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Contribution of  Ayurveda to Modern Surgery – A Critical Review

CSP November 27, 2020
Contribution of  Ayurveda to Modern Surgery – A Critical Review

Lahange S M, Vikash B, Bhangare A N, Shailza B. A Critical Review Study on Contribution of Ayurveda to Modern Surgery. Open  Access J Surg. 2017; 6(3): 555693. DOI: 10.19080/OAJS.2017.06.555693. 

Abstract  

Anatomy is broadly appreciated as being one of the cornerstones of medical education especially for surgery. Learning anatomy through the  dissected cadaver is viewed as the uniquely defining feature of medical courses. Explosion of knowledge in the field of surgery was feasible only  due to exploration of human body through human cadaver dissection. Sages of ancient India are still relevant as they not only gave the vision of  happy social and personal life, with great sense of ecological balance but they also discovered many scientific facts and truth about human body.  Such discoveries formed the basis of many sciences of present era. In this topic we will discuss specifically about the facts of modern surgery  which were already described in very scientific manner by the seers of Āyurveda. Suśruta is considered as the father of surgery even today, but if  we go through the Āyurveda text, essentials of human anatomy are very precisely described by Suśruta, so Suśruta should also considered as the  father of human anatomy. Ācārya Suśruta has paid great attention towards the structural organization of the human body. This was emphasized  to such an extent that no surgeon should start his surgical carrier unless he is well aware with human anatomy.

Introduction 

Ācārya Suśruta has not only mentioned the anatomical  locations of various body structures but also given the detailed  description right from development of various organs,  intrauterine life of foetus, month wise development of foetus,  nutrition of foetus, maternal health etc. Suśruta has separately  explained the anatomical aspects of the body and one section  of the Suśruta samhitā has been devoted exclusively for this,  which is known as the Śārīr sthāna (section related to the study  of human body). He planned to first deal with Sriṣtī utpattī kram,  Embryology (Garbhāvakrānti Śārīr) and then anatomy of the  human body. He also stressed on the importance of observational  and practical experience in surgery. For this he mentioned a  separate chapter named ‘Yogyā sūtrīya’ in Sūtra sthāna. He may  be the first person to advocate dissection to gain the first hand  knowledge of the human anatomy.

Suśruta was a strong supporter of human dissection as  evident from his texts. His texts include a systematic method for  the dissection of the human cadaver. They were mastered from  extensive human dissection which they skilled despite religious  interference. He considered that aspiring surgeons must first be  an anatomist for skilful and successful practice. The physician  or surgeon desiring to have the exact knowledge of Śalya śāstra should thoroughly examine all parts of dead body after its  proper preservation. Practical knowledge along with theoretical  knowledge is very essential for any practitioner. Although it is  considered that Plastic Surgery is a relatively new branch of  science but the origin of the plastic surgery had its roots more  than 4000 years old in India, back to the Indus River Civilization.

The ślokās (hymns) associated with this  civilization were compiled in Sanskrit language in the form of  Vedas, the oldest sacred books of the Hindu religion. This era is  referred to as the Vedic period in Indian history during which the  four Vedas, namely the Rigveda, the Sāmaveda, the Yajurveda,  and the Atharvaveda were compiled. All the four Vedas are in  the form of ślokās (hymns), verses, incantations and rites in  Sanskrit language. ‘Suśruta Samhitā’ is believed to be a part  of Atharvaveda. Perhaps the greatest contribution of Suśruta  was the operation of rhinoplasty. The detailed description of  the rhinoplasty operation in the Suśruta samhita is incredibly  meticulous and comprehensive. There is evidence to show that  his success in this kind of surgery was very high. This need not  come as a surprise because surgery (Śastrakarma) is one of  the eight branches of Āyurveda, the ancient Indian system of  medicine.  The oldest treatise dealing with surgery is the Suśruta samhitā. Suśruta was one of the first to study the human  anatomy. Suśruta moved by his intense human approach to life  and equipped with superb surgical skills, did the operation of  rhinoplasty with remarkable skill, grace and success. The details  of the steps of this operation, as recorded in the Suśruta samhitā,  are amazingly similar to the steps that are followed even today  in such advanced plastic surgery. The famous Indian Rhinoplasty  (reproduced in the October 1794 issue of the Gentleman’s  Magazine of London) is a modification of the ancient Rhinoplasty  described by Suśruta. Even today forehead flap is referred to as  the Indian flap.

