Ancient and recent Yantra and Shastra

Surgical instruments and its uses

1. Knowledge of Ancient and Recent Yantra & Shastra:- Surgical instruments & their appliction in surgical practice By:- Dr. Sumit Kumar PG Scholar Guided by:- Prof. (Dr.) Deepali Sundari Verma Dr. Pawan Kumar Verma Dr. Amar Kumar Dr. Haider Ali Dr. Rakesh Raushan

2. Contents Introduction. Ancient classification and uses of Yantra. Ancient classification and uses of Shastra. Modern Surgical instruments and its application in surgical practices. Discussion Conclusion

3. INTRODUCTION Acharya Sushruta is the father of surgery and known for his contribution to the field of Shalya Tantra (surgery). Susrutha Samhita has elaborate description of Yantras & Shastras used for various Shalya karma. A detailed description of 121 types of surgical instruments is available in Yantravidhi adhyaya (101) and Shastra vidhi adhyaya (20). Susrutha has also described Anushastras that are used for those in whom shastra cannot be used.

4. Ancient classification of yantra Shalyas are those which affects both the MANAS AND SHAREERA and Yantras are used for their aaharana . तत्र , मनः शरीराबाधकराणि शल्यानि , तेषामाहरणोपायो यन्त्राणि According to Susrutha Yantras are 101 in number among them hastha is pradhana tama . Yantra are broadly classified into 6 types 1 Swathika yantra Cruciform instruments 2 Sandamsha yantra Dissecting forceps 3 Tala yantra Scoops 4 Nadi yatra Tubular instruments 5 Shalaka yantra Probe like instruments 6 Upayantra Accessory instruments

5. NAME OF YANTRA NUMBER TYPES SWASTHIKA 24 VYALA MUKHA-9  SIMHA MUKHA (LION FORCEPS)  VYAGHRA MUKHA (TIGER FORCEPS)  VRIKA MUKHA (WOLF FORCEPS)  TARAKSHU MUKHA (HYENA FORCEPS)  RIKSHA MUKHA (BEAR FORCEPS)  DWEEPI MUKHA (PANTHER FORCEPS)  MARJARA MUKHA (CAT FORCEPS)  SRIGALA MUKHA (JACKAL FORCEPS)  MRIGAIRVARUKA (DEER FORCEPS) PAKSHI MUKHAM 15 KAKA MUKHA (CROW FORCEPS) KANKA MUKHA (HERON FORCEPS) KURARAMUKHA (OSPREY FORCEPS)  CHASA MUKHA (BLUEJOY FORCEPS)  BHASA MUKHA (EAGLE FORCEPS)  SASHAGHATI MUKHA (HAWK FORCEPS)  ULOOKA MUKHA (OWL FORCEPS)  CHILLI MUKHA (KITE FORCEPS)  SHYENA MUKHA (VULTURE FORCEPS)  GRIDHRA MUKHA (VULTURE FORCEPS)  KROUNCHA MUKHA (CATLEW FORCEPS)  BHRINGARAJA MUKHA (BUTCHER BIRD)  ANJALIKARNA MUKHA  AVABHANJANA MUKHA  NANDIMUKHA MUKHA

6. NAME OF YANTRA NUMBER TYPES SANDAMSA YANTRA 2 SANIGRAHA ANIGRAHA TALA YANTRA 2 EKATALAM DWITALAM  NADI YANTRA 20 BHAGANDARA YANTRA-2  ARSHO YANTRA-2  VRANA YANTRA-1  BASTI YANTRA-4  UTTARABASTI YANTRA-2  MUTRAVRIDHISRAVANA YANTRA-1  JALODARA SRAVANA YANTRA-1  DHUMANETRA YANTRA-3  NIRUDHAPRAKASHA YANTRA-1  SANNIRUDHAGUDA YANTRA-1  ALABU YANTRA-1  SRINGA YANTRA-1

7. NAME OF YANTRA NUMBER TYPES SALAKA YANTRA   28 GANDUPADA MUKHA-2  SARPAPHANA MUKHA-2  SARAPUNKHA MUKHA-2  BADISA MUKHA-2  MASURADALAMATRA MUKHA-2 KARPASAKRUTA USHNEESHA-6  DARVI-3  JAMBAVAVADANA-3  ANKUSHAVADANA-3  KOLASTHI DALAMATRAMUKHA-1  ANJANA SALAKA-1  MUTRAMARGA VISHODHANARTHAM-1  UPAYANTRA 25 RAJJU, VENIKA, PATTA, CHARMA, ANTARVALKALA, LATA, VASTRA, ASHTEELASMA, MUDGARA, PANITALA & PADATALA, ANGULI, JIHVA, DANTA, NAKHA, MUKHA, BALA, ASVAKATAKA, SHAKHA, SHTEEVANA, PRAVAHANA, HARSHA, AYASKANTA, KSHARA, AGNI, BHESHAJA.

