After the preceding chapter distinguishes the sirAs and identifies those considered suitable or unsuitable for puncture, the commentary says it is appropriate to present the historical procedure for sirAvyadha.
Key terms
sirAvyadha (siravyadha)
The historical procedure of puncturing a sira for bloodletting.
vidhi
A prescribed method or procedural rule.
vyadhya-avyadhya sirA (vyadhya-avyadhya sira)
SirAs classified as suitable or unsuitable for puncture.
Adhikarana 2 (3) · Śloka 3
bālasthavirarūkṣakṣatakṣīṇabhīrupariśrāntamadyapādhvastrīkarśitavamitaviriktāsthāpitānuvāsitajāgaritaklībakr̥śagarbhiṇīnāṁ kāsaśvāsaśōṣapravr̥ddhajvarākṣēpakapakṣāghātōpavāsapipāsāmūrcchāprapīḍitānāṁ ca sirāṁ na vidhyēt , yāścāvyadhyāḥ, vyadhyāścādr̥ṣṭāḥ, dr̥ṣṭāścāyantritāḥ, yantritāścānutthitā iti ||3||
View original
बालस्थविररूक्षक्षतक्षीणभीरुपरिश्रान्तमद्यपाध्वस्त्रीकर्शितवमितविरिक्तास्थापितानुवासितजागरितक्लीबकृशगर्भिणीनां कासश्वासशोषप्रवृद्धज्वराक्षेपकपक्षाघातोपवासपिपासामूर्च्छाप्रपीडितानां च सिरां न विध्येत् , याश्चाव्यध्याः, व्यध्याश्चादृष्टाः, दृष्टाश्चायन्त्रिताः, यन्त्रिताश्चानुत्थिता इति ||३||
Meaning of the śloka
The text prohibits sirA puncture in children, older people, those who are very dry, wounded, depleted, fearful, exhausted, intoxicated, fatigued by travel or sexual activity, emaciated, sleep-deprived, pregnant, or described by the source as klIba; in those immediately after emesis, purgation, decoction enema, or oil enema; and in people severely affected by cough, breathlessness, wasting, advanced fever, convulsions, paralysis of one side, fasting, thirst, or fainting. It also prohibits puncturing a sirA classified as unsuitable, one that cannot be seen, one seen but not properly controlled, or one controlled but not raised.
The commentary explains the exclusions largely in terms of incomplete or depleted tissues, risk of vAta aggravation, fainting on seeing blood, exhaustion, impaired mental state, weak digestion, or danger to bodily survival. KShata may mean a chest wound or injury by a sword or similar object; Gayi instead compounds it as a person depleted by a wound and therefore at risk of vAta disease. A fearful person is considered liable to faint. Recent emesis or purgation is specified before recovery diet and oleation. Pregnancy, emaciation, cough, breathlessness, and wasting are excluded because tissues are considered depleted. In advanced fever, blood loss is feared to provoke delirium and related complications. The closing reference to sirAs already declared unsuitable is a comprehensive reminder, not a redundant statement.
Key terms
kShatakShINa (kshatakshina)
Wounded and depleted, or according to Gayi, depleted because of a wound.
klIba (kliba)
A historically context-dependent category; the commentary associates it with depleted reproductive tissue and low resilience.
शोणितावसेकसाध्याश्च ये विकाराः प्रागभिहितास्तेषु चापक्वेष्वन्येषु चानुक्तेषु यथाभ्यासं यथान्यायं च सिरां विध्येत् ||४||
Meaning of the śloka
For disorders previously described as treatable by removal of blood, the text directs puncture of a nearby sirA according to established practice and rules, while the condition is still considered unripe. It extends the same approach to certain unlisted conditions moving toward suppuration.
The commentary links the indicated disorders to an earlier list beginning with skin disorders, nodules, and swellings. It says the word 'unripe' is stated to emphasize bloodletting among external procedures, although the lack of blood in a mature collection would already imply this restriction. Unlisted conditions means those approaching maturation but regarded as amenable to blood removal. YathAbhyAsa is interpreted as near the affected site. YathAnyAya means without omitting preliminary measures such as oleation and sudation.
