International Journal of Trend in Scientific Research and Development (IJTSRD) Volume 5 Issue 6, September-October 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 @ IJTSRD | Unique Paper ID – IJTSRD47653 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1414 Scientific Validation of Parasurgical Procedures - A Review Article Dr. S. Tameem Ansari 1 , Dr. Syeda Ather Fathima 2 , Dr. Shivalingappa J. Arakeri 3 , Dr. Mohasin Kadegaon 4 , Dr. Geethanjali Hiremath 4 1PG Scholar, 2Principal, 3Professor & HOD, 4Assistant Professor, 1, 3, 4Department of PG Studies in Shalya Tantra, 1, 2, 3, 4Taranath Government Ayurvedic Medical College, Ballari, Karnataka, India ABSTRACT The parasurgical procedures are the specialized procedures which are described by Acharya Sushruta “The Father of Surgery”. These are the separate procedures other than major surgical procedures called Ashtavidha Shastra Karmas. These procedures have special indications other than major surgical procedures like children, sensitive patients etc, which are more helpful & effective where medicine & surgery will not give the expected results. These parasurgical procedures include Ksharakarma, Ksharasutra, Agnikarma, Raktamokshana & so on. As these procedures are results oriented & most popular among Ayurvedic fraternity. So there is a need to explore these techniques on the modern scientific background so that these procedures should be well practiced on scientific background with confidence, so that it can contribute more to the present Ayurvedic surgical knowledge. Keeping this in background, here an attempt is made to substantiate the scientific validation of parasurgical procedure is made. KEY WORDS: Parasurgical procedures, Ksharakarma, Ksharasutra, Agnikarma, Raktamokshana- Jalaukacharana, Siravyadha, Prachana, Shringa & Alabu How to cite this paper: Dr. S. Tameem Ansari | Dr. Syeda Ather Fathima | Dr. Shivalingappa J. Arakeri | Dr. Mohasin Kadegaon | Dr. Geethanjali Hiremath "Scientific Validation of Parasurgical Procedures - A Review Article" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456- 6470, Volume-5 | Issue-6, October 2021, pp.1414-1419, URL: www.ijtsrd.com/papers/ijtsrd47653.pdf Copyright © 2021 by author (s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0) INTRODUCTION: Shalya tantra is one of the most specialized branch of Ashtanga Ayurveda where Acharya Sushruta who is worshipped as the “The Father of Surgery” has described various treatment modalities relating to both surgical and parasurgical procedures. It has widely been practiced in the various clinical settings depending on the training and exposures of the physician. With renewed interest in the parasurgical procedures in the recent times Agnikarma, Ksharakarma, Ksharasutra, Raktamokshana- Jalaukacharana, Siravyadha, Prachana, Shringa and Alabu have gained foremost appraisal to attempt treatment effectively in the management of different surgical conditions. Kshara is the substance which is obtained by burning some specific medicinal plants & the Ash is processed in a systemic manner. It is of 2 types1, 1) Paneeya Kshara, 2) Pratisaaraneeya Kshara. Kshara is best among Shastra & Anushastra2. Pratisaaraneeya Kshara is useful in Dermatoses, Hyperkeratosis, Ringworm etc Skin conditions, Fistula In Ano, Tumors, Hemorrhoids, Indolent ulcers & so on3. Along with Pratisaaraneeya Kshara, Ksharasutra & Kshara Varti are widely used for the management of Bhagandhara, Nadivrana & Dushtavrana also. Agnikarma is used in curing different diseases & has got world wide popularity because of its simple administration & efficacy in variety of disorders. It is unique form of therapy performed with the help of agni4 which can cure those diseases also, which can’t be cured by Bheshaja, Kshara & Shastrakarma5. It is described to be superior to Ksharakarma as the diseases treated by it do not relapse & moreover those incurable by medicine, operations & caustic yield to it. It is specially indicated in Hemorrhoids, Tumors, Fistula in Ano, severe pain in skin, muscle, vein, ligaments, joints & bone caused by aggravated vata6 etc. IJTSRD47653 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47653 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1415 Raktamokshana therapy is the blood cleansing & purification therapy. It is the prime process of blood detoxification. It is one among the shodhana karma according to Acharya Sushruta & Charaka. Skin diseases, Granthi, Shopha, Raktajanya diseases do not occur in those persons who are subjected to proper bloodletting time to time7. The specific indications of Jalaukacharana are Pitta dushta raktaja rogas, Gulma, Arsha, Vidradhi, Kushta, Vatarakta, Galarogas, Netrarogas, Visha and Visarpa8. The specific indications of Siravyadha are Vidradhi except tridoshaja, Arbuda, Granthi, Stanarogas, and Dantapupputa etc Kshudrarogas are indicated. Vagbhata added those conditions arise due to Pitta & Kapha, diseases which do not respond to Sheeta- Ushna, Snighda- Rooksha treatment should be understood as being born of Dushta Rakta & Raktamokshana should be performed9 . Prachana is indicated in Pindita Rakta, Twak Rogas, Indralupta, Kshudrarogas, and Utsedayukta Vrana. Shringa is indicated in Vata dushta raktaja rogas, while Alabu is indicated in Kapha dushta raktaja rogas10, 11. SCIENTIFIC VALIDATION OF PARASURGICAL PROCEDURES 1. Action of Kshara in Specific Diseases: Haemorrhoids:
Causes Coagulation of proteins in Haemorrhoidal plexus (Chemical Cauterization of Pile masses)
Disintegration of Haemoglobin into Haem and globinBlackish brownish discharge
Necrosis of Tissues Sloughing in 3-7 days
Fibrosis of Plexus & Scar Tissue Formation
Adhesions of Mucosal, Sub mucosal coats
Prevention of further dilatation of veins & Prolapse of regional Mucosa of anus.
