FAQs

According to Su:Sh.6/44 if sadyapranhar Marmas are damaged it could cost one's life. That is why surgery is contraindicated at those vital points. But now a days surgeries of shir, hridaya, &Basti are commonly performed. Is it not contradicting sushruta samhita? Is it not necessary to redefined this kind of statements? It is true that Sadyapranhar marma isn't actually what the word 'Sadyaha' literally means. Here the literal meaning of sadyapranhara shouldn't be considered because death may be prolonged upto 15 days depending on the severity of trauma & status of oja of the patient. The marmaghata described in Ayurveda are unplanned warfare injuries or sometimes due to some error (pramada) on part of the vaidya. Surgery is a planned procedure, hence; we cut coronary artery the circulation is maintained by artificial methods & then the anastomosis is carried out later. Although there is a trauma to the coronary artery, it doesn’t produce any ischaemia resulting in death. However, in accidental trauma this doesn't happen. Let us consider the example of Basti, another sadyapranhar marma. It becomes a sadyapranharamarma during surgery for removal of calculus, when the vaidya cuts the bladder at two places due to error. This is a type of pramada (iatrogenic error). Cutting of bladder at Two places or place & not closing it properly leads to the extravasation of urine (especially when such cut is intra peritoneal part). This leads to toxic condition in the death of the patient. ShirosadyapranharMarm – This is to be classified into 3 varieties - Trauma upto skull bones Trauma upto meninges Trauma upto brain Trauma upto skin & bones doesn’t lead to death. Trauma upto meninges leads to escape of mastulungasrava i.e. escape of cerebrospinal fluid. If it isn't controlled by Ayurvedic measures described in shirobhighata or according to modern methods by protein coagulation then it results in death. It may be immediate or gradual depending upon the loss of CSF. Trauma upto brain results in damage to brain matter or even drowsing out of the same through the injury, thus resulting in immediate death. This is how sadyapranharmarmas are interpreted. Several herbal or herbomineral combinations for treatment of Arshas (haernorrhoids or polyps) are described in Ayurvedic texts. What is the mode of action of these drugs? Is there any effect of these medicines in deprivation of circulation to piles minimizing the intrabdominal pressure, bringing back elasticity of dilated anal veins, as muscle relaxants, or as laxative for conservation purpose? Although piles are nothing but anatomical defect (vericosity of anal veins), how far is it relevant to prescribe these drugs in treatment of Arsha routinely with or without surgical intervention? The grouping could be 1) Constipation - straining - development of Arshas. 2) Dysfunction of यकृत-रक्तवहस्रोतस -say- cirrhosis-portal hypertension-systemic circulation fails to cop up the situation- resulting in bleeding piles (vericosity) 3) R. ventricular failure - congestion or blood in Liver portal system-stagnation- piles. Treatment medical was more insisted as piles above the Hiltons line i.e. in relation to trutiya vali were difficult to treat surgically for want of anaesthesia and hence medical treatment is given in detail.

These drugs are mainly designed to prevent constipation, improving dhatawagni of (रक्त), making the remaining Liver cells more activated thus reducing portal hypertension Haemostatic drugs to stop bleeding Drugs activating the cardiac system Para surgical, Kshara sutra, Application of kshar, Agni surgical. When we give a para surgical or surgical treatment in piles we follow in a particular way why? one important aspect in case of ksharkarma is that a particular direction is adopted. The positions as dakshina, vama, purva etc. are correlated lo the primary piles situated at 7 o'clock, 4o'clock & 11 o'clock. Ksharkarma is to be carried out only on one arsha at any given time. If we perform it on all the arshas at the same time, there will be development of sericultures, e.g. it we do Ksharkarma at 11 o'clock position, then kshar may fall by gravity on arshas at 4 o'clock & 7o'clock position also. To prevent this we start with 7 o'clock position (on vama side), then there is less erosion elsewhere, that is at 4 o' clock (dakshins side) & 11 o clock (at purva side). Same procedure is followed in the excision cautery of piles as it always happens that the blood oozing from 11 o'clock positioned piles obliterated the operative field at 4 o'clock & 7 o'clock positions.

4. Why has Sushruta not told sravi & shushka arsha? Hetus of arsha & bhagandara are ushna, tikshna annapan. So how can ushnakshar in their treatment be beneficial & what is mechanism of action? Description signs & symptoms of vataja, pittaja & kaphaja & Raktaja arsha are self explanatory. Vataja – parishushkani Pittaja - Praklinnani Kaphaja - Shleshmajani Raktaja – Dustam analpam asruja sravani (सु.नि.२/१०-१३) This shows that Pittaja &Raktaja arsha are sravi while vataja & kaphaja are ashravi. Actually, sushrut has failed to explain the pain factor as well as features like mukulsuchimukharkriti & parishushka in vatajaarsha. For such pathology Involvement of skin is essential. Sushrut describes - श्लेष्मजानि.... स्निग्धानि पाण्डूनि करीरपनसास्थिगोस्त- नाकाराणि ।

Such features aren't possible unless the medodhatu takes part in samprapti. Vagbhatta has modified samprapti given by Sushrut.

