By Dr.R.B.Gogate,G.F.A.M., A.V.P. (Shalya-Shalakya)
Many detailed surgical procedures are read in Ayurveda but not much information about anaesthetics drugs is offered by available Samhita editing for Surgical procedures on piles, fissure or kidney stones. The patient was either tied up with ropes to operation table or held tightly by assistants. In Mutravrudhi or Dakodara patient needs to be incised and bled. Indicated Snehan and Swedan lessen the pain in such patients. This is applicable even today. Madhughruta, Yashtimadhughruta or warm Bala tail application on all kinds of fresh incised wounds reduce intensity of pain. I regularly use yashtimadhugruta for burning painful wounds successfully in my clinic. Some Ayurvedicists, experts in Marmavidnyana are known to create local or general anaesthesia by pressing or by applying heat at a particular spot in a patient. The patient comes out of this stage when a particular spot is again touched by the doctor. I did not come across such reference in Ayurvedic text and I claim there is none. Accidental injury anywhere in the body can lead the patient to neurogenic Shock. Chronic alcoholics exhibit very low pain threshold hence it was practised to dope such patients with alcohol before surgery. Sushrut indicated Agnikama, Vidhhakarma and Raktamokshan to lessen the pains in Vatavyadhi. Thousands of patients had responded to this kind of treatment in my own clinic. Late Vaidyaraj Madhavarao Shendye taught me a special trick of Viddha Chikitsa. The patient enjoys painless life for a few months following Viddha Chikitsa that too without consuming any pain killer. Abscess can be opened with the said trick without using local anaesthesia. This treatment is found effective in both ways, in paralysing as well as re establishing nerve sensations, In anosmia Vyadhana is indicated on the tip of a nose. Sublingually vyadhana is indicated in stammering speech. I personally tried this on many patients with great results. Any ailment injurious to body and mind should be eliminated according to Sushruta. No individual chooses to live with pain. Ayurvedic text therefore reads `
‘यत मनोविघातकरं तत् शल्यम्।’ सुखसंज्ञकम्आरोग्यम्’
Pain is 'Shul' as well as "Vedana' in Ayurved distinctive demostration between the terms cannot be defined. Following text is read in Ayurveda. शूल प्रशमन- शूलघ्न (च.सू.४/८) शूलनाशक,शूल- रुजा (च.सू.१४/३) मज्जास्थिगतस्यकुपित अनिलस्य- एक लक्षणयम् (च.चि. २८/३३) चरकगण- शूल प्रशमन- सुश्रुत पिप्पल्यादि वेदना स्थापन- वेदना- लक्षण दुःखम् (च.शा. १/८६) दुःखाची वेदना, दुःखाचे स्थान वेदनोच्छेदपूर्वकम् शरीरस्य प्रकृतौ स्थापनम् (च.सू. ४/१८) चरक गण वेदना स्थापन, सुश्रुत लोध्रादि Considering the references in Ayurved 'Shul' seems to be related with` AnnavahaStrotas' where as "Vedana' in context to incised as well as 'Abhighataj Pain'. Pharmaceutical evidence also agrees with this assumption. Vata predominance and Kapha Avrutatva potent to shul. In VedanaVata pitta prevels.
संज्ञास्थापन- संज्ञा- स्मृति (च.सू.५३/७४) संज्ञा- संवेदना, सुखदुःखादिज्ञानम् (च.नि. ८/३) सु.तं संज्ञानाश- संज्ञा षष्ठ्श्चेतना धातुः- चैतन्यनाशः संज्ञावह स्रोतस – मनोवह स्त्रोतस संज्ञास्थापन- संज्ञा ज्ञानं स्थापयतित् (च.सू. ४/८) चरकगण- संज्ञास्थापन, सुश्रुतप्रियंग्वादिगण
The main purpose of this procedure is to bring back the conscious state. Murchha leads to Sanyas which ultimately terminates in death. Therefore it becomes inevitable to see that the patient comes out of anaesthesia. This includes Trasan Chikista.
भ्रम-अल्पसंज्ञत्वम मज्जप्रदोषजः रक्तपित्तनिलोत भ्रम- giddiness, diziness, confusion मूर्च्छा- चेतनाच्युति- Becomes senseless or stupid or unconscious.
Ayurved science proposes grave to.... states of a person namely Mad, Bhram, Murchha, Sanyas, Dosha, Alcohol. Toxins, injuries are the responsible factors for these stages. Disability or death is sure to take place due to injury at Marma sthan, disoriented. Vataj, Pittaj. Kaphaj, Murcha require certain period and is related to ruga, hence both these factors are not worth for surgical anaesthesia. Alcohol may not be palatable and the dose required to concentrate anaesthesia is unpredictable. Therefore Visha dravya can be selected for purpose, since the dose of Visha is extremely low it can be easily introduced. Amongst them Akashiya, Vayaviya, Tejas, Vyavayi & Vikasi Visha drugs seen to be more better. The site of bleeding may or may not induce murchha, hence cannot be considered. General Anaesthics are nothing but Visha dravya & are used widely. State of anaesthesia is vishajanya murchha according to Ayurveda. Amongst these Vishadravya, Ether, Ethyl chloride, Halothene, Nitrous oxide is used which bear following properties, namely Akashiya, Vayaviya, Tejes, Vyavayi& of Vikasi. lf used in large doses all these prove themselves fatal. Vyavayi & Vikasi property properly appear to be more important for the fallowing reasons.
