Ashtangasamgraha 34

English (machine translation) 34

Language: English

34.1

Now we shall expound the chapter named 'The Procedure for Blunt Instruments and Sharp Instruments' (Yantraśastravidhi). / Thus indeed spoke Ātreya and the other great sages. / Thus indeed spoke Ātreya and the other great sages.

34.2

Foreign bodies (śalya) cause affliction to the mind and the body. / Instruments (yantra) are the means for extracting those manifold foreign bodies lodged in various locations, for applying sharp instruments, alkali, and thermal cautery in hemorrhoids, fistula-in-ano, and the like, and for protecting the remaining parts of the body; / likewise, in administering enemas and so forth, there are horns, gourds, cupping glasses, and the like, as well as jāmbavauṣṭha and other tools. / There are also others of manifold forms and manifold functions, implements for healthy and sick persons. / Therefore, because of their actions, it is impossible to determine their precise number. / That rounded, raised swelling is remembered as a granthi (cyst) because of its knotting.

34.3

Others, however, state that there are one hundred and one blunt instruments. / Here, however, they are taught in summary as sixfold: / that is to say, cross-pincers (svastika), gripping forceps (sandaṃśa), pick-forceps (tāla), tubular instruments (nāḍī), probes (śalākā), and accessory instruments (anuyantra). / Among these, that arising from vāta is accompanied by extension, pricking, and splitting pain, and is black.

34.4

Among them, cross-pincers (svastika-yantras) have diverse ferocious animal mouths such as those of the heron, lion, vulture, and osprey; their names correspond to their shapes; they are generally made of iron and are eighteen finger-breadths long. / They are fastened at the neck with pins having ends shaped like a lentil seed, have their handles curved like an elephant goad at the base, and are intended for extracting foreign bodies lodged in bone. / Among them, those with the mouths of a lion, tiger, serpent, crocodile, and the like should be used when the handles of the foreign bodies are visible; / in other cases, however, as appropriate according to the shape of the wound, those with the mouths of a heron, crow, osprey, and the like [should be used]. / Soft like an inflated bladder, when ruptured it discharges clear blood.

34.5

Gripping forceps (sandaṃśas) are of two kinds, with a catch and without a catch, each sixteen finger-breadths long. / Those two are prescribed for extracting foreign bodies situated in the skin, flesh, veins, and ligaments. / Likewise, another gripping forcep is six finger-breadths long, half a finger-breadth wide, with two curved arms, shaped like the meeting of the thumb and fingertip, [used] for extracting minute foreign bodies, eyelashes, and proud flesh of wounds. / When ruptured, it discharges hot blood; that from śleṣman is painless, dense, / cold, of the same color [as the skin], itchy, and when ripe discharges thick pus.

34.6

And likewise is the mucuṭī (tweezers). / It, however, has fine teeth, two straight arms, is bound at the base with a ring, and by pressing the ring is [used] for extracting the remainder of an excised pterygium and proud flesh from deep wounds. / And lodging in the veins and flesh, accompanied by numbness, it has the signs of pitta.

34.7

The pick-forceps (tāla-yantras) are also two, twelve finger-breadths long, shaped like a fish's palate, single-scooped and double-scooped, intended for extracting foreign bodies from the ear and tubular sinuses. / Unctuous, large, hard, wrapped with veins, having the form of kapha.

34.8

Tubular instruments (nāḍī-yantras) are hollow, of manifold types, of manifold uses, and have an opening on both ends or an opening on one end. / They are for viewing a foreign body situated in a channel, for extracting it, for facilitating an operation, and for suction. / One should make them with a circumference corresponding to the orifice of the channel and of a length suited to the application. / By means of vāyu, it produces a granthi that is extremely unctuous, soft, and mobile.

34.9

For viewing a foreign body in the throat, one should make a tube ten finger-breadths long and five finger-breadths in circumference; but for grasping a handle with two ears, a tube with three perforations at the mouth according to that measure; / likewise, for one with four ears, one with five perforations at the mouth; / but a foreign-body remover (śalyanirghātinī) [should have] a head shaped like a lotus seed-vessel, be twelve finger-breadths long, and have a hollow bore of three finger-breadths. / That [cyst], when ruptured, discharges thick, copper-colored, black, or white fat.

