitalia, scrotum, etc.
Ayogya:
Sīvana is contraindicated in wounds which are caused by:
Kṣāra, Agni or Viṣa.
It is also contraindicated if there is Antaḥ Lohita (blood clot) or Antaḥ Shalya (foreign body is
still inside).
Sīvana Prakāra: (Types of Suturing)

1) Vellitaka (Continuous)
2) Gophaṇikā (Blanket)
3) Tunnasevanī (Subcuticular)
4) Ṛjugranthi (Interrupted)
Sūchī Prakāra: (Types of Needles)

1) Vṛtta Sūchī (Round body needle) -> Used where the tissue is thin. At joints, the
needle should have a circular tip and have 2 angula length.
2) Tryasrā Sūchī (Triangular cutting needle) -> Used where the tissue is thicker. Needle
should be straight, have a triangular tip and have 3 angula length.
3) Dhanurvakra Sūchī (Curved needle) -> Used at vitals areas (Marma), testicles and
abdominal viscera.
 Suturing
Suture is a stitch or a row of stitches holding together the edges of a wound or
surgical incision.
 Needles
Needles are sharp pointed structures used to puncture tissue.
a) Ideal Needle:
- Made from high quality stainless steel
- As thin and slim as possible without compromising strength
- Should cause minimal trauma to the tissue
- Should be able to penetrate tissue with minimal resistance
- Should resist abnormal bending
b) Varieties:
According to According to Cutting According to Eye According to Tip Miscellaneous
Shape Edge
1) Straight 1) Round body 1) Traumatic (with eye) 1) Triangular tip 1) Spatula needle
2) Curved 2) Cutting body 2) Atraumatic (eyeless) 2) Round tip 2) Micro-point needle
(Single armed / (Conventional cutting 3) Blunt point
Double armed) / Reverse cutting)
 Suture Material
Surgical suture is a medical device used to hold body tissues together after an
injury or surgery.
a) Ideal Suture Material:

- Easily available and cost effective
- Should not promote growth of bacteria around it
- Should have a uniform diameter
- Non-allergic, non-carcinogenic
b) Varieties:
Absorbable Non-absorbable
It is absorbed in the body. It either gets digested It remains inside the body and retains its tensile
by enzymes and removed by phagocytosis, or it it strength for at least one year.
gets broken down by hydrolysis and removed by
phagocytosis.
Natural Synthetic Natural Syntethic

Catgut, Collagen, Vicryl (Polyglactin), Silk, Cotton, Steel, Nylon, Silver, Polyester,
Fascia lata, Kangaroo Dexon (Polyglycolic acid), Linen Polyethylene, Prolene,
or Beef tendon PDS (Polydioxanone), Platinum wire, Silver wire
Polyglycaprone
 Types of Knots:
 Types of Sutures:
CHAPTER ViI: Yogya
In Sushruta Saṁhitā, Sūtra Sthāna, Chapter 9, Yogyāsūtrīyamadhyāya, the concept of

experimental surgery has been described and named as Yogyā.
Yogyā is the preparation process of training a surgeon to achieve dexterity and confidence in
performing Senahanādi as well as Chedanādi Shastrakarma, and thereby becoming eligible
(Yogyā) to use this practical knowledge for the benefit of others.
Even if a person is well read and possesses theoretical knowledge, without becoming Yogyā,
that person is an incompetent physician.
 Chedana Yogyā
Chedana should be demonstrated and practiced on models such as Kuṣmāṇḍa
(pumpkin gourd), Ālābū (bottle gourd), Kālindaka (watermelon), Trapusa
(cucumber), etc.
It is done to learn the proper application of Chedana karma by experiencing the
required force which is needed to excise different types of tissues with different
surfaces and resistances.
Utkartana (excessive cutting) and Apakartana (inadequate cutting) should also be
demonstrated.
 Bhedana Yogyā
Bhedana should be demonstrated and practiced on models such as urinary bladder
of animals or leather bag filled with water or variours other substances having
different consistences.
It is done to learn the proper application of Bhedana karma by experiencing the
insicion method on materials with different wall tension and content.
 Lekhana Yogyā
Lekhana should be demonstrated and practiced on a broad sheet of animal leather
with hair.
It is done to learn the proper application of Lekhana karma by experiencing the use
of the surgical instrument in order to adequately balance it and to avoid injury of
underlying structures.
 Vyadhana Yogyā
Vyadhana should be demonstrated and practiced on models such as vessels of
dead animals or lotus stem.
It is done to learn the proper application of Vyadhana karma to gain dexterity in
piercing a structure adequately.
 Eṣaṇa Yogyā
Eṣaṇa should be demonstrated and practiced by using holes eaten by moths in
pieces of wood, bamboo, dried bottle gourd, etc.
It is done to learn the proper application of Eṣaṇa karma to be able to identify the
nature of the foreign body inside a structure in terms of size, number and fixity.
 Āharaṇa Yogyā
Āharaṇa should be demonstrated and practiced by using models such as Panasa
(jack fruit), Bimbī, Bilva phala majja, Mṛta Pashu Danta (teeth of dead animals).
It is done to learn the proper application of Āharaṇa karma to experience the
optimum grip and force required to remove a structure whie causing minimum
damage to the surrounding structures.
 Visrāvaṇa Yogyā
Visrāvaṇa should be demonstrated and practiced by using the surface of Shalmalī
covered with Madhucchiṣṭa (bee wax).
It is done to learn the proper application of Visrāvaṇa karma by practicing
superficial incision without cutting deeper than the skin.
 Sīvana Yogyā
Sīvana should be demonstrated and practiced by using a thin or thick piece of cloth
or leather.
It is done to learn the proper application of Sīvana karma by practicing the different
suturing methods on structures with different thickness.
 Bandhana Yogyā
Bandhana should be demonstrated and practiced on models made from mud,
cloth, etc. (manikin) and parts of the humany body.
It is done to learn the proper application of Bandhana karma by practicing the
different bandaging methods, with different bandage materials on different
locations on the body.
 Agni Kṣāra Yogyā

Agni and Kṣārakarma should be demonstrated and practiced on soft parts of animal
muscle / flesh (Māṁsa).
It is done to learn the proper application of Agnikarma and Kṣārakarma by
practicing their different methods and to observe Agni and Kṣāra Dagdha Lakṣaṇa.
Vishikhanupraveshana
Vishikhānupraveshana is the process of entering into the medical profession, described in

Sushruta Saṁhitā, Sūtra Sthāna, Chapter 10, Vishikhānupraveshanīyamadhyāya.
"Vishikha" indicates the removal of the tuft of hair on the head which was maintained as a
custom during the period of studentship. Traditionally, it was removed upon completion of
the studies.
The student should fulfill the following requirements to be eligible for becoming a Vaidya:
He/She must …
1) … be well versed in the Tantra (theoretical knowledge).
2) … be able to properly understand the meaning of what has been studied.
3) … have observed the various therapies and their effects.
4) … have been made eligible (Yogyā) through practical training.
5) … be able to recapitulate (summarize and state the main aspects) of the Tantra.
6) … have obtained the permission of the King.
7) … have cut the nails and shaved the beard.
8) … be clean, wear a white dress, hold an umbrella and stick, and wear footwear.
9) … maintain a peaceful mind, pleasant speech and good deeds.
10) … remain friendly and helpful towards all living beings.
11) … have trained and capable assistants.
When examining a patient, the physician should use Ṣaḍvidha Parīkṣā:

Pañchgyānendriya + Prāshna
CHAPTER ViIi: Marma
मारयन्त्तीणत ममावणि ॥ (सु - शा - ६/३ डल्हन)

Marmas are the spots which lead to death when injured.
जी्स्िानं तु ममव स्यात् ।

Marma = Jīvasthāna
 Saṅkhyā: 107
 Vargīkaraṇa: 5
A) Aṅga Bheda: Classification according to region
1) Ūrdhva Shākhā 22 (11 in each upper limb)
2) Adho Shākhā 22 (11 in each lower limb)
3) Udara & Vakṣa 12 (2 in abdomen, 10 in chest)
4) Pṛṣṭa 14 (6 in lower back, 8 in upper back)
5) Ūrdhvajatrugata 37 (12 in neck, 25 in head)
107
B) Nivesha/Rachanā Bheda: Classification according to structure

1) Māṁsa 11
2) Sirā 21
3) Snāyu 27
4) Asthi 08
5) Sandhi 20
107
C) Māna/Pramāna Bheda: Classification according to dimension

1) Ardhāṅgula 56
2) Ekāṅgula 12
3) Dvyaṅgula 06
4) Tryaṅgula 04
5) Chaturaṅgula 29
107
D) Saṅkhyā Bheda: Classification according to number

1) Ekasaṅkhyā 06
2) Dvisaṅkhyā 52
3) Chatursaṅkhyā 36
4) Pañchasaṅkhyā 05
5) Aṣṭasaṅkhyā 08
107
E) Vyāpat/Pariṇāma Bheda / Pañcha Vikalpa: Classification according to prognosis
1) Sadyaḥ Prāṇahara 19
2) Kālāntara Prāṇahara 33
3) Vishalyaghna 03
4) Vaikalyakara 44
5) Rujākara 08
107
1) Sadyaḥ Prāṇahara Marma

Saṅkhyā = 19
Mahabhūta = Agni
Viddha Lakṣaṇa:
Inability to perceive Indriyārtha, Loss of Manas & Jnāna, Tīvra Rujā
Injury to Sadyaḥ Prāṇahara Marma leads to immediate death or within 7 days.
2) Kālāntara Prāṇahara Marma

Saṅkhyā = 33
Mahābhūta = Agni & Jala
Viddha Lakṣaṇa: Dhātu Kṣaya, Tīvra Rujā
Injury to Kālāntara Prāṇahara Marma leads to death within 15-30 days.
3) Vishalyaghna Marma
Saṅkhyā = 03
Mahābhūta = Vāyu
Viddha Lakṣaṇa: Tīvra Rujā
Injury to Vishalyaghna Marma leads to death immediately or soon after Shalya
is removed.
4) Vaikalyakara Marma
Saṅkhyā = 44
Mahābhūta = Jala
Viddha Lakṣaṇa: Injury to Vaikalyakara Marma leads to deformity.
5) Rujākara Marma
Saṅkhyā = 08
Mahābhūta = Agni & Vāyu
Viddha Lakṣaṇa: Injury to Rujākara Marma leads to severe pain.
 Marmaviddha Sāmānya Lakṣaṇa:

Bhrama, Pralāpa, Pātana (falling due to unconsciousness or dizziness), Pramoha,
Vicheṣṭana, Saṁlayana (numbness), Uṣṇatā, Srastāṅgatā (flaccid limbs), Mūrcchā,
Ūrdhvavāta, Vātaja Vedanā, Māṁsodaka & Raktasrava
 Marmāghāta Nidāna:
Chedana (excision), Bhedana (incision), Abhighāta (injury), Dahana (tearing) on the
site of Marma leads to Marmāghāta.
 Importance of Marma Shārīra in Shalyatantra:

- Location of Marma must be known to protect these sites during surgery.
- Injury to Marma provides knowledge about the prognosis of the patient.
- Marmagata Roga are difficult to treat.
 Tri-Marma
There are 107 Marmas in the body. However, according to Āchārya Charaka, out of
these, three Marmas have greater importance. They are known as Tri-Marma.
1) Shiraḥ
2) Hṛdaya
3) Basti
1) Shiraḥ
Shiraḥ is the head.
Shiraḥ is the Sthāna of Pañchagyānendriya,
Prāṇa Vāyu, Ālochaka Pitta, Tarpaka Kapha.
i. Aṅga Bheda: Ūrdhvajatrugata (Shiraḥ - 25 Marmas)
ii. Vyāpat Bheda: Sadyaḥ Prāṇahara Pradhāna (15 Marmas)
2) Hṛdaya
Hṛdaya is the heart.
Hṛdaya is Mūlasthāna of Prāṇavaha, Rasavaha & Manovaha Srotas.
Hṛdaya is the Sthāna of Ātman, Manas, Para Ojas,
Vyāna Vāyu, Sādhaka Pitta, Avalambaka Kapha.
i. Aṅga Bheda: Vakṣa
ii. Rachanā Bheda: Sirā
iii. Māna Bheda: Chaturaṅgula
iv. Saṅkhyā Bheda: Ekasaṅkhyā
v. Vyāpat Bheda: Sadyaḥ Prāṇahara
3) Basti
Basti is the urinary bladder.
Basti is Sthāna for Apāna Vāyu.
i. Aṅga Bheda: Udara
ii. Rachanā Bheda: Snāyu
iii. Māna Bheda: Chaturaṅgula
iv. Saṅkhyā Bheda: Ekasaṅkhyā
v. Vyāpat Bheda: Sadyaḥ Prāṇahara Pradhāna
Marma Aṅga Rachanā Vyāpat Māna Bheda Saṅkhyā Sthāna
Bheda Bheda Bheda Bheda
Ūrdhva-
Sthapanī jatrugata: Sirā Vishalyagna Ardhāṅgula Ekasaṅkhyā Eyebrow center
Shiraḥ
Adhipati " Sandhi Sadyaḥ Ardhāṅgula Ekasaṅkhyā On the top of the head at the
Prāṇahara spiral of hairs
Shaṅkha " Asthi Sadyaḥ Ardhāṅgula Dvisaṅkhyā Center of the temples

Prāṇahara
Utkṣepa " Snāyu Vishalyagna Ardhāṅgula Dvisaṅkhyā Superior part of the temples
(above Shaṅkha)
Apāṅga " Snāyu Vaikalyakara Ardhāṅgula Dvisaṅkhyā Outer canthus of the eyes
Vidhura " Sirā Vaikalyakara Ardhāṅgula Dvisaṅkhyā Back of the ears
Kṛkāṭikā " Sandhi Vaikalyakara Ardhāṅgula Dvisaṅkhyā Junction of head and neck
(atlanto-occipital joint)
Inside the nasal passage, on

Phaṇa " Sirā Vaikalyakara Ardhāṅgula Dvisaṅkhyā the lateral side at the level of
junction between the nasal
bone and cartilage
Just above the eyebrows at the

Āvarta " Sandhi Vaikalyakara Ardhāṅgula Dvisaṅkhyā junction of frontal, sphenoid
and zygomatic bone.
Vessels on either side of the

Shṛṅgāṭaka " Sirā Sadyaḥ Chaturaṅgula Chatursaṅkhyā nose which nourish the sense
Prāṇahara organs; nose, tongue, eyes,
skin, ears
Kālāntara Sutures of the skull; Coronal,

Sīmanta " Sandhi Prāṇahara Chaturaṅgula Pañchasaṅkhyā Saggital, Lambdoid, Right &
Left Squamous suture
Ūrdhva-
Nīlā jatrugata: Sirā Vaikalyakara Chaturaṅgula Dvisaṅkhyā On either side of the trachea in
Grīvā the neck region
Manyā " Sirā Vaikalyakara Chaturaṅgula Dvisaṅkhyā On either side of the trachea in
the neck region
Kanṭhasirā / Sadyaḥ 4 on each side of the throat

Mātṛka " Sirā Prāṇahara Chaturaṅgula Aṣṭasaṅkhyā (external & internal carotid
artery & jugular vein)
Stanamūla Vakṣa Sirā Kālāntara Dvyaṅgula Dvisaṅkhyā Two aṅgula below the nipple of
Prāṇahara the chest
Stanarohita " Māṁsa Kālāntara Ardhāṅgula Dvisaṅkhyā Two aṅgula above the nipple of
Prāṇahara the chest
Apalāpa " Sirā Kālāntara Ardhāṅgula Dvisaṅkhyā Below shoulder joint, on the
Prāṇahara upper part of each flank
Apasthamba " Sirā Kālāntara Ardhāṅgula Dvisaṅkhyā On either side of the sternum,
Prāṇahara at the level of the nipple
Hṛdaya " Sirā Sadyaḥ Chaturaṅgula Ekasaṅkhyā Heart

Prāṇahara
Guda Udara Māṁsa Sadyaḥ Chaturaṅgula Ekasaṅkhyā Rectum

Prāṇahara
Basti " Snāyu Sadyaḥ Chaturaṅgula Ekasaṅkhyā Urinary bladder

Prāṇahara
Nābhī " Sirā Sadyaḥ Chaturaṅgula Ekasaṅkhyā Umbilicus

Prāṇahara
On either side of the base of
Āṁsa Pṛṣṭha Snāyu Vaikalyakara Ardhāṅgula Dvisaṅkhyā the neck on the trapezius
muscle
In the upper back, on either