प्रधानधमनीरनुप्रपद्याधो गत्वा गुदमागम्य प्रदूष्य गुदवलीर्मांसप्ररोहान्‍ जनयति.....॥ (सु.नि. २/४) दोषाः त्वक्‍मांसमेदांसि संदूष्य विविधाकृतीन्‍ । मांसांकुर पानादौ ........ ॥ (वाग्भट)

This perfectly explains the signs & symptoms of arsha.

5. According to the modern science there is recurrence of fistula after excision. But in ksharsutra there is no recurrence. Is it because there is no excision? We do find recurrence with both techniques. Recurrence depends on the type of fistula skill & experience of surgeon, as well as underline disease like tuberculosis, pilonidal sinus. By using ksharasutra we do the cutting by kshar क्षरणात्‍ क्षणतात्‍ वा क्षारः ।

1. In the treatment of Inguinal hernia Antravridhi Two surgical procedures are done Agnikarma in inguinal regime? In the aprapta phalkosha antravridhi chedana & dahana are indicated on the thumb. I perform Viddha chikitsa followed by Agnikarma. This particular procedure is indicated in recently strangulated hernia. This procedure brings about the relaxation of abdominal muscles resulting in self reduction. It is to be used as a palliative treatment. This has also been referred in the chinese acupuncture for a cure of reducible antravridhi. After reducing hernia ardhachandrakrutidahan is performed. Healing of dahana scar leads to contraction scar in the inguinal area resulting in closure of inguinal canal. This procedure is adopted in patients above the age 40 yrs. As it is likely to block or injure spermatic cord. This has boon tried by Vaidya Karmarkar & I have seen it personally.

1. Agnikarma in Inguinal region is curative Treatment. Incision &dahan on Angusta is to reduce obstructed hernia आंत्रवृध्दि निवृत्तये। What is the difference between tumour &gulma? (Su. U. 42)

1. Tumour can occur in any part of body. Mamsarbuda & raktarbuda are incurable. They are stable.
2. Gulma is related to GIT. The swelling which we palpate is intraped air. Palpable lumps are produced by different organisms e.g. ileocaecal tuberculosis, crohn's disease, hypertrophic pylorus etc. Raktagulma, which is an achalagulma, is entrapped blood in uterus.

संचारी यदीवाचकः Gulmas are initially medical conditions, which gradually converted into surgical ones. The findings in abdomen are like that of a subacute obstruction. In tumours, cells are immature & there is abnormal cell proliferation. In gulma the cells are hypertrophied or we get a pathology of particular organism. 8. What is the scope of complimentary management of malignancy in Ayurveda?

1. Rasayanchikitsa in Ayurveda is helpful in preventing the complications of chemo or Thermo therapy.
2. Bhallatak Siddha Ghrita, Milk or Takra gives relief in mucus secreting caranoma of GI tract by regression of mass.
3. Vaikrant or Hiraka Bhasma shows regression in some tumours
4. According to Ayurved they are (असाध्य).

9. Is it possible to do agnikarma at agneyamarma (sadyapranhar, KalantarPranharmarma)? will it affect agni? (Su.sh.6/23) According to Ayurveda, no agnikarma should be done at marma. Dhamnis are especially avoided as it is going to affect any directly. 10. Can wax oil, honey etc is more beneficial than electric cautery in dahan karma? (Su.Su. 12/4) The kind of cautery & its indications have been described in Ayurveda. If the tumours are to be removed en-mass (nishesha) then dry electric cautery is indicated. In cases like kadara. snehan is always preferred along with dry cautery due to its penetration property. So while performing operations like amputation usually sneha is preferred. 11. Should agnikarma instruments be sterilised? Not necessary, as the temperature is more than 70 degrees celsius. 12. Can agnikarma minimize the compression of sciatica? If yes, then how? (su. su. 12/10) Yes, by reducing the spasm of lumbar muscles. but the treatment should be supported by स्नेहन, स्वेदन आणि बस्ति. 13. What is the difference between thermocautery &Agnikarma, practically &theoratically? For agnikarma we use different metals like Gold, Silver, Copper, Iron etc. Their indications vary according to the gamitva of that dravya (su. sutra 12/4). They have different temperature when we heat them Herbal materials like pippali, haridra, Bhallatak are alo used Materials of animal origin like Godanta etc are also used.Their sites & indication vary e.g. twacha, mamsa, sira etc. 5) Thermocautery is classified as 1. Cutting 2. Haemostatic There is no relation to curing of disease.

