The eighth chapter of Sharirasthana of Sushruta Samhita is known as as Sira Vyadha Vidhi Shariram Adhyaya. This chapter offers with the process of puncturing the vein / phlebotomy.
Sira Vyadha Vidhi- Process of puncturing the vein / phlebotomy
अथातःसिराव्यधविधिंशारीरंव्याख्यास्यामः ॥१॥
यथोवाचभगवान्धन्वत्तरिः ॥२॥
Now we’ll expound the chapter by title Sira Vyadha Vidhi – process of puncturing vein / phlebotomy; as revealed by the venerable Dhanvantari.
Vyadhana Anarha – individual unsuitable for puncturing
बालस्थविररूक्षक्षतक्षीरुपरिश्रान्तमद्यपाध्वस्त्रीकर्शितवमितविरिक्तास्थापितानुवासितजागरितक्लीबकृशगिर्भिणीनां
कासश्र्वासशोषप्रवृद्धज्वराक्षेपकपक्षाघातोपवासपिपसामूर्च्छाप्रपीडितानां चसिरांनविध्येत्,याश्चाव्याध्याः। व्यध्याश्चादृष्टाः ।दृष्टाश्चायन्त्रिताः, यन्त्रिताश्चानुत्थिताइति॥३॥
Contraindications for siravedha –
The siras – veins shouldn’t be punctured in –
– kids,
– the outdated aged,
– individuals who’re dry, wounded, debilitated, fearful,
– those that are enormously fatigued,
– those that have consumed wine,
– those that are exhausted by lengthy stroll or
– those that are exhausted on account of indulgence in extreme sexual actions
– those that have had vomiting or purgation,
– those that have been administered decoction and oil enemas,
– those that have saved awake at evening,
– impotent individuals
– emaciated individuals
– pregnant girls
– those that are affected by cough, dysponea, consumption, excessive fever, convulsions, partial paralysis, hunger, thirst and fainting
Beneath talked about siras additionally ought to by no means be punctured –
– these that are contraindicated / prohibited from puncturing
– these siras that are indicated for puncturing however aren’t seen
– these siras that are clearly seen however can’t be managed (or held for puncturing)
– these siras which aren’t raised / engorged, although managed
Vyadhana Arha – Appropriate for puncturing
शोणितावसेकसाध्याश्चयेविकाराःप्रागभिहितास्तेषुचापक्वेष्वन्येषुचानु क्तेषुयथाभ्यासंयथान्यायंचसिरांविध्येत् ॥४॥
Siravedha or vein puncture as a therapeutic measure ought to be carried out in all ailments that are curable by raktamokshana i.e. bloodletting, as defined earlier in Sutra Sthana part, chapter 14 of the identical treatise (Sushruta Samhita).
With one’s medical / surgical expertise and apply and likewise after adopting applicable measures and procedures, siravedha can be executed in different ailments which haven’t grow to be pakva i.e. mature (ripened, suppurated), additionally in these ailments which haven’t been indicated for shonitavaseka – bloodletting.
प्रतिषिद्धानामपिचविषोपसर्गेआत्ययिकेचसिराव्यधनमप्रतिषिद्धम्॥५॥
Siravyadha i.e. puncturing of vein just isn’t prohibited even within the veins contraindicated for puncturing when an individual is severely affected by poisons or in situations of emergency.
Vyadhana Vidhi – Process of puncturing
तत्र स्निग्धस्विन्नमातुरं यथादोषप्रत्यनीकं द्रवप्रायमन्नं भुक्तवन्तंयवागूंपीतवन्तंवायथाकालमुपस्थाप्यसीनंस्थितंवाप्राणानबाधमानोवस्त्रपटचर्मान्तर्वल्कललतानामन्यतमेनयन्त्रयित्वानातिगाढंनातिशिथिलंशरीरप्रदेशमासाद्य प्राप्तंशस्त्रमादायसिरांविध्येत् ॥६॥
Snehana and Swedana – As a part of preparatory measures, the affected person ought to be administered with –
– snehana – oleation and
– swedana – sudation and
Drava Anna – to the affected person who has been administered with snehana and swedana, liquid meals or yavagu i.e. thick gruel ought to be given. These meals ought to have reverse qualities as these of the aggravated doshas.
