Surgical Anatomy in Ayurveda

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Preface

Many valuable versions are available in Ayurvedic text concerning common surgical problems faced by a man right from his birth till death. An Ayurvedic surgeon should known the anatomical changes which follow as a sequele of any congenital disorder, post natal infections or trauma in the form of Surgical disease. He should also know the structural, physiological or pathological changes which take place at the anatomical and physiological level. Uptill now no such attempt has been made to prepare an original manuscript which gives valuable and independent information to an undergraduate or post graduate scholar undergoing speciality in “Shalya – Shalakya” (surgery and E.N.T. diseases) or Sharir. Thus authors felt urgent need for writing such a book which tells anatomical facts of practical surgical value to the students and practitioners of Ayurveda.

While going through the book readers may feel that some of the topics dealt are only of academic importance, yet an attempt has been made to provide valuable information concerning Sharir Rachna (Anatomy) of clinical and practical value. While preparing the text of book authors have referred very authentic versions chosen from Ayurvedic texts particularly from charak, sushrut and vagbhat.

The textual quotations may apparently look conceptual yet they are of great importance to surgeons of ayurveda who have established basic foundations of all surgical methods while dealing with diseases like Asthi Bhagna (fractures), Sira-Vedh (Venupuncture), Arsh (Piles), Bhagandar (Ano rectal fistula), Gastrointestinal or thoracic problems, Shalya karma (Operative Procedures), Kshudra Roga or Shalya Shalakya.

Foreword

In the modern industrialized world large number of young people in their early productive stage of life get handicapped or die either due to injury, infection or trauma. Some die due to terrorism, rioting or homicidal attack. Some of them die instantaneously or late after suffering from prolonged illness. All these cases are enlisted a surgical cases. Providing proper management to these cases should be instituted, for many of them can be saved from pain and grief. Their proper care may help them to lead an acceptable quality of life.

In the present scenario haste and hurry, pollution, trauma, infection and incidence of malignancy are becoming one of the major health hazards. But quite a few of them have preventive and curative aspect, providedly they are given early attention and are not neglected.

There are two main categories of surgical problems; emergent and nonemergent.

Every surgical case should not be taken as emergency with grave danger to life. There are many other non-emergent surgical diseases which can be effectively managed. If surgeon can easily identify or locate the exact structure involved in the disease, he can judge whether it is emergent or non-emergent surgical situation. For a surgeon the precise knowledge of human anatomy is must. A surgeon is supposed to go through physical examination and then link it with disease. In Udar shool (acute abdomen) cases, pain may be either due to renal colic, ureteric colic, intestinal obstruction, appendicular colic or even can be due to strangulated hernia. There surgeon has to differentiate between the precise location of pain and referred pain. After proper assessment of anatomy involved, he finally decides to hold knife and make an incision on the abdominal wall. In ayurveda as well as in modern days surgeons have evolved methods of minimal invasive surgical (MIS) techniques where there is minimal loss of blood, minimal duration for wound healing and minimal hospital stay is required.

There are many important areas in Shalya and Shalakya Tantra which need satisfactory and convincing explanation like.

1. Shastra Karma:
In Ayurveda eight types of shastra karma have been indicated by sushrut, where as, charak has suggested only six types of shastra karma. Sushrut has also suggested number of many types of surgical instruments for different operative procedures.

2. Marma:
Ayurvedic vision about Marma (Vulnerable points) on body surface gives us latest knowledge about peaks of injury i.e. in relation to pain i.e. Rujakar marma, in relation to extraction of foreign body i.e. Vishalyaghana Marma, in relation to instant death at the time of injury i.e. Sadyaha Pranahar marma and in relation to instant death at the time of injury i.e. Sadyaha Pranahar marma and in relation to delayed death from the first minute of trauma or injury to several days or weeks i.e. Kalantar Pranachar Marma.

3. Asthi Sandhi and Sanghat:
Ayurveda also tells us about number of bony and joint diseases like Asthi Bhagna (Bony fractures), Asthi Chuti (dislocation of joints), Asthi Sanghata (Complex joints), and some specific diseases like Amavata, Vata Shonit, Sandhivata, Asthi Kshaya and Asthi Saushirya. The solitary disease involving only knee joint has been termed as kroshtu shirsha and is the best example of sanghat. In ayurveda full attention has been given towards diseases which are prevalent in society like Ashmari, Arsh, Bhangandar, Guda Bhransha, Ashthila and yakridalyodar.