34.10

The hemorrhoid speculum is of three kinds: / Made of copper, iron, gold, ivory, horn, or wood, cow-teat-shaped, four fingers long, one [being] the length of the palm; five fingers in circumference for men, six fingers for women. / [One is] two-slit for inspection, [and one is] one-slit for operative procedure; / for thus inspection is easy, and there is no overstepping by the knife, alkali, or cautery. / But the slit is three fingers long and of the breadth of the belly of the thumb. / In the remaining finger [of length], there is an elevated, rolled-back rim, half a finger [in height] below and half a finger above. / The third is indeed identical, named śamyā, devoid of a side-slit, for the purpose of compression. / In fistula-in-ano, however, one should make it by removing the lip above the slit. / And like that is the speculum for nasal hemorrhoids and tumors: tube-shaped, two fingers long, single-slit, and of the circumference of the forefinger. // That bone-knot [occurs] in an infantry soldier from plunging suddenly into water.

34.11

Likewise, a finger-guard, into which a finger is inserted, having somewhat thick, rounded lips, with upper and lower openings, cow-teat-shaped, four fingers [long], made of ivory, horn, or wood. / Fastened with a strong thread to the wrist, it should be employed in draining the mouth. // Vāta, having compressed, constricted, bent, and dried up [the veins], / produces a non-pulsating, painless knot; that is called sirā-knot [varix].

34.12

In inspecting vaginal ulcers, the instrument is sixteen fingers [long], / tubular in the middle, four-walled, having four rods, tied above with a sliding ring, with an orifice like a lotus-bud, and dilating upwards by manipulating the rods at the base. / The two instruments for cleansing and smearing sinus ulcers are six fingers long, shaped like an enema tube, without ears at the mouth, with channels accommodating a thumb at the base and a pea at the mouth. / In abdominal dropsy, one should apply a tube open at both ends, or a quill tube. / In oily enema, urethral or vaginal douche, insufflation, fumigation, urine-enlargement [catheterization], stricture of the prepuce, and so on, instruments have been stated each in their respective places. // Or on a wet limb, or one devoid of bandage, or one struck by a stone.

34.13

The horn is short, medium, or long—eighteen or twelve fingers in length—with an inlet-mouth of three fingers, an aperture the size of a mustard seed at the tip, wrapped with thin leather, and with an orifice shaped like a nipple. / That is for sucking vāta, poison, blood, fluid, and vitiated breast milk. / But the gourd is for sucking kapha and blood. / It is twelve fingers long, eighteen fingers in circumference, with a circular, raised mouth of three or four fingers, and it should be used with a burning wick of kuśa, balvaja grass, or cotton inside. / And in the same way, the pot, by measure and procedure; / but it is for elevating and dissolving abdominal swellings. // It causes burning and itching; this is remembered as an ulcerous knot.

34.14

The rod-instruments also have various shapes and various purposes, and their lengths and circumferences correspond to the requirement. / Among them, two with mouths like earthworms are for the work of probing. / Two of eight and nine fingers, with mouths like lentil halves, are for extracting foreign bodies situated in channels. / There are six cones: / among them, two of twelve and sixteen fingers, with mouths like snake-hoods, are for the action of separation; / likewise, two of ten and twelve fingers, with arrow-notch-shaped mouths, are for shifting; / two with fish-hook-shaped mouths are for extracting. / Likewise, a fetal hook, resembling a cone, eighteen fingers [long], with a bent tip, is for extracting an impacted fetus. / Likewise, [a hook] with a curved tip like a serpent's hood, named after that, is for extracting urinary calculi. / Likewise, a tooth-extractor is four fingers [long], with an arrow-notch-shaped mouth and thick, rounded edges. // And those situated in vulnerable spots, throat, and abdomen, but a large knotted tumor [arbuda].

