Probing Surgical Questions 

Ayurvedic Answers

Prof. Rahul Sherkhane

Department of Shalya Tantra,
Faculty of Ayurveda Institute of
Medical Sciences
Banaras Hindu University

Ayurveda, the traditional Indian system of medicine is broadly divided into two major sects, the followers of Charaka Samhita are considered to be the exponents of Internal Medicine, whereas the branch following the tradition of Sushruta Samahita is proponents of surgical discipline. ‘Sushruta Samhita’ is realistic and systematic compilation of surgical practices that describes exquisite basic fundamental principles of surgery such as planning, precision, hemostasis, etc. along with basics of specialised surgery like plastic and reconstructive surgery, cosmetic surgery, trauma management, fracture management such as opposition, stabilisation, rehabilitation and prosthetics. Sushruta did not limit his teachings to principles and procedures only; he described every minute details of surgical instruments like designing, manufacturing and maintenance, He also emphasised on practice of surgical procedure on inanimate objects, watermelons, clay plots etc, in his monumental treatise. Splendid procedure of rhinoplasty is still practised today by contemporary plastic surgeons as per the description available in Indian system of medicine and that’s why Sushruta is rendered as ‘the Father of Plastic Surgery’.

In contrast to well-developed traditional surgical discipline, the conventional surgical practices were barbaric and techniques were rudimentary till the mid-nineteenth centuries. But over the past two centuries because of advances in science and technology, surgery is transformed from a risky art to a scientific discipline capable of treating many diseases and conditions. In due course of time surgery took a variety of forms and is often performed using minimally invasive techniques such as laparoscopy, endoscopy etc. These advancements have helped patients to recover earlier, hospitalization stays are less, outcomes are good, and complications are very few but in certain conditions like fistula in ano, haemorrhoids, chronic non healing ulcers etc are still challengeable for contemporary surgeons but these conditions can be addressed effectively by various parasurgical methods described by Sushruta. Therse unique and practical Parasurgical procedures are minimally invasive, easy to perform, economical and as effective as surgery, if selected appropriately and used judiciously.

Some unique features of Indian surgical science are as below

Surgery without Scalpel

Beauty of surgical discipline of Ayurveda is to avoid or minimise the need for surgical intervention. Sushruta advised unique and novel methods where surgery is absolutely or relatively contraindicated. These techniques are equally or more effective than surgical procedures and an excellent example of this is the use of ksharsutra in fistula in ano. In India contemporary surgeons have also accepted ksharsutra as treatment of choice for anal fistulae. Not only fistula in ano but ksharsutra has also potency to cure various anorectal disorders if used wisely. Leech therapy is another valuable therapy that is being used comprehensively in plastic and reconstructive surgery, Microvascular surgery, Chronic non healing wounds, inflammatory conditions, various dermatological conditions etc. Another unique non-invasive treatment modality is Agnikarma, in which, intended articles are heated and applied on affected area for treatment to disseminate heat directly into the body tissue to treat diseases. The method is most commonly used for chronic painful muskulo-skeletal conditions, frozen shoulder, sciatica, heel pain etc.

Wound Healing with Herbs:
Chronic wounds are major healthcare concern and it is noteworthy that the five-year mortality rate for patients of chronic wounds is significantly higher than that for patients with colorectal, breast, and prostate cancers. Managing chronic wounds is a daunting task and currently anti-microbial agents, healing promoters, gauze, films, hydrocolloids, hydrogels, foams, alginates, hydrofibers, tissue engineered skin substitutes are available for wound management. However, there is no efficient evidence-based therapy available for specific chronic wounds.
Ayurveda has unique concepts and approaches to address the various types of wounds. Numerous herbal drugs are being used since antiquity which have remarkable recovery rate in wounds. Number of phytochemicals derived from medicinal plants have been proved scientifically for their potent and promising therapeutics wound healing effect based on the variety of the active and effective components such as flavonoids, essential oils, alkaloids, phenolic compounds, terpenoids, fatty acids, and so on. These traditional medicines can be explored over modern therapy due to the low cost, limited adverse effects, better bioavailability and efficacy.

Surgical Conservatism
Sushruta has advised surgical intervention only in situation when there is failure of medical management. Abundant number of single herbs and formulations are described in Sushuta Samhita that are useful for management various surgical diseases for treatment and prevention of recurrence of diseases. Efficacy of these formulations and single herbs have been proved clinically and in experimental models, eg Varun and Pashanbeda are being used for treatment and prevention of urolithiasis, Amalaki proved useful for prevention of acute pancreatitis in animal models. These are many such grey area where Ayurveda can contribute a lot. Another surgical disorders like ulcerative colitis, Crohn’s disease where medical and surgical management are not specific, Ayurvedic therapies are found to be effective and further research in this area may open new panoramas.

Surgery without antibiotics
In Recent research, it is proved that major surgery can be possible without antibiotics, Yadav and his colleagues (Yadav S, et al) successfully performed major surgery with the help of perioperative Ayurvedic medicines. So during this era of antibiotic resistance Ayurveda may prove new ray of hope.

Botanicals as Therapeutic Adjuvants
In India 24% to 39% cancer patients uses AYUSH therapies in one or another way. Several conventional oncology hospitals have established integrative oncology centre to integrate relevant treatments for improving quality of life in patients with cancer. Many preclinical studies established anticancer properties of herbs and formulations, Some of the Ayurvedic formulations also have chemopreventive, antimetastatic, antiproliferative, chemosensitizing, and radiosensitizing activities. Certain clinical studies in cancer patients showed that the adjuvant Ayurvedic formulation could reduce adverse events such as vomiting, mucositis, alopecia etc at some extent. Botanicals from Ayurveda such as Azadirachta indica, Carica papaya, Plumbago zeylanica, Ocimum sanctum, Tinospora cordifolia and Catharanthus roseus etc has proven potent anti-cancer activity.