Positioning the affected person – Correct time for conducting siravyadha is determined. The affected person who has undergone snehana and swedana and drava anna as talked about above ought to be made to sit down in erect posture, on a chair, near the doctor.
Tying bands – Later he ought to be tied with both of the beneath talked about issues –
– bands of garments
– leather-based
– inside bark of timber,
– creeper or another such supplies
They need to be tied taking care that –
– the affected person’s life just isn’t endangered
– he isn’t managed or restrained from motion,
– the band is tied neither very firmly nor very loosely
Later, the doctor ought to seek for correct website for conducting the puncture and the sira at that website shall be punctured, utilizing applicable instrument.
Contraindications for doing vein puncture
नैवातिशीतेनात्यष्णेनप्रवातेनचाभ्रिते॥
सिराणांव्यधनंकार्यमरोगेवाकदाचन ॥७॥
Vein puncture shouldn’t be executed on –
– very chilly days
– highly regarded days
– days on which there’s heavy breeze,
– very cloudy day,
– wholesome individuals
तत्रव्यध्यसिरांपुरुषंप्रत्यादित्यमुखमरत्निमात्रोच्छ्रितेउपवेश्यासनेसक्थ्नोराकुञ्चितयोर्निवेश्यकूर्परे सन्धिद्वयस्योपरि हस्तावन्तर्गूढाङ्गुष्ठकृतमुष्टी मन्ययोःस्थापयित्वायन्त्रणशाटकंग्रीवामुष्ट्चोरुपरिपरिक्षिप्यान्येनपुरुषेणपश्चात्स्त्थितेनवामहस्तेनोत्तानेन शाटकान्तद्वयं ग्राहयित्वाततो-ब्रूयात्दक्षिणहस्तेनसिरोत्थापनार्थंनात्यायतशिथिलं यन्त्रमावेष्टयेति,असृकस्त्रावणार्थं तयन्त्रंपृष्ठमध्येपीडयेति, कर्मपुरुषंचवायुपूर्णमुखंस्थापयेत्; एषउत्तमाङ्गगतानामन्तर्मुखवर्जानांसिराणांव्यधनेयन्त्रणविधिः ।
पादव्यध्यसिरस्यपादंसमेस्थानेसुस्थितंस्थापयित्वाऽन्यंपादमीषत्संकुचितमुच्चैःकृत्वाव्यध्यसिरंपादंजानुसन्धेरधःशातकेनावेष्ट्चहस्ताभ्यांप्रपीड्चगुल्फंव्यध्यप्रदेशस्योपरिचतुरड्गुलेप्लोतादीनामन्यमेनबद्धावापादसिरांविध्येत्।
अथोपरिष्ठाद्धस्तौगूढङ्गुष्ठकृतमुष्टीसम्यगासने स्थापयित्वा सुखोपविष्टस्य पूर्ववद्यन्त्रंबद्धवाहस्तसिरांविध्येत् ।
गृध्रसीविश्वाच्योःसङ्कुचितजानुकूर्परस्य।
श्रोणिपृष्टस्कन्धेषून्नामितपृष्ठस्यावाक् शिरस्कस्योपविष्टस्य विस्फूर्जितपृष्ठस्यविध्येत् ।
उदरोरसोः प्रसारितोरस्कस्योन्नामितशिरस्कस्य विस्फूर्जितदेहस्य।
बाहुभ्यामवलम्बमानदेहस्यपार्श्वयोःअनामितमेढ्रस्यमेढ्रे।
उन्नमितविदष्टजिह्वाग्रस्याधोजिह्वायाम् ।
अतिव्यात्ताननस्यतालुनिदन्तमूलेषुच ।
एवंयन्त्रोपायानन्यांश्चसिरोत्थापनहेतूनबुद्धचाऽवेक्ष्यशरीरवशेनव्याधिवशेनचविदध्यात् ॥८॥
Controlling / manipulating the veins of the pinnacle –
Positioning the affected person – The one who is chosen for siravyadha is made to sit down on a chair going through east. The chair ought to be of the peak of his forearm. The individual ought to sit on the chair flexing his legs on the knees. He ought to maintain his elbows on his knees and clench his fists.