Suśruta took surgery in medieval India to admirable heights  and that era was later regarded as the Golden Age of Surgery  in ancient India. Because of his numerous seminal contributions  to the science and art of surgery in India, he is regarded as  the ‘Father of Indian Surgery’ and the ‘Father of Indian Plastic  Surgery’. In “The source book of plastic surgery”, Frank McDowell  aptly described Suśruta as follows: “Through all of Suśruta’s  flowery language, incantations and irrelevancies, there shines  the unmistakable picture of a great surgeon. He attacked disease  and deformity definitively, with reasoned and logical methods.”  Suśruta, the father of Indian surgery has described the scientific  technique of Rhinoplasty and Lobuloplasty (repairing of severed  nose and lobes of ear in his treatise of Suśruta samhitā). It is  evidently true that the modern surgery throughout the world  has got inspiration from the ancient surgery of Suśruta and  it has been quoted by Hersberg of Germany that “Our entire  knowledge of Plastic Surgery took a new turn when these  surgical techniques of India became known to us”.

Acārya Caraka studied the anatomy of the human body  and various organs. He gave 360 as the total number of bones,  including teeth, present in the human body. He also described  the numbers of muscles, joints etc. in the Human body. He  considered heart to be a controlling centre. He explained that the  heart is connected to the entire body through 10 main channels.  He also claimed that any obstruction in the main channels led  to a disease or deformity in the body. He also described about  the concept of body cavity. The object of present study is to  trace out the most significant and valuable hidden treasures of  anatomy and surgery practiced in the past. Attempt has been  also made out to investigate the valuable materials of immense  importance pertaining to anatomical surgical literature available  in Āyurvedic literature.

Suśruta had depth understanding about various procedures  which represents the equivalent of modern techniques used in  plastic and reconstructive techniques and thus implies a good  knowledge of human facial anatomy. The writings of many great  eminent scholars passed from ancient India to Arabians after  the invasion by Alexander the Great. From them it passed on to  Greeks and Romans. Hence ancient India deserves the credit of origin of modern medicine rather than to Greece and Arabia.  The paradox still persists why the achievements of this ancient  Indian legendary was not in limelight.

Various Surgical Procedures Mention In Ayurveda 

Aṣṭavidha śastra karma (Surgical procedures) (Su. Sū.5/5) 

The Śastra karma (surgical procedures) is of eight types.  They are: Chedya, Bhedya, Lekhya, Vedhya, Eṣya, Āhārya,  Visrāvya and Sīvya [1-4].

  1. Types of Sadhyovraṇa (Traumatic wound) (Su. Ci.2/8-10) 

Ancient Ācāryās have classified the traumatic wound of  innumerable shapes with respect to their features into six types  broadly:

  1. a) Chinna
  2. b) Bhinna
  3. c) Viddha
  4. d) kṣata
  5. e) Piccita
  6. f) ghṛṣṭa.

Yogyā sūtrīya (Principles of experimental surgery)  (Su.Sū.9/4) 

  1. Experiments of Chedana: The different experiments of  Chedana should be demonstrated on pumpkin-gourd, bottle  gourd, water-melon, cucumber, Eravāruka and Karkāruka.  Chedana in the superior as well as inferior directions should  also be implemented upon these.
  2. Experiments of Bhedana: The experiments of  Bhedana should be demonstrated on leather bag, urinary  bladder of an animal and leathern bottle etc. full of water  and slime.
  3. Experiments of Lekhana and Vedhana: The  experiments of Lekhana should be demonstrated on a piece  of skin which must be hairy and those of Vedhana on the  vessels of dead animals and on the lotus stalks.
  4. Experiments of Eṣaṇa and Āharaṇa: The experiments  of Eṣaṇa should be demonstrated on wood which must be  eaten by moth, bamboos, reed tubes and mouth of a dried  gourd; and those of Āharaṇa on jackfruit, Bimbī, the pulp of  Bilva fruit and on the teeth of dead animals.
  5. Experiments of Visrāvaṇa and Sīvana: The procedure  of Visrāvaṇa should be demonstrated on a piece of Śālmali  wood coated with bees wax and Sīvana should be practised  on the borders of fine, closely knitted cloths and on the  borders of soft leather.
  6. Demonstration of Bandhana (bandaging): The  procedure of bandaging should be demonstrated on different  parts and subdivisions on the dummies made of cloth.  Experiments of Agni and Kṣāra karma. The experiments of  the use of Agni and Kṣāra should be demonstrated on soft  muscle pieces. Plastic surgery of ear should be demonstrated  on soft leather, muscle bellies and lotus stalks.
  7. Miscellaneous experiments: The experiments of  applications of nozzles of enema apparatus and the wound  irrigation should be demonstrated on the side hole of an  earthen pot full of water and on the mouth of a gourd.