Āṁsaphalaka " Asthi Vaikalyakara Ardhāṅgula Dvisaṅkhyā side of the vertebral column in
the scapular region
On the upper part of the pelvis,

Kaṭīkataruṇa " Asthi Kālāntara Ardhāṅgula Dvisaṅkhyā on either side of the vertebral
Prāṇahara column
Pārshvasandhi " Sirā Kālāntara Ardhāṅgula Dvisaṅkhyā Lower end of Pārshva, at the
Prāṇahara level of L1
Bṛhatī " Sirā Kālāntara Ardhāṅgula Dvisaṅkhyā On each side of the vertebral
Prāṇahara column at the level of the
nipple of the chest
Nitamba " Asthi Kālāntara Ardhāṅgula Dvisaṅkhyā Above the pelvis on either side
Prāṇahara of the vertebral column
On either side of the sacrum,

Kukundara " Sandhi Vaikalyakara Ardhāṅgula Dvisaṅkhyā just above the fleshy part of
the buttocks
Jānu Shākhā Sandhi Vaikalyakara Tryaṅgula Dvisaṅkhyā Knee joint
Kūrpara " Sandhi Vaikalyakara Tryaṅgula Dvisaṅkhyā Elbow joint
Urvī " Sirā Vaikalyakara Ekāṅgula Dvisaṅkhyā Center of the thighs
Bāhvi " Sirā Vaikalyakara Ekāṅgula Dvisaṅkhyā Center of the upper arms
Viṭapa " Snāyu Vaikalyakara Ekāṅgula Dvisaṅkhyā Between the hip and testes
Kakṣadhara " Snāyu Vaikalyakara Ekāṅgula Dvisaṅkhyā Between thorax and axilla
Gulpha " Sandhi Rujākara Dvyaṅgula Dvisaṅkhyā Ankle joint
Maṇibandha " Sandhi Rujākara Dvyaṅgula Dvisaṅkhyā Wrist joint
Between thumb and index

Kṣipra " Snāyu Kālāntara Ardhāṅgula Chatursaṅkhyā finger in UL / great toe and
Prāṇahara succeeding toe in LL
Talahṛdaya " Māṁsa Kālāntara Ardhāṅgula Chatursaṅkhyā Center of the palms and soles
Prāṇahara
Indrabasti " Māṁsa Kālāntara Ardhāṅgula Chatursaṅkhyā Center of the forearms

Prāṇahara and calfs
Two aṅgula above (proximal)

Kūrcha " Snāyu Vaikalyakara Chaturaṅgula Chatursaṅkhyā Kṣipra
Just below the wrist and

Kūrchashirā " Snāyu Rujākara Ekāṅgula Chatursaṅkhyā ankle joint
Three aṅgula above

Āṇi " Snāyu Vaikalyakara Ardhāṅgula Chatursaṅkhyā the knee joint
Above Bāhvī near the shoulder

Lohitākṣa " Sirā Vaikalyakara Ardhāṅgula Chatursaṅkhyā joint in UL / Above Urvī near
the hip joint in LL
CHAPTER ix: Kshara & ksharakarma
Kṣāra is a caustic substance, alkaline in nature, obtained from ashes of medicinal plants.
Its use is milder than Shastra karma, therefore it is described as an Anushastra.
 Nirukti & Paribhāṣā:

तर क्षरिात् क्षिनाद्वा क्षारः ॥ (सु - सू - ११/४)
The term Kṣāra is derived from its actions Kṣaraṇa and Kṣaṇana.
Kṣaraṇa refers to Vilayana (corrosion, liquefying, removing, melting) or Chalana

(mobilization) of Doṣas.
Kṣaṇana refers to Hiṃsā (destroying, killing, injuring) of Tvak, Māṁsādi.
Kṣāra is the substance which removes the vitiated tissue from its location by
liquifying and destroying it due to its corrosive nature.
 Kṣāra Guṇa & Karma:

1) Rasa = Kaṭu Lavaṇa pradhāna
2) Guṇa = Saumya, Nāti Tīkṣṇa, Na Mṛdu, Shukla, Shlakṣṇa, Picchila,
Abhiṣyandī, Shiva (soothing, auspicious), Shīghra (quick acting)
3) Vipāka = Kaṭu
4) Vīrya = Uṣṇa
5) Prabhāva = Tridoṣaghna
Karma: Dāhana, Pāchana, Vilayana, Dāraṇa (tearing, splitting), Shodhana,

Ropana, Shoṣaṇa, Stambhana, Lekhana, Kṛmi-Āma-Kapha-Kuṣṭha-Viṣa-Medas
Upahanta (destroying), Puṁsatva Nāshaka (reduces fertility or causes
impotency if taken in excess)
 Kṣāra Doṣa:
1) Atimārdava (too mild)
2) Atishvaitya (too white)
3) Atyuṣṇa (too hot)
4) Atitīkṣṇa (too strong)
5) Atipiccila (too slimy)
6) Atisarpita (too spreading)
7) Sāndratā (too dense / thick)
8) Apakvatā (incompletely processed)
9) Hīnadravyatā (less Dravya used for its preparation)
 Kṣāra Bheda: - 2
1) Pratisāraṇīya Kṣāra
It is used for Bahir Parimārjana.
a) Mṛdu (Kaṣṭauṣadhi)
b) Madhyama (Kaṣṭauṣadhi & Rasauṣadhi)
c) Tīkṣṇa (Rasauṣadhi)
2) Pānīya Kṣāra
It is used for Antaḥ Parimārjana.
It is also called Ksārodaka. Mṛdu Kṣāra chūrṇa is mixed with 6 parts of water
and used for Pānārtha.
 Kṣāra Yogya:
- Kuṣṭha, Kiṭibha, Dadru, Maṇḍala
- Kilāsa, Bhagandara, Arbuda, Arshas, Duṣṭavraṇa, Nāḍī, Charmakīla, Tilakālaka,
Nyaccha Vyaṅga, Mashaka
- Bāhya Vidradhi, Kṛmi, Viṣa
- Mukharoga, Upajihvā, Adhijihvā, Upakusha, Dantavaidarbha, Rohiṇī
- Garaviṣa, Gulma, Udara, Sharkarā, Ashmarī
- Agnisaṅga, Ajīrṇa, Arochaka, Ānāha
- Ābhyantara Vidradhi, Kṛmi, Viṣa, Arshas
 Kṣāra Ayogya:
- Durbala, Bāla, Vṛddha, Bhīru, Garbhinī, Ṛtumātī, Napuṁsaka
- Raktapitta, Jvara, Bhrama, Mada, Mūrcchā, Timira, Sarvāṅga Shotha, Prameha,
Uraḥkṣata, Tṛṣṇa, Hṛdroga, Mūrdhāroga, Atisāra
 Kṣāra Mātrā:
Required quantity depends on the affected area.
According to Āchārya Ḍalhana, the thickness of applied Kṣāra should be equal
to the thickness of a nail.
a) Adhama = ½ pala (24 ml)
b) Madhyama = 3 kārṣa (36 ml)
c) Uttama = 1 pala (48 ml)
 Kṣāra Mahatva:
- Among all Shastra and Anushastra, Kṣāra is most important (Pradhānatama).
- It can can produce surgical effects like Chedana, Bhedana and Lekhana.
- It is Tridoṣa shāmaka.
- It can be used externally (Pratisāraṇīya) and internally (Pānīya).
- It is even useful in Atikṛcchrasādhya Vyādhi.
 Kṣāra Nirmāṇa:
a) Mṛdu Kṣāra Dravya: Apāmārga, Kuṭaja, Ashvakarṇa, Āragvadha, Tilvaka, Arka,
Snuhī, Pāṭāla, Vāsā, Kaḍalī, Chitraka, Agnimantha, Guñja, Muṣka, Tila, Yava, Arka,
Chiñcha
b) Madhyama Kṣāra Dravya: Bhasma Sharkarā, Shuddha Sharkarā, Shukti,

Shaṅkhanābhī
c) Tīkṣṇa Kṣāra Dravya: Dantī, Dravantī, Chitraka, Lāṅgulī, Karañja, Svarṇakṣīra,

Hiṅgu, Ativiṣā, Pravāla, Biḍa lavaṇa, Sauvarchala lavaṇa
Preparation Method:
i) Mṛdu Kṣāra Dravya is cut into small pieces, dried and mixed with a small
quantity of Shuddha Sharkarā (lime stone) in Nivāta Sthāna.
ii) By using dried twigs of Tila, the above mixture is burnt.
iii) The ash is collected and mixed with 6 parts of Jala / Gomūtra.
iv) It is filtered through a cloth for 21.
v) The filtrate is kept in an iron vessel and subjected to Mṛdu Agni while
stirring it well. As the water content reduces, the solution becomes reddish
and slimy. Continued heating will produce a clear, white powder.
At this stage, Mṛdu Kṣāra is formed.
vi) To obtain Madhyama Kṣāra, the above prepared Mṛdu Kṣāra is mixed with
Madhyama Kṣāra Dravya (8 pala all together) after heating red hot.
The mixture is boiled over fire until a paste, which is neither too solid nor too
liquid, is formed.
vii) To obtain Tīkṣṇa Kṣāra, Madhyama Kṣāra procedure is done by additionally

adding 20 gm each of various Tīkṣṇa Kṣāra Dravya in powder form.
Testing the Potency of Kṣāra:

Tīkṣṇa Kṣāra will burn Eraṇḍa Nāla (stalk) upon counting to 100.
Atitīkṣṇa Kṣāra will burn Eraṇḍa Nāla before counting to 100.
Atimṛdu Kṣāra will not burn Eraṇḍa Nāla even after counting to 100.
 Kṣāra Vidhi:
1) Pratisāraṇīya Kṣāra Vidhi
The affected site is roughned by rubbing, scrapping, scratching, etc.
The Kṣāra should be applied by using Shalākā. The required quantity depends
on the affected area. According to Āchārya Ḍalhana, the thickness of applied
Kṣāra should be equal to the thickness of a nail.
It should be left undisturbed for 100 Mātrakāla. Then the site is washed with
Amla Drava Dravya like Nimbū svarasa, Kāñjī, etc.
Samyak Dagdha Lakṣaṇa Hīna Dagdha Lakṣaṇa Ati Dagdha Lakṣaṇa

Vyādhihara, Kṛṣṇatā, Vyādhivṛddhi, Toda, Kaṇḍū, Dāha, Pāka, Rāga, Srava,
Lāghava, Asrava Jāḍya (sluggishness, Aṅgamarda, Klama, Pipāsā,
stiffness, insensibility) Mūrcchā, Maraṇa
2) Pānīya Kṣāra Vidhi

Mṛdu Kṣāra chūrṇa is mixed with 6 parts of water and used for Pānārtha.
This is known as Kṣārodaka.
a) Adhama = ½ pala (24 ml)
b) Madhyama = 3 kārṣa (36 ml)
c) Uttama = 1 pala (48 ml)
 Kṣāra Sūtra:
Kṣāra Sūtra is a thread medicated with Kṣāra Dravya used to perform slow excision
by mechanical pressure.
No clear reference regarding the preparation of Kṣāra Sūtra has been mentioned in
the classical ayurvedic texts.
A standard method of preparation of Kṣāra Sūtra with fixed thickness of the thread
and fixed numbers of coatings by Kṣāra has only later been established and is
followed nowadays.
Required Materials:
- Barbour’s linnen threads No-20; these have desired tensile strength which is
retained up to the period of its processing and application.
- Apāmārga Kṣāra
- Haridrā Chūrṇa
- Snuhī Kṣīra / Guggulu dissolved in alcohol
Snuhī Kṣīra should be collected 2 hours before its use, otherwise it will solidify.
Preferably, it should be collected in the early morning, in April or October.
Guggulu dissolved in alcohol and water may be used as a substitute for Snuhī Kṣīra.
It is available throughout the year, it is easily prepared and less irritative.
Furthermore, Guggulu is described as Pūtihara, Vedanāsthāpana, Vraṇashodhana
and Vraṇaropaka Dravya. It has a good binding action on the thread and its anti-
bacterial & anti-inflammatory activities have been proven effective.
Kṣāra Sūtra Cabinet:
A special cabinet for the preparation of Kṣāra Sūtra is designed. It has one large
chamber for the thread hangers, and one small chamber for the hot air blower.
A thermormeter is kept inside to record the temperature.
Kṣāra Sūtra Preparation:

- Barbour’s linnen threads No-20 are spread horizontally throughout the length of
the hanger. Each thread is smeared with Snuhī Kṣīra with the help of a sterile gauze
piece. Threads are smeared uniformly all around.
- Hangers are placed inside the cabinet, which is then closed properly and hot air is
blown inside to dry the threads for 1 day.
This produces 1 coating around the thread. The process is repeated until 11
coatings with Snuhī Kṣīra have been done.
- Then, 7 coatings are applied with Snuhī Kṣīra and Apāmārga Kṣāra. For this
process, thread is smeared with Snuhī Kṣīra, applied on the hanger, and is then
covered with Apāmārga Kṣāra chūrṇa. The hanger is tapped slowly and gently to
remove excess Kṣāra from the thread. The hanger is kept in the cabinet and the
threads are dried.
- Further, 3 coatings are applied with Snuhī Kṣīra and Haridrā Chūrṇa in the same
manner as described above.
- In this way, 21 coatings are applied over the threads in 21 successive days.
The pH values of Apāmārga Kṣāra Sūtra is 9-11.
- Each thread, measuring about 10-11 inches, should be cut off the hangers, folded
at the middle, and sealed in a polythene bag which is kept in a glass tube. The
sealed glass tubes are exposed to UV radiation. A small silica bag is also kept inside
the glass tube to absorb moisture. The tubes are labelled with description of date
of manufacture, sealing and batch number.
 Yogya:
Piles (Haemorrhoids), Fistula-in-ano (Anal fistula), Fissure-in-ano (Anal fissure),
Abscess in ano rectal region, Pilonidal Sinus, Anal Cryptitis
 Application of Kṣāra Sūtra in Fistula-in-ano:

The patient is anesthetized with local or spinal or general anesthesia. Then a probe
with a Kṣāra Sūtra is passed through the external opening of the fistula to the
internal opening in the anal canal. The probe is gently taken out through the anal
opening along with Kṣāra Sūtra in the groove of the probe.
Both ends of the Kṣāra Sūtra are tied together. The Kṣāra Sūtra is replaced by after
one week. The Kṣāra Sūtra gradually cuts and heals the tract.
 Application of Kṣāra Sūtra in Haemorrhoids:

The patient is anesthetized with local anesthesia. The pile mass is held with pile
holding forceps and brought out of the anal orifice. An incision is given at the
mucocutaneous junction. Slight pull is exerted over the pile mass and transfixed by
Kṣāra Sūtra at the base. The ligated pile mass is placed back inside the rectum and a
rectal pack with Yaṣṭīmadhu Taila / Ghṛta is applied.
 Application of Kṣāra Sūtra in Pilonidal Sinus:

The patient is anesthetized with local anesthesia, then a probe with Kṣāra Sūtra is
passed through the external opening of the pilonidal sinus to the skin. Both ends of
the Kṣāra Sūtra are tied together. The Kṣāra Sūtra is replaced after one week.
The Kṣāra Sūtra gradually cuts and heals the sinus tract.
 Advantages of Kṣāra Sūtra over Shastrakarma:

- Minimal trauma, only a very narrow and fince scar remains
- No or minimal bleeding
- No incontinence
- Recurrence of disease is practically nil
- Minimal hospital stay
- Cost effective
क्षारद्वय & क्षारत्रिक
स््ण्जवक्षारो य्क्षारः क्षारद्वयमुदाहृतम् ।
सौर्ानयेन समायुक्तं क्षारणरकमुदाहृतम् ॥ ६ ॥ (र.त. - २)
1) Svarjikā kṣāra Sodium bicarbonate
2) Yava kṣāra Potassium carbonate
3) Taṅkana kṣāra Borax
क्षारपञ्चक
मष्ट्ु कक्षारो य्क्षारः णकंशक
ु क्षार ए् च ।
स््ण्जवक्षारणस्तलक्षारः क्षारपञ्चकमुच्यते ॥ ७ ॥ (र.त. - २)
1) Muṣka kṣāra Schrebera swietenioides
3) Kiṁshuka kṣāra Butea monosperma
5) Tila kṣāra Sesamum indicum
क्षाराष्टक
सधु ापलाशणशखरणचञ्चाकव णतलनालजाः ।
स््णजवका या्शुकि क्षाराष्टकमुदाहृतम् ॥ ८ ॥ (र.त. - २)
1) Snuhī kṣāra Euphorbia neriifolia
2) Palāsha kṣāra Butea monosperma
3) Apāmārga kṣāra Achyranthes aspera
4) Chiñcha kṣāra Tamarindus indica
5) Arka kṣāra Calotropis procera
6) Tila kṣāra Sesamum indicum
CHAPTER x: agnikarma
Agnikarma is the cauterization method used for curing different diseases, especially if
Auṣadha, Shastrakarma or Kṣārakarma are not efficient. It is described as an Anushastra.