4. Surgical techniques:

Surgical techniques like Siravedha (Venupuncture) has also been suggested. Surgeons have also been cautioned about the slippry nature of veins.

5. Diseases of vertebral column:

Though there is no mention of anatomy of vertebral column in Ayurvedic literature but sushrut has talked about verterberal column diseases like manyastambha (Cervical spondylosis) and katistambha (lumbar spondylitis), parshwa shool, Avabahuka, Vishvachi and gridhrasi roga. These diseases may occur as complications of spinal disorders. Basically these are neurological problems of spinal nerves. The nerurological problems are generated due to defects in the regional verterbra. All these conditions clinically appear as muscular spasm or wasting or fibrosis, secondary to cervico-brachial or lumbo-sacral plexuses. Pathology may be taken as fibromyalgias or disease like frozen shoulder. Ayurveda has clubbed all of them in one category of vata vyadhis.

6. Sroto-dushti or Srotas-avrodha (Obstructive Problems):

In Ayurveda obstructive surgical diseases like Mutra Krichha due to Ashtheela rog (Benign prostatic hypertrophy) and Ashmari formation (Urinary stone) have been narrated which are very common diseases of senile age. Other examples are diseases like Baddha Gudodar (Intestional obstruction) or Mutra Vridhi (Extra Vasation of urine).

7. Shalya Karma (Operative procedures)

8. Kshudra Rog (Minor surgical diseases)

9. Rakta (Blood)

In Shalya tantra importance of Rakta (blood) has also been high lighted:

This means blood is essential for body. Body is sustained essentially by Rudhir-Rakta (Blood). It has been advised that blood should be protected and preserved carefully. In present scenario ‘Blood bank’ culture has been replaced against the valuable suggestion given above by sushrut.

It can therefore be concluded that the subject of Sharira Rachna is not an independent identity in entire Aurvedic literature but the morphological study of human body has been done purely on applied and surgical basis. Sharir Rachna is not only a subject but a concept or an understanding which has escalated through ages to establish itself as basic science of life. It is a foundation of all medical and surgical problems arising during the course of life. The more you unveil it, more you desire to know.

The present book has been written with an objective to properly understand the applied and surgical significance of all those structures of human body in relation to any external or internal injury or trauma or due to infection, degeneration or exhaustive diseases. The book has fulfilled the objective of the authors to present better and useful picture of human anatomy for a physician or surgeon to approach the diseased anatomy, by understanding its values, especially in reference to surgical anatomy. The subject of surgical anatomy and significance even baffles the minds of modern anatomists.

I am sure this book on surgical anatomy in Ayurveda authored by Prof. D.G. Thatte an icon of Ayurveda Sharir and his associate Dr. (Mrs.) Sanyukata Gokhale will prove equally useful to the Ayurvedic surgeons, under – graduate and post-graduate scholars of Sharir Rachna, Shalya and Shalakya Tantra both.

I congratulate both the authors for such a rich and valuable contribution in the field of surgical anatomy.

About the Author

Prof. D. G. Thatte Born on 2nd August, 1930, in District Banda of Uttar Pradesh in a traditional Maharastrain family with academic intent. From the very beginning Prof. Thatte was interested in Ayurveda and Indian medicine. Prof. Thatte got BMBS graduate degree and Lucknow University in 1957 with Gold Medal and M.D. Degree and Hon. Causea from West Germany and thereafter obtained his doctorate from Sri Lanka.

Dr. Thatte opted for teaching career putting aside all the lucrative offers. As a dedicated teacher he reached to the highest post of Principal-cum-Superintendent, State Ayurvedic College, Lucknow besides holding the position of Head of PG Department of Sharir, State Ayurvedic College, Lucknow. Dr. Thatte also held administrative responsibilities of Additional Director, Ayurvedic & Unani Service, U.P. He was appointed as Guru (Prof.) of Rashtriya Ayurveda Vidyapeetha, New Delhi a Government of India undertaking and visiting professor at Institute of Medical Sciences, Banaras Hindu University, Varanasi. He is also a member of a Core Group for teaching Ayurveda to Foreign Scholars at his institute.

Prof. D.G. Thatte is founder Director/President of All India Sharir Research Institute and has tremendous experience in the field of Ayurveda teaching and research. He has contributed enormously on Sharir through scores of books and publications.