Making use of pressure – The affected person is now requested to maintain his clenched fists on the nape of his neck on each side and press on the nape.
Binding – Now a binder is taken and is handed above his neck and fists. The individual standing behind the chair on which the individual is seated will maintain the 2 ends of the binder. Elevating his left hand barely he ties a knot. The knot just isn’t very tight however enough sufficient to lift the veins. Then, he tightens the binder on the center of the affected person’s again.
Instruction to the affected person – Now, the affected person is requested to inflate his mouth with air.
That is the tactic of controlling or manipulating the veins of the pinnacle which aren’t spreading inwards, for puncturing.
Controlling / manipulating the veins of the legs (decrease limbs) –
Positioning the affected person – To conduct siravedha within the legs i.e. to puncture the leg veins, the affected person ought to place his one leg firmly on a fair place like sofa / cot. He ought to barely flex and rise the opposite leg above.
Binder – After positioning the affected person as mentioned above, a binder ought to be wrapped beneath the knee of the leg by which siravyadha is to be executed.
Conducting vein puncture – Now, the doctor ought to knead the ankle of the affected person with the assistance of his arms after tying a band of material or any such materials about 4 angula (8 cm) above the positioning of puncture. After this, he ought to puncture the vein of the leg.
Controlling / manipulating the veins of the arms (higher limbs) –
Positioning of the affected person – The siras of the arm – higher limb shall be punctured after the affected person retains his arms as defined earlier – with tightly clenched fists with thumb contained in the fists, with different fingers wrapping it and by making the affected person to sit down comfortably. He ought to be manipulated as described earlier following which the veins ought to be punctured.
Manipulation and puncturing the opposite veins
| Veins to be punctured | Place by which vein ought to be punctured |
| In Gridhrasi – sciatica and Visvaci – painful situation of the arm | With knee (in gridhrasi) and elbows (in visvaci) flexed |
| Veins of the pelvis, again and shoulders | By increasing the again of the affected person by making the him sit, elevating his again and reducing his head |
| Veins of the stomach and chest | With the affected person increasing his chest, elevating his head and stretching (increasing) his physique |
| Veins of the flanks | When the physique is resting on the arms |
| Veins of the penis | When the penis is erect |
| Veins of the tongue | Beneath the tongue whereas the tongue is saved lifted up and biting its tip |
| Veins of the palate and root of the tooth | When the individual retains his mouth very extensive open |
Thus, even in locations of physique whereby siravyadha has not been indicated, the vein puncture ought to be executed by binding the place with appropriate yantra or anuyantra and by adopting efficient strategies of management or manipulation which causes the vein to rise, in order that it may be simply punctured. Puncturing of the vein ought to be executed based mostly on the character of the physique of the affected person and the character of the illness.
Vyadhapramana- measurement of the puncture
मांसलेष्ववकाशेषुयवमात्रंशस्त्रंनिदध्यात्,अतोऽन्यथाऽर्धयवमात्रंव्रीहिमात्रंवाव्रीहिमुखेन, अस्थ्नामुपरिकुठारिकयाविध्येदर्धयवमात्रम् ॥९॥
| Area of the physique whereby puncturing must be executed | Dimension of the puncture |
| Muscular areas of the physique | Dimension of yava – barley grain |
| In different areas i.e. areas aside from muscular areas of the physique | Dimension of Half Yava or one vrihi (paddy)
Puncturing ought to be executed utilizing Vrihimukha Sastra – Trocar or Puncturing needle |
| Veins on the bones | Dimension of Half Yava
Puncturing ought to be executed utilizing Kutharika – small surgical axe |
Vyadhana Kala- appropriate time
व्यभ्रेवर्षासुविध्येत्तुग्रीष्मकालेतुशीतले ॥
हेमन्तकाले मध्याह्रेशस्त्रकालस्त्रयः स्मृताः ॥१०॥
Time of instrumentation for siravyadha are three, relying on the seasons.
