Instruments in ancient time(Yantra & Shastra)

Any foreign or extraneous substances which find a lodgement in human system & become painful to the body & mind alike, is called a shalya

Yantra are blunt instruments used for removal of foreign bodies

Shastra are sharp instrument used for operative procedures like-incision, excision etc.

No. of surgical instruments – 101 In all instruments hand is the most

important because none of them can be handled without it

All of them depend on hand for their principal auxiliary

All surgical procedures pre eminently require its co operation

How to make instruments

Should be made of iron or any other suitable material if iron not available

The mouths of these instruments should resemble mouths of birds & beasts

Uses of yantra

Shalya anveshan / Rog darshan – locating the foreign body or examination of diseases

Shalya aharan – extraction of foreign body

Shastra, kshar & agni yojanam – to facilitate shastrakarma, agnikarma & ksharkarma

To perform panchkarma like basti etc

Ideal instrument

Instruments should be made neither too large nor too small

Their mouths/ edges should be made sharp & keen

Should be made with special eye as to strength & steadiness

Should be provided with convenient handles

Types of yantra

Swastik yantra – 24 Sandansh yantra – 2 Tala yantra – 2 Nadi yantra – 20 Shalaka yantra – 28 Upayantra - 25

Swastik yantra - 24 Swastik yantra should be made to

measure eighteen fingers in length Their mouth should resemble those

of lions, tigers, wolves, bears, cats, deers etc like that of beast & birds

Two blades of swastik should be welded together by means of a bolt

Handle should be turned inward in shape of mace/ankush

Used in extracting shalya from bones

Names of swastik yantra

1. Sinha mukha2. Vyaghra mukha3. Vruk mukha4. Taraksh mukha5. Ruksh mukha6. Dwipi mukha7. Marjar mukha8. Shrugal mukha9. Mrugairvaruk mukha10. Kanka mukha11. Kurar mukha12. Chas mukha

13. Bhas mukha14. Shashaghati mukha15. Uluk mukh16. Chilli mukha17. Shyen mukha18. Grudhra mukha19. Kraunch mukha20. Bhringraj mukha21. Anjali mukha22. Karnavabhanjan

mukha23. Nandi mukha24. Kaak mukha

Sandamsh yantra - 2

Should be made to measure 16 fingers in length

Should be used to withdraw shalya from below skin, flesh, veins or nerves

Two classes – sanigraha i.e. soldered together with bolt & anigraha i.e. soldered together without bolt

Tala yantra - 2

Measures 12 fingers in length Two classes – single tala & double

tala Former resembles the scale of fish in

shape while latter resembles entire mouth of fish of Bhetuli species

Used for extracting splinters from inside the nose, ears & other external channels of body

Nadi yantra - 20 Tubular instruments like syringe with

passage running through their entire length

Constructed in various shapes depending upon purpose

Length & circumference of a nadi yantra should be made to commensurate with those of the passage (strotas) into which it is intended to be introduced

Some of them are opened at one end while others at both

Uses of nadi yantra

To remove foreign bodies from systems (strotas)

For diagnosis of diseases For aspiration, suction etc To perform procedures of

Panchkarma easily

Types of nadi yantra

Arsho yantra – 2 Bhagandar yantra -2 Vrana basti yantra – 2 Basti yantra – 4 Uttar basti yantra – 2 Mutra vriddhi visravana

yantra

Dakodara sravan yantra Dhum yantra Niruddha prakash yantra Sannirudh guda yantra Allabu yantra Nadi swedan yantra

According to vagbhata

Kantha avaloknartha nadi yantra

Ghati yantra Anguli tranak yantra Yoni vranekshan yantra Shalya nirghatini nadi yantra

Shalaka yantra - 28

Gandupad mukha – 2 Sarpa phana mukha –

2 Sharpunkha mukha – 2 Badish mukha – 2 Masur dal matra

mukha-2 Karpas kritoshnish – 6

Darvyakruti – 3 Jambav vadana – 3 Ankush vadana – 3 Kolasthi dal matra

mukha Anjanarth shalaka Mutra marga

vishodhanarth

According to vagbhata

Garbha shanku Dant paatan Karna shodhan Antra vardhma

Gandupadmukha shalaka

Tip looks like an earthworm Used to find the track in fistula i.e.