8. SWASTHIKA YANTRA They are 18 angulas in length. Their ends are shaped like the faces of ferocious beasts and birds and called after their names.  The fulcrums are at the middle and of the size of a masura . Handles are either rounded off or bent at an angle at their ends. Used for the extraction of foreign bodies impacted in the bones. If foreign body which is visible- Simhamukha yantra If foreign body which is invisible- Kankamukha yantra.  Kankamukha is considered as the best among the swastika yantras. Also called Pradhan Yantra It can be easily introduced and turned in all directions and also it grasps firmly and extracts a foreign body without any harm to all parts of the body.

9. Name of the forceps Use  Image CHEATLE'S FORCEPS  To pick sterilised articles  Does not have lock  SPONGE HOLDING FORCEPS  [RAMPLEYS] Fenestrated, serrated, flat distal end.  To clean the operative field,  To swab cavities,  To mop the oozing area KOCHER'S FORCEPS Got serrations in the distal blade s and opposing tooth in the tip  Used to hold pedicles, tough structures, cut ends of the muscles  MAYO'S TOWEL CLIP  To fix the drapes in operative field. Fix the suction tube. Fix diathermy wires in operative tables. ARTERY FORCEPS HAEMOSTAT To catch bleeding point.  To open the fascial planes in different surgeries. To pass a ligature.  To hold fascia, peritoneum, aponeurosis.  To hold the sutures 1 2 5 4 3

10. Name of the forceps Uses Image ALLIS TISSUE HOLDING FORCEPS Distal blades are not opposing to each other Used to hold the skin flaps, fascia, Aponeurosis ,bladder wall. Got teeth in each blade which are opposing and a lock on the proximal part. BABCOCK'S FORCEPS It has a triangular expansion with fenestrations at the opening end.  To hold any part of bowel, Fallopian tubes, Appendix, Ureter, cord.  NEEDLE HOLDER Smaller distal blades with criss cross serrations often with a groove in the middle.

11. SAMDAMSHA YANTRA Those which have a firm grip over the shalyas or those which hold the shalya very strongly are known as samdamsha . They are 16 angula in length  Two types- Sanigraha and Anigraha ie , forceps with or without catch.  Used to extract the shalyas from the soft structures like twak , mamsa , sira and snayu .   The samdamsha yantras can be correlated to the Dissecting forceps used in modern surgery.

12. PLAIN NON-TOOTHED DISSECTING FORCEPS  It is used to hold delicate structures like peritoneum, bowels, vessel, nerves, tendons. TOOTHED DISSECTING FORCEPS  It is used to hold skin and tough structures. This is the forceps which is always used while suturing the skin.

13. TALA YANTRA Tala yantra are 12 angula in length. Shaped like the talu of a fish Two types namely Ekathala and Dwithala Instruments with one tala resemble one lip of the fish, and those with two talas represent its entire face. Used of extracting foreign bodies from the ear, nose and sinuses in the body.  The tala yantras can be correlated to the Scoops used in modern surgical procedures.

14. EAR SCOOP  To clean the ear canal of ear wax. VOLKMANN'S SCOOP  To scoop cavities, ulcer bed, granulation tissues. Different sized scoops are present on either side.

15. NADI YANTRA Nadeeyantras are hollow tubular instruments . The Nadi Yantra are described to be of various kinds and to serve many purposes.( अनेकप्रकाराणी   अनेकप्रयोजनानि ) They are open either at one or both ends . Used for the extraction of foreign substances from different srothases of the body.  Used as a diagnostic apparatus for inspection of diseases in the canals.

