Sushruta Samhita Sutrasthana Chapter 8: Shastravacharaniya Adhyaya (Sharp Instruments and Their Usage)

The 8th chapter of Sutrasthana of Sushruta Samhita is named as Shastravacharaniya Adhyaya. This chapter deals with Sharp instruments and their usage.

अथातः शस्त्रावचारणईयनध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भगवान् धन्वन्तरि ः ।२॥

Now, we will propound the chapter by name Sastravacaraniya – usage of sharp instrument; as revealed by the venerable Dhanvantari.

 Sastranama & Sankhya: Names and number of sharp instruments

विंशतिः शस्त्राणि; तह्यथा-मण्डलाग्रकरत्रवृद्धिपत्रनखशस्त्रमुद्रिकोत्पलपत्रकार्ध-धारसूचिकुशपत्राटीमुखशारिमुखान्तर्मुखत्रिकूर्चककुठारिकाव्रीहिमुखारावेतासपत्रकब-डिशदन्तशङ्क्केषण्य इति ॥३॥

There are twenty kinds of Shastras – sharp instruments. They are as below tabulated –

Benefits of Shastras: Sharp instruments in surgical practice

तत्र मण्डलाग्रकरपत्रे स्यातां छेदने लेखने च, वृद्धिपत्रनखशस्त्रमुद्रिकोत्पलपत्रकार्धधाराणि छेदने भेदने च, सूचीकुशपत्राटीमुखान्तर्मुखत्रिकूर्चकानि विस्त्रावणे , कुठारिकाव्रीहिमुखारावेतसपत्रकाणि व्यधने सूची च,बडिशं दन्तशङ्कुश्चाहरणे, एषण्येषणे आनुलोम्ये च, सूच्यः सीवने; इत्यष्टविधे कर्मण्युपयोगः शस्त्राणां व्याख्यातः

Description of Shastras –

Among these sharp instruments –

Thus, the purpose and usage of various kinds of shastras – sharp instruments in the eight kinds of surgical techniques has been described.

Shastra grahana vidhi: Mode of holding the sharp instruments

तेषामथ यथायोगं ग्रहणसमासोपायः कर्मसु वक्षये-तत्र वृद्धिपत्रं वृन्तफलसाधारणे भागे गृह्णीयात्, भेदनान्येवं सर्वाणि, वृद्धिपत्रं मण्डलाग्रं च किंचिदुत्तानेन पाणिना लेखनेबहुशोऽ वचार्थं , वृन्ताग्रे विस्त्रावनानि, विशेषेण तु बालवृद्धसुकुमारभीरुनारीणां राज्ञां रजामा(पु)त्राणां च त्रिकुर्चकेन विस्त्रावयेत्, तलप्रच्छादितवृन्तमङ्गुष्ठप्रदेशिनीभ्यां व्रीहिमुखं, कुठारिकां वामहस्तन्यस्तामितरहस्तमध्यमाङ्गुलाऽङ्गुष्ठविष्ठब्ययाऽभिहन्यात् , आराकरपत्रैषण्यो मूले, शेषाणि तु यथोयोगं गृह्णीयात् ॥५॥

Now, the method of holding each of the sharp instruments mentioned above, while conducting surgical procedures shall be explained.

Vrddhipatra Sastra and other shastras meant for bhedana – The method of holding these shastras for conducting surgical procedures is the same. They shall be held exactly in between the vrnta – handle and phala – blade of the instrument.

While using the purpose of Lekhana, Vrddhipatra and Mandalagra Shastra shall be held by the hand slightly raised up. These sharp instruments shall be used many times for doing lekhana.

The shastras used for the purpose of visravana should be held at the tip of the handle of the surgical / sharp instrument.

For doing Visravana, Trikurchika Shastra shall be used, mainly in the below mentioned kinds of patients –

–       children,
–       aged persons,
–       persons of tender physique,
–       persons afraid of sharp instruments,
–       women,
–       king and
–       royal persons – princes / king- like persons

Vrihimukha sastra should be held in the hand (palm) in such a way that its handle is concealed. The surgeon shall hold this shastra with his thumb and index finger (in the middle).

After having held the Kutharika Shastra in the left hand, it should be stroked by the middle finger of the right hand, released after holding it with the thumb.