Eshana karma

Sarpa phana mukha shalaka

Tip looks like snake’s hood Used for extraction of calculi –

ashmari haran

Sharpunkh mukha shalaka

Tip looks like an arrow Used to elevate shalya after an

incision at the site of shalya or to loosen glass pieces or thorn embeded in sole i.e. Chalana

Badish mukha shalaka

Tip looks like a fine fishing hook Used for extraction i.e. Aaharan

Masur dalmatra mukha shalaka

Thikness is like that of masur dala (bengal gram)

To remove foreign body from strotas

Karpas kritoshnish shalaka

Cotton swabs or buds Used to clean ears or ulcers

Darvyakruti shalaka

Spoon shaped tip Used to apply alkali in ksharkarma

Jambav vadana shalaka

Tip like that of the seed of jambu Used for agni karma

Ankush vadana shalaka

Tip curved like ankusha i.e. cane of elephant used to control elephants

For agnikarma & ksharkarma

Kolasthi dalamatra mukha shalaka

Tip looks like half cut pear seed Rough surface is used for removal

of nasarbuda (tumors of nose)

Anjana shalaka

Tip like buds Used to apply collerium (eye

ointment) Now a daya collapsible tubes are

available

Mutra marga vishodhini shalaka

Tip like flower called Malati Urethral dialators

Garbha shanku shalaka

Breech hook Tip is branched like forcep Used to take out dead or living

foetus from womb

Dant patan shalaka

Tip like sharpunkh but length is less than sharpunkh

Used to elevate the root of teeth having dental carries and extraction of tooth

Karna shodhan shalaka

Spoon shaped tip Ear scoop Used for removing wax from ear

Antra vardhma shalaka

Semicircular tip Used in inguinal hernia i.e. antra

vriddhi for agnikarma i.e. cauterization on inguinal canal

Defects of blunt instruments

1. Atisthula – very thick2. Asaram – without strength / soft 3. Atidirgha – very long4. Atirhasva – very short5. Agrahi – not holding objects6. Vishamgrahi – holding objects

improperly

7. Vakra – crooked/irregular/asymmetrical

8. Shithila – weak/soft9. Atyunnata – very

elevated/asymmetrical10. Mridukila – soft/loose nails/rivets11. Mridumukha – soft holding part12. Mridupash – loose catch

Ideal yantra Devoid of above 12 defects Measuring 18 fingers in length

Chief yantra Among all blunt instruments Kankamukha (heron mouthed) is chief Can be withdrawn easily Can be inserted easily Holds foreign body firmly Best for work at all places of body

Shastrakarma

1. Chedan – excision, cutting2. Bhedan – dividing, separating3. Lekhan - scrapping4. Vedhan – puncturing, pricking5. Eshan – probing, searching6. Aaharan – extraction7. Visravan – blood letting8. Sivan - suturing

Shastra

Any device or instrument which caused injury to tissue is considered as shastra

This is an intentional indury caused by the surgeon in operative procedure

The nature of injury depends upon the type of instrument & nature of operation

Shastra – 20

1. Mandalagra 2. Karapatra3. Vriddhi patra4. Nakha shastra5. Mudrika6. Utpalpatra 7. Ardha dhara8. Suchi9. Kusha patra 10. Aatimukh

11. Sharari mukha12. Antar mukha13. Trikurchaka14. Kutharika15. Vrihi mukha16. Aara 17. Vetas patra18. Badisha shastra19. Danta shanku20. Eshani