अणननना णक्रयते इणत अणननकमव ।
अणननना कृ त््ा यत् कमव, अननेः सम्बणन्त्ध ्ा यत् कमव तदणननकमव ।
The therapeutic procedure in which Agni is used, is called Agnikarma.
 Paryāya: Dāhakarma, Dāhana, Dahana, Vahnikarma, Tāpanakarma
 Mahatva:
- Diseases treated properly by Agnikarma, do not recur.
But if, for example, a tumor was treated and cured by Agnikarma, and the patient
indulges again in Apathya Āhāra and Vihāra, a similar growth may appear, which is
taken as the same.
- Diseases which cannot be treated by Auṣadha, Shastra or Kṣāra, may be cured by

Agnikarma.
- दाहः सङ्कोचयेत् णसराः ।

Agnikarma constricts the vessels (and therefore can cease bleeding).
- Agnikarma sterilizes the cauterized area (thereby preventing infection).
 Uparakaṇa:
1) Tvacha Dagdha: Pippalī, Ajāshakṛt, Godanta, Shara (arrow), Shalākā
2) Māṁsa Dagdha: Jāmbavauṣṭha (a rod-lile cauterizing instrument made from
black stone, with its tip resembling Jambuphala), Similar instruments made
from other metals
3) Sirā Snāyu Sandhi Asthi Dagdha: Kṣaudra, Guḍa, Sneha (Ghṛta, Taila, etc.)
 Agnikarma Kāla:
Agnikarma can be done in all the Ṛtus except Grīṣma and Sharada Ṛtu, because
Uṣṇa Guṇa is aggravated in these seasons. In case of emergency, Agnikarma may
also be done during Grīṣma and Sharada if adequate cooling measures are adopted.
 Bheda:
A) According to used substances:
1) Rūkṣa (Pippalī, Ajāshakṛt, etc.)
2) Snigdha (Kṣaudra, Ghṛta, Taila, etc.)
B) According to cauterized tissue:

1) Tvacha Dagdha (used in Maṣa, Aṅgaglāni, Mūrdhātimantha, Charmakīla, etc.)
2) Māṁsa Dagdha (used in Arshas, Bhagandara, Granthi, Nāḍī, Duṣṭavraṇa, etc.)
3) Sirā Snāyu Sandhi Asthi Dagdha (used in Shliṣṭavartma, Asṛkasrāva, Nīla, etc.)
C) According to shape or pattern: (Akṛti Bheda)

1) Valaya (circular)
2) Bindu (drop)
3) Vilekhā (straight line)
4) Pratisāraṇa (spreading, flat)
+
5) Ardhachandra (semicircular)
6) Svastika
7) Aṣṭapada
Ā. Sushruta has mentioned 1-4. Ā. Vāgbhaṭa added 5-7.
 Chaturvidha Agnidagdha:
तर प्लुष्टं ददु नव धं सम्यनदनधमणतदनधं चेणत चतुण्वधमणननदनधम् । (सु - सू - १२/१६)
1) Pluṣṭa Dagdha Lakṣaṇạ: (scorched, singed)
Vivarṇa & Pluṣyate Atimātra (severe burning sensation)
Ā. Vāgbhaṭa mentioned Tuccha Dagdha instead of Pluṣṭa Dagdha.
Its features are discolouration, severe burning sensation, and non-emergence
of blisters.
Chikitsā: Uṣṇa Chikitsā by warming the body and using Uṣṇa Vīrya Dravya to
relieve obstructed Vāyu.
2) Durdagdha Lakṣaṇa: (wrong, blister formation)

- Sphoṭa (blisters)
- Tīvra Choṣa (sucking type of pain), Tīvra Dāha, Tīvra Rāga, Tīvra Pāka,
Tīvra Vedanā -> these take a long time to subside.
Chikitsā: Uṣṇa & Shīta Chikitsā; application of Ghṛta, poultices and other
cooling measures. Ā. Ḍalhana mentioned that Shīta Chikitsā should be used if
the affected part is deeply rooted to; and vice-versa.
3) Samyak Dagdha Lakṣaṇa: (proper, superficial)
- Anavagāḍha (not too deep)
- Tāla varṇa (colour of palm fruit)
- Pūrvalakṣaṇa yukta (associated with previously mentioned symptoms in a
milder form; burning sensation, pain, etc.)
Chikitsā:
- Siddha Ghṛta Alepana (Tugakṣīrī, Plakṣa, Chandana, Gairika, Guḍūchī)
- Similar methods are adopted as for Pittaja Vidhradi
Tvak Dagdha Lakṣaṇa:

- Shabda prādurbhāva (production of sound)
- Durgandhatā (bad odour)
- Tvak saṅkocha (constriction of skin)
Māṁsa Dagdha Lakṣaṇa:

- Appearance of colour like that of pigeon (dark grey)
- Alpa Shvayathu & Vedanā (mild swelling & pain)
- Shuṣka Saṅkuchita Vraṇatā (dryness and constriction of the wound)
Sirā Snāyu Dagdha Lakṣaṇa:

- Kṛṣṇa Unnata Vraṇatā (black and elevated wound)
- Srāva sannirodha (cessation of flowing – exudation, blood)
Sandhi Asthi Dagdha Lakṣaṇa:

- Rūkṣa Aruṇatā (dryness and reddish discolouration)
- Karkashā Sthir Vraṇatā (Roughness and firmness of the wound)
4) Atidagdha Lakṣaṇa: (excessive, deep burn)

- Māṁsa avalambana (hanging / torn muscles)
- Gātravishleṣa (body stiffness)
- Sirā Snāyu Sandhi Asthi Vyāpādam Atimātra (excessive damage to Sirādi)
- Jvara, Dāha, Pipāsā, Mūrcchā
- Vraṇa heals only after a long time, and even after healing, it remains
discoloured.
Chikitsā:
- Torn muscles should be removed, followed by cooling therapies
- Alepana (Shāli, Tiṇḍukī tvak & Ghṛta)
- Vraṇa is covered with leaves of Guḍūchī or from an aquatic plant
- Similar methods are adopted as for Pittaja Virsarpa
- Madhuchiṣṭa, Madhuka, Lodhra, Sarjarasa, Mañjiṣṭha, Chandana and Mūrva
should be macerated and cooked with Ghṛta. This Siddha Ghṛta is best for
healing wounds in all kind of burns.
 Yogya:
- Severe pain in Tvak, Māṁsa, Sirā, Snāyu, Sandhi, Asthi
- Wounds with elevated, hard and numbed granulation
- Kaphaja Granthi, Arshas, Arbuda, Bhagandara, Apachī
- Shlīpada (Vātaja - 4 aṅgula above Gulpha;
Pittaja - aṅgula below Gulpa;
Kaphaja - 4 aṅgula above Kṣipra Marma)
- Charmakīla, Tilakālaka, Antravṛddhi
- Sandhi Sirā Chedanādi (on Sandhi and Sirā if Chedanādi karma have been done)
- Nāḍī, Shoṇita Atipravṛtti
 Ayogya:
- Pittaprakṛti
- Antaḥ Shoṇita (internal hemorrhage)
- Bhinna Koṣṭha (ruptured viscera)
- Anuddhata Shalya (foreing body has not been removed)
- Durbala, Bāla, Vṛddha, Bhīru, Garbhinī, Rajasvāla
- Anekavraṇa Pīḍita (those who are affected with multiple wounds)
- Jvara, Atisāra, Hṛdroga, Shiroroga, Pāṇḍu, Aruchi, Timira, Ajīrṇa
- Agnikarma should not be done on sites such as Marma, Snāyu, Sevanī, Gala,
Nābhī, Vṛṣaṇa, Meḍhra
 Agnikarma Vidhi:
1) Pūrvakarma
In all diseases and seasons, the patient should take Picchila Āhāra before
undergoing Agnikarma.
2) Pradhānakarma
- All the required equipments should be kept ready.
- The patient should sit or lie down with his head held tight by attendants.
- The tip of the instrument used for performing Agnikarma is kept in the fire
until the tip is red-hot.
- Then the heated instrument is kept on the indicated area on the patient’s
body by creating marks such as Valayana, Bindu, Vilekhā, etc.
- Agnikarma is done until Samyak Dagdha Lakṣaṇa are observed.
3) Pashchātkarma
The cauterized area should be anointed with a mixture of Madhu & Ghrita for
Sandhānakara and Rakta Pitta Shāmana.
CHAPTER xI: raktamokshana
 Introduction
Raktamokṣaṇa is a type of Shodhanakarma. It is a blood cleansing procedure which is
mentioned as one of the Pañchakarma according to Ā. Sushruta and Ā. Vāgbhaṭa.
Ā. Charaka has mentioned the procedure, but did not include it under Pañchakarma.
Same as the other Shodhanakarma, Raktamokṣaṇa may be done for preventive or
curative purpose.

Rakta = Blood
Mokṣaṇa = Releasing
Raktamokṣaṇa is the therapeutic procedure of releasing blood from the body.
रक्तस्य मोक्षिं रक्तस्रा्ः ।
 Paryāya: Shoṅitamokṣaṇa, Raktanirharaṇa, Raktaharaṇa, Raktasravaṇa, Raktasrāva,

Asravisṛti, Avasechana
 Mahatva:
- Raktamokṣaṇa is the best method to purify vitiated Rakta Dhātu.
- Those who undergo Raktamoḳsaṇa regularly at proper time will not be afflicted
with Tvakroga, Granthi, Shopha and other Raktaja Vikāra.
- In Shalya Tantra, Raktamokṣaṇa by Sirāvyadha is considered as half the treatment
or even complete treatment for diseases, same as Basti Karma is in Kāyachikitsā.
- Among all Shodhana Karma, Raktamokṣaṇa is the best for treating skin diseases.
- In Visarpa, Raktamokṣaṇa is the best treatment. It alone produces the same effect
as all other therapies combined.
 General Principles & Rules:

1) Raktamokṣaṇa should be done according to the strength of Rogi, Roga and
Āshaya (site of structure from where blood is released). The blood flows easily
and properly out from vessels of located in the limbs; less so from the head.
2) If Raktasrāva does not occur properly, vitiated blood should be removed again
either on the same day in the evening or on the next day. If the blood is
excessively vitiated, Raktamokṣaṇa should be done again after a fortnight.
3) Raktamokṣaṇa Kāla:
- Raktamokṣaṇa should be performed in moderate climatic conditions; neither
too hot nor too cold.
- It should be done during the day when the sun is visible.
- During Sharada Ṛtu, Rakta tends to get vitiated so Raktamokṣaṇa is indicated.
- During Varṣa Ṛtu, it should be done when the sky is clear.
- During Grīṣma Ṛtu, it should be done when the atmospheric temperature is
comparatively low (morning or evening).
- During Shīta Kāla (Hemanta & Shishira Ṛtu), it should be done during mid-day.
4) Raktamokṣaṇa should not be done on persons who are below the age of 16 or
above the age of 70 years.
5) Rakta is Jīvasthāna. So one should always take care not to cause Atiyoga of
Raktamokṣaṇa. Additionally, due to excessive Raktamokṣaṇa, Vāta gets
aggravated. Therefore, extra special care should be given if the patient is
afflicted with Vātavyādhi.
 General Indications:
Kuṣṭha, visarpa, Piḍaka, Raktapitta, Asṛgdara, Guḍapāka, Meḍhrapāka, Mukhapāka,
Plīhā, Gulma, Vidradhi, Nīlikā, Vyaṅga, Piplu, Tilakālaka, Dadru, Charmadala,
Shvitra, Pāma, Asramaṇḍala, Akṣirāga, Puṣṭyasyagandhatā, Upakusha, Raktameha,
Vātarakta, Vaivarṅya, Agnimāndya, Gurugatratā, Santāpa, Aruchi, Shiroruja,
Annapāna vidāha, Tiktodgāra, Amlodgāra, Kaṭūdgāra, Klama, Krodhādhikyatā,
Buddhisammoha, Lavaṇāsyatā, Sveda, Sharīra daurgandhya, Mada, Kampa,
Svarakṣaya, Atinidra, Ati-tamodarshana, Kaṅḍū, Kotha, Mashaka, Nyaccha,
Indralupta, Arbuda, Aṅgamarda, Upajihvikā, Raktatvak, Raktanetratā,
Raktamūtratā, Bhrama, Arsha, Apachī, Dantapuppuṭa, Dantaveṣṭa, Granthi,
Galashūla, Shlīpada, Ūrustambha
 General Contraindications:
Bāla, Vṛddha, Garbhinī, Sūtikā, Abhukta, Daurbalya, Asvinna, Atisvinna, Sarvāṅga
Shopha, Kṣīṇa, Pāṅḍuroga, Udara, Mūrcchā, Chardi, Shoṣa, Shvāsa
 Vargīkaraṇa / Prakāra:
1) Shastra kṛta visravaṇa
a) Sirāvyadha
b) Pracchāna
2) Anushastra kṛta visravaṇa

a) Jalaukāvacharaṇa
b) Shṛṅgāvacharaṇa
c) Alābū-avacharaṇa
d) Ghaṭīyantrāvacharaṇa
 Sirāvyadha
The surgical procedure of puncturing or sectioning a vein for therapeutic purpose and
thereby accomplishing Raktamokṣaṇa is called Sirāvyadha.
It should be done in people who are physically strong and not afraid of the procedure.
The vein which is near the site of the lesion or disease is most ideal for Sirāvyadha.
It is preferred to perform this procedure in the morning after taking light and liquid diet.
 Yogya: Visarpa, Vidradhi, Plīhā, Gulma, Agnimāndya, Jvara, Mukharoga, Netraroga,

Mada, Lavaṇāsyatā, Kuṣṭha, Vātarakta, Raktapitta, Kaṭūdgāra, Amlodgāra, Bhrama
 Ayogya:
Bāla, Vṛddha, Bhīru, Garbhinī, Rūkṣa, Kṣatakṣīṇa, Shrama, Madyāpa, Klība,
Adhva-karshita, Strī-karshita, Vāmita, Virikta, Asthāpita, Anuvāsita, Jāgarita,
Karshya, Kāsa, Shvāsa, Shoṣa, Pravṛddha Jvara, Ākṣepaka, Pakṣāghāta, Upavāsa,
Pipāsā, Mūrcchā
 Vidhi:
1) Pūrvakarma
- Preparation of equipments: Intravenous cannula, 20 cc syringe, tourniquete,
Kidney tray, Disinfectants, Cotton swab, Bandage material, Madhuka chūrṇa
- Snehapāna (to be done 2-3 days before the procedure)
- Abhyaṅga & Bāṣpa Svedana (to be done on the day of the procedure)
- Laghu & Drava Āhāra (E.g.: Yavāgū)
2) Pradhānakarma
- The patient should be placed in a comfortable position so that the vein which
is to be punctured can be approached easily. Supine position is in most
occasions the best choice.
- The circulation in the selected vein is blocked by applying a tourniquet just
proximal to the site which will be punctured.
- The site is painted with aseptic solution.
- The vein is slightly stroked by releasing the index finger from the thumb to
make it more distended.
- The engorged vein is punctured with the IV cannula. It is inserted into the
vein to its fullest length. The needle within the cannula is removed. This will
lead to release of blood from the vein. Blood flow is allowed until it stops by
itself; or until a maximum amount of 540 ml (1 prāṣṭha) of blood is drained.
- The cannula is removed and the punctured site is bandaged after applying
the powder of Madhuka (Glycyrrhiza glabra).
3) Pashchātkarma
- Pathya: Laghu Āhāra, Dīpana, Vishrāma
- Apathya: Atishīta & Atyuṣṇa Āhāra, Guru Āhāra, Adhyashana, Māruta, Agni,
Ātapa sevana, Krodha, Shokādi, Vyāyāma, Divāsvapna, Travelling, Continuous
studying, Continuous sitting in the same position
 Samyak Vidda Lakṣaṇa:
- Svayameva avatiṣthate (bleeding from the punctured site stops by itself)
- Lāghava (feeling of lightness)
- Vedanā shānti (remission of the pain)
- Vyādhirvega parikṣaya (remission of the disease)
- Manoprasāda (feeling of serenity)
 Upadrava & Chikitsā:

1) Ayoga / Hīnayoga Vidda
a) Nidāna:
- If Sirāvyadha is done on a cloudy day or if it is done in a windy place.
- If Pūrvakarma is not done properly (Snehana, Svedana).
- If puncturing is done improperly.
- If Sirāvyadha is performed after intake of Guru Āhāra.
b) Lakṣaṇa: Shopha, Dāha, Rāga, Pāka
c) Chikitsā: Elā, Kuṣṭha, tagara, Pāṭhā, Bhadradāru, Viḍaṅga, Chitraka,

Trikaṭu, Āgāradhūma, Haridrā, Arkāṅkura, Naktamāla phala; either 3 or 4
or as many as available of these Dravya should be powered, mixed with
plenty of Lavaṇa and Taila, and rubbed on the punctured site. This will
cause proper flowing of Rakta.
2) Atiyoga Vidda
a) Nidāna:
- If Sirāvyadha is done when there is excessive heat.
- If there was Atiyoga of Svedana.
- If the vein is punctured excessively.
- If blood is allowed to flow out excessively by an unskilled, inexperienced
or ignorant physician.
b) Lakṣaṇa: Shiro-abhitāpa, Āndhya, Adhimantha, Timira, Dhātukṣaya,

Ākṣepaka, Pakṣāghāta, Ekāṅgaroga, Tṛṣṇa, Dāha, Hikkā, Shvāsa,
Pāṇḍuroga, Maraṇa
c) Chikitsā: Lodhra, Madhuka, Priyaṅgu, Gairika, Sarjarasa, Shālmalī puṣpa,

Shaṅkha, Shukti, Māṣa, Yava and Godhūma should be powdered above
the the punctured site and pressed with the tip of the finger. The patient
should be covered with a moist cloth, kept in a cold room, treated with
Shīta Upanāha and Pariṣeka; or the are may be burnt (cauterized) either
by Kṣāra or Agnikarma.
Modern Management: Ligation of the punctured vein, hemostatic drugs,

blood transfusion if needed.
 Pracchāna
The therapeutic procedue of incising the skin superficially and thereby accomplishing
Raktamokṣaṇa is called Pracchāna.
 Yogya:
- Piṇḍita Rakta (congestion of blood), Indralupta, Kṣudrakuṣṭha, Tvakroga,
Utsedhyukta Vraṇa
- As Pūrvakarma for Shṛṅga, Alābū or Ghaṭīyantra Avacharaṇa
 Ayogya:
- Before or after Sirāvyadha / Jalaukāvacharaṇa
- Marmasthāna
 Vidhi:
1) Pūrvakarma
- Preparation of equipments: Scalpel blade, cotton swab, Gauze piece,
Disinfectants, Madhuka chūrṇa
- No specific preparation of the patient is necessarily needed. However,
Snehana and Svedana can be done to improve the effect of Pracchāna.
Snehapāna (Hīna Mātrā; for 2-3 days before the procedure)
Abhyaṅga & Bāṣpa Svedana (on the day of the procedure)
2) Pradhānakarma
- The site of the lesion where incision will be made is painted with disinfectant.
- With a scalpel, a straight (Ṛju) incision is made which should neither be too
deep (̣Nāti gambhira) nor too shallow (Nāti uttāna). The depth is
approximately 2 mm. The incision is always made from the distal part to the
proximal part of the body. Similar incisions are made parallel to the earlier one
involving the complete area of the lesion; the incesions should not be done
obliquely (Na tiryak).
- While incising, Sirā, Snāyu and Sandhi should be avoided.
- When the bleeding stops, the incised site is bandaged after applying the
powder of Madhuka (Glycyrrhiza glabra).
3) Pashchātkarma
Same as for Sirāvyadha
 Upadrava & Chikitsā:

Excessive bleeding: Dravya should be applied which are Kaṣāya, Shīta and
Stambhaka. If bleeding does not stop, Pāchana should be done with Shaṅkha
Bhasma.
 Jalaukāvacharaṇa
Jalauka refers to the leech. Jalaukāvacharaṇa is a method of accomplishing
Raktamokṣaṇa by applying the leech to a specific site and allow it to suck vitiated blood.
For this purpose, only the non-poisonous (Nirviṣa) leeches are used.
 Jalauka Vargīkaraṇa:
A) Based on Poison
1) Saviṣa Jalauka
i) Kṛṣṇā
ii) Karburā
iii) Algardā
iv) Indrāyudhā
v) Sāmudrikā
vi) Gochandanā
Originate from decomposed urine and feacel matter of toads and poisonous
fish, in ponds of stagnant and turbid water.
General characters: Thick and elongated middle portion, Both ends are thin,
Slow moving, Fatigues quickly, Sucks slowly and little quantity of blood.
2) Nirviṣa Jalauka
i) Kapilā
ii) Piṅgalā
iii) Shaṅkhmukhī
iv) Mūṣikā
v) Puṇḍarīkamukhī
vi) Sāvarikā
Originate from decomposed vegetable matter, decayed stems of several

aquatic plants such as Padma, Utpala, Nalina, Kumuda, Pundarika, etc. found in
clear water.
General characters: Strong and large bodied, “Greedy” (start sucking readily
and a lot of blood), Round, Blue colored lining on the dorsal side of the body.
B) Based on Gender
1) Puruṣa Jalauka
Hard skin, big head along with semi-lunar look with a large front portion.
Indicated in highly vitiated Doṣa and Jīrṇa Roga.
2) Strī Jalauka
Delicate, thin skin, small sized head, the lower body is large.
Indicated in Alpa Doṣa and Āshu Roga.
 Yogya:
- Sāmānya Raktamokṣaṇa Yogya
- Rakta vitiated by Pitta Doṣa
- Bāla, Vṛddha, Sukūmāra, Garbhinī, Bhīru
- Gulma, Arsha, Vidradhi, Vātarakta, Galāmaya, Netraruk, Viṣa-daṁṣṭa,
Visarpa, Kuṣṭha, Shiroshūla
 Vidhi:
1) Pūrvakarma
i) Preparation of equipments: Nirviṣa Jalauka (3-4), Cotton swab, Gauze piece,
Kidney tray, Needle, Saindhava Lavaṇa, Haridrā chūrṇa, Madhuka chūrṇa
ii) Preparation of the leeches: Water is kept in a kidney tray and mixed with
about two spoons of Haridrā chūrṇa. The leeches are placed in the tray.
The leeches become very active. They are kept in the turmeric water for about
48 mintues and are then shifted to another kidney tray containing clear water.
iii) Preparation of the patient: No specific preparation of the patient is

necessarily needed. However, Snehana and Svedana can be done to improve
the effect of Jalaukāvacharaṇa.
2) Pradhānakarma
Jalaukāvacharaṇa should be done during the morning time.
i) Virukṣaṇa Chikitsā is done on the expected site of leech application. This is
done by rubbing dry powder of properly cleaned soil or cow dung. It is
essential to remove the oiliness because the leeches may not attach if the site
is greasy.
ii) Application of Jalauka: Jalauka is picked up between the thumb and index
finger, and its mouth is held close to the application site. The leech may be
grasped between the fingers with a cotton or gauze piece. If the leech fails to
attach itself, then a drop of milk or blood may be placed on the site. If even
this fails, a small puncture is made with a needle to cause bleeding, and the
leech is applied.
iii) Observation & Care: When the leech starts sucking the blood, rhythmic
wavy movements of its body are seen. It should then be covered by a wet
gauze piece. While draping the leech, the mouth portion is kept free. At
frequent intervals, small amount of water is poured on the leech to keep it
moist and cool. As the leech continues sucking, one can observe the wavy
movements in its body as well as increase in its dimension.
Jalauka only sucks vitiated blood, just like a swan drinks only the milk from a
mixture of milk and water. When it completes sucking, it falls off by itself.
When itching and pain occur at the site of leech application, it indicates that
Jalauka started sucking pure blood. If it does not detach independently,
Jalauka should be removed by sprinkling Saindhava Lavaṇa or Haridrā chūrṇa
over its mouth.
3) Pashchātkarma
i) Care of Vraṇa: As the saliva of the leech contains hirudin and anticoagulant,
even after the leech separated, bleeding continues. Therefore, as soon as the
leech detaches, bleeding should be arrested. After cleaning the site and
dusting with Madhuka chūrṇa, the wound is bandaged tightly.
ii) Care of Jalauka: In a kidney tray, about one spoon of Haridrā chūrṇa or
Saindhava Lavaṇa is kept. The leech is grasped between the thum and index
finger, and its mouth is made to touch the Haridrā chūrṇa or Saindhava
Lavaṇa. Sooner or later, the leech starts vomiting the blood. Leech is allowed
to expel as much as possible. When it stops vomiting, the remaining portion of
the blood is squeezed out. This is done by grasping the tail end between
thumb and index finger, and the body of the leech is squeezed from the tail
towards the mouth. The leech is then placed in clean water, and becomes
more active again.
If the leech is not made to vomit the vitiated blood, it is likely to die.
If it is made to vomit properly, the leech may be reused for Raktamokṣaṇa
after about one week. Jalauka should always be handled gently.
 Upadrava:
Complications mainly occur if Saviṣa Jalauka is mistakenly used for Raktamokṣaṇa.
Lakṣaṇa: Atimātra Shvayathu, Kaṇḍū, Mūrcchā, Jvara, Dāha, Chardi, Mada, Sadana
Chikitsā: Viṣa Nāshaka Chikitsā, Raktapitta prashamana
Indrāyudhā = Asādhya; it leads to Mahāgada

 Shṛṅgāvacharaṇa
Shṛṅga refers to the horn of a cow which is hollow and can be used for Raktamokṣaṇa.
The broad end applied to the skin during the procedure. At the narrow tip, a hole is
made which is then coered with a cloth. The mouth is applied and air from the horn is
sucked to create a vacuum and promote bleeding.
Alternatively, the hole in the tip of the horn is fitted with a rubber tube, which again is
fitted with a 50 ml syringe; a vacuum is created by withdrawing the piston of the syringe.
 Yogya:
- Rakta afflicted with Vāta Doṣa or Vāta-Pitta
- Raktaduṣti is restricted to Tvak
 Ayogya: Rakta afflicted with Kapha Doṣa
 Vidhi:
1) Pūrvakarma
- Preparation of equipments: Shṛṅga fitted with tube and syringe, Scalpel
blade, Cotton swab, Gauze piece, Madhuka chūrṇa
- Snehana and Svedana can be done to improve the effect.
- Pracchāna
2) Pradhānakarma
- When bleeding occurs, the broad end of Shṛṅga is applied on the incised site.
- It is firmly pressed against the skin, and the piston of the syringe is withdrawn
to create a vacuum and promote the flow of blood. After several minutes, the
piston is released and Shṛṅga is removed.
- The wound is cleaned and bandaged after applying Madhuka chūrṇa.
3) Pashchātkarma
 Alābū-avacharaṇa
Alābū refers to the bitter bottle gourd (Lagnaria vulgaris).
The ideal Alābū should be 12 aṅgula in length, 18 aṅgula in circumference, with and
opening of 3-4 aṅgula wide.
It is made hollow by removing its soft core after making a hole at its tip, dried in the sun,
and painted with varnish internally. It can then be used for Raktamokṣaṇa.
 Yogya:
- Rakta afflicted with Kapha Doṣa
- Piṇḍita Rakta
- Lesions involving deeper structures
 Vidhi:
1) Pūrvakarma
- Preparation of equipments: Alābū, Scalpel blade, Cotton swab, Gauze piece,
Taila, Jātyādi taila, Madhuka chūrṇa
- Snehana and Svedana can be done to improve the effect.
- Pracchāna
2) Pradhānakarma
- When bleeding occurs, the cotton swab is soaked in oil, ignited and placed
inside the Alābū. Now the mouth of the Alābū is applied by holding it
horizontally so that the flame of the burning cotton does not come in contact
with the body. The cotton burns as long as oxygen is available. As it removes
the oxygen, a vacuum is generated in the Alābū which draws blood from the
incised wounds. After some time, Alābū is removed.
- The site is cleaned with Jātyādi taila and bandaged after applying Madhuka
chūrṇa.
3) Pashchātkarma
 Ghaṭīyantrāvacharaṇa
Ghaṭīyantra is described as a Nāḍīyantra by Ā. Vāgbhaṭa. It is an earthen instrument with
a larger rounded base and a tubular upper portion used for Raktamokṣaṇa in the same
way as Alābū-avacharaṇa.
 Yogya: Rakta afflicted with Pitta Doṣa, Piṇḍita Rakta

CHAPTER xii: bandhana / Bandaging
 Bandhana
Bandhana is the bandaging procedure to bind a wound or a part of the body with a
protective and supportive strip of material.
 Prayojana:
- It protects and helps to keep the wound clean.
- It promotes healing.
- It immobilizes bones & joints, providing support and stability.
 Bandhana Dravya:
Strips of material made from:
Kṣauma (flax) Kārpāsa (cotton)
Āvika (sheep’s wool) Antarvalkala (inner layer of barks)
Kausheya (silk) Patrorṇa (plant fibres)
Chīnapaṭṭa (china cloth) Alābūshakala (pices of bottle gourd)
Rajju (rope) Latā (creeper)
Viḍala (split bamboo) Charma (leather)
Pichu: Pichu is cotton devoid of its Bīja; comparable with a gauze piece.
Plota: Plota is a cloth which is used as a swab.
Kavalikā: Kavalikā is a bandage by keeping 2 or 4 folds of cloth over a wound.
Vikeshikā: Vikeshikā is comparable to a kind of compression garment.
However, according to Ā. Ḍalhana, Vikeshikā or Varti is the application of Kalka,
Ghṛta, etc. over Vastra or Sūtra above the wound.
 Yogya:
- Chūrṇita (crushed wounds)
- Mathita (lacerated wounds)
- Bhagna (fractures)
- Vishliṣṭa (dislocation of joints)
- Atipātita (completely broken or displaced bone)
- Asthi Snāyu Sirā Chinna (torn bones, ligaments or vessels)
 Ayogya:
- Wounds caused by Pitta, Rakta, Abhighāta and Viṣa
- Wounds associated with Shopha, Dāha, Pāka, Rāga and Toda
- Burns caused by Kṣāra and Agni
- When the muscles of the wound are falling off due to suppuration.
- Māṁsapāka (gangrene), Dāruṇa Gudapāka (severe suppuration of the rectum)
- Piḍakā due to Kuṣṭha, Agnidagdha or Madhumeha
 Prakāra / Bheda:
14 types of Bandhana according to Ā. Sushruta.
Utsaṅgī was additionally mentioned by Ā. Vāgbhaṭa.
No. Bandha Modern Correlation Application Site

