Sastrakarma Vidhi in Ashtanga Hridaya Sutrasthana 29: Vagbhata's Fifteen Bandhas, and Why the Cut Gets Five Verses

📖 26 min read · Ashtanga Hridaya, Sutrasthana, Chapter 29, verses 1–79

Sastrakarma Vidhi: where chapter 29 sits in the Sutrasthana

The Sutrasthana of the Ashtanga Hridaya closes with six chapters on the surgical craft, arranged as a working sequence: 25 is Yantra Vidhi, the blunt instruments; 26 is Shastra Vidhi, the sharp ones, its second half turning to raktamokshana and the leech; 27 is Siravyadha Vidhi; 28 is Shalyaharana Vidhi, the extraction of a lodged shalya; 29 is this chapter; and 30, Kshara-Agnikarma Vidhi, closes the section with the caustic alkali and the cautery. Four already have pages here: the hundred and one yantras, the twenty-six sharp instruments, the twelve leeches, and the ten methods of extraction.

It opens in the standard manner: After 'Salyaharana-vidhi', Acarya Vagbhata expounded the chapter 'Sastrakarma-vidhi' (Surgical Procedure), thus said Lord Atreya and other great sages. It runs to seventy-nine verses. In the edition used here — Vidyanath's translation of the Sutrasthana, published by Chowkhamba — it occupies printed pages 397 to 411, and every verse number below is the one printed in that text's margins.

Verse 1: the knife is what you reach for when medicine has failed

For a chapter called Surgical Procedure, the first substantive line is a restraint. Verse 1 reads, in this translation: In both the exogenous and endogenous diseases, if the medical treatment fails, then only go for the surgical therapy.

The scope is wide — the externally caused and the internally arisen are both named, so the rule is not confined to injuries — and the ordering places sastrakarma last in a queue, after medical management has failed. The page on chapter 28 notes this verse as a summary of the whole surgical group; from inside chapter 29 it does something narrower, setting up the twelve verses that follow, all of which are about not cutting yet.

The chapter's next move is the sequence meant to make surgery unnecessary. It begins from a causal chain stated flatly: a vrana follows the formation of pus, and pus is preceded by sopha. So the swelling is where the work starts, and the first task is to establish which dosha predominates in it. Then a graded series — cold applications, the pouring of liquids, raktamokshana, and the purificatory measures vamana and virechana. Only if the sopha still does not subside does the chapter reach vilayana, liquefaction, followed by upanaha, the poultice. Nothing on the ladder involves a blade — and the three-stage clock that comes next exists because this ladder has a point of exhaustion that somebody has to recognise.

Ama, pacyamana, pakva: three stages of one sopha

Verses 2 to 5 divide sopha into three: ama sopha, pacyamana sopha and pakva sopha. The translation glosses them as un-ripened, in the process of ripening, and ripened.

The vocabulary is not medical in origin. Ama is the word for a raw fruit and for undigested food; pakva for a cooked dish and a ripe mango. Vagbhata uses the pair elsewhere in the Sutrasthana: chapter 13, Doshopakramaniya, sorts doshas into sama and nirama by the image of an unripe fruit, on the same argument — you cannot act on something raw as though it were finished. Sushruta's Uttara Tantra applies the same pair to the six kinds of atisara.

What makes the three stages usable is that every sign given for them is external — nothing the physician cannot see, touch or ask about.

Ama sopha: five signs, and every one of them mild

Verse 2 gives the unripe swelling five features, and the striking thing is how much of it is stated as absence or as degree rather than as presence:

• Mild swelling.
• Mild temperature over the site.
• Mild pain.
• No discoloration of the skin.
• Hardness.

Three mildnesses, one negative and one positive finding. An ama sopha is recognised largely by what it is not yet doing — a hard thing to build a rule on, which is why the chapter makes the consequences of getting it wrong so explicit a few verses later.

Pacyamana sopha: the ghee that melts on the skin

Verses 3 and 4 turn to the swelling in the act of ripening, and the register changes completely. Now everything is present and loud: discoloration and redness; a swelling the text compares to a bladder distended with air; a continuous bursting pain; a splitting pain felt through the whole body, with yawning; then anorexia, burning, thirst, jwara and insomnia; and tenderness.