34.15

There are six cotton-tipped rods for the operations of wiping away moisture and alkali from various ulcers. / Among them, two of six and seven fingers are applicable for far and near nasal ulcers; / two of ten and twelve fingers are for the anus. / The ear-cleaner has a ladle-shaped mouth, [shaped like] the tip of an aśvattha leaf. / Likewise, for the work of alkali and cautery, there are jambu-lip [rods] of twelve and eight fingers, with tips measuring two fingers, one finger, and half a finger respectively. // Generally, owing to an abundance of fat and kapha, and due to firmness, it does not suppurate.

34.16

And the rods are thick, slender, long, short, and medium. / But in inguinal hernia, rods curved like a crescent moon, projecting upwards from the middle [are used]. / For cauterizing nasal hemorrhoids and tumors, [there is a rod] with a mouth the size of half a jujube stone, with curved lips. / And for applying alkali, poison, and medicines, there are three ladles eight fingers long, ladle-shaped, with cupped mouths measuring the size of the nails of the little finger, ring finger, and middle finger respectively, and shaped like cupped palms. / In urethral or vaginal douche, collyrium, and so forth, [rods] have been taught each in their respective places. // And one should cause it to ripen when it is distended, with discharge, and gathered into a fleshy mass.

34.17

The accessory instruments are: lodestone, rope, leather, intestine, cloth, stone, hammer, palms of the hands and soles of the feet, fingers, tongue, teeth, mouth, branches, nails, hair, horse's bridle, time, digestion, joy, and fear. // Constantly [flowing] corrupted blood, abundant—that is blood-tumor [soṇitarbuda].

34.18

These should be applied appropriately to the whole body, or to a part of the body, / to a joint, to the visceral cavity, and to an artery.

34.19

The actions of instruments are: extracting, filling, bandaging, separating, turning, shifting, opening, compressing, cleansing channels, pulling out, drawing forth, piercing, elevating, depressing, breaking, churning, sucking, probing, splitting, straightening, washing, blowing, applying collyrium, and wiping—these are generally twenty-four in number. // The doṣas situated in the flesh and blood, having resorted to the feet over time, / slowly produce a solid swelling; they call that elephantiasis.

34.20

Because it rotates well, penetrates deeply, grasps what is to be grasped and extracts it, / therefore among instruments the heron-beaked [forceps] is foremost, and because it has authority over all locations. // And rough from vāta; but from pitta, yellow, accompanied by burning sensation and fever.

34.21

The sharp instruments (śastra), however, are twenty-six.

They are: the tooth-scraper (dantalekhana), the round-headed knife (maṇḍalāgra), the vṛddhipatra, the lotus-leaf instrument (utpalapatra), the adhyardhadhāra, the ring-knife (mudrikā), the scissors (kartarī), the serpent-mouth knife (sarpavaktra), the saw (karapatra), the kuśa-leaf knife (kuśapatra), the āṭīmukha, the antarmukha, the scissors-bill knife (śarārīmukha), the trikūrca, the axe-headed trocar (kuṭhārikā), the rice-grain lancet (vrīhimukha), the probe (śalākā), the cane-leaf knife (vetasapatra), the awl (ārā), the ear-piercer (karṇavyadhana), the needle (sūcī), the needle-brush (sūcīkūrca), the churning probe (khaja), the director (eṣiṇī), the hook (baḍiśa), and the nail-instrument (nakhaśastra).

And for the most part they are six fingers long, forged from well-blown and tempered iron, blue as a blue-lotus petal, easy to hold, well-proportioned, well-edged, with carefully shaped tips, and not rough or misshapen; and each is usually of two or three [varieties], their blades being a quarter or a half of their own measure.

One should employ them according to the disease and bodily region.

Their forms, like those of the blunt instruments (yantra), are mostly explained by their very names.