16. NADI YANTRA TYPES PRAMAN USES MODERN CORRELATION IMAGE BHAGANDRA YANTRA EKACHIDRA DWICHIDRA 4A Find out the internal opening of a fistula ARSHO YANTRA EKACHIDRA DWICHIDRA 4 A-long circumference In Male-5A In Female-6A Dwichidra  is used for visualising Ekachidra used for kshar , agni , shastra karma Proctoscope Used to visualise the rectum and the anal canal UTTAR BASTI 14A long Circumference malati pushpa vrinthavat Lumen- sarshapa nirgam To administer uttara basti dravya . 1.Rubber ball vaginal douche 2.Simple red rubber catheter

17. NADI YANTRA USE MODERN CORRELATION IMAGE Vrana yantra Vrana prakshalan Syringe irrigator Dakodara yanta Vishraavan Cannula Mutra vridhi yantra Vishraavan Cannula Dhoomyantra Dhoom pana Inhalers Nirudhayaprakasha yantra Dialatation Catheters Sannirudhra guda yantra Dialatation Anal dialator Alabu /Sringa yantra Rakta mokshana Cupping glass suction ball horn 

18. SHALAKYA YANTRAS Gandupada mukha Blunt instrument with its end shaped like the head of an earthworm.   It is used for eshana karma  It can be compared to the Blunt probe Sharapunkha mukha The end of this shalaka is shaped like the leaves of sharapunkha . It is used for chalana karma It can be compared to Tooth elevator. 

19. Sarpaphana mukha   Ends are shaped like the hood of a snake   It is used for vyuhana karma . Retractors are used to hold aside tissues to explore deeper structures Badisha mukha   The tips of badisha mukha salaka resembles a fine fishing hook  2 types- Swanatagra , Natrayanatagra   Used for Arma nirharana   Also to remove the shalya by hooking them and to take them out by force. This can be compared to the Hook like instrument   Masooradalamatra mukha   Their ends are shaped like that of a masoora and are slightly curved.  They are used for extracting shalyas from the srothases . 

20. Karpasa krithoshneesha   They are six in number  One end of the shalaka is covered by karpasa or cotton. They are used for wiping. These can be compared to the Swab probes Darvyakriti These are 3 in number  They are shaped like a spoon  Used for the application of kshara karma This can be compared to a Spoon shaped instruments  Jambava vadana They are 3 in number  Their ends resemble jamboo phala hence are known as jambava vadana .  Ankusha vadana   These are also 3 in number  It has the shape of an elephant drivers goad  Both jambava and ankusha vadana are used for agnikarma .  This can be compared to a Diathermy or electrocautery

21. Kolasthimatra mukha   It is sharp at the periphery and depressed at the middle.  Used for the extraction of nasa arbuda   It can be compared to a Nasal curette  Anjana shalaka   It is 8 angula in length with a thickness of a kalaya and the ends are shaped like buds.  Used for the purpose of application of collyrium. Mutramarga vishodhanartham   Its ends are rounded like the stalk of a malathi pushpa   It is used for cleaning the urethral canal.  It can be compared to a Urethral Sound or Bougie

22. UPAYANTRA Upayantra  are those which are similar to yantras , but are inferior to yantras. These can be used in the whole body, or the organs of the body, in sandhi, kostha , dhamani according to the need. Upayantra Use Correlation Rajju (Rope) Thread or a rope Used for aristha bandhan Touniquet   Venika ( Interwined Rope) Used for aristha bandhan Kshara sutra can be considered Touniquet

23. Upayantra   Use  Modern correlation Patta  Different types of clothes  Bandage, towels, mops, Charma  Skin  In guda bhramsa for bandaging  arishta   bandhana in sarpadamstra   udara , after udara patana   Skin grafts Antarvalkala inner bark of trees like palasha ,  udumbara , ashwatha   bandana in bhagna   Splints made of bamboo, Steel are used in fracture management. Lata Climbers Used for giving traction Ropes and belts are used for giving traction Vastra  Clothes, bandage Surgical aprons, gowns, bandage guaze , mops. Asthilashma Dheergha varthula pashana .  Removal of asthi gata shalya Hammers are used in orthopaedic surgery

24. Upayantra   Use  Correlation  Image  Mudgara Made up of wood  Used similar to asthilashma Hammers are used in orthopaedic surgery Panipadatala Vimlapana   Reduction of fratures Fracture reduction Anguli  Vimlapana ,  eshana ,  peedana   P/R, P/V examinations. Used during surgery Jihwa For rogi pariksha . Removal of netra gata shalya . Soft damp swabs are used for removal of foreign body from eyes. Danta  Used for making instruments like arshoyantra Instead of danta steel is used for manufacture of instruments Nakha For separating layers of skin Dushya shalya aaharana in surgery  Used for suction  Are used to remove small foreign materials from skin.  suction pump and suction balls 

