An English Translation of the Sushruta Samhita (Bhishagratna ed.)

duly fomented i^Sveda) atid anointed (Sneha) with oily preparations. A liquid* food or diet consisting of articles which are antidotal to the bodily principles (Doshas) which engendered the disease or Yavagu (gruel) should be given to him at first. Then at the proper season (i.e., not in the rainy or winter season etc.) the patient should be brought near the surgeon and made to sit or lie down and the part to be incised upon should be bound, neither too loosely {e.g., in the extremities etc.) nor too tightly (^.^.,in the head etc.), with any of the accessories, such as cloth, linen, skin, the inner fibres of a bark, creepers etc., so as not to create any pain or agitation in his mind. Then the vein should be duly opened with proper instru- ment (and with a careful regard to the situation of any local Marma). 5

IVletrical text : —Venesection should not be
performed in an extremely cold or hot, cloudy or windy
day. It is forbidden to open a vein without necessity
or in a healthy person, or in a disease in which such as a
proceeding is absolutely prohibited. 6.

The Yantra-Vidhi :— The patient whose
vein is to be operated upon should be seated on a stool
to the height of an Aratni (distance of the elbow from
the tip of the small finger) with his face turned towards
the sun. He should keep his legs in a drawn up or
contracted posture resting his elbows (Kurpara) on his
knee-joints and the hands with his two thumbs closed
in his fists placed on (the upper ends of; his Manyas
(sterno mastoid muscles), Then having cast the binding

* A liquid food is recommended for the purpose of liquefying the blood so as to bleed easily. . . -

200 THE SUSHRUTA SAMHITA. [Chap. VIII.

linen on the two closed fists thus placed on the neck, the surgeon should ask another man from the back side of the patient to take hold of the two ends of the cloth with his left hand having the palm turned upward, and then ask him to tie up with his right hand the bandage round the part, neither too diffusely nor too tightly nor too loosely, so as to raise the vein and to press the bandage round the back for a good out-flow of blood. Then he (surgeon) should perform the operation in the desired spot, the patient having been previously asked to sit with his mouth full of air {i.e., he should confine his breathing till the surgical operation is com- pleted). This proceeding should be adopted in opening any vein of the head, save those which are situated in the cavity of the mouth . 7.

In the case of opening a vein (Sird) in the leg, the
affected leg should be placed on a level ground, while
the other leg should be held in a somewhat contracted
posture, at a little higher place. The affected leg should
be bound with a piece of linen below its knee-joint
and pressed with the hands down to the ankle. A liga-
ture of the above kind should then be tied four fingers
above the region to be incised upon, after which the
vein should be opened. 8.

In the case of opening a vein (Sira) in the arms,
the patient should be caused to sit easily and fixedly
with his two thumbs closed in his fists (as above).
A ligature ol the above-mentioned kind (rope etc.,)
should be tied (four fingers above the part to be incised
upon and the vein opened in the aforesaid manner.
The knee-joint and the elbow should be held in a
contracted or drawn up posture at the time of opening
a vein in a case of Gridhrasi (Sciatica^ and Vis'vachi,
respectively. The patient should hold his back raised

Chap. Vlli.] SARTRA STIIANAM. 201

up and expanded and his h^ad (and shoulders) bent down
at the time of opening a vein in the back, shoulders and
the Sroni (hips). He should hold his head thrust back
and his chest and body expanded at the time of open-
ing a vein in the chest or in the abdomen. 9-12.

He shall embrace his own body with his arms at the time of opening a vein in his sides. The penis should be drawn downward (2>., in an flaccid state) on a similar occasion in that region. The tongue should be raised up to the roof of the mouth and its fore-part supported by the teeth at the time of opening a vein in its under-surface. The patient should be told to keep his mouth fully open at the tim^ of opening a vein in the gums or in the palate. Similarly a Surgeon should devise proper and adequate means for the purpose of raising up (distinct appearance of) a Sira (vein) and determine the nature of the bandao'e to be used therein accordinor to the exigencies {i.e., the health and the kind of diseases of the patient), of each case. 1 3-17.

An incision to the depth of a barley-corn should be
made with a Vrihimukha instrument (Into a vein
situated) in the muscular parts of the body, whereas the
instrument should b3 thrust oily half that depth or to
the depth of a Vriki seed in other places (Vrihi here
signifies S'likadkdnya as well as Rakta-s':ali\ An inci-
sion over a bone should be made with the Kutharikd
(small surgical axe) to the half depth of a barley-
corn. 18-19.

IVIemorable Verses :— An opening should

be effected in such a day in the rainy season as would
be devoid of the rumblings of a thunder-cloud, during
the cold (2>., in the fourth) part of the day in summer,
and at noon in the winter season (Hemanta). These
are the only three times of opening a vein. A well

202 TiiE SIJSHRUTA SAMHITA. [Chap. VIII.

and successfully pierced vein bleeds in streams (almost simultaneously with the thrusting of the knife) and spontaneously stops after a Muhurta (a little while). The vitiated blood is seen first to flow out of an opened vein, like the drop of yellow pigment first coming out of a Kusumhha flower. Blood does not flow out from an in- cision made into a vein of an unconscious (Murchchhita), much frightened, or a thirsty patient. An incision of a vein without proper bandaging and raising up is attend- ed with a similar result. 20-23.