Key terms
shoNitAvaseka (shonitavaseka)
Removal or letting of blood in the historical treatment system.
apakva
Unripe or not yet fully suppurated.
vipAkAbhimukha (vipakabhimukha)
Moving toward maturation or suppuration.
yathAbhyAsa (yathabhyasa)
Near the affected region, according to the commentary.
yathAnyAya (yathanyaya)
Following the prescribed preparatory sequence.
Adhikarana 4 (5) · Śloka 5
pratiṣiddhānāmapi ca viṣōpasargē ātyayikē ca sirāvyadhanamapratiṣiddham ||5||
View original
प्रतिषिद्धानामपि च विषोपसर्गे आत्ययिके च सिराव्यधनमप्रतिषिद्धम् ||५||
Meaning of the śloka
Even for people ordinarily excluded, the text says sirA puncture is not prohibited in poisoning or in a condition it considers immediately life-threatening.
The commentary presents an exception based on grave circumstances, including children, older people, and the other excluded groups. AtyAyika is explained as a condition from which destruction is imminent, exemplified by a severe vidradhi regarded as having no other remedy in this historical framework.
Key terms
viShopasarga (vishopasarga)
Affliction or complication from poison.
AtyAyika (atyayika)
An immediately dangerous or potentially fatal condition.
vidradhi
A deep inflammatory swelling or abscess-like disorder used as an example.
apratiShiddha (apratishiddha)
Not prohibited under the stated exceptional circumstances.
The passage gives a historical preparation and positioning sequence before puncturing a sirA. The patient is oleated and warmed, given a mostly liquid, doSha-appropriate meal or yavAgU, positioned seated or standing at a suitable time, and restrained so that breathing and other vital functions are not impeded. A region away from marmas and an instrument considered appropriate are then selected. The source specifies that restraint should be neither excessively tight nor excessively loose.
The commentary distinguishes preliminary preparation from the principal procedure. Calling the person Atura indicates that blood should not be removed from a healthy person. A liquid-rich meal is intended to promote the blood, while yavAgU is an alternative based on habituation. Suitable timing includes seasonal and weather restrictions. Positioning may be seated or upright. The restraint is interpreted as less tight on the head and not overly loose on the limbs. The selected bodily region must be free of marmas, and the instrument must be appropriate to the intended historical procedure.
Key terms
snigdha-svinna
Prepared by oleation and warming or sudation.
yavAgU (yavagu)
A thin gruel offered as an alternative preparatory intake.
yantraNa (yantrana)
Restraint or compression used historically to make a sirA prominent.
marmarahita pradesha
A region believed to be free of vital points.
Adhikarana 6 (7) · Śloka 7
naivātiśītē nātyuṣṇē na pravātē na cābhritē |
sirāṇāṁ vyadhanaṁ kāryamarōgē vā kadācana ||7||
View original
नैवातिशीते नात्युष्णे न प्रवाते न चाभ्रिते |
सिराणां व्यधनं कार्यमरोगे वा कदाचन ||७||
Meaning of the śloka
SirA puncture should not be performed in extreme cold, extreme heat, strong wind, cloudy weather, or at any time in a healthy person.
The passage describes different historical methods of positioning and compression intended to make selected sirAs prominent in the head and neck, feet, hands, limbs, back, pelvis, shoulders, abdomen, chest, flanks, genital region, underside of the tongue, palate, and gums. It varies posture and restraint according to body region and disease and tells the practitioner to use judgment in choosing comparable methods. These details form the text's regional restraint method for sirA puncture.
The commentary explains the purpose as raising sirAs in different regions. It defines the seat height through a traditional forearm measure and clarifies several postures and restraints, including the role of an assistant and the meaning of the person undergoing the procedure. 'Except inward-opening' excludes sirAs within the mouth from the head-and-neck method. Plota means cloth, with bark and similar materials included as alternatives. Contracted knee and elbow positions are associated with gRdhrasI and vishvAcI respectively. For back, pelvis, and shoulders the trunk is extended and the head lowered; for abdomen and chest the chest and head are raised and the body extended. Separate arrangements are described for flanks, genital anatomy, tongue, palate, and gums. The commentary concludes that unlisted restraint methods were also to be devised by judgment according to body and disease.
