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Is there a need of paradigm shift for Surgery in Ayurveda? - Dr. Arnab Ray
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Is there a need of paradigm shift for Surgery in Ayurveda?

06

Nov 2017

Is there a need of paradigm shift for Surgery in Ayurveda?

Posted By Arnab Ray Posted on November 6, 2017

The history of surgical intervention in different diseases trails from good old Vedic era in India. We get a plenty of evidences of surgical intervention in traumatic injuries, abscess, bone fractures, renal stones, prostate diseases, warfare injuries and haemorrhage in various chapters of Atharva veda.1 Later in Ayurvedic literatures it evolved as a separate stream and derived its name as Shalya Tantra. Around 800 BC Ayurveda served the society as the principal healthcare system of Indian subcontinent. Charaka Samhita and Sushruta Samhita were the two most important reference books. As we find them today, Charaka Samhita mainly deals with the medicinal management of various diseases while Sushruta Samhita prioritizes the issues of surgical importance.

Dr. Hirschberg, a German surgeon says, 2 “the whole plastic surgery in Europe had taken its new flight when the cunning devices of Indian workman became known to us. The transplanting of sensible skin flaps is also an entirely Indian method.” He also says, “the Indians knew and practiced ingenious operations which always remained unknown to the Greeks and which we Europeans only learnt from them with surprise.” There are innumerable examples in the History of Indian Medicine to substantiate this view. Jivaka stands out to be the most illustrious surgeon in 5th Century BC who received his medical education under the renowned physicians and surgeons of Taxila University and served as Royal physician in the court of Magadha king Bimbisara. 3

Surgery was studied in a very methodical manner in ancient India. 4 A surgeon’s training was conducted in various setups like classroom education, observation of procedures, hands on training on dummies, cadavers and also on living bodies. The knowledge of human physiology and relevant anatomy were given prime importance. The law of the land permitted them to practice surgical procedure on completion of education and training. The surgeons were equipped with trained paramedics. Various surgical instruments were designed and medicines of herbal and mineral origin were used. The surgeons of ancient India were involved in both civil and military services. 4,5

This scenario changed when the orthodox people who had monopoly in teaching various sciences started neglecting the surgeons because of their dislike to touch the dead body, blood, pus and other diseased organs. 6 The lack of knowledge of appropriate anaesthesia used to cause pain during operation, which naturally invited public rejection. The Buddhist thought of the Mauryan Emperor Ashoka, who ruled the largest empire ever in the Indian subcontinent and one of the world’s largest empires at its time between 268BC and 232 BC, discouraged anatomical study on animals and surgical intervention on ethical and compassionate ground. The king established hospitals for human being and animal but promoted medicinal management only; surgery received no patronage.6 The Mughal period (1526-1857) and British rule (1858-1947) were also not in furtherance of Ayurvedic surgery. 6

The ball started rolling again after independence. By the time the world started exploring robotic surgery, the scientists are also looking into Ayurveda for conservative management of otherwise surgically curable diseases, better surgical techniques and for safe & better medicines.

For quite some times in the past, the pseudo modernists refused to acknowledge anything that they could not apprehend and tried to build up an attitude of contempt against traditional system of medicine. They could, to a certain extent, keep the system confined to the services of the Adibashis and the poor people in India. But the essence of Ayurveda created a global awareness and is now the most widely recognized traditional system of medicine of Indian origin. The world has started realizing that, Ayurveda has got something to contribute to the ailing humanity. The global population is travelling India in search of better health through Ayurveda. Guess, not many houses will be found in India where an Ayurvedic product has not reached ever, it might be in the form of cosmetics or drugs; but the scenario is not all the same with surgical stream of Ayurveda. The society is still not comfortable with the term ‘Ayurvedic surgery’. Only a few high-end people suffering from some typical ailment, search for ‘Ayurvedic surgeon’ when they come to know that the particular condition is not easily curable by conventional western method of treatment or is hazardous. Many a people visit Ayurvedic hospitals across the nation for surgical treatment without even knowing that an Ayurvedic surgeon is going to operate on them. Ayurvedic medicinal treatment especially panchakarma has attained a global awareness making India a destination for health tourism but the contribution of Ayurvedic surgery in national economy is still not measurable. Let me elaborate few reasons for this.

  • As of now, Ayurvedic surgery is confined to few pockets like ksharasutra application is various types of fistula and sinus, Agnikarma (thermo-cauterization), Raktamokshana (blood-letting therapy), marma chikitsa (comparable to orthopaedic and pain management), vrana chikitsa (wound management) etc. No serious thought is given to go beyond to these specialities.
  • The surgery is not only about cutting and closing; it is preceded and followed by pre-operative preparation and post-operative management respectively. These involve issues like vaccinations, anaesthesia, IV fluid management, blood transfusion etc. The present national legal guidelines are not supportive to Ayurvedic surgeons in all the cases.
  • Not all medical insurance providers reimburse the expenditure of surgery performed by an Ayurvedic surgeon, forget about cashless benefit.

People often wonder about the contribution of Ayurvedic surgeon in modern healthcare service. Allow me to elaborate this doubt a little more. Any surgical or so called parasurgical procedure performed by an Ayurvedic surgeon can be performed by a modern surgeon also but the reverse is not the same; then why people will consult an Ayurvedic surgeon for their treatment; this may sound like a lay-man’s talk but I do believe this doubt is still relevant in the community as a whole. Science is a dynamic process but most of the Ayurvedic surgeons do find practically no training module to upgrade their knowledge and skill other than ksharasutra related issues.

In a country where a qualified surgeon is scarcely available in the vast rural community, we are still awaiting to bridge the gap with this alternatively trained skilled human resource. I do believe if policies are supportively framed, the Ayurvedic surgeons will prove themselves competent to serve the community more effectively at least at the district level hospitals. I propose to the policy makers of this country through this article to give a serious thought to this issue. I also do believe that, Ayurvedic fraternity is supposed to indulge themselves in fundamental surgical research based on the principles and theories of Ayurveda. There are numerous ideas available in ancient books. The ancient Indian surgeons have introduced many fundamental techniques to the world, the modern Ayurvedic surgeons of India have yet more to give if they are nurtured supportively.

References:

  • Ray A, Gaur BL (2010), Methodological study of surgery in Ayurveda, PhD thesis submitted to the faculty of Ayurveda, Rajasthan Ayurveda University.
  • Sinh Jee HH Bhagvat (1998), History of Hindoo Medical Science, Logos Press, New Delhi.
  • Buddha Prakash (1964) Political and social movements in ancient Panjab (from the Vedic age up to the Maurya period), Motilal Banarsidass, New Delhi. India
  • Srikantha Murthy KR (2002), Sushruta Samhita, Chaukhambha Orientalia, Varanasi, India
  • Leonardo RA (1943), History of Surgery, Forben Press, New York, USA.
  • Udupa KN (1961), Principles of General Surgery, Benaras Hindu University Press, Varanasi, India

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