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Doctors who don’t learn medicine and surgery are “a bird with one wing”

Surgery in India recently presented the modern-day end of its millenniums-old spectrum when Dr. Tejas Patel, a surgeon from Gujarat, performed a telerobotic coronary surgery – on a patient 32 Kms away.

What about the historical, ancient end of the same spectrum? Long ago, estimated to be around 600BC, ancient India had an extraordinary tradition of Ayurvedic surgery called “Shalya Tantra.” Amazingly advanced for its times, the principles and practices it advocates continue to astound surgeons of the allopathic stream today – those that have heard of it.

“Shalya” means “a broken arrow or a sharp part of a weapon.” and “Tantra” means “maneuver”. Shalya Tantra was regarded as a means to remove irritating factors that produce pain or misery to the body. In those times, when, apart from usual medical conditions, there were also injuries from wars or from disfiguration as a punitive measure, Shalya Tantra served also to treat grievous wounds and disfigurement – through plastic and other innovative forms of surgery that were unheard of in other parts of the world of those ages.

The first systematic compendium of the medical system known as Ayurveda was the “Charaka Samhita” by Acharya Charaka, and remained as the authoritative textbook for almost 2000 years. It mentions earlier medical practitioners like Acharya Atreya and Acharya Agnivesh. “Ashtanga Sangraha”, “Charaka Samhita” and “Sushruta Samhita” are the three treatises that form the foundation of Ayurvedic science. “Samhita” in Sanskrit means “compendium.”

The first two deal mainly with Ayurvedic knowledge of medicine, while Sushruta Samhita, written by the celebrated sage-physician Sushruta, is an in-depth treasure-house of surgical knowledge. Sushruta Samhita deals with procedures for complicated surgeries like cataract, cesarean, amputation, rhinoplasty (this pioneering technique brought him great fame), cleft lip and other forms of plastic surgery, and removal of kidney stones and cataracts. Gynaecology, embryology, genetics, and obstetrics are described. Midwifery is discussed, and so is dissection on cadavers to gain knowledge of anatomy. Sushruta also developed a surgical procedure for trichiasis.

He taught surgical skills to students, known as “saushrutas” by making them practice surgery on cucumbers, watermelons and pumpkins and also on leather bags filled with water or mud of varying densities. He used wine and hen bane as anaesthetic, needles of bone or bronze, and sutures – some of them soluble – of tendon, hair, silk and bark. He used leeches to avert blood-clotting, described types of incisions and gave an accurate, in-depth study on fractures and fracture-management principles and techniques. He pioneered non-invasive treatments with heat and light-rays, and used ant-heads for stitching up and healing wounds! He practiced brain surgery and craniotomy too.

What was the importance of Sushruta’s contribution? He recognized the need for a bold, path-breaking new branch of human endeavour that would supplement medicinal treatment with a range of surgical interventions and operations that would speed up the process of curing disease and healing pain. In his assiduous pursuit of a scientific system to cure disease through physical intervention, he was a path-breaker propounding many sophisticated classifications and treatment-methodologies.

Sushruta Samhita’s 184 chapters detail 1,120 medical conditions, 300 types of medical surgeries and 120 types of medical instruments made of wood, stone and other natural material, and 650 drugs of animal, vegetable and mineral origin. He classified all surgery under eight heads.He highlighted the benefits of clean living and good habits, pure thinking, proper waste-elimination, suitable exercise and healthful diet, and additionally, inclusion of medicines for treatment. Complicated procedures for preparing medicines are described in the Samhita.

Now prepare to be surprised: Sushruta’s “Kshara” therapy for ano-rectal disease can enable cure through patient-friendly, less invasive Ayurvedic techniques that have proven, high-success rates and reduced side-effects. It is especially beneficial for the elderly, those for whom surgery is not advised and those with cardiovascular diseases.

Apart from this, he described in great detail madhumeha (diabetes), hritshoola (angina) and medoroga (obesity).

Sushruta insisted that a physician must be grounded in knowledge of medicine as well as of surgery and other “sister branches.” Otherwise he would be “like a bird with one wing.” His advice to physicians, “A physician who has set out on this path should have witnessed operations. He must be licensed by the king. He should be clean and keep his nails and hair short. He should be cheerful, well-spoken and honest.”

He urged surgeons to ensure perfect healing. These prescriptions of attributes a surgeon should possess seem to be relevant for medical practitioners even today: “Courage, presence of mind, quick handedness, non-shaking grip of sharp and good instruments, non-sweating, sharp instruments, self confidence and self command are what should be possessed by a surgeon. A good surgeon carries the operation to success and to the advantage of his patient, who has entrusted his life to the surgeon. The surgeon should respect this absolute surrender and treat his patient as his own son.”

Sushruta stressed that surgeons should aim for perfect healing which is characterized by “the absence of any elevation, indurations, swelling mass, and the return of normal coloring.”

How did mankind forget this incredibly detailed and scientific treatise that gave so much in-depth, detailed information about holistic health, surgery and well-being? The answer lies in centuries of invasion and destructive occupation and later, of colonization’s deleterious effects on our unparalleled heritage and our civilisational self-esteem. Add to that our lack of ability and willingness to preserve and practice what has been handed down to us by our path-breaking ancestors. They were “disruptive” without ever knowing the term.

It does take humility to learn from our predecessors and pass on that learning to our succeeding generations. A heartening fact is that today several aspects of Shalya Tantra are seeing a conscious revival by the Art of Living’s Panchakarma Department.

To sum up, Sushruta is known as “The Father of Surgery” and The Father of Plastic Surgery,” and with extremely good reason. All in the Allopathic and other streams could gain a lot by studying this great sage-physician’s ever-relevant contributions in every aspect of surgery. It would immensely benefit their patients as well as their own practice.

– Padma Koty

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