Key terms
sirotthApana (sirotthapana)
Making a sirA rise or become prominent through historical positioning and compression.
yantraNavidhi (yantranavidhi)
The method of restraint or compression.
karmapuruSha (karmapurusha)
The person undergoing the procedure.
plota
A cloth used as a binding material in the historical method.
antarmukha sirA (antarmukha sira)
An inward-opening or intraoral sirA excluded from one regional method.
The source specifies different shallow insertion depths and different instrument shapes for fleshy regions, less fleshy regions, and locations over bone.
The commentary says the verse varies instrument placement and instrument type by anatomical region. Fleshy sites include the abdomen and buttocks. The measurements use yava and vrIhi grain units, with vrIhi here understood as a pointed grain, specifically red rice. Exact procedural measurements are not reproduced in this educational meaning because applying them without modern anatomical control would be unsafe.
The text recognizes three seasonal times for use of an instrument: a cloudless day during the rains, a cool part of a summer day, and midday in the cold season.
Because recurring time is divided into rainy, hot, and cold seasons, the commentary specifies conditions within each. Vyabhra means a day without clouds in the rainy season. A cool summer time is explained as after the third part of the day. Hemanta stands for the cold season generally. These timings are said to concern an extremely urgent disease, not a healthy person; for a healthy person the commentary instead mentions a single ordinary time around autumn in the broader tradition.
Key terms
vyabhra
Cloudless weather during the rainy season.
grIShma (grishma)
The hot or summer season.
hemanta
The early winter season, used here for cold weather generally.
shastrakAla (shastrakala)
A seasonally selected time for an invasive procedure.
The text defines a properly opened sira as one from which blood flows in a stream after an appropriate incision, continues for a prescribed short period, and then remains stopped when restrained.
🔊 Audio coming soon
Show commentary
suviddhasirālakṣaṇamāha- samyagityādi| muhūrtamiti muhūrtaśabdaḥ sravēdasr̥gityatra ca sambadhyatē||11||
Meaning of the commentary
The commentary presents these as the signs of a suviddha sira. The word muhurta is grammatically connected both with the duration of blood flow and with its remaining stopped after restraint.
Key terms
suviddhA sirA (suviddha sira)
A vessel regarded in the historical procedure as properly opened.
samyakshastranipAta (samyak-shastra-nipata)
What the source regards as proper application of the instrument.
dhArA (dhara)
A continuous stream.
muhUrta (muhurta)
A traditional interval applied here to both flow and subsequent arrest.
Just as yellow coloring is said to flow first from safflower blossoms, the text says that when a sira is opened, the blood considered disturbed emerges first.
The commentary states the intended claim directly: after venesection, dushṭa or altered blood is believed to flow before the rest.
Key terms
kusumbhapuShpa (kusumbha-pushpa)
Safflower blossom used in the comparison.
pItikA (pitika)
Yellow coloring said to issue first from safflower.
duShTa rakta (dushta rakta)
Blood regarded as altered or disturbed in the classical model.
sirAviddha (sira-viddha)
A vessel that has been opened or punctured.
Adhikarana 12 (13) · Śloka 13
mūrcchitasyātibhītasya śrāntasya tr̥ṣitasya ca |
na vahanti sirā viddhāstathā'nutthitayantritāḥ ||13||
View original
मूर्च्छितस्यातिभीतस्य श्रान्तस्य तृषितस्य च |
न वहन्ति सिरा विद्धास्तथाऽनुत्थितयन्त्रिताः ||१३||
Meaning of the śloka
Even when a sira has been opened, it may fail to flow in a person who has fainted, is extremely afraid, exhausted, or thirsty, or when the procedural restraint has not made the vessel prominent.
The commentary attributes absent flow in fear and related states to vayu closing the mouth of the vessel. When the restraint has not elevated or made the vessel ready, blood is not directed toward the opening. It notes that the same point appears elsewhere but is repeated here because this is a different procedural context.
