Seevan karma is placed at the 8th place in Ashtavidha shashtra karma.
(Ref. Su.su. 5/5)
Shastra karma – surgical activity are of 8 kinds viz.
This is placed not because it is least important, but the reason of this placement is because after finishing the first seven shastra karma’s it is employed.
Chedya ( incising , excising , removing )
Bhedya ( incision )
Lekhya ( scraping )
Vedhya (puncturing, piercing)
Eshya (probing, searching )
Aaharya (extracting, pulling out, removing)
Visravya ( draining)
Sivya (sewing, suturing )
While defining shasthi upakrama’s in first chapter of Sushruta Chikitsasthana Acharya Susruta says – (Ref. Su.chi. 1/ 45)
Wounds which are not having any complications of ripening (suppuration), localized in the muscle & having wide opening should be sutured as described in 25th chapter of Sushruta Sutrasthana (Ref. Su.su. 25/ 20)
The wound should be elevated (raised up slightly ), placed in normal position & then sutured.
Indication :- (Ref. Su.su. 25)
Disease arising from fat such as tumors etc. which have been cut / incised . Scrapped well, sadhyovrana (traumatic wound ) and diseases localized on movable joints require suturing.
Contraindication :-(Ref. Su.su. 25)
Wounds caused by alkali, fire & poison , those which emit air (gas) from inside, those having blood clot & foreign body inside should be well purified.
Procedure of suturing & Materials :
The whole procedure of suturing can be divided under 3 main headings :(Ref. Su.su. 5/3)
(Ref. Su.su. 25/18,19)
The surgeon desires of performing any of these activities should , collect the materials required such as Yantra, Shashtra, Kshara , Aagni, Shalaka, Shringa, Jalauka, Alabu, Jamboushta, Pichu, Prota, Sutra , Patra, Patta, Madhu, Ghrita , Vasa , Paya, Taila, Kashay, Aalepana kalka, Shitoshnodaka kataha, Parikarminaha.
Sand, hairs, nails etc. bones (pieces of bones) which are present & moving inside the wound, these will cause pus formation greatly in the wounds & give rise to many kinds of pain. So these should be removed entirely.
Purification of the wound should be done by using decoction of drugs having cleansing properties as given below.
Pradhan Karma : (operative )
(Ref. Su.su. 25/ 20) (Ref. Su.su. 25/ 25-26)
Next, the wound should be elevated (raised up slightly ) , placed in thenormal position & then sutured with appropriated suturing material. While suturing , punctures should be made neither very far nor very near (from one hole to another ), If the punctures are far apart, that will give rise to pain in the edges of the wound & if very near the edges will get torn.
External suturing : (Ref. Su.su. 25/ 20-21)
The wound sutured either with thin thread of bark of ashantaka, flax, jute, linen, ligament, horse hair, fibre of murva or of guduchi.
Ref.(Su.Chi. 14/17) The intestinal exudates cleaned, the cut ends of the intestine are brought closer & got bitten by big black ants; after they have stuck up well , their body should be cut off & removed but not their heads. Used for internal suturing as it is absorbable.
Needles: Ref.(Su.su. 25/23,24,25)
Suchi ( needle ) for suturing should be round ( cylindrical & straight ) & of two angula (4cm) long for places which have less of muscles & for joints. For places which are broad , needle with three edges (triangular) & of three angula (6cm) in length is ideal. For suturing on vital points, scrotum & abdomen it should be curved like bow. In this way sutring needles are of three kinds. They should be having sharp point , manufactured nicely, their hind tip resembling the stalk of malati flower & round.
Types of needles:
1. Vrutta (cylindrical & straight)
2. Dhanurvakra (curved )
3. Tryastra (triangular )
Types of Suturing :
Four types of suturing are mentioned in Sushruta Samhita
1. Vellitaka (Continuous)
2. Gophnika (blanket)
Paschat Karma : (Post operative) Ref.(Su.su. 25/27-28)
After suturing has been done properly, the wound should be sprinkled with the powder of priyangu, Sauviranjana, yashti, rodhra or of fruit of shallaki or ash of linen cloth, then the wound should be bandaged appropriately & the patient advised the regimen (of food & activities ) to be adhered.
Along with other measures Pathyaapathya i.e. dietic regemen is one of the important therapies according our classics.
Patient should not consume Nava Dhaanya, Mastu, Sarshapa, Kalaaya, Kulattha and Nishpaava. He also avoids food materials prepared out of Haritaka Shaaka, Amla, Lavana, Katu substances, dry meat, dry vegetables, goats flesh, sheep, and aquatic animals, fatty substances, very cold water, Krashara, Dadhi, milk etc.
He should avoid heavy meals and also harmful articles of diet, unpleasant noises and scenes, jealousy, rage, fear, grief, meditation, Raatri Jaagarana, irregular food habits, sleeping on an uneven bed, Langhana, heavy exercise, standing for a long time , Adhyashana, Ajeerna etc.
Patient of wound should eat diet consisting of old rice and boiled Shaali rice, not extremely liquefied and Snigdha and taken with cooked meat of animals of Jaangala species soon get rid of the disease. A diet consisting of boiled rice, Tanduleeyaka, Jeevanti, Vatsaka, Moolaka, Patola, Kaaravella, fried with Saindhava and mixed with the juice of Daadima and Aamalaka. Mudgha soup treated as above is also prescribed. Barley powder, Vilepi, Kulmaasha and boiled water should also be given to the patient for food and drink.
Patient should perform protective measures against effecting stars and spirits. He should strictly follow the Yama and Niyama. All these right performances help in early healing of wound.