| Season by which puncturing of vein ought to be executed | Circumstances |
| Varsa Rtu – wet season | On days which aren’t cloudy |
| Grisma Rtu – summer time | At a time when it’s cool |
| Hemanta Rtu – winter | At noon |
Samyak Viddha Laksana – correct puncture
सम्यक्शस्त्रनिपातेनधारयायास्रवेदसृक्॥
मुहर्तं रुद्धा तिष्ठेच्चसुविद्धांतांविनिर्दिशेत् ॥११॥
यथाकुसुम्भपुष्पेभ्यःपूर्वंस्रवतिपीतिका॥
तथासिरासुविद्धासु दुष्टमग्रे प्रवर्तते॥१२॥
When the instrumentation in direction of siravyadha – puncturing of vein has been executed in a correct manner and the blood set free correctly, the beneath talked about indicators may be noticed –
– blood flows out in stream, for a time interval of 1 muhurta – 28 minutes and
– later, the bleeding stops by itself accord
Simily – Giving an analogy to elucidate bleeding after siravedha, Acharya says that solely vitiated blood flows out first after the siras have been punctured similar to a yellow-colored liquid flows out from the Kusumbha flowers, when these flowers are crushed.
Asrava – absence of circulate
मूर्च्छितस्यातिभीतस्य श्रान्तस्यतृषितस्यच ॥
नवहन्तिसिराविद्द्धास्तथाऽनुत्थितयन्त्रिताः ॥१३॥
Beneath talked about are the situations by which the blood doesn’t simply circulate out when the siras are punctured –
– in those that have fainted,
– in those that are enormously afraid,
– in these exhausted
– in those that are thirsty,
– in situations when the veins aren’t correctly raised for puncturing by manipulations
Circumstances whereby puncturing ought to be executed within the midday
क्षीणस्यबहुदोषस्यमूर्च्छयाऽभिहतस्यच ॥
भूयोऽपराह्वविस्राव्यासाऽपरेद्युस्त्र्यहेऽपिवा॥ १४॥
Puncturing ought to be executed within the afternoon or on the subsequent or third day the beneath talked about sorts of individuals –
– those that are debilitated,
– those that have nice accumulation of doshas,
– those that are by murcha – fainting
Samshamana
रक्तंसशेषदोषंतुकुयोदपिविचक्षणः ॥
नचातिनिःस्त्रुतंकुर्याच्छेषंसंशमनैर्जयेत् ॥१५॥
The doctor / surgeon who’s conducting siravyadha – bloodletting by vein puncture, could at occasions enable little amount of vitiated blood contained in the physique after having let majority of vitiated blood out of the physique, however ought to by no means enable blood to circulate out in extra. The doshas which have been left over within the physique after bloodletting ought to be later mitigated with appropriate palliative therapies.