Use of various shastra in shastrakarma

Mandalagra & karapatra – chedan & lekhan

Virddhipatra, nakhashastra, mudrika, utpalapatra, ardha dhara – chedan, bhedan

Suchi, kush patra, aatimukha, shararimukha, antar mukha, trikurchaka - visravan

Kutharika, vrihimukha, aara, vetas patra, suchi – vedhan

Badish, danta shanku – aaharan Eshani – eshan Suchi – sivan

According to vagbhata

1. Sarpasya 2. Vedhan shalaka (lingnash vedhan)3. Kurcha4. Khaja5. Kartari6. Karna vedhan shalaka (yuthika)

Merits of sharp instruments(shastra sampat) Sugrahani – handle must be very

convenient with a good grip Sulohani – should be made of

highly purified iron Sudharani – edge must be very

fine & designed as per the purpose for which it is meant

Suroopani – it should be with bright finishing & attractive appearance

Susamahit mukhagrani – the tip & ends of the instrument must be well designed

Akaralani – there shouldn’t be any unevenness / irregularity in its make

Demerits of shastra

Atisthul – very big / thick Atyalpa – very small / thin Atidirgha – very long Atirhasva – very short

Cutting edge deformity Vakra- crooked / bent Kuntha – blunt Khanda – broken Khara – hardInstruments with opposite qualities

should be used, except karapatra (saw)

Its edge should be hard & rough, since it is used to cut the bones

Dhara pramanideal thickness of cutting edge

Masuri – size of lentil Ardhamasuri – size of half lentil Kaishiki – size of hair Ardhakaishiki – size of half of hair

Shastra payanatempering of instruments

Methods of tempering instruments1. In alkali2. In water3. In oil

Instruments tempered in alkali – cutting arrows & bones

Tempered in water – cutting, splitting, & tearing of muscles

Tempered with oil – venesection & cutting ligaments

Upayantra - 25

Rajju (thread)- poisoning, fistula Venika (roap) – tourniquet Patta (sheet of cloth) – dressing,

bandaging charma (leather) – in prolapse of

rectum, practice of suturing Valkala (hard inner layer of bark of

trees) – splint in fractures

Lata (creeper)- suturing Vastra (cloth) – dressing, bandaging,

sling support in shoulder dislocation Ashthilashma (hard stone) –

rehabilation after # metacarpal Mudgar (mortor) – to mobilize foreign

body embeded in bones Hasta, anguli – vimlapana, reduction

of bones in # Jivha – remove foreign body in eyes

Nakha – visible surperficial foreign body

Mukha – suction of bld / poison Bala (hair) – suturing, remove

shalya from throat Ashwakatak, shakha (horse bridle

& branch of tree) – remove shalya from bone

Shthivan (act of splitting)- stone in food, cough

Pravahana (straining at defeacation/ micturation) – obstructed feacus, flatus, fetus, urine

Harsh (joy/ excitement)- depression etc

Ayaskant (magnet) – superficial shalya made of iron

Kshar, agni, bheshaj – various diseases

Anu shastra(substitutive instruments) Twak sar (skin of bamboo) – chedan

& bhedan Sphtika (crystal) – chedan & bhedan Kaach (bits of glass) – chedan &

bhedan Kuruvinda (a sort of crystal) –

chedan& bhedan

Jalauka (leech) – raktmoksham Agni (fire) – agnikarma Kshar (alkali) – ksharkarma Nakha (nails) – aaharan Leaves of trees like goji,

shephalika, shakpatra & karira – lekhan

Bala (hair) – chedan Anguli - aaharan

Dissecting forceps

plain toothed

heamostatic forcep

Spencer’s artery forcep

curved

Spencer’s artery forcep

straight

Kocher’s artery forcep

Mosquito forcep

curved straight

Needle holder

Sinus forcep

Tissue holding forceps

Lane’s tissue holding

Babcock’s tissue holding

Swab holder

Towel clip / clamp forceps

Pinchter type Forcep type

Abdominal retractors