The Gerson Institute of Ayurvedic Medicine

Scott Gerson, M.D., Ph.D. (Ayurveda) Medical Director, Jupiter Medical Center Dept. of Integrative Medicine Division of Education and Research

Jupiter Medical Center at The Calcagnini Center for Mindfulness
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Plastic Surgery in Ayurveda

Most people regard plastic surgery as a modern contrivance which addresses only the most superficial aspects of one’s appearance and has no importance in a natural approach to optimal health. People are often surprised to learn that Ayurveda has a venerable tradition of plastic surgery.

The Mind-Body, Body-Mind Connection

The interconnection between mind and body is a preeminent fact in the Ayurvedic conception of a human being. Both mind and body spring from the same cosmic source and the distinction between them is illusory. There was never a doubt in Ayurveda about the existence of a powerful mind-body connection through which emotional, mental, social, spiritual, and behavioral factors can directly affect our physical health. Most people recognize that negative thinking or holding rigid negative emotions, beliefs or attitudes towards oneself or others can activate the stress response and trigger illness. Changing these thoughts and beliefs can promote healing.

But the mind body connection goes both ways. Not only do negative thoughts and emotions promote physical disease, but also your thoughts and emotions are also influenced by the state of your body.

 

One of the ultimate goals of Ayurveda and the yogic tradition is to free the mind of all the perturbations of thoughts and emotions so that one may achieve higher states of consciousness and full human potential. Disease is seen as an obstacle of this goal and Ayurveda was created to remove all disease and maintain health to permit the pursuit of life’s ultimate purpose.

 

Low self-esteem may not be a “disease” but it can certainly be devastating. It destroys love, creativity, and happiness. Low self-esteem leads to many other related psychological disturbances. If such feelings persist or become exacerbated they can lead to a sense of failure, despair and depression. Related feelings of being inferior to others not only create social disadvantages (borne of “not being attractive”), but this also can lead to unhealthy compensatory behaviors (drug and alcohol use, food addictions, over-intellectualization, etc.). When we study the history of Ayurveda from its earliest beginnings we find how utterly comprehensive Ayurveda is in addressing all disease from many different approaches—everything from foods to herbs to mantras to surgery—whatever is necessary—in an effort to eradicate it.

Origins of Surgery in Ayurveda

“History” by definition is a narrative of events and people of past periods in a chronological order. The word “history” has a seemingly obvious meaning, but we should nevertheless define it for the sake of clarity with regard to Ayurveda. “History” is derived from the Greek word for “inquiry” (ἱστορία, historia) and it has come to mean a written account of past events. History therefore requires the existence of a written language. This definition cannot be applied strictly to the history of Ayurveda because of the unavailability of written texts over multiple periods of several centuries each. For centuries in ancient India, knowledge was propagated by word of mouth from guru [teacher] to shishya [student] and this form of teaching persisted till the arrival of the Aryans somewhere between 2000-1500 BC. The first known writing was recorded in Bramhi script (predating Sanskrit) in the third century B.C. Our principle sources of information regarding ancient Hindu culture and medicine are the four Vedas amongst which the Rig Veda was the earliest and the Atharva Veda, the latest. The Atharva Veda, believed to have been composed some time in 1200 BC is the most important source of information on ancient Hindu medicine. All four Vedas are in the form of shlokas (hymns), verses, incantations and rites, used on appropriate occasions to gain the favor of the respective deity, depending upon the affliction to be treated.

The original systematized form of Ayurvedic medicine dates back to a conference of learned sages invited from far and wide convened in the foothills of the Himalayas near Rishikesh. This was akin to a present-day medical conference attended by modern physicians. But this ancient conference was completely different in one important aspect. Its attendees were not only the scientists of the day, but were also enlightened and highly-conscious persons whose minds were free from the influences of Rajas and Tamas. These priest-scientists, by virtue of their lifetimes of prayer and penance, could receive the uninterrupted eternal wisdom without any possibility of misunderstanding or doubt. They were known by many names including aptas (authorities), sista (refined), and vibuddha (enlightened). At this conference fragments of absolute knowledge from many individuals were assembled and organized. Two main schools of thought emerged: the Atreya school of internal medicine (Kayachiktsaya) and the Dhanvantari school of surgery (Shalya tantra). Sushruta was a renowned student of Dhanvantari. Although initially existing as an oral tradition, Sushruta’s written compendium on surgery became the authoritative text on that subject probably authored around 300 AD. There are scholars, however, who cite evidence that an “original” Sushruta lived around 600 BC and that the author of the existing Sushruta Samhita was actually a “later” Sushruta. It should also be noted that alongside this historical version exist a parallel mythical account of Dhanvantari in which he is known as an incarnation (the 17th) of Lord Vishnu. Thus, Ayurvedic texts imply a connection between (perhaps even an evolution) medical knowledge and the philosophic thought and religious traditions which existed concurrently.

The Suśhruta Saṃhitā contains 184 chapters in which he describes 1120 medical conditions, over 300 surgical procedures, 120 surgical instruments and classifies human surgery in eight categories: Chedana (excision), Bhedana (incision), Lekhana (scraping), Aharana (extraction), Vedhana (puncturing), Sravyam (Evacuating), Eshana (probing), Sivana (suturing). He lived, taught and practiced his art on the banks of the Ganges in the area that corresponds to the present day city of Varanasi in North India.