Sravapramana- amount offlow
बलिनोबहुदोषस्यवयःस्थस्यशरीरिणः ॥
परंप्रमाणमिच्छन्तिप्रस्थंशोणितमोक्षणे ॥१६॥
In keeping with the opinion of consultants, 1 prastha – 640ml roughly – of blood ought to be allowed to circulate out after puncturing the vein whereas conducting siravyadha in –
– robust individuals
– individuals having nice accumulation of doshas and
– individuals who’re of appropriate age i.e. center age
Vyadhasthana – place of puncturing
तत्र पाददाहपादहर्षचिप्पविसर्पवातशोणितवातकण्टकविचर्चिकापाददारी प्रभृतिवुक्षीप्रमर्मणउपारिष्ठाद् द्यङ्गुल्लेव्रीहिमुखेनसिरांविध्येत्, शेलीपदेतच्चिकिस्तितेयथावक्ष्यते, कोष्ट्तकशिरः, खञ्जपङ्गुलवातवेदनासुजङ्घायां, ऊरुमूलसश्रीतांगलगण्डे, एतेनेतरसक्थिबाहूचव्याख्यातौ; विशेषतस्तुवामबाहौकूर्परसन्धेरभ्यन्तरतोबाहुमध्ये प्लीह्रि कनिष्ठिका-नामिकयोर्मध्येवा, एवंदक्षिणबाहौयकृद्दल्ये(कफोदरेच), एतामेवचकासश्वासयोरप्यादिशन्ति, गृध्रस्यमिवविश्र्वाच्यां, श्रोणिंप्रतिसमन्ताद् ह्यङ्गुलेप्रवाहिकायांशूलिन्यां, परिवर्तिकोपदंशशूकदोषशुक्रव्यापत्सुमेढ्रमध्ये, वृषणयोःपार्श्वेमूत्रवृध्द्यांनाभेरधश्चतुरङ्गुलेसेवन्यादकोदरे, वामपार्श्वेकक्षास्तनयोरन्तरेऽन्तर्विद्रधौपार्श्वशूलेच, बाहुशोषावबाहुकयोरप्येके, वदन्त्यंसयोरन्तरे, त्रिकस्सन्धिमध्यगतांतृतीयके, अधःस्कन्धसन्धिगतामन्यतरपार्श्वसंस्थितांचतुर्थके, हनुसन्धिमध्यगरामपस्मारे, शङ्खकेशान्तगतामुरोऽपाङ्गललाटेषुचोन्मदे, जिह्वारेगेष्वधोजिह्वायांदन्तव्याधिषुच, तालुनितालुनितालव्येषुकर्णयोरुपरिसमन्ताम्कर्णशूलएतद्रोगेषुच, गध्राग्रहणेनासारोगेषुचनासाग्रे, तिमिराक्षिपाकप्रभृतिष्वक्ष्यामयेषूपनासिकेलालट्चामपाङ्ग्चांवा, एताएवशिरोरोगाधिमन्थप्रभृतिषुरोगेष्विति ॥१७॥
| Circumstances / ailments by which siravedha – vein puncture is to be executed | Website / Vein for conducting vein puncture |
| Pada daha – burning sensation of toes / soles
Pada harsa – tingling or tenderness within the toes / soles Cippa – whitlow Visarpa – erysipelas, herpes Vatasonita – gout Vatakantaka – ankle joint sprain Vicarcika – pores and skin illness, eczema Padadari – fissures within the soles and so forth. |
Sira located 2 angula – 4 cm above the Ksipra Marma (important spot current in between massive toe and the subsequent toe)
Instrument used – Vrihimukha Sastra – trocar, thick needle |
| Slipada – filariasis | The tactic of puncturing the vein shall be described within the chapter coping with its remedy (Chikitsa Sthana, chapter 19) |
| Krostukasirsa – irritation of knee joint
Khanja – limping Pangu – lameness Vata Vedana – pains brought on by aggravated vata
|
In janghas – calves,
Location – 4 angula – 8 cm above the ankle joint |
| Apaci – tumor occurring within the neck, lymphadenitis of the neck | 2 angula – 4 cm beneath the Indrabasti Marma (a significant spot positioned on the heart of the calf muscle) |
| Gridhrasi – sciatica | 4 angula – 8 cm – both above or beneath the knee joint |
| Galaganda – tumor occurring within the neck, Thyroid swelling, Goiter | Vein current on the root / base of the thigh |
| Pliha – ailments / enlargement of spleen | Within the left arm, both on the inside facet of the elbow joint or on the heart of the arm or within the space between little and ring fingers |
| Yakriddalyodara – stomach enlargement brought about on account of enhance in measurement of liver – hepatomegaly and
Kaphodara – stomach enlargement brought on by elevated kapha |
In the proper arm, on the similar locations talked about for vein puncture in case of enlargement of spleen above (no 7) |
| Kasa – cough