1 Kosha Circular / Finger bandage Thum, fingers, toes
2 Dāma Crepe / Sling bandage Narrow parts
3 Svastikā Spica / Figure 8 bandage Joints, palms, soles, ears, eyebrows,
intermammary region
4 Anuvellita Spiral bandage Extremities
5 Mutolī Winding / Circular bandage Neck, penis
6 Maṇḍala Abdominal binders or similar ones Circular or rounded parts
7 Sthagikā Supporting bandage with splints / Terminal parts of fingers, toes, penis
Stump bandage
8 Yamaka Twin bandage To cover two adjoint wounds
9 Khaṭvā Four-tailed bandage Mandible, temple, cheek
10 Chīna Eye bandage Outer canthus of eye
11 Vibandha Many-tailed bandage Back, abdomen, chest
12 Vitāna Head / Cape-line bandage Head (scalp)
13 Gophaṇā T bandage Chin, nose, lips, shoulders, pubic region
14 Pañchāṅgī Many-tailed bandage Supraclavicular regions
15 Utsaṅgī Arm sling Bāhu
 Bandaging
A bandage is a piece of material used either to support a medical device such as a
dressing or splint, or on its own to provide support to or to restrict the movement of a
part of the body.
When used with a dressing, the dressing is applied directly on a wound, and a bandage
used to hold the dressing in place. Other bandages are used without dressings, such as
elastic bandages that are used to reduce swelling or provide support to a sprained ankle.
Tight bandages can be used to slow blood flow to an extremity, such as when a leg or
arm is bleeding heavily.
 Ideal Dressing:
- Protect the wound from trauma
- Impermeable to bacteria
- Allow oxygenation
- Retain moisture
 Types of Bandage:
1) Gauze
2) Compression
3) Triangular
4) Tube
1) Gauze Bandage
The most common type of bandage is the gauze bandage, a simple woven strip
of material, or a woven strip of material with a Telfa absorbent barrier to
prevent adhering to wounds. A gauze bandage can come in any number of
widths and lengths, and can be used for almost any bandage application,
including holding a dressing in place.
2) Compression Bandage
The term 'compression bandage' describes a wide variety of bandages with
many different applications.
Short stretch compression bandages are applied to a limb (usually for
treatment of lymphedema or venous ulcers. This type of bandage is capable of
shortening around the limb after application and is therefore not exerting
ever-increasing pressure during inactivity. This dynamic is called resting
pressure and is considered safe and comfortable for long-term treatment.
Conversely, the stability of the bandage creates a very high resistance to
stretch when pressure is applied through internal muscle contraction and joint
movement. This force is called working pressure.
Long stretch compression bandages have long stretch properties, meaning
their high compressive power can be easily adjusted. However, they also have
a very high resting pressure and must be removed at night or if the patient is in
a resting position.
3) Triangular Bandage
Also known as a cravat bandage, a triangular bandage is a piece of cloth put
into a right-angled triangle, and often provided with safety pins to secure it in
place. It can be used fully unrolled as a sling, folded as a normal bandage, or
for specialized applications, as on the head. One advantage of this type of
bandage is that it can be makeshift and made from a fabric scrap or a piece of
clothing. The Boy Scouts popularized use of this bandage in many of their first
aid lessons, as a part of the uniform is a "neckerchief" that can easily be folded
to form a cravat.
4) Tube Bandage
A tube bandage is applied using an applicator, and is woven in a continuous
circle. It is used to hold dressings or splints on to limbs, or to provide support
to sprains and strains, and it stops bleeding.
 Rules for Bandaging:
1) Apply the outer side of the tail of the bandage to the injured part.
2) Bandage limbs from below upwards and from within outwards.
3) Apply a bandage so that each layer covers two-thirds of the previous one. Keep
the edges parallel.
4) Never bandage without having previously applied a pad of cottonwool.

The cottonwool prevents compression of the veins and still allows the
bandaging to be firm. If there is a wound, gauze should be placed over it
before the cottonwool is applied.
5) Stand in front of the hand or foot when bandaging a limb.
6) In dressing a limb or fixing a splint do not cover the tips of the fingers or toes;
they are a useful guide to whether the bandage is too tight. Blueness of the
nails and swelling or numbness of the fingers indicate the need to loosen the
bandage.
7) Make all reverses or crossings in a line on the outer side of the limb
8) When bandaging the elbow keep it at right angles and make sure that a large
pad of cottonwool is placed round the joint to avoid constricting the blood
vessels.
9) When bandaging the knee keep it slightly bent.
10) Complete the bandage with a safety-pin or a narrow strip of adhesive plaster.
CHAPTER xiii: pranasta shalya &
nirharana upaya
तर मनःशरीराबाधकराणि शल्याणन … ॥ ४ ॥ (सु - सू - ७)

Shalya are those (substances) which produce troubles to the mind and body.
Shalya is derived from the roots Shal or Shval. Shal means “moving quickly” and Shval
indicates “causing pain/misery”. Therefore, Shalya is considered as the object which
moves quickly and causes pain or misery.
Shalya is generally considered as a foreign body which entered the body.

Pranaṣṭa Shalya is the foreign body which is lost/vanished (not visible).
Nirharaṇa Upaya are the means of extracting the Shalya.
 Shalya Bheda:
1) Sharīrika - Danta, Nakha, Kesha, etc.
2) Āgantūja - Metals, arrows, wood, stones, straws, horns, bones, etc.
1) Avabaddha (fixed)
2) Anavabaddha (loose)
 Shalya Gati:
Once Shalya has entered the body, it may move in any of the following directions:
1) Ūrdhva (upwards)
2) Adha (downwards)
3) Arvāchīna (backwards / reverse)
4) Tiryak (sidewards / transverse)
5) Ṛju (straight)
 Direction of Removing Shalya:

1) Pratiloma
Shalya is removed opposite to the direction of entry when it has penetrated
less than half of the depth of the affected body part.
2) Anuloma
Shalya is removed in the same direction of entry when it has penetrated
beyond half of the depth of the affected body part.
 Shalya Nirharaṇa: Extraction of Anavabaddha Shalya.
1) Svabhāva (natural methods)

Lacrimation, Sneezing, Eructation, Coughing, Micturition, Defecation, Flatus
These are the natural methods by which Shalya is removed.
2) Pāchana (suppuration)
If Shalya is deeply situated in the muscles and does not form an abscess,
suppuration should be induced. As putrefication occurs, Shalya comes out with the
flow of pus and blood or by its own gravity.
3-5) Bhedana (incision), Dāraṇa (splitting), Pīḍana (squeezing)

A formed abscess which does not burst may be incised or split open. If even after
opening, the Shalya does not come out, squeezing should be done manually or with
the help of medicines.
6-8) Pramārjana (brushing, rubbing, wiping), Nirdhmāpana (insufflation),

Prakṣālana (washing, cleansing)
In case of minute Shalyas located in the sense organs, Nirharaṇa should be done by
washing, blowing air, wiping or sweeping with a brush, cloth or fingertips.
9-10) Vamana (emesis), Virechana (purgation)

Shalya which entered the body along with food should be removed by inducing
vomiting or purgation (depending on whether Shalya is located in Āmāshaya or
Pakvāshaya).
11) Pradhamana (sternutatory powder)

Pradhamana is sternutatory powder which is used to induce sneezing to remove
Shalya from the nose, throat, etc.
12) Pravāhaṇa (straining)

Pravāhaṇa helps to remove Shalya such as obstructed Vāta, Mūtra, Purīṣa, Garbha.
13) Āchūṣaṇa (sucking)

Āchūṣaṇa by mouth or horn is done to remove gases, fluids, poisonous blood and
vitiated breastmilk.
14) Ayaskānta (use of magnet)

Ayaskānta is the use of a magnet to remove metallic foreign bodies that entered
the body.
15) Harṣa (cheerfulness, happiness)

Shalya affecting the Hṛdaya or Manas, such as Shoka, Bhaya, etc. should be
removed by inducing cheerfulness and providing happiness.
CHAPTER xiV: Fluid, electrolyte,
acid base balance & Nutrition
 Introduction to Physiology of Fluids and Electrolytes

Well over half of the body's weight is made up of water. The body's water is being
restricted to various spaces, called fluid compartments.
The three main compartments are:
i) Fluid within cells
ii) Fluid in the space around cells
iii) Blood
To function normally, the body must keep fluid levels from varying too much in these
areas. Some minerals - especially the macrominerals (minerals the body needs in
relatively large amounts) - are important as electrolytes.
Electrolytes are minerals that carry an electric charge when they are dissolved in a liquid
such as blood. The blood electrolytes - sodium, potassium, chloride, and bicarbonate -
help regulate nerve and muscle function and maintain acid-base balance and water
balance.
Electrolytes, particularly sodium, help the body maintain normal fluid levels in the fluid
compartments because the amount of fluid a compartment contains depends on the
amount (concentration) of electrolytes in it. If the electrolyte concentration is high, fluid
moves into that compartment (a process called osmosis). Likewise, if the electrolyte
concentration is low, fluid moves out of that compartment. To adjust fluid levels, the
body can actively move electrolytes in or out of cells.
Thus, having electrolytes in the right concentrations (called electrolyte balance) is
important in maintaining fluid balance among the compartments.
The kidneys help maintain electrolyte concentrations by filtering electrolytes and

water from blood, returning some to the blood, and excreting any excess into the urine.
Thus, the kidneys help maintain a balance between daily consumption and excretion of
electrolytes and water.
Electrolytes are important because they help to:

- Balance the amount of water in the body.
- Balance the body's acid/base (pH) level.
- Move nutrients into cells.
- Move wastes out of cells.
- Make sure that nerves, muscles, the heart, and the brain work properly.
 Dehydration
Dehydration occurs when more water and fluids leave the body than enter it. Even low
levels of dehydration can cause headaches, lethargy, and constipation.
The human body is roughly 75% water. Without this water, it cannot survive. Water is
found inside cells, within blood vessels, and between cells.
A sophisticated water management system keeps our water levels balanced, and our
thirst mechanism tells us when we need to increase fluid intake.
Although water is constantly lost throughout the day as we breathe, sweat, urinate, and
defecate, we can replenish the water in our body by drinking fluids. The body can also
move water around to areas where it is needed most if dehydration begins to occur.
Most occurrences of dehydration can be easily reversed by increasing fluid intake, but
severe cases of dehydration require immediate medical attention.
 Causes:
The basic causes of dehydration are not taking in enough water, losing too much
water, or a combination of both.
Additional causes of dehydration include:
- Diarrhea; the most common cause of dehydration and related deaths. The large
intestine absorbs water from food matter, and diarrhea prevents this from
happening. The body excretes too much water, leading to dehydration.
- Vomiting; it leads to a loss of fluids and makes it difficult to replace water by

drinking it.
- Sweating; the body’s cooling mechanism releases a significant amount of water.

Hot and humid weather and vigorous physical activity can further increase fluid loss
from sweating. Similarly, a fever can cause an increase in sweating and may
dehydrate the patient, especially if there is also diarrhea and vomiting.
Hidrosis is the process of activating the sweat glands via M3 receptors.
Hyperhidrosis is a disorder marked by excessive sweating. It usually begins at
puberty and affects the palms, soles, and armpits. Sweating is the body's way of
cooling itself and is a normal response to a hot environment or intense exercise.
- Diabetes; high blood sugar levels cause increased urination and fluid loss.
- Frequent urination; usually caused by uncontrolled diabetes, but also can be due
to alcohol and medications such as diuretics, antihistamines, blood pressure
medications, and antipsychotics.
- Burns; blood vessels can become damaged, causing fluid to leak into the
surrounding tissues.
 Risk Factors:
- People at higher altitudes
- Athletes, especially those in endurance events, such as marathons, triathlons, and
cycling tournaments.
- People with chronic illnesses, such as diabetes, kidney disease, cystic fibrosis,
alcoholism, and adrenal gland disorders.
- Infants and children; most commonly due to diarrhea and vomiting.
- Dehydration in older adults is also common; sometimes this occurs because they
drink less water so that they do not need to get up for the toilet as often. There are
also changes in the brain meaning that thirst does not always occur.
 Symptoms:
Early symptoms of dehydration include dry mouth, lethargy, and dizziness.
The first symptoms of dehydration include thirst, darker urine, and decreased urine
production. In fact, urine color is one of the best indicators of a person’s hydration
level - clear urine indicates good hydration and darker urine indicates dehydration.
As the condition progresses to moderate dehydration, symptoms include:
Dry mouth, Lethargy, Weakness in muscles, Headache, Dizziness
Severe dehydration (loss of 10-15 percent of the body’s water) may be

characterized by extreme versions of the symptoms above as well as:
Lack of sweating, Sunken eyes, Shriveled and dry skin, Loss of skin tugor, Low blood
pressure, Increased heart rate, Fever, Delirium, Unconsciousness
Symptoms in children:
- In babies a sunken fontanel (soft spot on the top of the head)
- Dry tongue and mouth
- Irritability
- No tears when crying
- Sunken cheeks and/or eyes
- No wet diaper for 3 or more hours
 Complications:
- Low blood volume; less blood produces a drop in blood pressure and a reduction
in the amount of oxygen reaching tissues; this can be life threatening.
- Seizures; due to an imbalance of electrolytes.
- Kidney problems; including kidney stones, urinary tract infections, and eventually
kidney failure.
- Heat injury; ranging from mild cramps to heat exhaustion or even heat stroke.
 Overhydration
Overhydration is an excess of water in the body.
 Causes & Risk Factors:

Overhydration occurs when the body takes in more water than it loses.
- People can develop overhydration if they have a disorder that decreases the
body’s ability to excrete water or increases the body's tendency to retain water.
- Overhydration can occur when people drink much more water than their body
needs. People, particularly athletes, who drink excessive water to avoid
dehydration can develop overhydration.
People may also drink excessive water because of a psychiatric disorder called
psychogenic polydipsia. The result is too much water and not enough sodium.
Thus, overhydration generally results in low sodium levels in the blood
(hyponatremia), which can be dangerous.
However, drinking large amounts of water usually does not cause overhydration if
the pituitary gland, kidneys, liver, and heart are functioning normally. To exceed
the body’s ability to excrete water, a young adult with normal kidney function
would have to drink more than 6 gallons of water a day on a regular basis.
- Overhydration is much more common among people whose kidneys do not

excrete urine normally, for example, among people with a disorder of the heart,
kidneys, or liver, or among premature infants, whose kidneys are immature.
- Certain drugs, such as some antidepressants, can also cause overhydration in

susceptible people.
- Overhydration may also result from the syndrome of inappropriate antidiuretic

hormone secretion. In this syndrome, the pituitary gland secretes too much
vasopressin (also called antidiuretic hormone), stimulating the kidneys to conserve
water when that is not needed.
 Symptoms:
Brain cells are particularly susceptible to overhydration and to low sodium levels in
the blood.
When overhydration occurs slowly and is mild or moderate, brain cells have time to
adapt, so only mild symptoms (if any) like distractibility and lethargy may ensue.
When overhydration occurs quickly, vomiting and trouble with balance develop. If
overhydration worsens, confusion, seizures, or coma may develop.
When overhydration occurs and blood volume is normal, the excess water usually
moves into the cells, and tissue swelling (edema) does not occur. When excess
blood volume occurs, fluid can accumulate in the lungs and lower legs.
 Electrolyte Disorders
Electrolytes are elements and compounds that occur naturally in the body. They control
important physiologic functions.
Electrolytes include calcium, chloride, magnesium, phosphate, potassiu, sodium.
These substances are present in the blood, bodily fluids, and urine. They are also
ingested with food, drinks, and supplements.
An electrolyte disorder occurs when the levels of electrolytes in the body are either too
high or too low. Electrolytes need to be maintained in an even balance for the body to
function properly. Otherwise, vital body systems can be affected.
 Etiology:
Electrolyte disorders are most often caused by a loss of bodily fluids through
prolonged vomiting, diarrhoea, or sweating. They may also develop due to fluid loss
related to burns.
In some cases, underlying diseases, such as acute or chronic kidney disease, are
responsible for an electrolyte imbalance.
The exact cause may vary depending on the specific type of electrolyte disorder.
 Clinical features & Symptoms:

Mild forms of electrolyte disorders may not cause any symptoms. Such disorders
can go undetected until they are discovered during a routine blood test.
Not all electrolyte imbalances cause the same symptoms, but many share similar
symptoms.
Common symptoms of an electrolyte disorder include:
Arrhythmia, Tachycardia, Fatigue, Lethargy, Malaise, Convulsions, Nausea,
Vomiting, Diarrhoea or Constipation, Abdominal cramping, Muscle cramping,
Myasthenia, Irritability, Confusion, Headaches, Numbness, Tingling sensation
 Types:
Elevated levels of an electrolyte are indicated with the prefix “hyper-.” Depleted
levels of an electrolyte are indicated with “hypo-.”
Normal Value
1) Calcium: Hypercalcemia and Hypocalcemia 8.6-10.3 mg/dL
2) Chloride: Hyperchloremia and Hypochloremia 96-106 mEq/L
3) Magnesium: Hypermagnesemia and Hypomagnesemia 1.7-2.2 mg/dL
4) Phosphate: Hyperphosphatemia or Hypophosphatemia 3.4-4.5 mg/dL
5) Potassium: Hyperkalemia and Hypokalemia 3.6-5.2 mmol/L
6) Sodium: Hypernatremia and Hyponatremia 135-145 mEq/L
1) Calcium: Hypercalcemia and Hypocalcemia
Calcium is a vital mineral that the body uses to stabilize blood pressure and
control skeletal muscle contraction. It is also used to build strong bones and
teeth and to regulate the bone mineral density (BMD).
- Hypercalcemia occurs when there is too much calcium in the blood.