Karṇa bandha vidhi (Techniques of repairing the ear lobuloplasty) (Su.Sū.6/10) 

There are fifteen techniques of the repair of the ear. They  are as follows: Nemisandhānaka, utpalabhedyaka, vallūraka,  āsaṅima, gaṅḍakarṇa, āhārya, nirvedhima, vyāyajima,  kapāṭasandhika, ardhakapāṭasandhika, samkṣipta, hīnakarṅa,  vallīkarṅa, yaṣṭikarṇa and Kākauṣṭhaka.

  1. Nemisandhānaka: Out of them the Nemi repair  technique is indicated when both flaps of the divided ear are  thick, wide and equal.
  2. Utpalabhedyaka: This technique is indicated when  both flaps of the ear lobule are circular, wide and equal.

iii. Vallūraka: It is indicated when both flaps of the divided  ear lobule are short, circular and equal.

  1. Āsaṅima: It is indicated when the inner fap of the  divided ear lobule is long and the outer flap is almost  negligible.
  2. Gaṅḍakarṇa: It is indicated when the outer flap of  the divided ear lobule is long and the inner flap is almost  negligible.
  3. Āhārya: His technique is indicated when both flaps of  the divided ear lobule are absent.

vii. Nirvedhima: It is indicated when both flaps of the  divided ear lobule are absent upto the root of the ear and it  is repaired with the tragus as the base.

viii. Vyāyajima: This technique is indicated when one of the  flaps of the divided ear lobule is thick, the other one is thin or  one is regular and the other irregular.

  1. Kapāṭasandhika: It is indicated when the inner  division is long and the outer one is short.
  2.  : It is indicated when the outer division is long and the  inner is short.

These above ten techniques of ear repair are curable.  Their nomenclature is almost self-explanatory about pattern  of the technique involved. The five techniques beginning with  Samkṣipta etc. are not curable.

  1. Samkṣipta: It is indicated when the pinna is atrophied  and one flap of the divided ear lobule is absent and the other  one is very small.
  2. Hīnakarṇa: It is indicated when both flaps of the split  ear lobule are devoid of a base and little musculature is  present in and around the cheek.

iii. Vallīkarṇa: It is indicated when the ear lobule flaps are  thin, unequal and short.

  1. Yaṣṭikarṇa: It is indicated when both flaps of the split  lobule have keloids, are avascular and very small.
  2. Kākauṣṭhaka - It is indicated when the flaps of the  split ear are devoid of musculature, have abridged ends and  an insignificant blood supply.

Nāsikā sandhān vidhi (Rhinoplasty) (Su.Sū.16/27-31) 

Suśruta describes the proper method of rhinoplasty when  the nose has been cut off. Taking a tree leaf which must be of  size similar to nose and placing it on the cheek, a flap should be  raised of the same size from the side if the cheek maintaining  its continuity; it should then be approximated to the front part  of the nose after making the nose raw and then the surgeon  should quickly suture the same by the correct technique.  Having examined the nose which has been properly sutured  and correctly shaped, the same should be fixed by two tubes  and elevated. Then, the powder of Rakta candana, Madhūka and  Rasāñjana should be sprinkled on the nose after elevating it. It  should be dressed properly with cotton and should be soaked  repeatedly with sesamum oil; Ghṛta should be administered to  the patient after the previous meal has been properly digested  and a purgative should be prescribed as instructed. When the  graft has properly taken up, base of the same should be snapped.  The short graft should be elongated and the long graft should be  made uniform.