1. For agnikarma different materials like Guda, Kshaudra, Pippal, Godanta etc. along with other lohas, are mentioned in classical texts. But practically this is difficult. What is the technique behind the temperature regularization? Can it be standardised? (su.su.12/4) We do use many of dravas said above as per indications given in book all these medicines when heated have a different temp when we touch them at a particular sport. they are also having different tissue affinity. Now our modern instruments could be used by adjusting their temp as per our need

1. Usually Raktamoksha is indicated in pittanubandhaja vyadhi, why it is advised in sleepad though it is kapha pradhan, why different sites for vataja pittaja & kaphaja. Why there is difference in places given by sushruta & Ashtang. A.hru. 3/30

सु.चि. १९/५४ मे सिरावेध वातज, पित्तज, कफज श्लीपद मे बताया है। परंतु वो अलग अलग जगह बताया है। अ.हृ. ३.३० वे अध्याय मेंउपरोक्त प्रकार का ही सिरावेध कर्म बताया गया है, ऎसा क्यो? श्लीपद व्याधी प्रमुखतः कफदोष से होता है। इसी मे कफ या वात दोष अधिक्य हिने से इस मे सिराव्यध कर्म संयुक्तिक लगता नहीं परंतु पित्तानुबंध होता है तब सिरावेध करना संयुक्तिक लगता है। क्यों की रक्तमोक्षण से पित्त कम होता है । अनुबंध किसी भी दोष का हो मगर श्लीपद कफ प्रधान व्याधी होने से पित्तज श्लीपद में सिरावेध कर्म बताना समझ सकते है परंतु वातज अनुबंध रहा तो अ.हृ. अनुसार २ अंगुल और सुश्रुतानुसार ४ अंगुल पर पित्तज श्लीपद होगा तो गुल्फसंधी के निचे २/४ अंगुल सिरावेध और कफज श्लीपद में अंगुष्ठ के पास सिरावेध बताया है। इस प्रकार स्थान और श्लीपद के दोष का संबंध क्या है?

Siravyadha has been advocated in vataja, pittaja, kaphaja Shlipada. There is no doubt about its indication in pittaja shlipada. According to the sushruta shiras are sarvavaha(सिराः सर्ववहाः) so when se perform siravyadha, it also drains vitiated vata, rakta, pitta & kapha. Therefore Raktamokshana is indicated in kaphaja & vataja shlipada also. Secondly, there is difference of anguli pramana i.e. the sites mentioned by Vgbhata& Sushruta. However,sushruta himself advocates that though raktmokshan is indicated at certain point, if performed anywhere near that particular point also gives positive result . Kapha being the heaviest angushtha sthana is indicated. Gulphasthana & urdhva gulpha are indicated for pitta & vata respectively. This indicates that lighter the dosha higher is the site for siravyadha. 17. Why is raktamokshana mentioned in shodhan therapy?

1. According to sushruta Raktamokshana is half treatment as charak’s basti is half the treatment.
2. (सिराज) are (सर्ववहा) i.e. they carry vata- pitta-kapha & Rakta and are in (बाह्यमार्ग)
3. When we do raktamokshana dushta doshas come first it may be (कफ,पित्त,रक्त)) & vata.
4. As doosta doshas in (बाह्यमार्ग) – The procedure of (पूर्वकर्म) are not needed. In the context of Gridhrasi siravedha is the line of treatment. In present context with the help of modern diagnostic aids like X-ray, MRI etc. the symptoms of Gridhrasi are observed in many of spinal lesions & It looks to be a syndrome. So in which condition can we select siravedha? (su.chi.5/23)

1. Bloodletting is useful if the lesion is outside the spinal column.
2. In some patients varicosity of the leg mimic the symptoms of sciatica here also bloodletting gives relief.
3. To give relief in pain and to cure the disease are two separate entities.

19.what is difference between Pandukarma & plastic surgery ? (su.chi1/94) Pandukarma isn’t meant only for restoring the original colour of skin,but it also should be considered along with krushnakarma (restoring the original colour of skin doesn’t meant only pandukarma but krushnakarm also should be considered. As both come under the category of savarnikaran. This is absolutely a local medical treatment. In case of plastic surgery we use skin graft of same patient. So there is no difference as pandukarma & krushnakarma. (here the question of Pandu & Krushnakarma doesn’t arise). Another difference is that savarnikaran treatment takes longer time while plastic surgery immediate effect.

1. How do vaman & virechana help as poorvakarma before surgery?
2. We have given vaman a day prior to surgery in tonsillectomy patients. Atropine was not given to them prior to surgery. No vomiting, pulse rate was constant. Post op. Smooth healing of foss, no post op. Pain.
3. We give virechana in patients like hernia, Hydrocele, piles, fistula, and in patients suitable to give virechana.
4. No distension , No cathetaraisation, no constipation, quick recovery.

1. Is there any role of Panchakarma in planned surgeries to minimize the dose & complications of anaesthesia drugs? Panchakarma logically should help in minimizing dose & complications of Anesthetic drugs. So far we have not taken trail but we do give (सद्योविरेचन, सद्यो वमन) as I Said above. The newer Anaesthetic drugs are now very safe. The antibiotics damage the patients more than the anaesthesia or surgical procedure.

Please note: The article(s) were written by Dr. R. B. Gogate during 1961-2010. The fundamental relevance of these holds true even today, yet the readers/viewers should consider the timeline and the limited availability of the resources which might conflict with the recent advancements.