During his illustrious career as a teacher and administrator Prof. Thatte was honoured with over dozens of awards and fellowships including State Award, Dr. Birbal Sahni Scientific Award, Ayurveda Shiromani Award, Ratna Sadasya of Rashtriya Ayurveda Vidyapeeth, New Delhi.

Prof. Thatte has also been honoured by International Award of Excellence in Ayurveda by Ayurveda Academy, Pune (Recognized Institution of Pune University). He has been honoured with Life Time Achievement Award by NIMA State Branch of Uttar Pradesh. He has been honoured by the title of Ayurveda Martand by All India Ayurvedic Specialist Association, Pune (INDIA) in the year 2006.

Prof. Thatte has been participating in international and national conferences as invited speaker or chairperson. Dr. Thatte has contributed around 80 papers in various international and national journals and has also published more than a dozen of books.

Prof. Thatte is still active even when he has attained the age of 79 and is being regularly invited as an expert for interviewing candidates in different selection committees of Indian Universities and also as an eminent personality of Ayurveda to deliver key note addresses or guest lectures.

Prof. Thatte has an army of talented and devoted disciples as his followers. Similarly Prof. Thatte has number of eminent scholarly friends in Ayurvedic world.

It is to his great credit that his devoted disciples hailinig from all over the country celebrated his 75th birth anniversary in the form of “Amrit Mahostsav” and felicitated him by an “Amrit Kalash” (Silver Gold) and also Gold Plated Crown in Feb. 1994 alongwith a citation on silver plate. This felicitation was done by the hands of then His Excellency, Hon. Governor of Uttar Pradesh Shri Vishnukant Shastri.

Prof. Thatte has been invited to deliver and also guest lecturers in western world like West Germany, Sweden and also Colombo Sri Lanka. He has chaired in an International conference on Acupuncture and delivered a guest lecture on Marma Science at Colombo, Sri Lanka in the year 1983.

About the Co-Author

Dr. Mrs. Sanyukta Gokhle a versatile teacher of Sharir Rachna, worked as Lecturer, Reader and also Head of Department of Sharir Rachna at Sri Ayurveda College, Nagpur for more than twenty five years. After her retirement from above institution, she is now holding the administrative responsibility of Principal, Gandhi Ayurvedic College, Sawange Meghe a constituent college of Dutta Meghe University of Medical sciences Wardha, (Maharastra).

During the course of her service carrier Dr. Mrs. Gokhle with acute urge for advancing her knowledge in Anatomy did MD in Rachna Sharir from Nagpur University and before putting her service papers, received highest award of PhD. From Kavi Kulgur Kalidas Sanskrit University Ramtek, Nagpur. Her PhD. Documentation titled “Mathematics in Ayurveda” is an admirable and novel approach of her vision on classical texts of Ayurveda.

She has also authored four other books in the field of Ayurveda which have been published and recognized in the field of Ayurveda literature.

She has also authored four other books in the field of Ayurveda which have been published and recognized in the field of Ayurveda literature.

Her long time devoted association with Prof. D.G. Thatte, kept her conscious for creativity in the field of Ayurveda Sharir. She is a receipient of Dr. B.G. Ghanekar Best Sharir Teacher Award from N.S.R.I. Lucknow. She was also recognized as National Dissector in Cadeveric dissection methodology programe organized by NSRI. She has credit of receiving many more academic awards from different universities and academic bodies. She has also guided number of M.D. Scholars as well as PhD. Scholars of many universities.

She has been participating regularly in many National and International Ayurvedic seminars, Conferences and workships.

The book in the hands of readers is her latest contribution for the benefit of graduate, post graduate scholars as well as for teaching faculty of Ayurveda.

Back of the Book

The book titled “Surgical Anatomy in Ayurveda” has been documented with specific vision and object to explore all relevant anatomy of human body which is involved in any type of injury or disease due to infection, degeneration, exhaustive disease, bony fracture and regional weakness due to neurological deficit. First the normal picture and thereafter the abnormal picture of anatomy described in the book will prove very useful for a physician and surgeon who wishes to understand structural values especially in reference to surgical anatomy. Minds of modern anatomists and surgeons baffle them when they go through the applied and surgical importance of Anatomy discussed in Ayurved books. Ocean of knowledge has been made available through this book which may give new guidelines towards towards performing surgery successfully.

Ayurvedic physicians, surgeons and undergraduate and postgraduate scholars will feel benefited by reading this book and will give an opportunity for looking upon the new areas of thrust for research in their respective disciplines.