Auṣṭha sandhān vidhi (Su.Sū.16/32) 

Plastic surgery of the cleft lip should be done similar to that  of rhinoplasty but without the use of two tubes. Only he who  knows these techniques, is entitles to be the royal physician.

Types of Sīvana karma (Suturing)(Su.Sū.25/22) 

The edges of the wound should be sutured by Gophaṇikā,  Tunnasevanī, and Ṛjugranthi and by other techniques of sutures  as and where applicable [1-8].

Cikitsā of Baddhagudodara (Intestinal obstruction)  and Parisrāvyuodara (Intestinal perforation) (Su. Ci.14/17) 

Cases of Baddhagudodara (intestinal obstruction) and of  Parisrāvyuodara (intestinal perforation) should be oleated,  fomented and anointed and then their abdomen should be incised  below the naval, four Aṅgula (Fingers) beyond the midline on  the left side, and after bringing out the intestines four fingers in  length at a time, they should be inspected and the stones, hair  balls or faecoliths obstructing the intestines should be removed.  After applying Madhu and Ghṛta the intestines should then be  put back in their original position and the external abdominal  wound should be sutured. Similarly in case of Parisrāvyuodara  (perforation), after removing the foreign body and cleansing  discharges, the edges of the hole in the intestine have been  brought together should be got bitten by black ants. When the  ants have bitten the intestines their body should be chopped  off leaving the heads behind. Then suturing should be done  as before and other reparative measures should be taken as  described earlier. Black clay mixed with Madhuka should then  be pasted and bandaging done. Thereafter, keeping the patient in  a room without wind, further post operative instruction should  be issued; he should be kept in a trough full of oil or Ghṛta and a  diet of milk should be given.

Cikitsā of Dakodara (Ascites) (Su.Ci.14/18) 

A patient of Dakodara (ascites) should first of all be managed  with the Vāta alleviating oils and subjected to sudation therapy  with warm water. He should sit and held firmly in the armpits by  dependable persons surrounding him. A deep puncture as deep  as a thumb breadth should be made by a trocar below the navel,  four Aṅgula beyond midline on the left side. Then, a tubular  instrument made of tin or of any similar metal or of quills and  open at both ends should be introduced and the ascitic fluid  should be removed. Thereafter, the canula should be removed,  the wound anointed with oil and salt and then bandaged. All  ascitic fluid should not be removed in one day. If removed all at  once, it causes thirst, fever, body ache, diarrhoea, asthma, cough  and a burning sensation in the foot; and the abdomen fills up  again quickly in patients with lowered vitality [7-9].

Therefore, the ascitic fluid should be drained little by little at  intervals of three, four, five, six, eight, ten, twelve or sixteen days.  After the Doṣa (ascitic fluid) has been drained, firm bandaging by  sheep’s wool, silk or leather should be done over the abdomen,  so that gases may not cause distension. For six months the food  should be taken with milk or Māmsa rasa of wild animals. Then  for the next three months food should be given with milk, diluted  with an equal quantity of water or with citrus fruit juices or with  the meat juices of wild animals. For the remaining three months  light and wholesome food should be taken. Thus in a year the  patient gets free from the disease.

Cikitsā of the Mūḍha garbha (Mal presenting foetus)  (Su.Ci.15/9), (Su.Ci.15/3) 

The procedure of bringing out a mal presenting foetus  is difficult than any other procedure. In this condition the  procedures have to be carried out only by palpation (bimanual  pressure) between the vagina and the liver, spleen, intestinal  canal as well as the uterus. Pushing up or pulling down of  the foetus, version, cutting up, incision, excision, pressure,  straightening and tearing of the foetus have to be carried out  by one hand only, avoiding injury to the pregnant woman and  to the foetus. Therefore, after due permission from the king,  all procedure should be carried out with the utmost care. The  medicines should also be given. In case the foetus is dead, the  pregnant woman should lie in supine position with her thighs  flexed and her waist raised by a pad of clothes. Then the hand of  the surgeon lubricated with the latex of Dhanvana, nagavṛttikā,  śālmalī, clay and Ghṛta should be introduced into the vagina and  the foetus should be manipulated. In case of presentation of legs,  the foetus should be pulled downwards by its legs.

