Lekhana means scraping or curettage of the skin or internal surfaces to remove diseased tissue. It is indicated for thickened skin, fungating wounds, and dead tissues. Scraping is done using instruments like mandalagara and karapatra to remove dead tissues and promote wound healing. Examples include debridement of wounds or ulcers, manual removal of placenta, and curettage in incomplete abortion. Vyadhana means puncturing or incising the skin or internal structures slightly using fine instruments like needles to drain out pus or fluids. It is used to drain abscesses or cysts.

1. ASHTA VIDHA SASTRA KARMA
IN SURGICAL PRACTICE
An Ayurvedic And Modern View
By,
Dr. S.TAMILARASAN B.A.M.S
P.G.SCHOLAR
DEPARTMENT OF SHALYA TANTRA
AMV C&H, HUBLI.

2. INTRODUCTION
• Shalya chikitsa performed in three different
stages like purva karma, pradhana karma and
paschath karma.
• In pradhana karma, Acharya Susruta explains
about 8 different surgical procedures under the
topic called ashta vidha sastra karma.
• In addition to this he is also explaining
yogyasootriyam i.e. understanding the surgical
procedures with practical knowledge.
• The recent advanced techniques are also
developing based on the ashtavidha sastra
karma.

3. CHARAKA (6) SUSRUTA (8) VAGHBHATA (13)
Paatana Chedana Susruta (8) + 5
Vyadhana Bhedana Uthpaatana
Chedana Lekhana Kuttana
Lekhana Vyadhana Mandhana
Visravana Eshana Grahana
seevana Aaharana Dahana
Visravana
Seevana
SASTRA KARMA ACC. TO DIFFERENT ACHARYA’S

4. SASTRA
KARMA
MODERN
CORRELATION
SASTRA’S USED
Chedana Excision/ectomy Mandalagara, karapatra, vrudhipatra, nakhasastra,
mudrika, utpalapatraka, ardhadhara
Bhedana Incision vrudhipatra, nakhasastra, mudrika, utpalapatraka,
ardhadhara
Lekhana Scraping Mandalagara, karapatra
Vyadhana Puncturing Kutharika, vrihimukha, ara, vetasapatra, suci
Eshana Probing Eshani
Aaharana Extraction Badisha, dantasanku
Visravana Draining Suci, kusapatra, adimukha, shararimukha,
antarmukha, trikurchaka
Seevana suturing suci

5. CHEDANA
(EXCISION/ECTOMY)
01
छेद्यं ननिःशेषतश्छेदनीयमशशिःप्रभृनत

6. Indication:
छेद्या भगन्दरा ग्रनन्थिः श्लैनमिकनतिलकालकिः |
व्रणवर्तिाार्बादान्यर्ाश्चिाकीलोऽनतथिाांसगि् ||३||
र्ल्यां जिबिनणिाांससङ्घािो गलर्बनडिका |
तनायबिाांसनसराकोथो वल्िीकां र्िपोनकिः ||४||
अध्रबषश्चोपदांर्ाश्च िाांसकन्द्यनििाांसकिः |५|
SU.SU.25/3-4
Yogyasootriyam:
पबमपफलालार्ूकानलन्दकत्रपबसै(सो)वाारुककाारुकप्रभृनिषब
छेद्यनवर्ेषान् दर्ायेि्,उर्तकिानापकिानानन चोपनदर्ेि्
SU.SU.9/4
CHEDANA

7. अपाकेषब िब रोगेषब कनिनेषब नतथरेषब च ||३३||
तनायबकोथानदषब िथा च्छेदनां प्राप्तिबच्यिे |३४|
SU.CHI.1/33
 Amputation of body parts
 Excision of dead tissue.
 Haemorrhoidectomy, Fistulectomy etc.
Chedana – Excision / Ectomy
Chedana means excision of part from the body using mandalagara, karapatra,
vrudhipatra, mudrika and utpalapatra etc.
Examples:

8. HAEMORRHOIDECTOMY - MILLIGAN MORGAN
TECHNIQUE

9. THYROIDECTOMY

10. GANGLION CYS T
EXCISION
Pterygium excision

11. BHEDANA
(INCISION)
02
भेद्यं भेदनीयं, निद्रध्यानद

12. BHEDANA
Indication:
Yogyasootriyam:
भेद्या विद्रधयोऽन्यत्र सिवजाद्ग्रन्थयय्त्रयय ||५||
आवितो ये विसर्ावश्च िृद्धय सवििारिकाः ा |
प्रमेहवर्डाः ा शोफ स्तनकोगोऽिमन्थयाः ा ||६||
ाः ु म्भीाः ानुशयी नाड्यो िृन्दौ र्ुष्करिकाः ाऽीजी |
प्रायश क्षुद्रकोगाश्च र्ुप्पुटौ ताीुि्तजजौ ||७||
तुण्डिाः े की वगीायुश्च र्ूिं ये च प्रर्ावाः |
बण्डस्तस्तथाऽश्मकीहेतोमेिोजा ये च ाः े चन ||८||
SU.SU.25/5-8
दृनिर्नतिप्रसेवकप्रभृनिषूदकपङ्कपूणेषब भेद्ययोगयाां
SU.SU.9/4