Coming to Ara, Karapatra and Esani Shastras, they should be held at their roots while using them.  

On the other hand, the remaining shastras should be held as suitable for the purpose.

Note –

Parts of Shastra

Each Shastra comprises of the below mentioned three parts –

1.   Dhara – it is the blade of the instrument, which is a sharp edge
2.   Phala – it is the middle part or the body of the blade. It is also the chief working part of the shastra.
3.   Vrnta or Varanga – is the handle of the shastra. It is present at the back of the instrument – the hind part.

­Shastra Akriti: Shape of Sharp Instruments

तेषां नामभिरेवाकृतयः प्रयेण व्याख्याताः ।६॥

The names of the shastras themselves depict their shapes.

Shastra Pramana: Size of the instruments

तत्र नखशस्त्रैषण्यावष्टाङ्गुले, सूच्यो वक्ष्यन्ते, प्रदेशिग्रपर्वप्रदेशप्रमाणा, मुद्रिका, दशाङ्गुला शरारीमुखी सा च कर्तरीति कथ्यते। शेषाणि तु षड्ङ्गुलानि॥७॥

Shastra Sampat: Features (merits) of best quality sharp instruments

तानि सुग्रहाणि, सुलोहानि, सुधाराणि, सुरूपाणि, सुसमाहितमुखाग्राणि, अकरालानि, चेति शस्त्रसंपत् ॥८॥

The best quality shastra should essentially comprise of the below enlisted qualities.

Shastra Dosa: Defective or undesired qualities (demerits) of sharp instruments

तत्र वक्रं, कुण्ठं, खण्डं, खरधारम्,  अतिस्थूलम्, अत्यल्पम्, अतिदीर्घम्, अतिह्रस्वम्, इत्यष्टौ शस्त्रदोषाः । अतो विपरीतगुणमाददीत अन्यत्र करपत्रात्, तद्धि खरधारमस्थिच्चेदनार्थम् ॥९॥

The eight undesired qualities, defects or demerits of the shastras are as below tabulated –

So, the instruments with above mentioned defects shall be rejected and the instruments having opposite qualities of those of the above mentioned shall be used with the exception of karapatra – saw. The edge of the karapatra should be hard and rough since it is used for cutting the bones.

Dhara Pramana: Size of the edge or blade of the sharp instrument

तत्र धारा भेदनानां मासूरी, लेखनानामर्धमासूरी, व्यधनानां विस्त्रावणानां च  कैशिकी, छेदनानामर्धकैशिकीति ॥१०॥

Badisha, Dantashanku and Eshani

बडिशं दन्तशङ्कुश्चानताग्रे। तीक्ष्णकण्टकप्रथमयवपत्रमुख्येषणी गण्डूपदाकारमुखी च ॥११॥

Badisa (hook) and Dantasanku should have their tips slightly bent. Esani is of three types –

–       Tiksna kantaka – that having the face resembling and pointing like a sharp thorn
–       Prathama yava patra mukha – that having the face resembling the first leaf (fresh leaf) of barley (which is germinating)
–       Gandupada akara mukhi – that having the shape and mouth resembling that of an earthworm

 Notes: Dalhana, the commentator explains that Esani (sharp probe) is of three kinds; one with a sharp point; the second in the shape of a barley leaf and third in the  shape of the mouth of an earthworm.

 Shastra Payana: Tempering of instruments

तेषां पायना त्रिबिधा क्षारोदकतैलेषु। तत्र क्षारपायितं शरशल्यास्थिच्छेदनेषु, उदकपायितं मांसच्छेदनभेदनपाटनेषु, तैलपायितं सिराव्यधनस्नायुच्छेदनेषु ॥१२॥

There are three methods of tempering the sharp instruments. They are as below mentioned –

Notes: The general procedure adopted for tempering the instruments is holding the blade over the flame of fire, making it red hot, immediately dipping it in a liquid for a few seconds and then removing it out. The sharpness of the blade of the sharp instrument becomes augmented and more effective in its performance when it is used in surgical procedures after tempering it.

Nishana: Sharpening

तेषां निशानार्थं श्लक्ष्णशिला माषवर्णां : धारासंस्थापनार्थं शाल्मलीफलकमिति ॥१३॥

Generally, a smooth stone slab of the colour of black gram is used for sharpening the blades of sharp instruments.