In case only one leg is presenting, the other leg should also  be extended and delivered. In case of breech presentation, the  hips should be pushed up along with the foetus and it should  be delivered by extending the legs. In transverse presentation  where the foetus is lying across like a transverse iron bar used  for closing the door, the lower posterior half of the foetus should  be pushed up and the upper half should be brought down  straight into the delivery passage and delivered. In case of the  head being bent to one side, the shoulders should be pressed  and pushed upwards, and delivery of the head is completed by  bringing it down in the parturient passage. When the arms are  presenting, the shoulders should be pushed upwards and the  foetus is delivered by pulling down the head along its normal  course. The last two mal presentations are incurable; therefore  when the above measures fail, surgery should be employed for  them. Cutting of the dead foetus should be done by Maṇdalāgra  śastra (circular knife) not by sharp pointed Vṛddhipatra śastra  as it will hurt the mother.

Arś (Haemorrhoid) Cikitsā(Su.Ci.6/4) 

According to Suśruta the patient suffering from piles should  be oleated and sudated. Thereafter, the patient, who has been  suffering from various types of pain due to Vāta, should take  unctuous and warm food consisting mainly of liquids and less  of cereals so that the pain may be relieved. The patient should  then be made to sit in a covered and clean place in moderate  climatic condition and on a flat plank or on a bed. The anus  should be facing towards the sun with the patient in the supine  position and the upper part of his body held in someone else’s  lap. The waist should be raised a little by a bundle of cloth or a  blanket under it. The neck and the legs should be firmly fixed by  a strap of cloth and the patient is held firmly by assistants so that  movements are not possible. Then his anus should be lubricated with Ghṛta and a well lubricated (rectal speculum) instrument  should be inserted straight into the rectum along its passage  little by little while the patient is straining.

After its insertion, the piles should be visualised (examined);  thereafter the pile mass should be pressed by a probe, wiped  with a cotton swab or a piece of cloth and caustic applied. As soon  as the caustic has been applied, the opening of the instrument  should be covered by the hand of the surgeon and he should wait  until the counting of one hundred. Then after wiping, the caustic  may be applied again, taking into consideration the strength  of the caustic and severity of the disease. The applications of  caustic should be stopped when the piles begin to acquire the  colour of the ripen Jambū fruit and get depressed and shrunken.  The caustics should then be washed away by sour gruel, yoghurt,  butter milk, vinegar or by the juice of citrus fruits. The pile mass  should be mollified by the application of Ghṛta mixed with  Madhuka and the instrument should be taken out. Thereafter the  patient should be made to get up and sit in warm water, whereas  cold water should be sprinkled over him [9,10].

According to some, warm water should be sprinkled. Then  he should be taken into a room free from direct approach of wind  and nursing instructions are given. The pile remnant may have  to be cauterized again. Thus, the pile should be treated one by  one at intervals of seven nights each. In case of multiple piles the  right one should be managed first; after the right the left one and  after that left posterior one; lastly the anterior ones should be  treated. According to Acharya Vāgbhatta after being evacuated  by taking enema, the person should sit either on a cot or plank.  With the upper portion of the body placed a little high, the anus  should face towards the sun, the region of the waist must be  raised up, the thighs and neck restrained, by tying them with  cloth and placed straight and held tight by attendants.

Aśmarī (Renal calculi) cikitsā (Su.Ci.7/30) 

 The patient should be oleated, when the Doṣās are eliminated  and body weight reduced a little. He should be massaged with  oil, sudated and given a feed; then, after finishing sacrificial  offerings while the priests should chant auspicious Mantrās  wishing welfare and after collecting all things mentioned in  Agropaharaṇīya chapter he should be reassured.