25. Upayantra   Use  Correlation  Image  Mukha  Used for suction suction pump and suction balls  bala Hair of human and horse.  Sivana karma  Galagatha shalya nirharana Catguts are used as suturing materials. Ashwakataka -Ring  For removal of asthigatha shalya Forceful extraction of foreign body  Shakha  Removal of deeply seated shalya   Forceful extraction of foreign body  Shteevana   Kapha nirharanartha   Mukha gata sookshama shalya nirharanartha   Expectoration Pravahana Vata mutra pureesha garbha sangha  Asru pravahana in netra gatha sookshma shalya Bearing down during labour

26. Upayantra   Use  Correlation  Image  Harsha  Dukha roopi shalya Used in psychological disorders Counselling. Ayaskantha   Sookshma loha shalya nirharanartha   Electromagnets Kshara   Chedana,bhedana   and lekhan Kshara sutra Agni  Agnikarma Diathermy  Bheshaja  Vrana shodhana , ropana , kshalana . Pooyarupi shalya nirharanartham Topical applications

27. DIFFERENT FUNCTION OF YANTRA  1.Nirghatana- pulling out after crushing,  2. Unmathana - pulling out after twisting,  3. Poorana- filling,  4. Marga shuddhi - clearing the passage,  5. Vyuhana - bringing together,  6. Aharana - extracting,  7. Bandhana- binding,  8. Peedana - rubbing,  9. Achushana - sucking, 10.Unnamana- lifting up,  11.Namana- pushing down, bending down  12.Chalana- shaking,  13.Bhanga- breaking, 14.Vyavartana- overturning,  15.Rjukarana- straightening etc. Are the functions of the yantras 

28. SHASTRA

29. Name of 20 Shastra 1. MANDALAGRA 2. KARAPATRA  3. VRIDDHIPATRA  4. NAKHASHASTRA  5. MUDRIKA  6. UTPALAPATRA  7. ARDHADHARA  8.SUCHI  9. KUSHAPATRA  10. AADHIMUKHA 11. SHARARIMUKHA  12 ANTARMUKHA  13. TRIKOORCHAKA  14. KUTAARIKA  15, VREEHIMUKHA  16. AARA  17. VETASAPATRA  18. BADISHA  19. DANTASANKHU  20. ESHANI

30. Shastra Karma 1) Chedan (Excision)  2) Bhedana (Incision)  3) Lekhana (Scraping)  4)  Vedhana  (Puncturing)  5) Visravana  (Draining)  6) Esana (Probing)  7) Aharana (Extraction)  8) Sivana (Suturing)

31. Mandalagra 2 types: vritamukha and kshurakara . measurement: 6 angula   used for chedana and lekhana .  Circular knife   Kara patra The word karapatra means that which looks  like  the  projecting fingers. Measurement: 6 angula   The edges are rough and serrated almost similar to a saw.  It also used for chedana and lekhana .  used in asthi chedana   Bone saw Vruddhi patra 2 types: Anchitagra  & Prayatagra Both are of seven angula in length in which the handle should be of five and half angula .(5½) Used for chedana and bhedana .   Scalpel  Popularly known as the surgeons knife  The instrument is detachable- handle and blade. This is used to incise the skin and subcutaneous tissues.  Curved Bistoury  Bistoury is a long, narrow bladed knife with a straight or curved edge and sharp or blunt point  Used for opening or slitting cavities or hollow structures. Nakha shastra It is eight angula in length, in which blade is two angula in length and one angula broad. Used for chedana and bhedana . Nail parer