34.22

Among them, the first three are for scraping (lekhana);

the three beginning with the vṛddhipatra are for slitting open (pāṭana);

four are for incising (bhedana);

the eight beginning with the maṇḍalāgra are for excising (chedana);

the five beginning with the kuśapatra are for scarifying (pracchāna);

the six beginning with the kuṭhārikā are for puncturing (vyadhana);

among these, the awl (ārā) and the vrīhimukha are also for incising and excising;

needles are for suturing (sīvana);

the needle-brush is for pricking (kuṭṭana);

the churning probe is for churning (mathana);

the director is for probing (eṣaṇa) and incising;

the hook is for grasping (grahaṇa);

the nail-instrument is for extraction (uddharaṇa),

and also for excising, incising, scraping, and scarifying.

Thus is their application in the twelvefold surgical operation.

34.23

In particular, the tooth-scraper, having a good grip, being four-sided, and single-edged, is for scraping tartar from the teeth.

The maṇḍalāgra, whose blade is as wide as the fingernail of the index finger, is to be employed for scraping and excising in eye-lid diseases, hypertrophied gum flesh, ill-positioned ulcers, uvulitis, and the like.

And elephantiasis (ślīpada) arises in marshy areas, especially from wandering [there].

34.24

The vṛddhipatra has the shape of a razor; in an elevated or deep swelling, one with a straight, needle-like tip is preferred;

but in the opposite case, one with an edge curved downward toward the back [is preferred].

[Swelling that is] of the same color [as the skin], hard, glossy, and shaped like an eggplant or myrobalan—

34.25

The finger-knife (aṅguliśastra), with its blade emerging from a ring, having a blade half a finger long similar to either the vṛddhipatra, the maṇḍalāgra, or the adhyardhadhāra, with a circular ring sized to fit the first joint of the index finger, and tied with a strong thread, is employed in throat disorders.

Some suppurate with little pain; others discharge and itch intensely;

others vanish, while others arise, persisting for a long time.

34.26

The scissors (kartarī) has loops on a third part [of its length] and is meant for cutting wounds, ligaments, hairs, and threads.

The serpent-mouth knife (sarpavaktra) is curved, with a blade of half a finger, and is meant for excising polyps and tumors of the nose and ears.

The saw (karapatra) is ten fingers long, two fingers wide, finely toothed, rough-edged, and fitted with a good handle; it is meant for sawing bone.

The kuśapatra and āṭīmukha have blades of two fingers.

The antarmukha is shaped like a crescent moon, with a blade of an adhyardha (one and a half) finger.

One should abandon [a patient] who has fever, vomiting, flank pain, cough, and coryza.

34.27

The kuṭhārikā has a broad handle, is shaped like a cow’s tooth, has a blade of half a finger, and is meant for puncturing veins situated over bone.

The vrīhimukha has a blade of an adhyardha (one and a half) finger and is meant for puncturing veins in fleshy regions, and for puncturing and incising scrotal enlargement, abdominal swelling (gulma), abscesses, and the like.

The probe (śalākā) has two ends, has tips shaped like the bud of a kurabaka flower, is made of copper, and is meant for puncturing cataracts (liṅganāśa).

Entering deep into the flesh and other [tissues], pus courses far ahead.

34.28

The awl (ārā) is four-sided, with a rounded point of half a finger that penetrates to that depth, and is meant for piercing the thick earlobe and for incising when there is doubt whether a swelling is ripe or unripe.

The ear-piercer (karṇavyadhana) is three fingers long, with a hollow of one finger, thick, and has a tip shaped like a jasmine bud.

One fistula (nāḍī) is straight; in others, that same tract takes multiple courses.

34.29

The needles (sūcī) are three, circular, and have deeply recessed, strong eyes.

Among them, in fleshy spaces, [the needle] is three fingers long and three-sided;

in ulcers of the joints, bones, and regions of little flesh, it is two fingers long and circular; and in the case of the large and small intestines and vital spots (marman), it is two and a half fingers long, curved like a bow, and has a tip like a grain of rice.

34.30

The needle-brush (sūcīkūrca) has a single round base with seven or eight needles well bound at the front; [it is used] in leprosy (kuṣṭha), vitiligo, facial blemishes, alopecia, numbness, and the like.

The churning probe (khaja), with eight barb-like points half a finger long at its end, made of copper or iron, is meant for extracting blood within the nose.