A weak person, or one afi"ected with the unusual derangement of the bodily Doshas etc., or one fainted (under operation), should not be subjected to a measure of continuous blood-letting at a time ; instead of that, the vein should be opened afresh in the same afternoon or on the following day, or on the third day (as the exi- gency requires). An intelligent surgeon should not allow the flow of blood to an excess but should stop the flow even with a remnant of the diseased blood in the system and administer soothing internal remedies (Samsamana) for the purification of the diseased rem- nant. Bleeding to the quantity of a Prastha* measure should be deemed sufficient for a strong and adult patient, stuffed with a large quantity of the deranged Doshas (in the body). 24-26.

The vein should be incised with a Vrihimukha instru-
ment at a distance of two fingers above the seat
of the Kshipra-marma in such diseases as Padadaha,
Pada-harsha, Ava-vahuka, Chippa, Visarpa, Vata-rakta,
Vdta-kantaka, Vicharchika, Padadari etc. The mode
of opening a vein in the case of Slipada (Elephantiasis)

* In medicinal preparalions, a Praslha measure is understood to be four seers in the case of liquids, but in Cises of excreta due to emetic and purgative measures and of blood-lettiDg, a Prastha m meant to be thirteen Palas and a half only.

[Chap. VIII, SARIRA STHANAM,

would b2 described under the treatment of that disease. In Vata-rogas, such as Kroshtuka-s'irah (Synovites), maimedness (Pangu) and lameness (Khanja\ the Siia (vein) of the Jangha (lower leg-calf), four fingers above the Gulpha, should be opened. In cases of Apachi (scrofula), the vein should be opened simultaneously with the appearance of the disease two fingers below the Indravasti-marma. In a case of Gridhrasi (sciatica), the vein should be opened four fingers above or below the Jdnu (knee-joint). In a case of goitre, the veins attached to the roots of the Uru (thighs) should be opened. The instructions regarding the opening of a vein in one leg shall hold good in the case of that in the other, as well as in cases of those situated in the two upper extremities (hands), but the speciality is that in a case of enlarged spleen, the vein near the Kurpara- sandhi (elbow-joint) of the left hand or that inside the fourth and the fifth fingers should be opened. Similarly in a case of Yakriddalyodara or Kaphodara, the corres- ponding vein in the right hand should be opened. Several authorities advise the opening of the same vein in cases of cough and asthma* due to the action of the deranged Kapha. 27-35.

In a case of Vis'vachi, the same argument holds good
(four fingers above or below the Kurpara-sandhi) as in
a case of Gridhrasi. In a case of Pravdhikd (diarrhoea)
attended with Sula (colic), the vein within two fingers
width around of the Pelvis (Sroni) should be opened.
The vein of the penis should be opened in a case of
Parikartikd (D.R.-ParivartikA), Upadansa, Suka-dosha
and seminal disorders. The vein on either side of

* Gayi holds that in cases of asthma and cough venesection should be had recourse to only when they are in a mild form.

204 THE SUSHRUTA SAMHITA. Chap. VIII.]

the scrotum should be opened in a case of hydrocele (Mutra-Vriddhi). 36-39.

The veui four fingers below the navel and on the left side of the Sevani (suture) should be opened in a case of Dakodara (ascites). In a case of internal abscess and colic in the sides (Pleurodynia), the vein in the region between the breast and the left armpit should be opened. Several authorities assert that in a case of Avavahuka and Vahusosha (atrophy of the hand), the vein between the Amsas (shoulders) should be opened. In a case of Tritiyaka (Tertian) fever^ the vein inside the Trika-Sandhi should be opened. In a case of Chaturthaka fever, a vein jo hied with either side of and below the shoulder-joint should be opened. In a case of Apasmara, the middle vein adjacent to the joint of the jaw-bones (Hanu-Sandhi) should be opened. In a case of insanity and hysteria* (Apasmara), the vein between the temple and the edge of the sculp or those in the Apanga (tips of the eyes), the forehead or the chest should be opened. In cases of the diseases of the tongue and the teeth, the veins on the under-surface (Adho-Jihva) of the tongue should be opened. In the case of a disease of the palate, the local vein should be opened. In diseases of the ears and specially in a case of inflammatory ear-ache (Karna-Sula), the vein along the region above the ears should be opened. In diseases of the nose and specially in a case of the loss of the smelling faculty, the vein at the tip of the nose should be opened. In cases of eye-diseases, such as

* Dallana, however, differs here from the text. He says, on the authority of Vagbhata, that the opening of a vein between the temple and the edgt of the sculp or those in the Apanga, the forehead and the chest should te recommended in cases of insanity only, and not in the case of of .^pas^mdra as well (as in the text).

Chap. VIII.] SARIRA STHANAxM. 205

Timira (blindness), Akshipdka (ophthalmia) etc., as well
as In diseases of the head and in Adhimantha, the veins
about the nose, the forehead and the Apdnga (the
outer canthus of the eyes), should be opened. 40-51.

Defective Venesection :— Now we shall

describe the twenty kinds of defects relating to an
opened vein (Dushta-vyadhana;. They are as follows : —
Durviddha, Atividdha, Kunchita, Pichchita, Kuttita,
Aprasrutd, AtyudirnA, Ante-abhihata, Parisushka,
Kunita, Vepita, Anutthita-viddhd, Sastrahata, Tiryag-
viddhd, Apavlddlia, Avy^dhyd, Vidrutd, Dhenukd,
Punhpunarviddha and Marmaviddha, i.e., incised about
the Sira-marma, the Sn^yu-marma, the Asthi-marma
and the Sandhi-marma. 52-53.