13. A surgical cut made through the skin to facilitate an operation or to visualize the
underlying structures.
अन्ििःपूयेमववक्त्त्रेषब िथैवोर्तसङ्गवर्ततवनप ||३४||
गनििर्तसब च रोगेषब भेदनां प्राप्तिबच्यिे |३५|
SU.CHI.1/34-35
 Episiotomy
 Incision of an abscess
 In majority of surgical procedures incision is the first step
 Fistulotomy, sphinterotomy, herniotomy
BHEDANA (INCISION)
Examples:

14. INCISION

15. THE SCALPEL AND BLADES

16. The scalpel may be held in one of two ways:
A. Fingertip grip
B. pencil grip.

17. ● Langer’s line is correspond to the
natural orientation of collagen
fibres in the dermis, and are
generally parallel to the
orientation of the underlying
muscle fibres.
● Incision made parallel to Langer’s
lines may heal better and produce
less scar than those that cut
across.
Role of Langer’s Line in Incision

18. How to make an incision..

19. Types of incisions
A. Use of reverse press cut incision
to make initial entry into the
peritoneal cavity.
B. A press cut incision into a fluid filled
structure

20. तत्र भ्रूगिशङ् खीीाटावक्षर्ुटौष्ठि्तजिेष्टाः क्षााः ु वक्षि्क्षण ेुु वतयवाः ् छे ि उक्त ||१३||
चन्द्रमिीिच्छे िान् र्ाव र्ािेुु ाः ाकयेत् |
अधवचन्द्रााः ृ तीींश्चावर् गुिे मेढ्रे च बुण्डद्धमान् ||१४||
अन्यथा तु वसकास्नायुच्छे िनम्, अवतमात्रीं िेिना, वचकाि् र सींकोहो, माींसाः न्दीप्रािुभावि
श्चेवत ||१५||
Su.su.5/13-15
Types of incision acc. To Ayurveda

21. Type of Incision Site of incision
Triyak – oblique • eye brow
• Cheek
• Temple
• Forehead
• Eyelid
• Lip
• Gum
• Axilla
• Abdomen
• Groin
Chandramandala – orb of moon • upper and lower limbs
Ardhachandrakruti – half moon
shaped
• anus and penis

22. Incision mentioned in Bhagandara Chikitsa
• Gothirtha - semicircular
• Sarvathobadra - circular
• Ardhalangalaka – incision on both sides being shorter on one side
• langalaka – equal incision on both sides
A.H. Utt.28/30
अर्धलाङ्गलकश्छेदः कार्यो लाङ्गलकोऽपि ा ा |
सा धतोभद्रको ा ाऽपि कार्यो गोतीर्धकोऽपि ा ा ||१०||
Su.Chi.8/11

23. ABDOMINAL INCISIONS

24. 1. Cuteo areolar incision
2. Radial incision
3. Gaillard Thomas’s submammary
incision
1. Incision for high operation Mcevedy
2. Incision for inguinal operation of
Lotheissen
3. Incision for low operation of
lockwood
These 3 incisions are useful in
femoral hernia
BREAST INCISIONS
GROIN INCISIONS

25. SITE OF INCISION DIFFERENT METHODS/TYPES
PENIS 1. Circumferential Incision for Van der
Meulen’s operation
2. U shaped Incision for epispadias
3. Racket shaped Incision for total
amputation of penis
RECTUM AND ANAL CANAL 1. Circumferential Incision for Theirsch’s
operation
2. Curved incision for Rectopexy
3. Cruciate incision for ischiorectal abscess
4. Circular incision for high level fistula
SCALP U shaped incision is used in Osteoplastic
flap method for access to brain

26. Ayurvdic incision Modern incision
Triyak (oblique) incision in kaksha (breast) Radial incision - It is made along the line
radiating from the areola of breast for
excision benign tumour and drainage of pus in
breast.
Triyak (oblique) incision in kukshi (abdomen) Kochers incision - it starts in the midline just
below the xiphoid process and runs
downwards and laterally about 2cm below and
parallel to the costal margin. It is popularly
used for gall bladder operation. It can be
correlated with tiryak (oblique) incision in
kukshi (abdomen) region.
Comparision of Ayurvedic and Modern incisions