Key terms
mUrcchita (murchhita)
Fainted or unconscious.
atibhIta (atibhita)
Extremely frightened.
anutthitayantrita (anutthita-yantrita)
Restrained without producing the intended prominence of the vessel.
sirAmukhanirodha (sira-mukha-nirodha)
Closure of the vessel opening in the commentary's explanation.
Adhikarana 13 (14) · Śloka 14
kṣīṇasya bahudōṣasya mūrcchayā'bhihatasya ca |
bhūyō'parāhṇē visrāvyā sā'parēdyustryahē'pi vā ||14||
View original
क्षीणस्य बहुदोषस्य मूर्च्छयाऽभिहतस्य च |
भूयोऽपराह्णे विस्राव्या साऽपरेद्युस्त्र्यहेऽपि वा ||१४||
Meaning of the śloka
For a depleted person whose bloodletting was considered necessary, or for someone in whom the procedure was interrupted by fainting, the text advises that any further release be staged later—again in the afternoon, the next day, or after three days.
The commentary frames this as gradual blood removal when a depleted person was nevertheless judged to require it. The reference to someone affected by fainting also includes a person who was not initially depleted.
Key terms
kShINa (kshina)
Depleted or weakened.
mUrcchA (murchha)
Fainting.
kramasrAvaNa (krama-sravana)
Staged or gradual removal of blood.
aparedyuH (aparedyuh)
On the following day.
tryaha
A period of three days.
Adhikarana 14 (15) · Śloka 15
raktaṁ saśēṣadōṣaṁ tu kuryādapi vicakṣaṇaḥ |
na cātiniḥsrutaṁ kuryācchēṣaṁ saṁśamanairjayēt ||15||
A discerning practitioner is advised to leave some of the blood considered dosha-affected rather than permit excessive loss; the remainder is to be managed with pacifying measures.
For a strong adult described as carrying abundant doshic disturbance, the traditional upper quantity for blood removal is stated as one prastha.
🔊 Audio coming soon
Show commentary
prasthaṁ sārdhatrayōdaśapalāni| tathā cōktaṁ- “vamanē ca virēkē ca tathā śōṇitamōkṣaṇē| sārdhatrayōdaśapalaṁ prasthamāhurmanīṣiṇaḥ”- iti||16||
Meaning of the commentary
The commentary equates one prastha with thirteen and a half palas and cites a verse assigning that quantity in the contexts of therapeutic vomiting, purgation, and bloodletting.
Key terms
prastha
A traditional volume or quantity measure used here as an upper limit.
sArdhatrayodashapala (sardha-trayodasha-pala)
Thirteen and a half palas, the commentary's equivalence for one prastha.
shoNitamokShaNa (shonita-mokshana)
Therapeutic removal of blood.
bahudoSha (bahu-dosha)
Having abundant doshic disturbance in the source's selection criteria.
The passage gives a long historical catalogue of conditions for which particular regional siras were selected for venesection. It groups disorders of the feet and legs, swelling and impaired gait, groin and genital disorders, abdominal and flank conditions, cough and difficult breathing, disorders of the arms and shoulders, periodic fevers, seizures and mental disturbance, and diseases of the tongue, teeth, palate, ears, nose, eyes, and head. For paired or corresponding disorders, it often applies the lower-limb pattern to the upper limb or selects the side associated with the affected region.
The commentary explains the regional catalogue while repeatedly limiting or qualifying it. 'And similar conditions' includes other foot disorders believed to involve blood. Apachi here means newly arisen rather than established. A sira near a joint is intended, because placing an instrument directly in a joint is prohibited. Gayi restricts the cough-and-breathlessness indication to mild cases for clearing pathways, since venesection was already prohibited in severe cases. The arm indications are variously read by Jejjata and Gayi, and apply especially when vata is considered obstructed by blood; the text also distinguishes proximity to the trika or jaw joint from penetrating the marma itself. Some read epilepsy together with mental disturbance at one head location, but the commentary rejects that reading and cites Vagbhata for separate sites. Ear pain is qualified as involving vata obstructed by blood. The final rule confines all these indications to disorders understood as caused by or associated with blood.