  1. Positioning of the patient: Then the patient, who  is strong enough and is not nervous, should sit down with the  upper part of his body resting in the lap of another person  sitting on a knee high plank facing east; the patient waist should  be raised by cushions and his knees and elbows flexed and tied  together by ropes or straps [11-13].
  2. Preoperative manipulation of the stone: Then,  after massaging the left side of the well-oiled umbilical region,  pressure should be applied by a fist below the naval until the  stone comes down. The lubricated index and middle fingers,  whose nails must be slimmed off then it, should be introduced

into the rectum and brought below the perineal raphe; thereafter,  with manipulation and force the stones should be brought  between the rectum and the penis. Keeping the bladder tense  and distended so as to obliterate the folds, the stones should be  pressed hard by fingers so that they become prominent like a  tumour.

Management of Asthi bhagna (Su.Ci.3/18-19) 

The surgeon should reduce all the movable and immovable  dislocated joints of the body by the methods of reduction as  traction, pressure, compression and bandaging [14].

Procedure of Arma chedana (Su.U.15/4-9) 

The Arma thus irritated, should be fomented quickly and  mobilized by the surgeon. The patient should then be asked to  look laterally and the Arma should be lifted with the help of a  hook at a point where it has become wrinkled. Then it should  be held with a pair of forceps (Mucuṇḍi) or with the help of  sutures and elevated without lifting it hurriedly. The lids should  be held apart tightly because of the risk of being hurt by the  instrument. The Arma thus weakened and suspended by the  three instruments (viz. Hook, pair of forceps and anchor sutures),  should be separated from all sides with the help of a sharp  circular knife (Maṇḍalāgra). After it has been freed from all sides  and also from the cornea and the sclera, it should be dissected as  far as its attachment to the vicinity of the inner canthus where  it should be excised, sparing the canthus carefully. If one fourth  of the tissue at its attachment is left intact, there is no danger  of injury to the eye. In case if there is any injury to the inner  canthus, there will be haemorrhage or a sinus may be produced  later on [15].

Cikitsā of Pakṣmakopa (Su.U.16/3-6) 

Pakṣmakopa is a relievable disease of the lids. A person  afflicted with it, should undergo oleation measures and be made  to sit in a proper position. The skin of his eyelid should be excised  obliquely in the shape and size of a barley-corn with the help of  a sharp instrument, at a point two parts below the eye brow and  one part away from the eye lashes, equidistant from the outer  and the inner canthi. The surgeon should then carefully stitch the  margins with horse’s hair. The part should be treated with Ghṛta  and honey followed by the subsequent measures as described  for wounds. One end of the stitch should be fixed by a bandage  over the forehead and the other end should also be held there by  the same bandage. When the surgeon has ascertained the scar  of operated wound to have firmly united, he should remove the  stitches of hair.

Cikitsā of linga nāśa (Su.U.17/57-60) 

In neither too hot nor too cold weather, the patient should  be subjected to oleation and sudation therapies. Then he should  be made to sit and positioned properly after which he should be  asked to fix his gaze towards his own nose continuously. Then the surgeon should hold a barley-shaped śalākā instrument between  the thumb, middle finger and index finger of his right hand and  should open the eyes and puncture the eyeball properly with  confidence towards the temporal canthus avoiding two parts of  the white part of eye from the cornea. The puncture should be  made neither too high nor too low, nor at the sides and saving  the network of veins. Then it should be directed towards the  natural orifice. The surgeon should operate with his right hand  on the left eye and with his left hand on the right eye.

Cikitsā of Lekhya Roga(Su.U.13/3-8) 

Lekhana (Scraping) is mentioned in nine diseases of eye [15- 20]. Now it’s common technique is being given. The patient, after  having oleation, emesis and purgating therapies, should be made  to lie down supine in a room free from the sun and the wind, and  held firmly in position by reliable persons. The lid should then  be everted by holding it between the left thumb and a finger and  fomentation applied to it with a pad of cloth dipped in lukewarm  water. The lid should be kept carefully averted between the  thumb and the finger by a piece of gauze so that it may neither  move nor slip. It should then be swabbed with a piece of gauze,  marked with a sharp instrument and finally scraped by it or by  leaves. When bleeding ceases, fomentation should be done, and  the lid should be rubbed with a fine powder of Manaḥśilā, trikaṭu,  rasāñjana and Saindhava mixed with honey. The lid should then  be washed with warm water, irrigated with Ghṛta and treated  like a wound. Fomentation and Avapīḍa nasya should be applied  from the third day onwards.