They are inhaled & exhaled easily and reach the brain within fraction of the second. They are extremely effective even at tissue level due to their Laghu, Sukshma, Ashu, Vikasi & vyavayi properties. They need no biotransformation. The srotas should be patent to welcome the drugs especially the conveying paths of Vyan, Pran and Udan. The lungs and containing VataVahini should be in the good physiological states. Udan should not be a state of usedha, nutrient vessels providing Oja to Hrudaya should be patent, there should be no obstructions in the path.
Characteristics of these drugs:
Vayaviya drugs- Laghu, Sheet, Ruksha, Khar, Vishad, Sukhama, Vikasi &Vyavayi. Akashiya drugs- Mridu, Laghu, Ruksha, Sukshma, Vyawayi. Vishad &Vivikta. Taijas drugs- Ushna, Tikshna, Sukshma, Laghu, Vishad, Khar & Urdhvagami. Vyavayi drugs - Following introduction in to the body these drugs are transmitted directly to the tissue level of whole body, for example Bhanga & Aphu (Opites). Vikasi drugs- They induce physiological relaxation in the body especially of joints eq. Kramuk & kodru. Animal eating grass are found to be paralysed for hours together if happen to eat kodru by mistake. The anaesthetics used are distinctive in accordence with Mahabhuta. Vayaviya anaesthetic is volatile in nature where as Agneya is inflammable. Naturally Murcha induced will vary in the signs & symptoms. The delirium, stammering, yawning trans are the signs in 'Mada'. This can be terminated in 'Murcha'. Tamaguna raises and individual gets paralysed. While explaining samprapti of Murcha Charaka state. Rasavaha, Raktavaha, Saudrıyavaha strotas become dushta due to Raja, Tama guna, the obstruction create slowly raises bringing Mada-Bhrama-Murchha-Sanyas. Sushruta adds Rhudaya dushti in Murcha, Rhudaya is seat of Rasa &Rakta. –
मूर्च्छा पित्ततमां प्रायः भा.नि..मुर्च्छा
This sutra indicated that the exact came of Murcha was unknown then. Modern anasthesiology cannot add anything to it. Charaka warns the vaidya about not letting the patient Murcha state for any long since the following Sanyasa avastha is worse. Murcha should be treated before the patients slip in sanyasa avastha. Trasana chikista is added to Saudnya sthapan drugs & other medicines. Retctal dilatation, throat irritation with endotracheal tube, application of tongue clip, pinching are Trasan chikitsa procedures.
Pharmakokinesis of General anarsthetic drugs The effect of general anaesthetics is immediate. They are conveyed to lungs through udan - Vayu, this is followed by Pranvayu to chetana sthan Shirastha Rhudaya and Manasthan Rhudaya. They are transmitted throughout the body through vyana. They affect the conveying vayu and harrase the function of the concerned Vayus follows- 1) Udan Vayu the patient is asked to count the numbers the change in his voice and ultimately failure in counting due to disturbance in memory is indicated by "Ashtanga-rhudaya' as follows.
उरःस्थानमुदानस्य नासा नाभी गलांश्चरेत्। वाक् प्रवृत्तीप्रयत्नोर्जा बलवर्णस्मृतीक्रिया ॥ अ.हृ.सू.१२/५ उदानेऽपि भ्रमादयः । दाहोऽन्त उर्जाभ्रंशश्च पित्तावृत्त उदान प्राणवायुः । Pranvayu - froathing, yawning increased, respiratory rate in the beginning. Loss of sensation and loss of memory, paralysis of nerves.
प्राणोत्र मूर्धगः । उरःकण्ठचरो बुध्दीहृदयेन्द्रिय चित्तधृक । ष्ठिवनक्षवथुद्गार निश्वासान्न प्रवेशकृत्॥ अ.हृ.स. १२/४ भ्रमोमूर्च्छा ऊर्जौ दाहः पित्तेन प्राणावृते । विदग्धेअन्नेनच वमनम्।
Vyanvayu - Total paralysis takes place in the end. Iris movements, respiration is stopped & the patient is submitted to Sanyasa Awastha.
व्यानोहृदिस्थितः कृत्स्न देहचारी महाजवः । गत्यपक्षेपणणोत्क्षेप निमेषोन्मेषणादिकाः॥ प्रायः सर्वाः क्रियास्तस्मिन् प्रतिबध्दा शरीरिणाम्॥ ७॥ अ.हृ.सू.१२/७
The theory of diffusion of gases is applied to all these Vayaveeya and Akashiya drugs. These are quickly circulated in the body & excreted immediately. They are fatal when introduced in large doses or are retained in the body for a longer period due to any reason. In such case the patient goes in deep anaesthesia and ultimately dies due to Sanyasa Awastha, Anaesthetic drugs containing Agneyatatva along with Vayaviya is not suitable for surgical procedures like cautery. Bhrama, Murchha, Daha, Vaman, Sweadadhikya is usually seen in Pranavrutta Pitta. In modern anaesthesia such complications can be abandoned with the help of another toxin called Atropin.
विषं विषघ्न उक्तं प्रभावः तत्र कारणम्।
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.