Swasa – dyspnea, respiratory problems |
In the identical locations talked about above (in pliha and yakriddalyodara) |
| Visvaci – ache within the arms | As defined in Gridhrasi – sciatica |
| Pravahika – dysentery
Sula – ache within the stomach, colic |
2 angula – 4 cm in entrance of the pelvis – pubic symphysis |
| Parivartika, Upadamsa, Suka Dosa – all are ailments of penis
Illnesses of semen |
In the midst of the penis |
| Mutra vriddhi – hydrocele | On the edges of the scrotum |
| Dakodara / Jalodara – ascites | Beneath the umbilicus, 4 angula – 8 cm on the left facet of the raphae of the stomach |
| Antar-vidradhi – inside abscess
Parsva-sula – ache within the flanks |
In between the axilla and breasts, on the left flank |
| Bahusosa – losing of arms
Apabahuka – lack of motion of arm |
Between two shoulders |
| Tritiyaka Jwara – tertian fever | Center of trika – higher again |
| Chaturthaka Jwara – quartan fever | Beneath the shoulder joint of decrease jaw, close to the ear |
| Apasmara – epilepsy, reminiscence problems | Vein located in the course of the joint of the decrease jaw, close to the ear |
| Unmada – madness, psychoses | Within the temple and border of hairs within the head, on the outer angle of the attention and brow |
| Jihva danta roga – ailments of the tongue and tooth | Above the ears |
| Lack of odor notion and ailments of the nostril | Tip of the nostril |
| Timira – partial blindness
Aksi-paka – ulceration of the attention Illnesses of the attention |
At upanasika – base of the nostril or
Brow or Outer angle of the attention |
| Shiroroga – Illnesses of the pinnacle
Adhimantha – illness of the attention, glaucoma Different such ailments |
Base of the nostril, brow and outer angle of the eyes |
Dusta Vyadha – Improper puncturing
दुष्टव्यधा विंशति:-दुर्विद्धाऽतिविद्वा कुञ्चितापिच्चिताकुटिताऽप्रस्रुताऽत्युदीर्णाऽन्तेविद्धापरिशुष्काकूणितावेपिताऽनुत्थितविद्धाशस्त्रहतातिर्यग्विद्धाविद्धाऽव्यध्याविद्रुताधेनुकापुनःपुनर्विद्धासिरास्नाय्वस्थिसन्धिमर्मसुचेति ॥१८॥
DustaVyadha or improper puncturing of vein is of twenty varieties. They’re as beneath talked about –
– Durviddha,
– Atividdha,
– Kuncita,
– Piccita,
– Kuttita,
– Aprasrta,
– Atyudirna,
– Anteviddha,
– Parisuka,
– Kunita,
– Vepita,
– AnuthitaViddha,
– Sastrahata,
– Triyakviddha,
– Aviddha,
– Avyadhya,
– Vidruat,
– Dhenuka,
– Punahpunar viddha and
– Mamsa Siran Snayu- AsthiSandhi Marma viddha
तत्रयासूक्ष्मशस्त्रविद्धाऽव्यक्तमसृक्स्रवतिरुजाशोफवतीचसादुर्विद्धा, प्रमाणातिरिक्तविद्धायामन्तःप्रविशतिशोणितंशोणितातिप्रवृत्तिर्वासाऽतिविद्धा, कुण्ठश्स्त्रप्रमथिता पृथुलीभावमापन्ना पिच्चिता, अनासादितापुनःपुरन्तयोश्चबहुशःशस्त्राभिहताकुटिता, शीतभयमूर्च्छाभिरप्रवृत्तशोणिताअप्रस्रुता, तीक्ष्ण्महामुखशस्त्रविद्धाऽत्युदीर्णा, अल्परक्तस्राविण्यन्तेविद्धा, क्षीणशोणितस्यानिलपूर्णापरिशुष्का, चतुर्भागादादिताकिंचित्प्रवृत्तशोणिताकूणिता, दुःस्थानबन्धनाद्वेपमानायाः शोणितसंमोहोभवतिसावोपिता, अनुत्थिरविद्धायाम छीन्नातिप्रवृत्तशोणिताक्रियासङ्गकरीशस्रहता, तिर्यक्प्रणिहितशस्त्राकिंचिच्छेषातिर्यग्विद्धा, बहुशः क्षताहीनशस्त्रप्रणिधानेनाविद्धा, अशस्त्रकृत्याअव्यध्या, अनवस्थितविद्धा, विद्रुता, प्रदेशस्यबहुशोऽवघटनादारोहद्व्यधामुहुर्मुहुःशोणितस्त्रावाधेनुका, सूक्ष्मश्स्त्रव्यधनाद्वहुशो बिन्ना पुनःपुनर्विद्धा, स्नाय्वस्थिरासन्धिमर्मसुविद्धा, स्नाय्वस्थिसिरासन्धिमर्मसुविद्धारुजांशोफंवैकल्यंमरणंचापादयति॥२९॥
Durviddha–
It’s the puncture of the vein made by a minute sharp instrument.