Father of Plastic Surgery

Sushruta gives us detailed discussions of an exhaustive range of surgical methods, which is inclusive of methods on how to deal with various types of tumors, internal and external injuries, fractures, hernia repair, complications during pregnancy and delivery, bladder and renal stones, intestinal obstruction, and even cataracts. However, it is in the field of plastic surgery of the abdomen, limbs, ear, nose, and lips that the surgeons of ancient India truly excelled. The earliest reference to plastic surgery was in the form of a myth in which Lord Shiva attached an elephant's head on his son's body. However it was Sushruta who innovated and brought plastic surgery to the world.

All the fundamental principles of plastic surgery are explained in Sushruta’s writings including pre-surgical planning, need for precision, hemostasis, hygiene, and excellence of instrumentation. In ancient India, advances in plastic surgery took place as a consequence of wars and the battle wounds sustained by warriors. In addition, certain criminal offenses were punished by severing of body parts (fingers, hands, noses, ears, etc.) and these individuals often sought the help of Ayurvedic surgeons in restoring these body parts. Sushruta described various reconstructive methods or different types of defects such as removal of disfiguring fatty depositions, cysts and swellings, release of the skin for covering small defects, and the use of rotated pedicle flaps for covering partial or complete loss of skin or tissue from an area.

Regarding this latter procedure, perhaps the most creative example of Sushruta's surgical expertise and brilliance is his comprehensive description of Rhinoplasty. The construction of a new nose captured the imagination of the medical world and brought him fame as the originator of plastic surgery. The famous Indian Rhinoplasty (reproduced in the October 1794 issue of the Gentleman's Magazine of London) is a modification of the ancient rhinoplasty described by Sushruta (c. 300 AD). Even today the pedicled forehead flap procedure is still utilized and is referred to as the”Indian flap.”

Here is Sushruta’s description of nasikasandhana (rhinoplasty) in his own words (Sushruta Samhita, Sutrasthana 16/46-51):

“The part of the nose to be reconstructed should first be measured with a leaf long and broad enough to cover the severed area. Then a patch of skin, equal in dimension to the preceding leaf, should be dissected (from downward up) from the living skin of the cheek, and turned back to cover the nose, preserving a small pedicle attached to the cheek. The part of the nose to which the skin is to be attached should be made raw by scarifying the nasal stump with a knife. The cool-headed physician then should swiftly position the skin flap onto the nose and stitch the two parts together. The physician must ensure that the joined parts are perfectly adhered and then insert two tubes of eranda (the castor-oil plant) in the position of the nostrils, so that the new nose forms a proper shape and to keep the adhesioned flap elevated and not obstruct respiration.The skin thus properly adjusted, it should then be sprinkled with a powder of licorice root, red sandal-wood and indian barberry plants. Finally, it should be covered with karpasa (cotton), and purified sesame oil should constantly applied. When the skin has united and granulated, if the nose is too short or too long, the middle of the flap should be divided and an endeavor made to enlarge or shorten it.”

Sushruta's contribution to the field of Plastic Surgery can be summarized as follows:

· Rhinoplasty (nose reconstruction using a pedicle flap).

· Classification of mutilated ear lobe defects and techniques for repair of torn ear lobes (15 different types of otoplasties).

· Reconstruction of absent ear lobe.

· Removal of disfiguring cysts and fatty accumulations.

· Repair of accidental lip injuries and congenital cleft lip.

· Piercing children's ear lobe with a needle or awl.

· Use of suture materials of bark, tendon, hair and silk.

· Needles of bronze or bone

· Classification of burns into four degrees and explaining the effect of heat stroke, frostbite, and lightening injuries.

· Fourteen types of bandaging capable of covering almost all the regions of the body and different methods of dressings with various medicaments.

· Use of wine to dull the pain of surgical incisions.

· Described 20 varieties of sharp instruments (sastras) and 101 types of blunt instruments (yantras) and their handling techniques.

· Systematic dissection of cadavers.

· Advocated the practice of mock operations on inanimate objects such as watermelons, clay, gourds and reeds.

· Use of leeches to keep wounds free of blood clots.

· A code of ethics for teachers as well as students.

 

All ancient civilizations have had various remedies for common illnesses, evolved through trial and error methods, accident or by inspiration. But such remedies were purely empirical, and not based on any logical understandings of Nature, human anatomy and physiology, illness or properties of medicines. Ayurveda, by contrast, though rooted in divine revelation, evolved as an organized system with a supremely rational and logical foundation. Vaidyas used their knowledge of herbal, mineral and other natural medicines effectively. In addition to and concurrently with advances in internal medicine, Sushruta and his students took surgery in ancient India to admirable heights. In light of his numerous seminal contributions to the science and art of plastic surgery in India, he is rightly considered the “Father of Plastic Surgery”. Today in modern Ayurvedic colleges, students pursuing the BAMS degree learn Shalyatantra (surgery, including basic plastic surgery) as a required subject in the 3rd year of studies and must demonstrate competence in both modern surgical methods as well as of shalyatantra (Ayurvedic surgery).

Frank McDowell in The Source Book of Plastic Surgery gives us his perspective on the Sushruta Samhita and legacy of Sushruta:

“Through all of Sushruta's flowery language, incantations and irrelevancies, there shines the unmistakable picture of a great surgeon. Undaunted by his failures, unimpressed by his successes, he sought the truth unceasingly and passed it on to those who followed. He attacked disease and deformity definitively, with reasoned and logical methods. When the path did not exist, he made one.”[1]

 



[1] Frank McDowell. The Source Book of Plastic Surgery. Baltimore;
Williams and Wilkins Company: 1977:5-85.