Key terms
sirAvyadha (sira-vyadha)
Historical therapeutic opening of a selected vessel.
vrIhimukha (vrihimukha)
A rice-grain-shaped instrument named for venesection.
raktAnubandha (rakta-anubandha)
A disorder understood as associated with blood.
sandhisamIpa (sandhi-samipa)
Near a joint, explicitly distinguished from placing an instrument into the joint.
marma
A vulnerable vital point to be avoided.
upanAsikA (upanasika)
A vessel region near the nose named in eye-related indications.
Twenty kinds of faulty venesection are listed: poorly opened, excessively opened, bent, crushed, repeatedly struck, non-flowing, excessively widened, opened at the margin, dried, only partly reached, trembling, opened without proper elevation, cut by the instrument, opened obliquely, missed, unsuitable for opening, unstable, 'cow-like,' repeatedly opened, and opening that injures a sira, snayu, bone, joint, or marma.
The commentary states that these are called dushṭavyadha because their opening or puncture is defective, and confirms their total as twenty. Their individual meanings are explained in the following passage.
Key terms
duShTavyadha (dushta-vyadha)
A defective or harmful act of puncture or opening.
atividdha
Opened or penetrated excessively.
tiryagviddha (tiryag-viddha)
Opened obliquely.
dhenukA (dhenuka)
A named faulty pattern involving repeated intermittent flow.
The text explains the twenty faulty openings. A very small opening yields little, indistinct blood with pain and swelling; an excessive opening may direct blood inward or cause profuse loss. A bent vessel can behave similarly. A blunt instrument may crush and broaden the site; repeated unsuccessful strikes bruise it. Cold, fear, or fainting may prevent flow, while an overly sharp, broad instrument makes an excessive opening. A marginal opening yields little blood; depletion can leave the vessel dry and filled with vayu; partial contact gives slight flow. Poor restraint may cause trembling and cessation of blood. Complete cutting produces profuse bleeding and loss of function; an oblique or inadequate opening leaves only a partial track or misses the vessel. An unsuitable vessel should not be opened. An unstable puncture or repeated striking can create multiple tracks and intermittent flow compared with milk from a cow's teats. Repeated opening at one site and injury to snayu, bone, sira, joint, or marma can cause pain, swelling, disability, or death.
The commentary glosses the terms in the list: avyaktam means indistinct because the quantity is small; inward flow means entry into the body; bent means made crooked; a blunt strike flattens and spreads the tissue; anasādita means not reached; partial contact means reaching only one quarter. In vepita, movement from poor restraint is followed by failure of blood flow. Shastrahata denotes complete division with excessive bleeding and destruction of actions such as movement. Dhenuka is so called because repeated tracks release blood intermittently like streams from a cow's teats. Repeatedly opened means multiple penetrations at the same place. The final comment says prevention lies in avoiding the causes and that established complications were historically treated with measures opposite to their cause.
Key terms
durviddha
An inadequately made opening with little flow, pain, and swelling.
atividdha
An excessive opening associated with inward or profuse bleeding.
piccita (picchita)
A crushed, flattened, broadened injury from a blunt instrument.
shastrahata (shastra-hata)
Complete instrumental division causing heavy bleeding and loss of function.
dhenukA (dhenuka)
Multiple puncture tracks with intermittent streams of blood.
marmaviddha (marma-viddha)
Puncture involving a vital point, associated with grave outcomes.
The verse says that complete mastery regarding siras is difficult because they are naturally mobile and shift like fish; therefore any intervention involving them demands exceptional care.
The commentary explains that even practice does not make a person wholly secure in relation to siras because they move like fish. Its point is that puncture of a sira requires great caution.
Key terms
sirA (sira)
A classical vessel-like channel whose exact modern identity varies by context.
shikShita (shikshita)
Trained or made proficient through practice.
cala (chala)
Mobile or shifting.
matsyavat
Like a fish, used as an image of movement.
tADayet (tadayet)
To strike or puncture in this procedural context; not operationalized here.