Permanent radical obliteration of Hemorrhoids & wound healing within 21 days. Rectal Prolapse:
Induces aseptic fibrosis of the rectal mucosa and adheres it properly
During healing it causes cicatrization, narrowing of lumen and strengthens the anorectal ring. Fistula-in-Ano: In Low fistulas, after fistulotomy, helpful for quick healing by debridement of fibrous tissue and avoids recurrence. Dushtavrana:
Best Substitue for Surgical debridement of Ulcer.
It acts only on the deranged, unhealthy growth & hypertrophied tissues.
Promotes fast epithelization, increase collagen deposition, reduced exudates and reduced edema and promotes granulation tissue formation. Tonsilitis:  Minute burns Coagulation of muco- lymphoid tissues  Reduces the intra-cellular space & aggregates the lymphoid tissues  Stimulates fibrosis of tonsillar tissue  reduces size of the tonsils. 2. Action of Ksharasutra12,13,14,15,16: Fistula In Ano & Pilonidal Sinus:
Helps in Cutting, Curetting, Draining and Healing of the fistulous track.
Caustic action - Destroys and removes unhealthy tissues & Promotes healing of the fistulous track.
Controls infection by the microbicidal action.
Facilitate the drainage of Pus in fistulous track and helps in healing. Theories:
Theory of Chemical Cauterization.
Theory of Antimicrobial Effect.
Mere Mechanical cut & Open theory.
Novel technique of local drug delivery. Action of Ksharasutra: Days Action of Ksharasutra 1 Local irritation and discomfort in the anal region. 2-4 Inflammation (local redness, burning sensation). 4 Necrosis: Kshara comes in contact with fistulous tract the stage of micro necrosis begins. 5-6 Shedding of unhealthy granulation tissue due to necrosis (cutting of fistulous tract), fibroblastic proliferation. 7 The Haridra coating of new Ksharasutra comes in contact with the fistulous tract which completes the healing. Low recurrence: The Ksharasutra allows invisible minor ramifications to drain in to the major tract by healing themselves totally before the major tract is cutoff. Hemorrhoids
Chemical Cauterization & Mechanical Strangulation of the blood vessels.
Local gangrene of the pile mass
Ischemic necrosis and debridement of unhealthy tissue.
Sloughing of mass & Healing of wound. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47653 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1416 3. Agnikarma Possible Scientific Explanations: 1. Gate control therapy17: Pain sensations are transferred by two types of fibers. “A” fibers (stimulated by heat, cold and touch) and “C” fibers (stimulated by pain). Here the gate mechanism is blocked by stimuli from A fiber, so the pain will not be felt. 2. According to scientist Dr. Ven Hanff18: The place where heat burns the local tissue metabolism is improved and thus it leads to increased demand of oxygen and nutrient of the tissue. This causes enhanced delivery of nutrients and more efficient removal of waste products, hence speeding up the natural process of repair. 3. Effect of heating on nerves19: Heat appears to produce definite sedative effects. The effect of heat on conduction has still to be thoroughly investigated but a physiological explanation has been offered by Sidney Licht (1965), there is evidence that any sensory excitation reaching the brain simultaneously with a pain excitation results in the pain impulse being more or less attenuated. Pain receptors of skin and motor end plate stimulated at 450C. Pathway for pain and thermal signals run parallel and ends into same area but only stronger one can felt. Therefore complete exclusion of pain impulse by heat occurs. 4. Counter irritation theory20: A counter irritant stimulates sensory nerve endings and relieves pain. 5. Effect on muscle tissue21: Heat induces muscle relaxation. 6. TENS effect22: Trans-electric nerve stimulation relieves pain by burning superficial nerve endings. 4. Rakta Mokshana Siravyadha 23 :
It is predominantly indicated in Pitta, Rakta & Kaphaja vyadhis or when pitta or kapha is in anubhandha to vata dosha.