Discussion 

All the eight types of surgical procedures mentioned in  Āyurveda are practiced in modern science also. The first one  is Chedana (excision) means complete removal of an organ;  Bhedana (incision) usually refers to a cut made during surgery;  Lekhana (scraping) means to remove from surface by forceful  strokes of an edged or rough instrument; Vedhana (puncture) is  a act of piercing or perforating with pointed instrument; Eṣaṇa  (probing) means a slender, flexible surgical instrument used to  explore a wound or body cavity; Āharaṇa (extraction) means to  draw out or to pull out; Visrāvaṇa (draining) means to remove  liquid from cavity by letting it flow away or out and Sīvana  (suturing) is used for the purpose of wound healing. All these  technique are not new but are known procedures since ancient  era [20-23].

The concept of practical training mentioned in Yogyā  sūtrīya adhyāya of Śārīr sthāna of Suśruta is still relevant. This  is followed by the modern medical practitioners by performing  the procedures of surgery like excision, incision, scraping,  puncturing, probing etc. on dummies and natural objects which  are having the same features. Before entering in the field of  practice, the training at internship serves the same purpose  which was proposed by Suśruta many years back. Basically this  was the concept of anatomical workshops to enhance the surgical  skills of surgeons. Even today such teaching methodology is  followed by prominent medical institutes in the world. The  necessary tool for performing any sort of reconstructive surgery  specially related to face the profound knowledge of anatomy and  dimensions of that specific part is must for a surgeon.

Suśruta has mentioned the procedure of Nāsika sandhān,  karṇa sandhān and auśtha sandhān. Here he had not mentioned  clear anatomy of nose, ear and lips but in Sutra sthāna where he  described Pramāṇa śārīr, he described various Pramāṇa of these  organs which further helps in doing sandhān (reconstructive  procedures) [24-27]. Those are-Nāsāputa of two Aṅgula,  breadth of Nāsāputa is one Aṅgula. By this description we can  consider that Suśruta was known about the anatomy of these  organs because without pursuing the knowledge of anatomy and  dimensions, one cannot perform any surgery. In modern science,  for medico-legal purpose, injuries caused by mechanical violence  are divided into bruises or contusions, abrasions, lacerated  wounds, incised or slash wound, punctured or stab wound and  perforating wound. Similarly, ancient clinicians have classified  the Sadhyovraṇa (traumatic wound) in view of their features  into six types broadly. In both these sciences similarities can be  seen accordingly.

Conclusion 

Suśruta was the first person who resorted to human  dissection to understand the structures of the body in detail.  By the unique method of scraping the body layer by layer he  also noted the features of various structures and described  them accurately. The concept and procedure of reconstructive  surgery has been explained in classics as Karṇa bandha  vidhi, nāsika sandhān vidhi and Auṣṭha sandhān vidhi. All the  eight types of surgical procedures and suturing techniques  mentioned in Āyurveda are practiced in modern science also.  With advancement of time, science is expanding its wings in  every field but basic principles remain always unchanged. That’s  why modern science also follows all these ancient principles so  the knowledge generally found in modern medical literature  is nothing but the amendment of Āyurvedic knowledge or  literature.