The directors (eṣaṇī) are two, very smooth to the touch; of the two, one is eight fingers long, for probing the hollows in ulcers that have sinus tracks, slough, foreign bodies, and discharge;

the other is needle-shaped and tied with an alkali-smeared thread, for splitting sinuses (nāḍī) and fistula-in-ano tracts.

The hook (baḍiśa) has an extremely curved beak with a tip sharp as a needle, for grasping the uvula, pterygium, and the like.

The nail-instrument (nakhaśastra) is eight fingers long, shaped like a horse's ear at one end and like a calf's tooth at the other, for extracting minute foreign bodies.

It discharges excessively at night, causes thirst, fever, and burning from pitta,

and during the day it flows copiously, discharging yellow, hot, and foul-smelling pus.

34.31

The minor instruments (aṇuśastra), however, are leeches, alkali, fire, sun-stone, glass, rock crystal, ruby, nails, rough leaves of the teak, night-flowering jasmine, and the like, cuttlefish bone, dry cow-dung, and so on.

One should also devise and prepare various blunt and sharp instruments and their operations by means of one's own intellect.

And the hand alone is the foremost of all here, because blunt and sharp instruments are subordinate to it.

At night, when discharge increases, one should abandon an all-inclusive form [of sinus fistula] caused by all [doṣas].

34.32

In this context, being too long, too short, too thick, too thin, crooked, uneven, having loose hold on what is to be grasped—these are the eight defects of blunt instruments.

Here, the first five, along with being blunt, notched, and rough-edged, are the eight defects of sharp instruments,

except in the case of the saw.

It constantly discharges thin, scanty, hot pus mixed with froth, accompanied by blood and pain.

34.33

Among them, an instrument tempered with alkali should be employed in cutting arrow-like foreign bodies and bones; one tempered with water, in cutting flesh;

and one tempered with oil, in slitting, incising, vein-puncturing, and ligament-cutting.

34.34

Furthermore, the blade edge for excising should be [thick as] a lentil; for scraping, half a lentil;

and for puncturing and draining, [as fine as] a hair.

34.35

Among them, [the physician] should, with great concentration, hold [instruments for] excision, incision, and scraping at the junction of the handle with the index finger, middle finger, and thumb; / [instruments for] draining by the index finger and thumb at the tip of the handle; / the barley-point knife at its mouth, with the tip of its handle concealed in the palm of the hand; / those intended for extraction at their base; / a small forceps and scissors above the loop and in the middle; / and the remaining ones as appropriate, according to the convenience of the operation.

34.36

Their whetstone is a very smooth stone possessing the luster of black gram or mung bean; / and the sheath for preserving the blade is a board of silk-cotton wood.

34.37

Even one who has mastered the treatises, if he has not performed practical training or has not witnessed the procedure very often, should not embark upon surgical operations, / because the body is pervaded by vessels, tendons, vital points, and so forth. / Therefore, he should perform practical training in extraction and other [procedures] as appropriate on hairy skin, flowers, fruits, gourds, cucumbers, water-filled bladders, mud-filled bladders, urinary bladders, hydrocele masses, muscular flesh, lotus stalks, and the like; / likewise, practical training in squeezing the enema bag on a channel in the side of a pot with a nozzle filled with water; practical training in applying cautery and caustics on soft pieces of meat; / practical training in bandaging on the limbs and minor parts of a puppet figure; / and furthermore:

34.38

A physician wishing to become skilled in practice should take an intact human corpse, not killed by poison, not suffering from a chronic disease, whose entrails have been extracted and inspected, wrap it in muñja grass and balbaja grass, place it inside a cage, and let it decompose in an unexposed place in a flowing river; / then, having removed it when thoroughly decomposed, having stretched out the body, he should gently scrape away [the layers] with any of [a brush made of] vetiver, bamboo whiskers, or the like, and examine with his own eyes, following the tradition taught by his preceptor, all the external and internal parts, beginning with the skin, limbs, vessels, and tendons.

Commentaries (1)

Śaśilekhā — Indu, Sanskrit

Linked texts (1)

Aṣṭāṅgasaṃgraha — Vāgbhaṭa, Sanskrit