Options –
– Invisible blood circulate
– Ache
– Swelling
Atividha–
Inn this sort, the measurement of the puncture executed on the vein is greater than what’s required.
Options –
– bleeding takes place contained in the physique i.e. blood circulate goes into the physique or
– the blood flows out in massive amount i.e. extreme bleeding takes place
Kuncita– is just like atividha.
Piccita–
It’s a puncture executed with a blunt instrument.
Options – the vein which has been crushed by such a blunt instrument attains extra breadth or thickness.
Kuttita–
This occurs on account of repeated puncture executed within the website of the vein whereby the vein just isn’t simply obtainable for puncture (repeated makes an attempt on an unclear vein).
Options – Harm of even the opposite veins within the neighborhood of the vein over which the puncture was tried.
Aprasrta–
On this situation, blood just isn’t set free from the vein which has been punctured. This occurs as a result of impact of coldness, worry or fainting.
Atyudirna–
On this kind, the puncture of the vein is made by a pointy and thick instrument.
Antebhihata–
In one of these puncturing, there’s scanty circulate of blood from the sira.
Parisuska–
It’s a situation in which there’s much less blood within the sira however it’s crammed with air.
Kunita–
It’s a situation which happens on account of a puncture executed on 1 / 4 portion of the vein.
Options – much less bleeding happens.
Vepita–
On this, the binding is made at an improper place.
Options – Blood doesn’t come out as a result of trembling of siras or on account of siravyadha executed with trembling arms of the surgeon.
AnuthitaViddha –
It presents with the identical signs as these of vepita defined above.
Sastrahata–
On this, there’s extreme slicing of the vein throughout the process.
Options – Copious circulate of blood and stoppage of capabilities of the vein and the associated physique half / components.
Tiryakviddha–
This occurs when the instrument used for siravyadha is pushed into the sira by its facet and likewise barely and as a consequence, the sira just isn’t reduce or punctured fully, because it ought to.
Apaviddha–
It’s a situation by which a number of wounds are brought about on account of insufficient utilization of the instrument (for puncturing the vein).
Avyadhya–
This situation happens when
– the puncture just isn’t executed by the instrument or
– when the siras that are unfit / contraindicated for puncturing are punctured by the instrument
Vidruta–
It’s punctured when the veins are unsteady (or when the doctor is unsteady in his thoughts).
Dhenuka –
It’s that situation by which the physique half is repeatedly hit with the aim of elevating the sira for siravyadha.
Options – repeated bleeding.
Punah Punar viddha–
On this, the sira is punctured a number of occasions due to the sharp instrument used for the process being small (minute).
Mamsa sira snayu asthi sandhi marma viddha – Puncture executed on the important spots positioned in / on muscle groups, veins, ligaments, bones, and joints offers rise to ache, swelling, deformity or demise.
