Trividh Karma – A Review study from Sushruta Samhita

Ayurveda the Science of life which has given importance to preventive as well as curative modalities of treatments . Ayurveda has been divided into eight branches according to Rights of treatments i.e. Ashtangas. Among the Ashtangas Shalya Tantra is one of the most important branch of Ayurveda. Sushruta has described various treatment modalities for treatment of diseases . Shalyatantra includes many Surgical and Parasurgical procedures For performing these procedures Acharya has been described number of karmas i.e. Trividh karma, Ashtavidh Sashtrakarma.

INTRODUCTION Acharya Sushruta the Father of Surgery has defined Shalya Tantra as it is the name of that branch which describes the methods of removal of different kinds of foreign bodies, such as grass, wood, stone, sand, bone, hair and nail; pus, exudation, vitiated ulcer, use of caustic alkalies and fire and diagnosis of ulcers or wounds 1 . Shalya means any foreign body or substance which can harm to body and mind of human beings 2 .
In Shalya Tantra, various Surgical and Parasurgical procedures have been explained. Acharya Sushruta described Trividh Karmas namely Poorva karma (pre-operative), Pradhana karma (operative) and Paschat karma (postoperative) 3 . Sushrutacharya was well aware about the complications of surgery, so he described trividh karma to minimize the complications and he has been given equal importance to all the 3 karmas as per the view of treatment.

Trividh Karma-1) Purva Karma-
It means Pre-Operative procedure .Firstly it includes Proper diagnosis , Proper and Detail History taking , General and Local examination of patient. Later on Purva Karma includes collection of all the essential equipment's . Acharya Sushruta has explained the list of materials required for the surgeon for performing surgical procedure should be collected, instruments (both sharp and blunt) caustic, fire, probes, horn, leeches, gourd (blood sucking apparatus) Jambhavostha (a cauterization probe) , cotton, gauze, suture and ligation materials, medicinal leaves, bandages, honey, ghee, milk, oil milk etc. and water to mitigate thirst, ointment, decoction, paste, fan, cold and hot water, frying pan and other earthen vessels, beddings and seats, obedient, steady and muscular strong paricharak should be kept ready to hold the patient during surgery 4 Sushruta has also described the preoperative appreciation of foreign body, its size, shape and exact location within the body and appropriate instrument for its removal should be selected preoperatively. He has also mentioned the preoperative diet and Nil by mouth for various types of surgeries, before all operations patient should take light diet only. Apart from these some exceptions such as artificial or instrumental delivery, abdominal conditions, piles, calculus disease, fistulain-ano, and surgical conditions of mouth the patient should be kept Nil by mouth before surgery 5 . Proper Purva Krama is required to prevent any complications or destruction of main action and ensuring the success.

2) Pradhana Karma -
Acharya Sushruta also mentioned the importance of sterilization of instruments to prevent post operative infection by heating sharp instruments in fire. Pradahan Karma includes the Shashtra Karma, before doing the main surgical procedure worship of Agni, Brahman and Vaidya should be done on the prospitious moment b and constellation by offering curd, sanctified rice, Different types of food drinks and gems; then offer oblation, sacrificial ritual and spiritual motets of benediction. After that the light diet is given and the patient and maintain the patients position as Purvabhimukh and the surgeon Should sit opposite side of the patient . Besides of Marma, Sira, Snayu, Sandhi, Asthi, Dhamani the incision should be done only once and its in the direction of Loma ( Hairs) till the total drainage of pus 6 . Oblique incision should be given in the following regionseyebrow, cheek, temple, forehead, eyelid, lip, axilla, belly and groin 7 . The experienced surgeon should make the circular or semicircular incision in the upper and lower limbs and in Guda and Medhra 8 . Acharya Sushruta has described eight type of shashtra Karma. ASHTAVIDH SHASTRAKARMA 9  and Jalodara (Ascites) for aspiration of fluids.

5) Yeshana -
Means probing. It is done by using probes of different Size and shape . it is indicated in sinuses, ulcer with impacted foreign body and those with tortuous tracks.

8) Sivana -
Sivana Means suturing. by using different types of needle according to body parts, it is indicated for diseases arising from fat such as tumor etc which have been incised, scraped well, Sadyovrana (traumatic wound) and diseases localized on movable joints. Types of Sivana 10 -

Sivana types
Suture types

3) Pashchat karma -
After the completion of the surgery, the patient should be assured by sprinkling cold water on his mouth and feet. The wound should be irrigated and pressed slowly, massaged and washed with decoction, then the decoction remained in the wound should be wiped out with a cotton swab and a Gauze containing thick paste of sesames, honey and ghee, neither too Soft nor too rough to be inserted into the wound . After covering with medicated paste and putting a piece of gauze, it should be bandaged. Fumigate it with analgesic and disinfectant drugs like guggulu, agaru, vacha, sarjras, salt, nimb patra etc. The patient is kept in post operative care unit i.e. vranitagara By following all Raskshoghna Karma for protection of wound and Patient for 10 days.

DISCUSSION:
As per review from Sushrut Samhita Acharya Sushruta has mentioned Trividh karmas and its Step by step implementation during surgical procedures . Acharya described Purva Karma , Pradahan karama and Paschat Karma in detail. He also explained Ashtavidh karma i.e. Main Surgical procedure under Heading of Pradahan Karma.

CONCLUSION :
The study can be concluded that Acharya Susruta has mentioned Trividh Kramas are Very useful For performing Surgical as well as para-Surgical procedures .From the study of above review article we can understand about the deep knowledge of Susrutacharya . Acharya Susruta has given prime importance to surgical procedures and he explained details about the Procedures under the main Heading of Trividh Karmas as Purva, Pradhan and Paschat Karma are very essential for a successful surgery without any complications and getting the complete relief from disease.