27. Ayurvdic incision Modern incision
Triyak (oblique) incision in Vankshan
(Groin/inguinal) region
Incision for Herniotomy- the incision is made
half inch above and parallel to the medial two
third of the inguinal ligament.
Chandramandalvat (orb of moon shaped)
incision in Pani (hand/upper limb) and Pada
(leg/lower limb)
In circular flap method of amputation, the
incision is circular. It is commonly used in
Gas-gangarene.
Ardhachandrakruti (half moon shaped)
incision at Medhra (penis).
U shaped incision is made to reconstruct the
urethra in case of Epispadias (urethra opens
on dorsal surface of urethra).
Comparision of Ayurvedic and Modern incisions

28. LEKHANA
(SCRAPING/CURRETTAGE)
03
लेख्यां लेखनीयां, रोनिडयानद

29. LEKHANA
Indication:
Yogyasootriyam:
ीेख्याश्चतस्रो कोवहण्य वाः ीासमुर्वजविाः ा |
मेिोजो ि्तजिैिभो ग्रण्डन्थयिवर्त्ाववधवजविाः ा ||९||
अशांवस मिीीं माींसाः न्दी माींसोन्नवतस्तथा |१०|
SU.SU.25/9-10
सरोनणण चिाडयाििे लेख्यतय
SU.SU.9/4

30. Debridement- The process of cleaning an open wound by removal of foreign material and
dead tissue, facilitating healthy tissue healing.
Currettage- Scraping of the skin or the internal surface of an organ or body cavity by
means of a curette, usually to remove diseased tissue or to obtain a specimen for diagnostic
purposes.
कनिनान् तथूलवृत्तौष्ठान् दीयािाणान् पबनिः पबनिः |
कनिनोर्तसन्निाांसाांश्च लेखनेनाचरेनिषक् ||३८||
SU.CHI.1/38
Examples:
 Debridement of wound or ulcer
 Curette in incomplete abortion
 Manual removal of placenta
 Lekhana of fistula tract
LEKHANA (SCRAPING/CURRETTAGE)

31. Wound debridement in diabetic foot ulcer:

32. VYAHDANA
(PUNCTURING)
04
वेध्यि् अल्पिबखैिः र्स्त्रैर्वयािनीयां नसरानद

33. VYAHDANA
Indication:
Yogyasootriyam:
िेध्ा वसका बहुविधा मूत्रिृण्डद्धिवाः ोिकम् ||१०||
SU.SU.25/10
िृिपर्बनसरासूर्तपलनालेषब च वेध्यतय
SU.SU.9/4

34. रोगे र्वयिनसाध्ये िब यथोद्देर्ां प्रिाणििः |
र्स्त्रां ननदध्याद्दोषां च स्रावयेि् कीनिािां यथा ||४४||
SU.CHI.1/44
Example:  Drainage of fluids
 All laproscopic procedures
VYAHDANA (PUNCTURING)

35. Siravyadhana in
sira granthi

36. Laproscopic surgeries

37. ESHANA
(PROBING)
05
एमयि् एषणीयां, नाि्यानद

38. ESHANA
Indication:
Yogyasootriyam:
एष्या नाड्य सशल्याश्च र ा उन्मावगव श्च ये |११|
SU.SU.25/11
घबणोपििकाष्ठवेणबनलनालीर्बमकालार्ूिबखेमवेमयतय
SU.SU.9/4

39. नािीव्रणाञ् र्ल्यगभाानबन्िागयबार्तसङ्नगनिः र्नैिः |
करीरर्ालाङ्गबनलनभरेषडया वैषयेनिषक् ||४१||
नेत्रवर्तिागबदाभ्यासनाि्योऽवक्त्त्रािः सर्ोनणिािः |
चबच्चूपोदकजैिः श्लक्षणैिः करीरैरेषयेत्तब िािः ||४२||
SU.CHI.1/41-42
Example:  Probing the fistula tract, sinus etc.
 Endoscopy, Colonoscopy etc.
ESHANA (PROBING)

40. Probing in Nadi vrana (pilonoidal sinus)

41. Probing in fistula

42. AAHARANA
(EXTRACTION)
06
आिायाि् आिरणीयां, र्का रानद

43. AAHARANA
Indication:
Yogyasootriyam:
आहायाव शाः व काण्डस्तस्रो ि्तजाः वमीोऽश्मकी ||११||
शल्यावन मूढ्गभावश्च िचवश्च वनवचतीं गुिे |१२|
SU.SU.25/11-12
पनसनर्णर्ीनर्ल्वफलिज्जिृिपर्बदन्िेमवािायातय
SU.SU.9/4

44. सांवृिासांवृिातयेषब व्रणेषब िनििान् नभषक् |
यथोक्तिािरेच्छल्यां प्राप्तोद्धरणलक्षणि् ||४३||
SU.CHI.1/43
Example:
 Extraction of impacted foreign body
 Removal of retained placenta
 Extraction of urinary calculi by lithotripsy
etc.
AAHARANA (EXTRACTION)