Helps to remove the Avarana of Pitta & Kapha dosha giving way for Anuloma Gati of Vititated vata. Modern View 24:
Stimulation to large sensory fibers from peripheral tactile receptors depresses the transmission of pain signals either from the same area of the body or even from many segments. This results in local inhibition.
It reduces intravascular pressure & volume which will reduces pain and swelling.
It reduces breakdown of RBC in turn reduces pigmentation & Itching. Jalaukavacharana The main constituents of the saliva of jalauka and their actions are as follows25. Constituents Mode of action Hirudin Most powerful Anti-coagulant, works as Diuretic & Antibiotic. (Other Anti- coagulants: Hementin, Hementerin, Annastatin) Bdellin Protease inhibitor like trypsin chymotrypsin or plasmin Eglin Digestive protease Apyrase & Destabilase Powerful platelet Anti-aggregate factor Hyaluronidase Enzyme which breaks hyaluronic acid responsible for connective tissue bonding. Anti- Elastase Degrade cutaneous elastastin at the level of Skin Piavit Leech prostanoids and has protective antithrombotic effects Haementin & Orgelase Have Hyperaemistic effect Lipase, Estarase Lipolytic substance Varicose Veins:
Anticoagulant effect: Hirudin by binding to thrombin. Also helps in reducing blood thickness and promotes optimum blood flow. Calin by binding to collagen
Clot Dissolving effect : Detsabilize  Breakup of Fibrin & Thrombolytic effect
Anti-Inflammatory Effect : Bdellins & Eglins  Inhibits trypsin & Plasmin
Bacteriostatic & Anaesthetic effect:
Anesthetic like Substances Relieve pain
Bacteria inhibiting substances Inhibits growth of Bacteria International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47653 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1417 Peripheral Vascular Diseases: Constituents Mode of action Hirudin Reduces factor VII -> Easy blood flow Apyrase (Platelet anti aggregate factor) Thrombus Destruction Eglin Acts as Anti-Oxidant by Reducing inflammation Esterase Prevents Hypercoagulation & Reduce fat flow Bdellin Digests foreign protein matrix & also digests undue intimal wall of the blood vessel Hyalurodinase Diffuses the blood for free flow and excrets antibiotication Histaminase Produces Vasodilatation action & Promotes regeneration Dushtavrana:
Hirudin improves Microcirculation
Hyalurinidase  Facilitates penetration & diffusion of pharmacologically active substances into the tissues
Trypsin, Plasmin  Reduces pain during bite
Histamine  Increase blood flow
Acetylcholine Vasodilator, Removing abnormal cells, reducing the bacterial load & formation of healthy granulation tissues.
All together Microcirculation within the wound  Bio-debridement prolonged oozing Healthy granulation tissue formation. Thrombosed Hemorrhoids: Hirudin & Hyaluronidase capillary tissue exchanging  Improves blood circulation Thrombolytic action  Dissolution of the organized blood clots Reduces swelling, Reduces pain. Plastic & Reconstructive Surgery:
Venous occlusion Thrombus Formation Flap necrosis
To relieve venous congestion leeches are used.
Alleviates tissue capillary pressure & local anticoagulation through
Active suction
Secretion of Vasoactive substance(Hirudin)
Passive oozing from bite wound
Better acceptance of flap: improving micro-circulation.
Reduced the rate of resection Leech Therapy in Modern Science:
Anti-Inflammatory Action
Anti-Metastatic action
Anti-Hyperglycemic action
Anticoagulatory effect
Leech therapy in Dentistry
Leech therapy in Eye & ENT disorders
Leech therapy in Reconstructive surgeries Shringa & Alabu: Negative Pressure  Stimulates circulation  Vasodilatation  Increasing blood supply  Increasing the metabolism  faster elimination of waste substances. International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47653 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1418 Cupping Therapy 26 : Prachana:
Prachana stimulates the accumulation of mast cells at the site & helps in improvement of circulation.
Prachana damages the superficial layers of skin and thus helps in rapid penetration of drugs. DISCUSSION: Acharyas have elaborately explained indication, mode of action of these parasurgical procedures in their treatises. But knowledge is only limited to Ayurveda fraternity. For wider acceptance and to explain their efficacy to modern world needs Scientific Validation. In this regard a thorough research by incorporating advanced techniques along with principles of Ayurveda is of paramount necessity. Research based standardization of the procedure helps in global acceptance of Parasurgical procedures CONCLUSION: Parasurgical procedures are unique and one of the greatest contributions of Ayurveda to the Surgical Field. They come into play where Surgery faces limitations. Scientific Validation of Parasurgical procedures is necessary for the global acceptance of our ancient science. REFERENCES: [1] Acharya Sushruta. Sushruta Samhita. 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