32. Mudrika Mudrika means ring. The instrument or shastra which fits around index finger. Also known as Anguli shastra.  Used for chedana and bhedana in kanta gata rogas   Finger knife Utpala patra   The blade of the shastra looks similar to the petal of utpala .  It has got a sharp edge.  Pramana: 6 angula , Blade 3 angula long and 1 angula broad  Used for chedana bhedana . incising vidradhi . Lancet Ardhadhara   The shastra is called so because half of the length of the shastra is sharp.  Also known as vakra dhaaram   Pramana: 8 angula in length, 2 angula broad A type of knife. Kushapatra The instrument which is small and fine similar to that of a kusha patra . Pramana:length of blade: 3 angula , handle: 2 angula . For Visravana , Siravyadha in galaganda and mukharoga .  Pagets knife Aatimukha The instrument which resembles the bird aati is known as aatimukha shastra.  Pramana: handle- 7 angula   Blade- 8 angula   Anterior 1 angula is phala bhaaga .  Uses: for visravana , siravyadha in greeva kaksha etc.  Episiotomy scissors Kutharika   That which is a miniature of Axe Handle of 7 and half angula , blade half angul   Phala is godanta sadrisha   Use: Vyadhana Karma.  Axe shaped knife or Chisel

33. Shararimukha Sharari is a bird with long beaks and the shastra which resembles sharari is know as sharari mukha shastra.  Also known as Kartari   Pramana: 12 angula   Uses: Visravanarth , Extension of incissions made by utpala yantra. Pair of scissors  2 basic types: one for soft tissues another for firmer tissues Antarmukha It is a cresent shaped shastra  Also known as Chandraardam .  Pramana: 8 angula   Similar to kartari   Trikoorchakam   Shastra with 3 brush like sharp needles mounted on a strong handle. Uses: visravan . Vrihimukha Tip of the shastra which looks like a Vreehi mukha Pramana : Handle- 2 angula , Blade- 4 anguli   Uses: Vyadhana in jalodara , mutravruddhi , siravyadhana . Trocar and cannula This has two parts. The inner sharp part is the trochar and outer blunt part is cannula. It is used to drain hydrocoele fluid. Ara This is a wide semi curved or straight knife with a short round handle.  Pramana: 8 angula phala - tila pramana Handle is similar to go pucha   Blade resembles kusha patra doorva ankura Used: Vyadhana , karna vyadhana asthi gata shalya nirbharnatham   Awl

34. Vetasapatra Shastra which looks like a bamboo leaf  Measurement: Blade is 4 angula in length and 1 angula broad  Used: vyadhana   Tenotomy knife Badisha  Shastra which is bend at its tip like a fishing hook Measurement: 6 angula   Handle: 5.5 angula   Blade: 0.5 angula   2 Types: Swanata - Fully curved                  Natyanata Semi curved Use: Aaharana Sharp hook Dantashanku   A conical sharp instrument with a very sharp tip Measurement: 6 angula Handle: 5.5 angula Blade: 0.5 angula   Use: useful in several dental disorders, used to scrape out the dental debris from the surfaces, corners and cervices of the teeth  Tooth scaler Eshani This is similar to all other probes, but for its sharp edge. The sharp probes has got the shape of a needle and are 8 anguli long.  Use: eshana and anulomana in probing or searching the course or direction of the pus in vidradi   Sharp probes, Director

35. Soochi These are suturing needles which are mainly Used for visravana and seevana karma, 3 types:  Vritta : round body needle 2 angula long  Used in regions where there is alpa mamsa and in sandhi.  Tisra or trikonaka : triangular in shape- 3 angula in length  Useful in suturing skin and fleshy areas  Dhanurvakra : needle curved like a bow-2 and a half angula long  Use in suturing the wounds of stomach intestines and vital parts of the body Needles  Types Based on existance of the eye  Atraumatic needle Traumatic needle Based on curvature  Straight needle Curved needle Based on the edge   Round body needle Cutting needle Reverse cutting needle Taper cut needle 

36. ANUSHASTRA 1. Twak sara  2. Sphatika  3. Kacha  4. Kuruvinda   5. Jalouka   6. Agni  7. Kshara    8. Nakha  9. Goji  10. shefhalika   11. Shakapara   12. Kareera   13. Bala  14. Anguli

37. CONCLUSION Susrutha was probably the first surgeon to describe different types of surgical instruments.   Susrutha's concepts of surgical instruments, the description of their quality, methods of manufacture and their usage are very unique.  History provides us ample evidence of foreign invasion and taking away with them ancient manuscripts related to surgery & medicine.  Some efficient surgeons of that time were also taken by the foreigners to learn the science from them.  This might be one of the reasons for the resemblance of the modern era instruments to those mentioned in our classics in one or the other way.  Most of the instruments described by Susrutha can be correlated to the instruments used in modern Surgery but with slight modifications.  So indeed Susrutha adores the name 'Father of Surgery'.

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