45. Foreign body extraction from nasal cavity

46. Tooth extraction

47. VISRAVANA
(DRAINING)
07
नवस्रार्वयां नवस्रावणीयां, िच्च नवद्रनिकबष्ठानद

48. VISRAVANA
Indication:
Yogyasootriyam:
स्राव्या विद्रधय र्ञ्च भिेयु सिवजादृते ||१२||
ाः ु ष्ठावन िायु सरुज शोफो यश्चैाः िेशज |
र्ाल्यामया श्लीर्िावन विुजुष्टीं च शोव तम् ||१३||
अबुविावन विसर्ावश्च ग्रन्थययश्चावितश्च ते |
त्रय्त्रययश्चोर्िींशा स्तनकोगा वििारिकाः ा ||१४||
सु(शु)वुको गीशाीूाः ीं ाः ण्टाः ा ाः ृ वमि्तजाः |
ि्तजिेष्ट सोर्ाः ु श शीतािो ि्तजर्ुप्पुट ||१५||
वर्त्तासृक्कफजाश्चौष्ठ्ा क्षुद्रकोगाश्च भूयश |१६|
SU.SU.25/12-16
मधूण्डच्छष्टोर्वीप्ते शाल्मीीफीाः े विस्राव्यस्य
SU.SU.9/4

49. नवस्रार्वयनवषयां दर्ायन्नाि- स्रार्वया इर्तयानद
Example:
 Draining abscess
 Draining of pus in pyothorax
 Urinary catheterization
VISRAVANA (DRAINING)

50. Post-Surgical drain

51. Abscess draining

52. Abscess draining

53. SEEVANA
(SUTURING)
08
सीर्वयां सीवनीयां, िच्च ‘‘सीर्वया िेदिःसिबर्तथाश्च नभत्त्वा सबनलनखिा गदािः

54. SEEVANA
Indication:
Yogyasootriyam:
सीव्या मेि समुत्थाश्च वभन्ना सुवीण्डखता गिा ||१६||
सद्योर ाश्च ये चैि चीसण्डिव्यर्ाविता [२] |१७|
SU.SU.25/16-17
सूक्षिघनवस्त्रान्ियोिृादबचिाान्ियोश्च सीर्वयतय
SU.SU.9/4

55. अपाकोपद्रबिा ये च िाांसतथा नववृिाश्च ये |
यथोक्तां सीवनां िेषब कायां सन्िानिेव च ||४५||
SU.CHI.1/45
Example:
 Suturing of the traumatic wounds.
 Ligation of haemorrhoid, bleeding vessels etc.
SEEVANA (SUTURING)

56. SUTURING

57. Suturing needle:

58. Types of needles:

59. Different Shape of suturing needles

60. Types of suture material
• Absorbable suture - degraded and eventually eliminated
(e.g. catgut, vicryl, monocryl)
• Non-absorbable suture - not degraded, permanent (e.g.
prolene, nylon, stainless steel)
• Natural suture - biological origin; may cause intense
inflammatory reaction (e.g. cat gut, chromic, silk)
• Synthetic suture - synthetic polymers; do not cause
intense inflammatory reaction (e.g. vicryl, monocryl,
nilon)

61. 1. Rijugranthi
2. Vellitaka
3. Gophanika
4. Tunnasevani
Interrupted suture
Continuous suture
Blanket of reinforcing suture
Buried or subcuticular suture
Types of suturing techniques in Ayurveda:
Riju granthi type of suturing, thread is inserted from two edges of wound and knot is tied. This is
interrupted type of suturing.
Vellitaka i.e. round. This is achieved by suturing continuously along the length of the wound
rapping the wound edges inside it.
Gophanika type of suturing is done in wounds which are shaped as footprints of crow.
Tunnasevani is done as like as the torn up garments are sutured.

62. Types of suture’s:

63. simple interrupted stitch - single stitches,
individually knotted used for uncomplicated
laceration repair and wound closure
continuous stitch - allows more rapid
wound closure carries the risk of complete
wound opening if the suture breaks
Simple interrupted and continuous suture

64. a. vertical mattress stitch -
affords precise approximation of
skin edges with eversion
b. horizontal mattress stitch -
provides added strength in
fascial closure; also used in
calloused skin. (e.g. palms and
soles)
Vertical and horizontal mattress stitches
ba

65. ● Intradermal horizontal bites
● Allow suture to remain for a
longer period of time without
development of crosshatch
scarring
● Better cosmetic result
Subcutaneous suture

66. Types of knots:
Simple
knot
Granny
knot
Square
knot
Surgeon’s
knot

67.  Each and every surgical
procedure comprises
either one or more of
these principle technique.
 Acharya Sushruta
categorize and simplify all
surgical techniques under
Ashtavidha sastra karma.
conclusion

68. Thank You