This is usually caused by:
Kidney diseases, Thyroid disorders, TB, Lung cancer, Breast cancer, Excessive
use of calcium or vitamin D supplements, Medications such as lithium or
theophylline.
- Hypocalcemia occurs due to a lack of adequate calcium in the bloodstream.
Causes can include:
Kidney failure, Hypoparathyroidism, Vitamin D deficiency, Pancreatitis,
Prostate cancer, Malabsorption, Certain medication such as heparin,
osteoporosis drugs or anticonvuslant drugs.
2) Chloride: Hyperchloremia and Hypochloremia

Chloride is necessary for maintaining the proper balance of bodily fluids.
- Hyperchloremia occurs when there is too much chloride in the body.

It can happen as a result of:
Severe dehydration, Kidney failure, Dialysis
- Hypochloremia develops when there is too little chloride in the body.
It is often caused by problems related to sodium and potassium.
Other causes can include:
Cystic fibrosis, Eating disorders such as anorexia nervosa, Scorpion stings,
Acute kidney failure
3) Magnesium: Hypermagnesemia and Hypomagnesemia

Magnesium is a critical mineral that regulates many important functions, such
as muscle contraction, heart rhythm and nerve function.
- Hypermagnesemia means excess amounts of magnesium. This disorder

primarily affects people with Addison’s disease and end-stage kidney disease.
- Hypomagnesemia means having too little magnesium in the body.
Common causes include:
Alcohol use disorder, Malnutrition, Malabsorption, Chronic diarrhoea,
Excessive sweating, Heart failure
4) Phosphate: Hyperphosphatemia or Hypophosphatemia
The kidneys, bones, and intestines work to balance phosphate levels in the
body. Phosphate is necessary for a wide variety of functions and interacts
closely with calcium.
- Hyperphosphatemia can occur due to:

Low calcium levels, Chronic kidney disease, Severe breathing difficulties,
Underactive parathyroid glands, Severe muscle injury, Tumor lysis syndrome,
Excessive use of phosphate-containing laxatives
- Hypophosphatemia can be seen in:
Acute alcohol abuse, Severe burns, Starvaṭīon, Vitamin D deficiency,
Overactive parathyroid glands, Certain medications such as intravenous (IV)
iron treatment, niacin (Niacor, Niaspan), and some antacids
5) Potassium: Hyperkalemia and Hypokalemia

Potassium is particularly important for regulating heart function. It also helps
maintain healthy nerves and muscles.
- Hyperkalemia may develop due to high levels of potassium. This condition

can be fatal if left undiagnosed and untreated. It is typically triggered by:
Severe dehydration, Kidney failure, Severe acidosis, Adrenal insufficiency
- Hypokalemia occurs when potassium levels are too low.
This often happens as a result of:
Eating disorders, Severe vomiting or diarrhoea, Dehydration, Certain
medications including laxatives, diuretics, and corticosteroids
6) Sodium: Hypernatremia and Hyponatremia

Sodium is necessary for the body to maintain fluid balance and is critical for
normal body function. It also helps to regulate nerve function and muscle
contraction.
- Hypernatremia occurs when there is too much sodium in the blood.

Abnormally high levels of sodium may be caused by:
Inadequate water consumption, Severe dehydration, Excessive loss of bodily
fluids as a result of prolonged vomiting, diarrhoea, sweating, or respiratory
illness
- Hyponatremia develops when there is too little sodium in the blood.
Common causes of low sodium levels include:
Excessive fluid loss through the skin from sweating or burns, Excessive fluid
loss due to vomiting or diarrhoea, Poor nutrition, Alcohol use disorder,
Overhydration, Thyroid, hypothalamic or adrenal disorders, Liver, heart or
kidney failure, Certain medications including diuretics and anticonvulsants
 Acid Base Balance
An important property of blood is its degree of acidity or alkalinity. The acidity or
alkalinity of any solution, including blood, is indicated on the pH scale.
The pH scale, ranges from 0 (strongly acidic) to 14 (strongly basic or alkaline).
A pH of 7.0, in the middle of this scale, is neutral. Blood is normally slightly basic, with a
normal pH range of about 7.35 to 7.45. Usually the body maintains the pH of blood close
to 7.40.
Blood acidity increases when the

- Level of acidic compounds in the body rises (through increased intake or production, or
decreased elimination).
- Level of basic (alkaline) compounds in the body falls (through decreased intake or
production, or increased elimination).
Blood alkalinity increases when the level of acid in the body decreases or when the level
of base increases.
 Control of Acid-Base Balance:

The body's balance between acidity and alkalinity is referred to as acid-base
balance. The blood's acid-base balance is precisely controlled because even a minor
deviation from the normal range can severely affect many organs. The body uses
different mechanisms to control the blood's acid-base balance.
These mechanisms involve the lungs, kidneys and buffer systems.
 Role of the lungs:

One mechanism the body uses to control blood pH involves the release of carbon
dioxide from the lungs. Carbon dioxide, which is mildly acidic, is a waste product of
the processing (metabolism) of oxygen and nutrients (which all cells need) and, as
such, is constantly produced by cells. It then passes from the cells into the blood.
The blood carries carbon dioxide to the lungs, where it is exhaled. As carbon
dioxide accumulates in the blood, the pH of the blood decreases (acidity increases).
The brain regulates the amount of carbon dioxide that is exhaled by controlling the
speed and depth of breathing (ventilation). The amount of carbon dioxide exhaled,
and consequently the pH of the blood, increases as breathing becomes faster and
deeper. By adjusting the speed and depth of breathing, the brain and lungs are able
to regulate the blood pH minute by minute.
 Role of the kidneys:

The kidneys are able to affect blood pH by excreting excess acids or bases. The
kidneys have some ability to alter the amount of acid or base that is excreted, but
because the kidneys make these adjustments more slowly than the lungs do, this
compensation generally takes several days.
 Buffer systems:
Yet another mechanism for controlling blood pH involves the use of chemical buffer
systems, which guard against sudden shifts in acidity and alkalinity. The pH buffer
systems are combinations of the body's own naturally occurring weak acids and
weak bases. These weak acids and bases exist in pairs that are in balance under
normal pH conditions. The pH buffer systems work chemically to minimize changes
in the pH of a solution by adjusting the proportion of acid and base.
The most important pH buffer system in the blood involves carbonic acid (a weak
acid formed from the carbon dioxide dissolved in blood) and bicarbonate ions (the
corresponding weak base).
 Types of Acid-Base Disorders:

1) Acidosis: The blood has too much acid (or too little base), resulting in a
decrease in blood pH.
2) Alkalosis: The blood has too much base (or too little acid), resulting in an
increase in blood pH.
Acidosis and alkalosis are not diseases but rather are the result of a wide
variety of disorders.
Types of Acidosis and Alkalosis:

Acidosis and alkalosis are categorized depending on their primary cause as:
i) Metabolic
ii) Respiratory
Metabolic acidosis and metabolic alkalosis are caused by an imbalance in the

production of acids or bases and their excretion by the kidneys.
Respiratory acidosis and respiratory alkalosis are caused by changes in carbon

dioxide exhalation due to lung or breathing disorders.
People can have more than one acid-base disorder.

 Electrolyte Changes in Specific Diseases
 Pyloric Stenosis
The classic electrolyte imbalance of pyloric stenosis is hypochloremic, hypokalemic
metabolic alkalosis.
 Intestinal Obstruction
There is persistent hyponatremia, a gradual drop in serum potassium
beginning 5 days after onset of obstruction, a progressive decrease in
chloride level over first week followed by a rise in urea level for a week and
an initial tendency towards acidosis gradually replaced by alkalosis.
 Anuria
Sodium is generally retained, but may appear normal, or hyponatremic, because of
dilution from fluid retention. Following the relief of a urinary tract obstruction,
hypovolemia, hyponatremia (true loss of sodium), hypokalemia, hypocalcemia,
hypomagnesemia, and bicarbonate loss are most likely to occur.
 Replacement Fluids in Surgery

The goal of IV fluid administration is to restore and maintain tissue fluid and electrolyte
homeostasis and central euvolemia, while avoiding salt and water excess. This will in turn
facilitate tissue oxygen delivery without causing harm. Achieving optimal IV fluid therapy
should improve perioperative outcomes and is a key component in many perioperative
guidelines and pathways. IV fluids, like other medications, should only be given in well-
defined protocols according to individual needs.
Intravenous fluids, also known as intravenous solutions, are supplemental fluids used in
intravenous therapy to restore or maintain normal fluid volume and electrolyte balance
when the oral route is not possible. IV fluid therapy is an efficient and effective way of
supplying fluids directly into the intravascular fluid compartment, in replacing electrolyte
losses, and in administering medications and blood products.
 Types of IV Fluids:
There are different types of IV fluids and different ways on how to classify them.
The most common way to categorize IV fluids is based on their tonicity:
1) Isotonic. Isotonic IV solutions that have the same concentration of solutes as

blood plasma.
2) Hypotonic. Hypotonic solutions have lesser concentration of solutes than
plasma.
3) Hypertonic. Hypertonic solutions have greater concentration of solutes than
plasma.
IV solutions can also be classified based on their purpose:
1) Nutrient solutions. May contain dextrose, glucose, and levulose to make up
the carbohydrate component, and water. Water is supplied for fluid
requirements and carbohydrate for calories and energy. Nutrient solutions are
useful in preventing dehydration and ketosis. Examples of nutrient solutions
include D5W, D5NSS.
2) Electrolyte solutions. Contains varying amounts of cations and anions that are
used to replace fluid and electrolytes for clients with continuing losses.
Examples of electrolyte solutions include 0.9 NaCl, Ringer’s Solution, and LRS.
3) Alkalinizing solutions. Are administered to treat metabolic acidosis. Eg.: LRS
4) Acidifying solutions. Are used to counteract metabolic alkalosis. E.g.: 0.9 NaCl
5) Volume expanders. Are solutions used to increase the blood volume after a
severe blood loss, or loss of plasma. Examples of volume expanders are
dextran, human albumin, and plasma.
 Enteral & Parenteral Nutrition

 Enteral Nutrition:
Enteral feeding refers to intake of food via the gastrointestinal (GI) tract.
Enteral feeding may mean nutrition taken through the mouth or through a tube
that goes directly to the stomach or small intestine. In the medical setting, the term
enteral feeding is most often used to mean tube feeding.
A person on enteral feeds usually has a condition or injury that prevents eating a
regular diet by mouth, but their GI tract is still able to function.
Being fed through a tube allows them to receive nutrition and keep their GI tract
working. Enteral feeding may make up their entire caloric intake or may be used as
a supplement.
Possible indications:
After a stroke which impairs deglutition ability, cancer, critical illness or injury,
failure to thrive, neurological or movement disorders that increase caloric
requirements
 Parenteral Nutrition:
Parenteral nutrition, or intravenous feeding, is a method of receiving nutrition
through the veins. Depending on which vein is used, this procedure is often
referred to as either total parenteral nutrition (TPN) or peripheral parenteral
nutrition (PPN).
Possible indications:
Crohn’s disease, cancer, short bowel syndrome, ischemic bowel disease
CHAPTER xV: Rakta mahatva &
Raktasrava
 Rakta Mahatva
Rakta is one of the Sapta Dhātu and its primary function is Jīvana. Rakta is Jīvasthāna,
hence it must be protected.
Ā. Sushruta, considered Rakta as the fourth Doṣa in addition to Vāta, Pitta and Kapha,
as it plays an important role in Shalya Tantra.
Ā. Charaka has not classified Rakta as a Doṣa, but also gave it greater importance among
the seven Dhātus. Vidhishoṇitīyam Adhyāya, Chapter 24 in Sūtra Sthāna, focuses
specifically on Rakta.
Ā. Ḍalhana mentioned that Rakta is the main factor in the formation of the body during
foetal life, nourishment of the body after birth, and if there is excessive loss of blood, the
person may die.
Shuddha Rakta is formed by intake of proper Āhāra and performing proper Vihāra. It is
responsible for Bala, Varṇa, Sukha and Āyuṣyā.
Rakta plays a vital role in the sustenance of Prāṇa.
 Raktasrāva / Hemorrhage
Haemorrhage is the condition in which there is escape of blood. Bleeding may occur
externally or internally into hollow viscera, serous cavities or tissue.
 Causes:
1) Traumatic bleeding
An injury can cause traumatic bleeding. Common types of traumatic injury:
Abrasions, haematoma or bruises, lacerations, puncture wounds, crushing
injuries, gunshot wounds
2) Medical conditions
Bleeding due to a medical condition is less common than traumatic bleeding.
Conditions that can cause bleeding include:
Haemophilia, leukemia, liver disease, menorrhagia, thrombocytopenia,
vitamin K deficiency, lung cancer, acute bronchitis, etc.
 Symptoms:
Symptoms of haemorrhage depend on the quantity of blood loss and the time
period in which bleeding occurs.
In general, following changes can be seen.
a) Early changes:
i) Vasovagal syncope: Slight sweating, pallor, giddiness, decreased blood
pressure, decreased pulse, ischemia, emotional stress, anxiety, fear
ii) Cardiovascular changes: Increased breathing, tachycardia due to secretion

of adrenaline, selective vasoconstriction to increase BP
iii) Reaction of blood: Increased platelet count & fibrinogen.
iii) Restoration of blood volume: There will be withdrawal of fluid and

electrolytes from the interstitial compartments to the plasma compartment,
and decrease in lympthatic flow. Water is drawn from dense connective tissue
to cause haemodilution.
b) Late changes:
Regeneration of lost blood occurs by stimulation of secretion of erythropoietin
(EPO) which stimulated the boned marrow to produce new RBCs. EPO is stimulated
due to diluted blood and as a result of anorexia.
 Atiraktasrāva Lakṣaṇa:
Shiro-abhitāpa, Adhimantha, Timira, Dhātukṣaya, Ākṣepa, Dāha, Pakṣaghāta,
Ekāṅga vikāra, Hikkā, Shvāsa, Kāsa, Pāṇḍuroga, Maraṇa
 Raktastambhaka Upaya:
1) Sandhāna (joining the edges of the wound by use of Kaṣāya Dravya)
2) Skandana (promote clotting by use of Hima Dravya)
3) Pāchana (dusting with bhasma over the bleeding site)
4) Dahana (cauterization to constrict the blood vessel)
 Haemostasis:
Haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a
damaged blood vessel. It is the first stage of wound healing. This involves coagulation,
blood changing from a liquid to a gel.
Haemostasis has three major steps:
1) Vasoconstriction
2) Temporary blockage of a break by a platelet plug
3) Blood coagulation, or formation of a fibrin clot
These processes seal the hole until tissues are repaired.
1) Vasoconstriction / Vascular Spasm

Vasoconstriction is produced by vascular smooth muscle cells, and is the blood vessel's
first response to injury. The smooth muscle cells are controlled by vascular endothelium,
which releases intravascular signals to control the contracting properties. When a blood
vessel is damaged, there is an immediate reflex, initiated by local sympathetic pain
receptors, which helps promote vasoconstriction. The damaged vessels will constrict
(vasoconstrict) which reduces the amount of blood flow through the area and limits the
amount of blood loss. Collagen is exposed at the site of injury; the collagen promotes
platelets to adhere to the injury site. Platelets release cytoplasmic granules which
contain serotonin, ADP and thromboxane A2, all of which increase the effect of
vasoconstriction. The spasm response becomes more effective as the amount of damage
is increased. Vascular spasm is much more effective in smaller blood vessels.
2) Platelet Plug Formation