Issues of Sira Vedha (vein puncture) and their treatments
सिरासुशिक्षितोनास्तिचला ह्येताः स्वभावतः॥
मत्स्यवत्परिवर्तन्तेतस्माद्यत्नेनताडयेत् ॥२०॥
अजानतागृहीतेतुशस्त्रेकायनिपातिते ॥
भवन्तिव्यापदश्चैताबहवश्चाप्युपद्रवाः ॥२१॥
स्नेहादिभिःक्रियायोगैर्नतथालेपनैरपि ॥
यान्त्याशुव्याधयःशान्तिंयथासम्यक्सिराव्यधात् ॥२२॥
सिराव्यधश्चिकित्सार्धंशल्यतन्त्रेप्रकीर्तितः ॥
यथाप्रणिहितःस्म्यग्बस्तिःकायचिकित्सिते ॥२३॥
Some verse right here:-
The sira must be punctured with nice efforts and ability as a result of –
– there isn’t any one who’s specifically or exactly educated in puncturing the sira and
– the sira is by nature slippery and it turns just like the fish
If the doctor / surgeon conducts instrumentation for puncturing the veins on the physique with out having full information of the process, he would undoubtedly give rise to many ailments and problems.
The ailments and problems that are produced on account of improper puncturing of siras don’t subside shortly by snehana and different therapies and likewise by exterior utility of medicaments and so forth. in contrast to these brought on by correct puncturing of siras.
Similar to vasti chikitsa i.e. enema remedy is taken into account as half remedy within the subject of Kaya-Chikitsa (inside or normal medication), Siravyadha – vein puncture or venesection is taken into account as half remedy in Salya-tantra (surgical college).
Varjya-avoidable
तत्र स्निग्धस्विन्नवान्तविरिक्तास्थापितानुवसितानुवसितसिराविद्धैः परिहर्तव्यानि क्रोधायासमैथुनदिवास्वप्नवाग्व्यायामयानाध्ययनस्थानासनचङ्क्रमणशीतवातातपविरुद्धासात्म्या जीर्णान्याबललाभात्, मासमेके, मन्यन्ते । एतेषां विस्तरमुपरिष्ठाद्वक्ष्यामः ॥२४॥
The individuals who’ve undergone therapies like snehana, swedana, vamana, virecana, asthapana vasti, anuvasana vasti and siravyadha ought to keep away from the beneath mentioned till they acquire power or for a interval of 1 month after these therapies (as per some authorities) –
– krodha – anger,
– ayasa – exertion,
– maithuna – copulation,
– divasvapna – day sleep,
– vak – talking loudly,
– vyayama – bodily workouts,
– yana – driving,
– adhyayana – research(in excessive pitch),
– sthana asana – sitting for very long time,
– chankramana – strolling an excessive amount of,
– shitavata – chilly breeze,
– atapa – daylight,
– viruddha, asatmya, ajirna ahara – meals that are incomputable and unaccustomed and likewise indigestion
Rakta Moksana Krama – strategies of blood
सिराविषाणतुम्बैस्तुजलौकाभिःपदैस्तथा॥
अवगाढं यथापूर्वंनिर्हरेद्दुष्टशोणितम् ॥२५॥
अवगाढेजलौकास्यात् प्रच्छन्नं पिण्डितेहितम् ॥
सिराऽङ्गव्यापकेरक्तेशृङ्गालाबूत्वचिस्थिते ॥२६॥
Beneath talked about are the completely different strategies of eradicating the vitiated blood from the physique. Raktamoksana – bloodletting or removing of vitiated blood ought to be executed utilizing one of many beneath talked about procedures –
– siravyadha – puncturing the vein, venipuncture, venesection,
– visana – sucking by a horn,
– tumbi – sucking by a pitcher gourd,
– jalauka – utility of leech or
– prachana – incising or scraping
Every previous one (reverse of given chronology) being mentioned to be the most effective methodology for deeper tissues (vitiated blood positioned within the deeper tissues).
When the vitiated blood is deep seated, jalauka (leeches) ought to be administered.
When the blood is clotted, pracchana i.e. incising / scraping the pores and skin is useful.
When the vitiated blood has unfold in your complete physique, siravyadha i.e. venesection is good.
When the vitiated blood is current solely within the pores and skin, visana / srnga or alabu i.e. horn or pitcher gourd shall be used to suck the vitiated blood and they are going to be useful.
इति श्रीसुश्रृतसंहितायांशारीरस्थानेसिराव्यधविधिशारिरं नामाष्टमोऽध्यायः ॥८॥
Thus ends the eighth chapter by title Siravyadha Vidhi in Sarira Sthana of Susruta Samhhita.