References 

  1. Caraka samhitā English translation by Priyavrat Śarmā Cikitsā sthāna  to Siddhi sthāna, Chaukhambhā orientalia, Vārānasi, 2.
  2. Caraka samhitā English translation by Priyavrat Śarmā Sūtra sthāna to  Indriya sthāna, Chaukhambhā orientalia, Vārānasi, 1.
  3. (1996) Caraka samhitā with Vidyotīnī hindī commentary by  Kāśīnāth Śāstri, Gorakhanātha Chaturvedī, Part-1&2, Published by  Chaukhambhā Bhārati Academy Vārānasi, (22ndEdn.).
  4. Diagnostic consideration in ancient Indian surgery based on Nidāna  sthāna of Suśruta samhitā part 3 by GD Singhal, LM Singh, KP Singh,  Chaukhambhā surbhārati prakāśan, Vārānasi.
  5. (2011) Essential Orthopaediccs, by J Maheshwari, published by Jaypee  Brothers Medical Publishers, New Delhi, edition 3 revised, 7threprint.
  6. Fundamental and plastic surgery considerations in Ancient Indian  surgery based on Suśruta samhitā part 1 by GD Singhal, SN Tripāthī,  GN Chaturvedī, Chaukhambhā surbhārati prakāśan, Vārānasi.
  7. John V Basmajian, Charles E Slonecker Grants method of anatomy. (11thEdn.), Williams and Wilkins, US.
  8. Peter L Williams Gray’s Anatomy. (38th Edn.), Chairman editorial board,  churchill Livingstone, British Library, London, UK.
  9. Chaurasia BD (2004) Human Anatomy. (4thEdn.), Satish Kumar Jain  for CBS publications and distributors, Darya Ganj, New Delhi, India, 2.
  10. Human Anatomy. (3rdedn.), Macminns.
  11. Non operative considerations in Ancient Indian surgery based  on Suśruta samhitā part 6 by GD Singhal, RH Śuklā, KP Singh,  Chaukhambhā surbhārati prakāśan, Vārānasi.
  12. Ophthalmic and otorhinolaryngological considerations in ancient  Indian surgery based on Uttar tantra of Suśruta samhitā part 8 by GD  Singhal, KR Śarmā, Chaukhambhā surbhārati prakāśan, Vārānasi.
  13. Pāriṣādyam Śabdārth Śārīram, Pandit Dāmodar Śarmā Gaur (1964)  (1stEdn.), Śri Baidyanāth Āyurveda Bhawan Pvt. Ltd, Calcutta, India.
  14. Diagnostic consideration in ancient Indian surgery based on Nidāna  sthāna of Suśruta samhitā part 3 by GD Singhal, LM Singh, KP Singh,  Chaukhambhā surbhārati prakāśan, Vārānasi.
  15. (2011) Essential Orthopaediccs, by J Maheshwari, published by Jaypee  Brothers Medical Publishers, New Delhi, 3rdedn revised, 7threprint.
  16. Fundamental and plastic surgery considerations in Ancient Indian  surgery based on Suśruta samhitā part 1 by GD Singhal, SN Tripāthī,  GN Chaturvedī, Chaukhambhā surbhārati prakāśan, Vārānasi.
  17. John V Basmajian, Charles E Slonecker Grants method of anatomy. (11thEdn.), Williams and Wilkins, US.
  18. Peter L Williams Gray’s Anatomy. (38thEdn.), churchill Livingstone,  British Library, London, UK.
  19. (2004), Chaurasia BD Human Anatomy. (4thedn.), Satish Kumar Jain for  CBS publications and distributors, Darya Ganj, New Delhi, 2.
  20. Human Anatomy. (3rdedn.), Macminns.
  21. Non operative considerations in Ancient Indian surgery based  on Suśruta samhitā part 6 by GD Singhal, RH Śuklā, KP Singh,  Chaukhambhā surbhārati prakāśan, Vārānasi.
  22. Ophthalmic and otorhinolaryngological considerations in ancient  Indian surgery based on Uttar tantra of Suśruta samhitā part 8 by GD  Singhal, KR Śarmā, Chaukhambhā surbhārati prakāśan, Vārānasi.
  23. (1964) Pāriṣādyam Śabdārth Śārīram, Pandit Dāmodar Śarmā Gaur  (1stEdn.), Śri Baidyanāth Āyurveda Bhawan Pvt. Ltd, Calcutta, India.
  24. Suśruta Samhitā English translation by KR Śrīkantha MurthyŚārīr  sthāna, Chaukhambhā orientalia, Vārānasi, 2.
  25. Suśruta Samhitā English translation by KR Śrikantha Murthy, Sutra  sthāna, Nidāna sthāna, Chaukhambhā orientalia, Vārānasi, 1.
  26. Suśruta Samhitā English translation by KR Śrīkantha Murthy, Uttara  sthāna, Chaukhambhā orientalia, Vārānasi, 3.
  27. (1995) Suśruta Samhitā of Suśruta with Āyurveda Tatva Sandipīkā hindī commentary by Kavirāja Ambikā Dutta Śāstri, Chaukhambhā Sanskrit Sansthān Vārānasi, Part 1-2 (9thEdn.).

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