A pod of Salmali fruits (with silk cotton inside) shall be used for maintaining the sharpness of the edges of the sharp instruments (for keeping the sharpened blades).

Right time to use the sharp instruments

 भवति चात्र
यदा सुनिशितं शस्त्रं रोमच्छेदि सुसंस्थितम् ॥
सुगृहीतं प्रमाणेन तदा कर्मसु योजयेत् ॥१४॥ 

One verse here:-

The shastra shall be used in surgical procedures only in the below mentioned conditions –

–       Sunishitam – only when its blade is sharpened well such that it can even split a hair into two
–       Susamsthitam – when it is well fixed
–       Sugruhitam – when it is properly held by the surgeon and
–       Pramanena – when it is of appropriate size

Anusastra: Accessory instruments

अनुशस्त्राणि नु त्वक्सारस्फटिककाचकुरुविन्दजलौकोग्रिक्षारनखागोजीशेफालिकाशाकपत्रकरीरवालाङ्गुलय इति ॥१५॥

Below mentioned are the anusastras – accessory instruments –

–              tvak sara – bamboo
–              sphatika – rock crystal
–              kaca – glass pieces
–              kuruvinda – corundum stone
–              jalauka – leech
–              agni – fire
–              ksara – caustic alkali
–              nakha – nail
–              leaves of goji (gojihva), sephalika, saka and karira
–              bala / vala – hair
–              anguli – finger

Areas of using anushastras (Accessory instruments)

शिशूनां शस्त्रभीरूणं शस्त्राभावो च योजयेत् ।
त्वक्सारादिचतुर्वर्गं छेद्ये भेद्ये च बुद्धिमान् ॥१६॥
आहार्यच्छेद्यभेद्येषु नखं श्क्येषु योजयेत् ।
विधिः प्रवक्ष्यते  पश्चात्  क्षारवह्रिजलौकसाम् ॥१७॥
ये स्युर्मुखगता रोगा नेत्रवर्त्मगताश्च ये ।
गोजीशोफालिकाशाकपत्रैर्विस्त्रावयेत्तु तान् ॥१८॥
एष्येष्वेषण्यलभे तु वालाङ्गुल्यङ्कुरा हिता ः ।

The physician should use anusastras – accessory instruments including bamboo, rock crystal, glass piece, corundum stone etc for conducting surgical procedures like excision and splitting in

–       children (who are naturally scared about instruments and sometimes the sharp instruments shall be harmful for using in kids)
–       persons who are afraid of sharp instruments
–       the absence of or non-availability of required sharp instruments during the time of surgical procedures

The nails shall be used in extraction, excision, and cutting and in any procedures where they can be used (as and when possible).

The procedure of using caustic alkalies, fire and leeches will be described later on (in the chapters ahead).

The leaves of goji, sephalika and sakapatra shall be used for draining the diseases of the mouth and of the eyelids of their fluid accumulation.

One should use eshani (probe) for eshana karma (probing, exploring). In the absence of eshani, probing shall be done using hairs, fingers or sprouts.

Shastra Nirmana: Manufacture of the instruments

शस्त्राण्येतानि मतिमान् शुद्ध शैक्यायसानि तु
कारयेत् करणप्राप्तं कर्मारं कर्मकोविदम् ॥१९॥

The intelligent physician / surgeon should get pure and strong (hard) iron (steel) for manufacturing the shastras. These sharp instruments should be manufactured by an experienced and skilled blacksmith.  

Secret of success in surgical practice

प्रयोगज्ञस्य वैद्यस्य सिद्धिर्भवति नित्यशः तु।
तस्मात् परिचयं कुर्या च्छस्त्राणां ग्रहणे सदा॥२०॥

The surgeon who is well versed and experienced (in use of sharp instruments, accessory sharp instruments, blunt instruments and accessory blunt instruments) in the surgical procedures will find success in conducting surgical procedures and curing the patients only if he practices these surgical techniques daily and regularly. Hence the physician / surgeon should always practice the methods of holding the sharp instruments correctly.

इति श्रीसुश्रुतसंहितायां सूत्रस्थने शस्त्रावचारणीयो नामाष्टमोऽध्याय॥८॥

Thus ends the Eighth chapter by name Sastravacaraniya, in Sutra Sthana of Susrutha Samhita.