Platelets adhere to damaged endothelium to form a platelet plug (primary haemostasis)
and then degranulate. This process is regulated through thromboregulation. Plug
formation is activated by a glycoprotein called Von Willebrand factor (vWF), which is
found in plasma. Platelets play one of major roles in the haemostatic process. When
platelets come across the injured endothelium cells, they change shape, release granules
and ultimately become ‘sticky’. Platelets express certain receptors, some of which are
used for the adhesion of platelets to collagen. When platelets are activated, they express
glycoprotein receptors that interact with other platelets, producing aggregation and
adhesion. Platelets release cytoplasmic granules such as adenosine diphosphate (ADP),
serotonin and thromboxane A2. Adenosine diphosphate (ADP) attracts more platelets to
the affected area, serotonin is a vasoconstrictor and thromboxane A2 assists in platelet
aggregation, vasoconstriction and degranulation. As more chemicals are released more
platelets stick and release their chemicals; creating a platelet plug and continuing the
process in a positive feedback loop. Platelets alone are responsible for stopping the
bleeding of unnoticed wear and tear of our skin on a daily basis. This is referred to as
primary hemostasis.
3) Clot Formation
Once the platelet plug has been formed by the platelets, the clotting factors (a dozen
proteins that travel along the blood plasma in an inactive state) are activated in a
sequence of events known as 'coagulation cascade' which leads to the formation of
Fibrin from inactive fibrinogen plasma protein. Thus, a Fibrin mesh is produced all
around the platelet plug to hold it in place; this step is called secondary haemostasis.
During this process some red and white blood cells are trapped in the mesh which causes
the primary hemostasis plug to become harder: the resultant plug is called as 'thrombus'
or 'clot'. Therefore, 'blood clot' contains secondary hemostasis plug with blood cells
trapped in it. Though this is often a good step for wound healing, it has the ability to
cause severe health problems if the thrombus becomes detached from the vessel wall
and travels through the circulatory system; If it reaches the brain, heart or lungs it could
lead to stroke, heart attack, or pulmonary embolism respectively. However, without this
process the healing of a wound would not be possible.
 In Emergency Medicine:
If an individual acquires a large injury resulting in extreme blood loss, then a
haemostatic agent alone would not be very effective. Medical professionals
continue to debate on what the best ways are to assist a patient in a chronic state;
however, it is universally accepted that haemostatic agents are the primary tool for
smaller bleeding injuries.
Some main types of haemostasis used in emergency medicine include:
1) Chemical/Topical
This is a topical agent often used in surgery settings to stop bleeding.
Microfibrillar collagen is the most popular choice among surgeons because it
attracts the patient's natural platelets and starts the blood clotting process
when it comes in contact with the platelets. This topical agent requires the
normal haemostatic pathway to be properly functional.
2) Direct pressure or pressure dressing

This type of haemostasis approach is most commonly used in situations where
proper medical attention is not available. Putting pressure and/or dressing to a
bleeding wound slows the process of blood loss, allowing for more time to get
to an emergency medical setting. This process allows for blood loss to be
decreased, giving the system time to start coagulation.
3) Sutures and ties

Sutures are often used to close an open wound, allowing for the injured area
to stay free of pathogens and other unwanted debris to enter the site;
however, it is also essential to the process of haemostasis. Sutures and ties
allow for skin to be joined back together allowing for platelets to start the
process of hemostasis at a quicker pace. Using sutures results in a quicker
recovery period because the surface area of the wound has been decreased.
4) Physical agents (gelatin sponge)
Gelatin sponges have been indicated as great haemostatic devices. Once
applied to a bleeding area, a gelatin sponge quickly stops or reduces the
amount of bleeding present. These physical agents are mostly used in surgical
settings as well as after surgery treatments. These sponges absorb blood, allow
for coagulation to occur faster, and give off chemical responses that decrease
the time it takes for the hemostasis pathway to start.
 Blood Transfusion
A blood transfusion is a procedure that restores blood to the body.
Blood transfusions work to replace blood that is lost due to injury or surgery. People can
also get blood transfusions to treat certain medical conditions.
 Types of Blood Transfusion:

According to the American Red Cross, there are four common types of blood
transfusions:
1) Red blood cell transfusions: A person may receive a red blood cell transfusion
if they have experienced blood loss, if they have anemia (such as iron
deficiency anemia), or if they have a blood disorder.
2) Platelet transfusions: A platelet transfusion can help those who have lower
platelet counts, such as from chemotherapy or a platelet disorder.
3) Plasma transfusions: Plasma contains proteins important for health. A person
may receive a plasma transfusion if they have experienced severe burns,
infections, or liver failure.
4) Whole blood transfusion: A person may receive a whole blood transfusion if
they have experienced a severe traumatic hemorrhage and require red blood
cells, white blood cells, and platelets.
 Blood Groups & Compatibility:

It is important that the correct blood type is used for a blood transfusion.
Otherwise, the body might reject the new blood, which can have severe
consequences.
 Indications for Blood Transfusion:
Severe anaemia (when the oxygen capacity of the blood compromises major
organs), severe haemorrhage, anaemia of chronic disorders (renal failure and
cancer), haemoglobinopathies (sickle cell disease, thalassaemia)
 Contraindications for Blood Transfusion:

Megaloblastic anaemia (vitamin B12 or folate deficiency - transfusion may cause
heart failure and death), iron deficiency anaemia, transfusion in healthy adults and
children where use of oral iron could rectify a low haemoglobin
 Complications & Management:

1) Allergic reactions like hives and itching - antihistamines
2) Fever - antipyretics
3) Auto-immune haemolytic reaction: It is a serious complication caused by the
patient’s body attacking the new RBCs. It damages the kidneys, and leads to
nausea, fever, chills, chest and lower back pain, dark urine.
4) Blood borne infection: HIV, Hepatitis B & C, Syphilis, West Nile Virus, etc.
5) Transfusion associated circulatory overload: The high osmotic load of blood
products draws volume into the intravascular space. It is treated with diuretics.
6) Major incompatibility reaction: Due to mismatched blood transfusion or
technical error like sampling, labelling, leading to intravascular haemolysis.
Features include haematuria, oliguria, pain in both loins, fever with chills and
rigors. Blood transfusion must be stopped and the blood is rechecked. Repeat
coagulation profile. Diuretics with frusemide 20-40 mg IV to flush the kidneys.
7) Minor incompatibility reaction: Due to reaction of antibodies to minor antigen
leading to extra vascular haemolysis. Features include malaise, jaundice, fever.
Supportitive treatment should be given.
CHAPTER xVI: Antibiotics, analgesics,
anti-inflammatory Drugs & emergency
drugs in surgical practice
 Antibiotics
Antibiotics, also known as antibacterials, are medications that destroy or slow down the
growth of bacteria.
Antiobiotics are either bacteriocidal or bacteriostatic.
 Classification:
1) Penicillins
The first penicillin gave rise to an entire class of antibiotics known as
penicillins. Penicillins are derived from a specific mold (a type of fungi),
Penicillium. They are widely used for skin, respiratory, ear, STDs, and dental
infections. They are highly effective against familiar organisms, such as staph
and strep. Rashes and allergic reactions are common with penicillins. Other
common side effects include diarrhea, nausea, and abdominal pain. Examples
of penicillins include: Amoxicillin, Ampicillin, Penicillin G, Penicillin V
2) Cephalosporins
Cephalosporins are related to penicillins. They both belong to a larger class
called beta lactams. Like penicillins, cephalosporins originally came from a
fungus, Cephalosporium. There are five generations of cephalosporins. Each
generation covers different types of bacteria. As a result, the class can treat a
variety of infections, from strep throat and skin infections to very serious
infections like meningitis. Because they are related to penicillins, some people
with penicillin allergies may also react to cephalosporins. Other common side
effects include diarrhea, nausea, heartburn, and abdominal pain. Examples of
cephalosporins include: Cefixime, Cefpodoxime, Cefuroxime, Cephalexin
3) Macrolides
Macrolides are a completely different class of antibiotics from the beta
lactams. But they effectively treat many of the same infections. This includes
respiratory, ear, skin, and sexually transmitted infections. So, they are very
useful for people with allergies to beta lactams. They are also useful when
bacteria develop resistance to beta-lactam antibiotics. However, macrolides
have a lot of drug interactions. Common side effects include nausea, vomiting,
stomach pain, and diarrhea. Examples of macrolides include: Azithromycin (‘Z-
pak’), Clarithromycin, Erythromycin
4) Quinolones
Fluoroquinolones or quinolones are active against a very wide variety of
bacteria. This makes them useful for treating infections when other antibiotics
have failed. They are also an alternative when people have allergies to other
antibiotics. They can treat anything from eye infections to pneumonia to skin,
sinus, joint, urinary or gynecologic infections and many more. However, this
class can be a problem for people with certain heart conditions and with some
other medicines. Common side effects include stomach upset or pain,
diarrhea, headache and drowsiness. Examples of fluoroquinolones include:
Ciprofloxacin, Levofloxacin, Moxifloxacin
5) Sulfonamides
Derived from the chemical sulfanilamide, ‘sulfa drugs’ have been around about
as long as penicillin. Technically, sulfonamides do not kill bacteria the way
other antibiotics do. Instead, they are bacteriostatic - they stop bacterial
growth and the immune system does the rest. They are very good topical
treatments for burns and vaginal or eye infections. They can also treat UTIs
(urinary tract infections) and traveler’s diarrhea. However, resistance is
common with this class. Common side effects include diarrhea, nausea, rash,
and sun sensitivity. Allergies are also common with the group. Examples of
sulfonamides include: Sulfacetamide, Sulfadiazine
6) Tetracyclines
These antibiotics come from a species of bacteria called Streptomyces.
Tetracyclines are bacteriostatic, like the sulfonamides. They treat various
infections, such as respiratory, skin and genital infections. They also treat
unusual infections, including Lyme disease, malaria, anthrax, cholera, and
plague. Common side effects include stomach pain or upset, sun sensitivity,
and yeast infections. Examples of tetracyclines include: Doxycycline,
Minocycline, Tetracycline
 Analgesics
Analgesics are medicines that are used to relieve pain. They are also known as painkillers
or pain relievers. Technically, the term ‘analgesic’ refers to a medication that provides
relief from pain without inducing sleep or unconsciousness.
 Use of Analgesics:
Analgesics may be taken to relieve pain that arises from a wide range of conditions,
such as appendicitis, cancer, scoliosis, fibromyalgia, gallbladder disease,
gastrointestinal disorders, headaches, improper lifting techniques, infection,
menstruation, migraines, multiple sclerosis, nerve damage, osteoarthritis, pain
syndromes, poor posture, rheumatoid arthritis, sprains, strains, surgery, trauma,
toothache, wound cleansing and debridement.
 Classification: The most common groups of Analgesics are:
1) Opioid Drugs (narcotics)

Opioid drugs act on the prain and may be used for short-term or long-term
pain relief.
Examples:
a) Morphine
Dose: 10-15 mg IM or SC, 2-10 mg IV, 2-3 mg intrathecal or epidural
Use: Analgesic, Sedative; Depressant of respiratory center, cough center,
temperature regulating center and vasomotor center.
It causes mild hyperglycemia.
b) Tramadol
Dose: 50-100 mg orally / IM / slow IV
Use: Medium intensity short-lasting pain due to injury, Chronic pain
2) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) / Non-Opioids

NSAIDs alleviate pain by reducing the local inflammatory response. They are
generally used to alleviate short-term pain and modest pain such as headache,
muscle strain, etc.
Examples:
a) Mephenamic acid
It is an analgesic, anti-pyretic and anti-inflammatory drug with low
efficacy. It acts on the PNS & CNS.
Dose: 250-500 mg TDS
Use: Muscle, joint and soft tissue pain, dysmenorrhoea
b) Diclofenac sodium
It is an analgesic, anti-pyretic and anti-inflammatory drug.
Dose: 50 mg TDS / BD orally, 75 mg deep IM, Voveron 1% topical gel
Use: Rheumatoid arthritis, osteoarthritis, dysmenorrhoea, post-traumatic
and post-operative inflammatory conditions
c) Paracetamol (Acetaminophen)
It is an analgesic and anti-pyretic drug.
Dose: 0.5-1 gm TDS; Maximum amount for adults is 1 gram (1000 mg) per
dose and 4 grams (4000 mg) per day
Use: Pain, Fever
 Side Effects:
Narcotic analgesics have many side effects, although people with cancer or
terminal illness taking narcotics for long periods of time may become tolerant to
some of these side effects.
Drowsiness, sleepiness, or dizziness is common with most narcotic analgesics.
This can affect driving or a person's ability to operate machinery and perform other
hazardous tasks. Alcohol may potentiate these effects.
NSAIDs may also cause side effects, especially when used at higher than
recommended dosages for long periods of time. Gastrointestinal side effects that
may occur include bloating, diarrhea, constipation, irritation of the lining of the
stomach, nausea or vomiting. NSAIDs may also affect kidney function and reduce
how quickly blood flows through the kidneys. They may cause retention of sodium
and water which can lead to edema and high potassium levels. Occasionally, they
may cause more serious damage to the kidneys.
 Emergency Drugs in Surgical Practice

Emergency medicine is the medical speciality involving care for undifferentiated and
unscheduled patients with illnesses or injuries requiring immediate medical attention.
Examples of Emergency Drugs:
 Adrenaline
Indication: Allergic reactions (anaphylactic shock), Acute attack of bronchial
asthma, Homeostasis, Cardiac arrest due to drowning, electrocaution, etc.
Adverse Reaction: Palpitation, headache, increased BP, tremors, angina, pallor
 Noradrenaline
Indication: Hypotension of circulatory failure, Hypotension following removal of
chromafic cell tumor
Adverse Reaction: Same as adrenaline
 Hydrocortisone
Indication: Anaphylactic shock, status asthmaticus, hypoglycemia, hyperglycemia
Adverse Reaction: Gastritis, peptic ulcer, perforation, hemorrhage, hypertension,
osteoporosis, delayed wound healing
 Morhpine
Dose: 5-20 mg / IM
Indication: Pain, ventricular failure
Adverse Reaction: Respiratory depression, urinary retention, low BP and low pulse
 Diazepam
Dose: 10 mg IM / IV
Indication: Pre-anesthetic medicine, convulsions, muscle relaxant in tetanus
 Insulin
Indication: Diabetes mellitus, diabetes ketoacidosis, hyperkalemia
Adverse Reaction: Hypoglycemia
 Lasix (Frusemide)
Indication: Renal calculi, pulmonary edema, poisoning
Adverse Reaction: Hypotension, dehydration due to excessive loss of potassium,
sodium and calcium
 Deriphyllin
Indication: To prevent and treat wheezing, shortness of breath, chest tightness
associated with lung diseases like asthma, chronic bronchitis, emphysema, COPD
Adverse Reaction: Irregular heart beat, convulsions, allergic skin reactions,
stomach discomfort
 Depin (Nifedipine)
Indication: Hypertension, angina pectoris
Adverse Reaction: Swelling of face, arms, lower legs; dizziness, headache, muscle
cramps
CHAPTER xViI: Diagnostic techniques
 X-Ray / Radiography
X-rays are a form of electromagnetic radiation that can pass through solid objects.
X-rays penetrate different objects more or less according to their density.
X-rays were first discovered by Wilhelm Conrad Roentgen, a German physics professor.
Roentgen also studied X-rays and their ability to pass through human tissues to produce
images of the bones and metals visible on developed film.
To obtain an X-ray image of a part of the body, a patient is positioned so the part of
the body being X-rayed is between the source of the X-ray and an X-ray detector. As the
X-rays pass through the body, images appear in shades of black and white, depending on
the type of tissue the X-rays pass through.
For example, the calcium in your bones makes them denser, so they absorb more
radiation and appear white on X-rays. Thus when a bone is broken (fractured), the
fracture line will appear as a dark area within the lighter bone on an X-ray film.
Less dense tissue such as muscle or fat absorbs less, and these structures appear in
shades of gray on X-ray film.
Air absorbs little of the X-rays, so the lungs and any air-filled cavities appear black on
an X-ray film. If pneumonia or tumors are present in the lungs, they are denser than the
air-filled areas of the lungs and they will appear as whiter spots on X-ray film.
 Common types of X-rays:

Abdominal x-ray, Barium x-ray, Bone x-ray, Chest x-ray, Dental x-ray,
Extremity x-ray, Hand x-ray, Joint x-ray, Lumbosacral spine x-ray, Neck x-ray,
Pelvis x-ray, Sinus x-ray, Skull x-ray, Thoracic spine x-ray, Upper GI and small bowel
series, X-ray of the skeleton
 Common uses of X-rays:

- Bone fractures
- Infections (such as pneumonia)
- Calcifications (like kidney stones or vascular calcifications)
- Some tumors
- Arthritis in joints
- Bone loss (such as osteoporosis)
- Dental issues
- Heart problems (such as congestive heart failure)
- Blood vessel blockages
- Digestive problems
- Foreign objects (such as items swallowed by children)
 Computerzied Tomography (CT) Scan /
Computerized Axial Tomography (CAT) Scan
Computerized (or computed) tomography, and often formerly referred to as
computerized axial tomography (CAT) scan, is an X-ray procedure that combines many X-
ray images with the aid of a computer to generate cross-sectional views and, if needed,
three-dimensional images of the internal organs and structures of the body.
Computerized tomography is more commonly known by its abbreviated names, CT scan
or CAT scan. A CT scan is used to define normal and abnormal structures in the body
and/or assist in procedures by helping to accurately guide the placement of instruments
or treatments.
A large donut-shaped X-ray machine or scanner takes X-ray images at many different
angles around the body. These images are processed by a computer to produce cross-
sectional pictures of the body. In each of these pictures the body is seen as an X-ray
"slice" of the body, which is recorded on a film. This recorded image is called a
tomogram. "Computerized axial tomography" refers to the recorded tomogram
"sections" at different levels of the body.
CT scans are performed to analyze the internal structures of various parts of the
body. This includes the head, where traumatic injuries, (such as blood clots or skull
fractures), tumors, and infections can be identified.
In the spine, the bony structure of the vertebrae can be accurately defined, as can the
anatomy of the intervertebral discs and spinal cord. In fact, CT scan methods can be used
to accurately measure the density of bone in evaluating osteoporosis.
Occasionally, contrast material (an X-ray dye) is placed into the spinal fluid to further
enhance the scan and the various structural relationships of the spine, the spinal cord,
and its nerves.
CT scans are also used in the chest to identify tumors, cysts, or infections that may be
suspected on a chest X-ray.
CT scans of the abdomen are extremely helpful in defining body organ anatomy,
including visualizing the liver, gallbladder, pancreas, spleen, aorta, kidneys, uterus, and
ovaries. CT scans in this area are used to verify the presence or absence of tumors,
infection, abnormal anatomy, or changes of the body caused by trauma.
The technique is painless and can provide extremely accurate images of body
structures in addition to guiding the radiologist in performing certain procedures, such as
biopsies of suspected cancers, removal of internal body fluids for various tests, and the
draining of abscesses which are deep in the body. Many of these procedures are
minimally invasive and have markedly decreased the need to perform surgery to
accomplish the same goal.
 Ultrasonography (USG)
An ultrasound is a tool used to take a picture. A sonogram is the picture that the
ultrasound generates. Sonography is the use of an ultrasound tool for diagnostic
purposes.
Ultrasonography is a form of body imaging using sound waves to facilitate a medical

diagnosis. A skilled ultrasound technician is able to see inside the body using
ultrasonography to answer questions that may be asked by the medical practitioner
caring for the patient. Usually, a radiologist will oversee the ultrasound test and report
on the results, but other types of physicians may also use ultrasound as a diagnostic tool.
For example, obstetricians use ultrasound to assess the fetus during pregnancy. Surgeons
and emergency physicians use ultrasound at the bedside to assess abdominal pain or
other concerns.
A transducer, or probe, is used to project and receive the sound waves and their
echoes. A gel is wiped onto the patient's skin so that the sound waves are not distorted
as they cross through the skin. Using their understanding of human anatomy and the
machine, the technician can evaluate specific structures and try to answer the question
asked by the patient's physician. This may take a fair amount of time and require the
probe to be repositioned and pointed in different directions. As well, the technician may
need to vary the amount of pressure used to push the probe into the skin. The goal will
be to "paint" a shadow picture of the inner organ that the health care practitioner has
asked to be visualized.
The physics of sound can place limits on the test. The quality of the picture depends
on many factors:
- Sound waves cannot penetrate deeply, and an obese patient may be imaged poorly.
- Ultrasound does poorly when gas is present between the probe and the target organ.
Should the intestine be distended with bowel gas, organs behind it may not be easily
seen. Similarly, ultrasound works poorly in the chest, where the lungs are filled with air.
- Ultrasound does not penetrate bone easily.
- The accuracy of the test is very much operator dependent. This means that the key to a
good test is the ultrasound technician.
 Uses:
1) Diagnostic uses for ultrasound
a) Obstetrics: Ultrasound is routinely used for assessing the progression of a
pregnancy. Pelvic ultrasounds can be obtained trans-abdominally where
the probe is placed on the abdominal wall, or trans-vaginally, where the
probe is placed in the vagina. For example, ultrasound in
obstetrics/gynecology is used to diagnose growths or tumors of the
ovary, uterus, or, Fallopian tubes.
b) Cardiology: Echocardiography evaluates the heart, the heart valve's
motion, and blood flow through them. It also evaluates the heart wall
motion and the amount of blood the heart pumps with each stroke.
c) Blood vessels: Ultrasound can detect blood clots in veins (superficial or

deep venous thrombosis) or artery blockage (stenosis) and dilatation
(aneurysms).
d) Abdominal structures: Aside from its use in obstetrics, ultrasound can

evaluate most of the solid structures in the abdominal cavity. This
includes the liver, gallbladder, pancreas, kidneys, bladder, prostate,
testicles, uterus, and ovaries.
e) The neck: The thyroid gland can be imaged using ultrasound looking for
nodules, growths, or tumors.
f) Knee joint: Ultrasound can be used to detect bulging of fluid from a

swollen knee joint into the back of the knee, called a Baker's cyst.
2) Screening uses for ultrasound

Ultrasound may be used to screen for blood vessel diseases. By measuring
blood flow and blockage in the carotid arteries, the test can predict potential
risk for future stroke. Similarly, by measuring the diameter of the aorta in the
abdomen, ultrasound can screen for aneurysm (abnormal dilatation) and the
risk of rupture. These tests may be indicated for an individual patient or they
may be offered as a community wide health screening assessment.
3) Therapeutic uses for ultrasound

Ultrasound may be used to help physicians guide needles into the body.
In situations where an intravenous line is required but it is difficult to find a
vein, ultrasound guidance may be used to identify larger veins in the neck,
chest wall, or groin.
Ultrasound may be used to guide a needle into a cavity that needs to be
drained (for example, an abscess) or into a mass to perform a biopsy.that
needs to be biopsied, where a small bit of tissue is removed for analysis
Transrectal Ultrasound / Sonography
Transrectal ultrasound (TRUS) is a technique that is used most commonly to evaluate
- the prostate gland (e.g. prostatic tumor) including ultrasound-guided prostate biopsies.
- depth of invasion of colon/rectal cancer (for staging purposes).
It can also be used for guidance in placing a transrectal drain, or in rare problem-solving
situations in which pelvic organs are inadequately evaluated with a transabdominal
approach and the transvaginal approach is not possible or not preferred.
Its utility in evaluating the prostate gland is analogous to transvaginal imaging in

women. The ultrasound probe is placed as close as possible to the organ of interest,
allowing a higher frequency probe to be employed with a subsequent improvement in
spatial resolution
 Fistulography
Fistulography is an internal diagnostic imaging technique performed by an interventional
radiologist to determine characteristics of a fistula. This imaging technique can give
interventional radiologists information about whether a foreign body or inflammation is
present in order to determine proper care.
Fistulography may be warranted in patients with recurrent fistulas or when a prior
procedure has failed to identify the internal opening. With this technique, the external
opening is cannulated with a small-caliber tube and contrast material is injected under
minimal pressure while films are taken in several projections. Fistulography may be
useful in identifying unsuspected pathology, planning surgical management, and
demonstrating anatomic relationships.
 Megnetic Resonance Imaging (MRI)

Magnetic resonance imaging or MRI scanning uses magnetism, radio waves, and a
computer to produce images of body structures.
Patients with heart pacemakers, metal implants, or metal chips or clips in or around the
eyes cannot be scanned with MRI because of the magnetic effect.
Claustrophobic sensation can occur with MRI scanning.
The MRI scanner is a tube surrounded by a giant circular magnet. The patient is
placed on a moveable bed that is inserted into the magnet. The magnet creates a strong
magnetic field that aligns the protons of hydrogen atoms, which are then exposed to a
beam of radio waves. This spins the various protons of the body, and they produce a
faint signal that is detected by the receiver portion of the MRI scanner. A computer
processes the receiver information, which produces an image.
MRI image and resolution is quite detailed, and it can detect tiny changes of structures
within the body.
An MRI scan can be used as an extremely accurate method of disease detection
throughout the body and is most often used after other testing fails to provide sufficient
information to confirm a patient's diagnosis.
In the head, trauma to the brain can be seen as bleeding or swelling. Other abnormalities
often found include brain aneurysms, stroke, tumors of the brain, as well as tumors or
inflammation of the spine.
Neurosurgeons use an MRI scan not only in defining brain anatomy, but also in
evaluating the integrity of the spinal cord after trauma. It is also used when considering
problems associated with the vertebrae or intervertebral discs of the spine.
An MRI scan can evaluate the structure of the heart and aorta, where it can detect
aneurysms or tears. MRI scans are not the first line of imaging test for these issues or in
cases of trauma.
It provides valuable information on glands and organs within the abdomen, and
accurate information about the structure of the joints, soft tissues, and bones of the
body. Often, surgery can be deferred or more accurately directed after knowing the
results of an MRI scan.
 Biopsy
Biopsy is the removal of a sample of tissue for examination under a microscope to check
for cancer cells or other abnormalities.
 Uses:
1) Diagnosing tumors and cancerous cells
Tumors may be determined as cancerous (malignant) or non-cancerous
(benign) with the help of biopsies.
2) Grading tumors
Biopsies of cancers help to grade the tumor. The microscopic structure of the
tumor often gives clues to the nature, rate of growth, aggressiveness of the
cancer. The cancer is staged based on this. Staging helps to determine the plan
of treatment and helps to predict the outcome or prognosis of the cancer.
3) Other uses
Biopsies can help identify other conditions such as infections and autoimmune
disorders. Bone biopsy for example helps in diagnosis of bone infections. Bone
marrow biopsy is used to diagnose cancer in the blood, such as leukemia and
also for effects of drugs, toxins and infections.
Biopsies may be performed on almost all organs like breast, kidneys, liver,
bone marrow, bone, skin, lung, lymph nodes, muscles, nerves, testes, thyroid,
bladder, heart, neck, prostate etc.
 Types:
There are many different types of biopsy procedures:
1) Needle biopsy: A fine needle is used to remove a small amount of tissue from
the tumor or growth. This is called fine needle aspiration cytology (FNAC).
2) Vacuum assisted biopsy: A thicker, hollow needle removes cores of tissue with
a single insertion of a vacuum assisted probe.
3) Surgical biopsy: Here a small surgery is performed. A small or whole of the
tumor is excised and removed for examination. This is a more extensive
procedure and may require hospital stay. When an entire lump or suspicious
area is removed, the procedure is called an ''excisional biopsy''. When only a
sample of tissue is removed with preservation of the histological architecture
of the tissue’s cells, the procedure is called an ''incisional biopsy'' or ''core
biopsy''.
 Cytological Study
Cytology is the medical and scientific study of cells. Cytology refers to a branch of
pathology, the medical specialty that deals with making diagnoses of diseases and
conditions through the examination of tissue samples from the body.
Cytologic examinations may be performed on body fluids (examples are blood, urine,
and cerebrospinal fluid) or on material that is aspirated (drawn out via suction into a
syringe) from the body. Cytology also can involve examinations of preparations that are
scraped or washed (irrigated with a sterile solution) from specific areas of the body. For
example, a common example of diagnostic cytology is the evaluation of cervical smears
(referred to as the Papanicolaou test or Pap smear).
In order for cytologic evaluation to be carried out, the material to be examined is

spread onto glass slides and stained. A pathologist then uses a microscope to examine
the individual cells in the sample.

शल्यतन्त्र Paper I, Part A

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शल्यतन्त्र

शल्यणमणत शल्यहरिप्रधानं तन्त्रं शल्यतन्त्रम् ॥ (सु - सू - १/७ डल्हन)

Yantra Modern Correlation Sushruta Saṁhitā Aṣṭāṅga Hṛdaya

Nāḍī Yantra Modern Correlation Number

Shalākā Yantra Number Use

1) Rajju (Rope) Used as tourniquet

 Bheda & Prayoga:

Shastra Modern Correlation Prayoga

Anushastra Modern Correlation Prayoga

 Length = 7 cm (most commonly used); some varieties may be 15-32 cm

 Position for Examination:

 Sponge Holding Forceps

 Lister’s Sinus Forceps

 Use: Traction, countertraction or both.

 Ryle’s Tube (Nasogastric Tube)

1) Base: Provided with a cork.

Āchārya Ḍalhana mentioned the physical method of sterilization of instruments before

Dhūpana karma (fumigation), characterized under Bahirparimarjana, has been

- Sarṣapa (Brassica campestris): It contains contrasting profile of glucosinolates which

- Jaṭāmāṁsī (Nardostachys jatamansi): It contains essential oil with antimicrobial action.

Disinfection describes a process that eliminates most or all pathogenic microorganisms,

Asepsis is the absence of bacteria, viruses, and other microorganisms.

Antisepsis is the prevention of infection by inhibiting or arresting the growth and

Decontamination is the process of removal of contaminating pathogenic microorganisms

Sanitization is the process of chemical or mechanical cleansing, applicable in public

Bacteriostasis is a condition where the multiplication of the bacteria is inhibited without

Bactericidal is the action of killing bacteria.

1) Physical Methods of Sterilization

Flaming is used in sterilization of inoculating loops or wires, forceps

Hot air oven is an electrical device used for sterilization of glassware,

Heating below 100° C is used for pasteurization of milk.

Heating at 100° C is the process of immersing objects into boiling water.

Autoclaving is the process of sterilization by using saturated steam

Infrared radiation is used for sterilization of syringes.

2) Chemical Methods of Sterilization

Ancient methods of Sangyāharaṇa include:

4) Vedanā Sthāpana Dravya

Anesthesiologists use a wide variety of drugs, in multiple combinations, in order to

1) Local Anesthesia (LA)

2) Regional Anesthesia (RA)

Types of regional anesthesia are:

v) Bier Block: Local anesthetics are injected intravenously to numb a limb,

Spinal Anesthesia is administered in the lower back/lumbar region using a

3) General Anesthesia (GA)

4) Monitored Anesthesia Care (MAC)

णरण्धं कमव पू्क

Preparation of the patient is done by Ekadashopakrama:

Nirjantukaraṇa: Sterilization of Sthāna, Upakaraṇa, Rogī and Shastravaidya is also included

1) Chedana (Excising, Removing)

Refer to the subsequent chapter for detailed description.

1) The patient should be sprinkled with cold water.

4) The wound should be fumigated (Dhūpana) with Vedanāshāmaka & Rakṣoghna

8) The patient should follow Pathyāhāra-vihāra according to the condition.

Shastra: Maṇḍalāgra, Karaptara, Vṛddhipatra, Nakha shastra, Mudrika, Utpalapatra,

Anushastra: Tvak sāra, Sphaṭika, Kācha, Kuruvinda, Nakha, Agni, Kṣāra

Shastra: Vṛddhipatra, Nakha shastra, Mudrika, Utpalapatra, Ardhadārā shastra

Anushastra: Tvak sāra, Sphaṭika, Kācha, Kuruvinda, Nakha, Agni, Kṣāra

Shastra: Maṇḍalāgra, Karapatra, Vṛddhipatra

Anushastra: Kṣāra, Gojihvā, Shephālikā patra, Nakha

Shastra: Kuṭhārika, Vṛhimukha, Ārā, Vetasapatra, Eṣaṇī, Kushapatra

Anushastra: Tvak sāra, Karīra

Anushastra: Karīra, Bāla, Aṅguli

Shastra: Baḍisha, Dantashaṅku

Anushastra: Nakha, Aṅguli