Adhikarana 20 (21) · Śloka 21
ajānatā gr̥hītē tu śastrē kāyanipātitē |
bhavanti vyāpadaścaitā bahavaścāpyupadravāḥ ||21||
The text claims that diseases subside more rapidly after correctly performed siravyadha than after oleation and related therapies or topical applications.
Siravyadha is described as a principal part—or, in another interpretation, half—of treatment in shalyatantra, comparable to the importance of a properly administered basti in kayachikitsa.
The commentary explains chikitsardha primarily as something chief or central within treatment; other interpreters take ardha numerically to mean half. A parenthesized quotation claims that draining blood purifies flesh, fat, bone, marrow, dhamanis, and skin affected by disturbed blood, while discharge of rasa, sweat, and related substances does not cleanse them fully.
Key terms
sirAvyadha (siravyadha)
Historical therapeutic puncture of a sira for bloodletting.
cikitsArdha (chikitsardha)
Interpreted either as a principal part of treatment or literally half of treatment.
shalyatantra
The classical surgical discipline.
basti
A therapeutic enema regarded as central in kayachikitsa.
The text states that people who have undergone oleation, sweating, emesis, purgation, asthapana or anuvasana basti, or sira puncture should avoid anger, exertion, sexual activity, daytime sleep, prolonged speech, exercise, travel, study, prolonged standing, sitting, walking, cold, wind, sun, incompatible or unsuitable food, and eating during indigestion until strength returns. Some authorities prescribe avoidance for one month. A fuller discussion is promised later.
The commentary treats these restrictions as generally applicable after the listed therapies. It defines sthana as remaining upright and asana as sitting, counts fifteen restricted factors beginning with anger and exertion, and locates the later detailed discussion in the section on treating patient complications.
Key terms
snigdha-svinna
A person who has undergone oleation and sweating therapies.
vAnta-virikta (vanta-virikta)
A person who has undergone therapeutic emesis and purgation.
AsthApita-anuvAsita (asthapita-anuvasita)
A person given the two historical categories of basti.
The text lists sira puncture, horn, gourd, leeches, and superficial incisions as historical means of removing disturbed blood from progressively different depths or distributions.
The commentary interprets pada here as small superficial incisions. It reads the methods as a graded sequence: superficial blood is addressed by incision, deeper blood by leeches, deeper still by a gourd, still deeper by a horn, and the most deeply or generally distributed blood by sira puncture.
Key terms
sirA (sira)
A vessel-like channel punctured in historical bloodletting.
viShANa (vishana)
An animal horn used historically as a suction device.
tumba
A gourd used historically for suction.
jalaukA (jalauka)
A leech used historically for blood removal.
pracchanna (prachchhanna)
Multiple small superficial incisions or scarification.
One authority assigns leeches to deeply situated blood and superficial incision to blood collected in a localized mass. When blood is distributed through siras or throughout a limb, sira puncture is indicated in this historical scheme; when it is situated in the skin, horn or gourd suction is assigned.
🔊 Audio coming soon
Show commentary
tatra sirāviṣāṇatumbajalaukaḥpracchannānāṁ viṣayaṁ kaścidāha- avagāḍhē ityādi||26||
Meaning of the commentary
The commentary explicitly presents this distribution of uses among sira puncture, horn, gourd, leech, and incision as the view of a particular authority, without reconciling it further with the preceding graded account.
Key terms
avagADha (avagadha)
Deep-seated, assigned here to leech application.
piNDita (pindita)
Collected or localized in a compact mass.
a~ggavyApaka (angavyapaka)
Spread throughout a limb or body part.
tvaci sthita (tvachi sthita)
Situated in the skin.
shRu~gga-alAbu (shringa-alabu)
Horn and gourd suction devices in the historical scheme.
This marks the end of the eighth chapter of the Sharirasthana in Dalhana's commentary on Sushruta entitled Nibandhasangraha. The transmitted spelling of Dalhana's name is shown with a textual variation.
Key terms
sirAvyadha (siravyadha)
Historical therapeutic puncture of a sira.
vidhi
Method, rule, or prescribed procedure.
shArIrasthAna (Sharirasthana)
The division concerned with embodiment and anatomy.