Surgery. Sushruta's surgery and modern surgery are examined together, and the distinctive Ayurvedic contributions — Kshara Sutra, Agnikarma, Ksharakarma, Raktamokshana and Marma — are where the paper separates a good answer from an average one.
Instruments and the three stages
Yantra: 101, in six groups — swastika, sandamsha, tala, nadi, shalaka, upayantra.
Shastra: 20, and the eight shastra karma — chhedana, bhedana, lekhana, vedhana, eshana, aharana, visravana, sivana.
Kshara Sutra: the medicated thread, prepared with Snuhi latex, Apamarga kshara and Haridra, used chiefly for fistula-in-ano. Its evidence base is the strongest of any distinctly Ayurvedic surgical technique and it is worth saying so.
Agnikarma: the cautery. Four types by site. Samyak dagdha lakshana.
Ksharakarma: pratisaraniya and paniya kshara. Kshara paka and the eight tests of good kshara.
Raktamokshana: indications, contraindications, and the quantity limits.
Paschatkarma: bandaging, diet, and the observation regimen.
Sushruta's list of what must be ready before an operation is essentially a surgical checklist, and is worth presenting as one.
Granthi, Arbuda, Vidradhi
Granthi: six types; a circumscribed swelling. Arbuda: six types; the classical account of neoplasm, with the note that it does not suppurate.
Dwirarbuda and adhyarbuda — recurrence and secondary growth — are described, which is a striking observation for the period.
Vidradhi: six types, internal and external; the stages of suppuration (ama, pachyamana, pakwa) and their signs.
Modern: benign versus malignant, biopsy, and when to refer rather than treat.
Emergency and trauma
Haemorrhage: classification and the four classical methods of arrest — sandhana, skandana, pachana, dahana.
Shock: recognition and immediate management.
Burns: the classical four degrees, and the modern rule of nines.
Sadyovrana — fresh wounds — and the six types by Sushruta.
Ashmari, Bhagandara, Vidradhi and the surgical counts
ASHMARI four: vataja (shleshmashmari is the commonest), pittaja, kaphaja and shukrashmari. Shukrashmari occurs only in adults and only in men.
Ashmari purvarupa: basti peeda, aruchi, mutrakrichra, nabhi shoola. The lakshana that names it is pain radiating to the tip of the penis and interrupted stream.
BHAGANDARA five: shataponaka, ushtragriva, parisravi, shambukavarta and unmargi. All five are described in Sushruta Nidana 4, and unmargi is the one that tracks aberrantly and is hardest.
VIDRADHI six: five by dosha plus agantuja, and two by site — bahya and abhyantara. Abhyantara vidradhi is the internal abscess and is the dangerous one.
NADI VRANA five and VRIDDHI seven. Bhagna is twelve kanda bhagna plus six sandhi mukta — eighteen in total.
GRANTHI six, ARBUDA six, SADYO VRANA six, VRANA VASTU sixty. Shashti upakrama — the sixty measures for vrana — is the block Sushruta gives in Chikitsasthana 1.
Yantra, shastra and the anushastra
YANTRA 101, in six classes: swastika 24, sandamsha 2, tala 2, nadi 20, shalaka 28, upayantra 25. Hasta — the hand — is the pradhana yantra and the first of them all.
SHASTRA 20 in eight karma: chhedana, bhedana, lekhana, vedhana, eshana, aharana, visravana and sivana. The eight karma are asked more often than the twenty instruments.
ANUSHASTRA: the substitutes when a metal instrument cannot be used — twacha sara, kacha, kuruvinda, jalauka, agni, kshara, nakha, gojihva, sephalika patra and shaka patra.
SIRAVYADHA is called ardha chikitsa in Shalya as basti is in Kaya. Sushruta names 8 sites in the leg, 16 in the arm, 56 above the neck and 34 in the trunk.
Contraindicated for siravyadha: the very young and very old, the pregnant, the exhausted, the frightened, and anyone in atisara, jwara or shosha.
Where the texts disagree
The count of 101 yantra and 20 shastra is Sushruta's; later texts add and reclassify.
Whether kshara sutra is Sushruta's own or a later development from his kshara and sutra descriptions is debated.
Rhinoplasty in Sushruta uses a cheek flap; the forehead flap known as the Indian method is a later development.
Commonly confused
Chhedana (excision) and Bhedana (incision).
Eshana (probing) and Vedhana (puncturing).
Kshara karma (chemical) and Agni karma (thermal).
Nija vrana (from the doshas) and Agantuja vrana (from outside).
Surgical technique changes and this manual is an examination summary, not an operative guide. Anything requiring surgery requires a surgeon.
Written to the NCISM subject outline. Where texts disagree on a count or an attribution, the explanation says so rather than picking one silently.
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