In the middle of that list sits one sign that is not a symptom but a test: solid ghrita placed on the site melts. It is a crude thermometer and the only instrumented observation in the diagnostic section. The physician is not asked to estimate the temperature; he is asked to put something with a known melting point on the skin and watch.

Eleven more signs from the Ashtanga Sangraha

The edition appends a note: the Ashtanga Sangraha, Vagbhata's larger prose work, gives eleven further features of pacyamana sopha. A paste smeared on the area dries faster than it should; a tingling like the sensation mustard paste produces; the crawling of ants; a feeling of being squeezed with the hands; of being pinched with the fingers; beaten with sticks; pricked with needles; cut with a sharp instrument; stung by a scorpion; burnt by cautery; and drilled with a burning coal.

One of those eleven is something the physician can watch. The other ten are sensations, obtainable only by asking the patient and believing the answer. Set beside the main verses, the diagnosis of a ripening sopha divides almost in half: the visible list belongs to the examiner, this one to the person examined.

Six of the ten similes name an injury — sticks, needles, a blade, a scorpion, cautery, a burning coal — so a text about instruments is describing pain by reaching for instruments. It is the only place in the chapter where the surgical vocabulary is figurative.

Pakva sopha: water in a leather bag

Verse 5 gives the ripened swelling, and the signs are mostly about how the surface behaves:

• The swelling becomes quiet — the translation says passionless, the heat and agitation having gone out of it.
• The skin loses its elasticity and wrinkles.
• It becomes pale, and elevated.
• It pits on pressure and fills again quickly.
• The contents shift inside it similar to the water in a leather bag.
• There is itching.
• And the earlier signs disappear.

The leather-bag comparison does real work. A water-skin has a specific feel — weight that moves, a wall that gives and returns — and anyone in the period had handled one. The sign is calibrated against an object every reader owns, as the ghrita test is calibrated against a substance every kitchen has.

Note the last item. The disappearance of the pacyamana signs is itself a sign of pakva. The clock does not simply add features as it advances; at the final stage it takes the previous stage's features away, so a physician watching only for intensity will read the quieting as improvement.

Verse 7 then adds a fourth state that was not in the original three, ati pakva sopha, over-ripened: pus now abundant, a cavity within, the skin thin, wrinkled and blackish, and hair falling from the site. Three stages plus one overshoot gives the clock a far end as well as a near one, which is what makes the chapter's central anxiety symmetrical. Too early is a named error; too late is a named error; the window between them is what the eleven similes and the melting ghrita exist to locate.

No pain without vata, no sopha without kapha

Verse 6 interrupts the sequence of lakshanas with a piece of theory, and it is the most quoted line in the chapter:

There will be no pain without vata, no burning sensation without pitta, no swelling without kapha, any redness and formation of pus without rakta. Hence the swelling is formed due to the involvement of all the tridosas along with the blood.

As a definition it is elegant: four cardinal findings, each assigned to one factor, and the conclusion that a sopha showing all four must involve all four. As a diagnostic instrument it is stronger, because it runs both ways. If pain is present, vata is implicated; if burning is absent, pitta is not. The signs become a formula rather than a list to be matched.

It also explains why the chapter never asks for the dosha of a swelling, only which one predominates: on this analysis a pus-forming swelling always involves all three plus rakta, so predominance is the only question that can sensibly be asked. For the framework there is a separate page on the tridosha in the Ashtanga Hridaya.

Raktapaka: the one that ripens without showing it

Verses 8 and 9 then supply the chapter's own counter-example, and it is the passage that most repays attention. In a kapha-vitiated state, the text says, ripening proceeds slowly and the complete signs are invisible. It is cold to the touch. Its colour is the colour of ordinary skin. The pain is mild. And it is very hard in touch similar to stone. On those findings, the verse concludes, an intelligent physician can diagnose raktapaka without doubt.

Every one of those four findings is also a finding of ama sopha. Cold, uncoloured, barely painful, hard: the earlier list said mild temperature, no discoloration, mild pain, hardness. The chapter has just described a swelling that reads as unripe and is in fact ripening — immediately after building a clock that depends on reading exactly that difference.

This is the chapter being careful, not careless. Having given a rule, it gives the case the rule will mishandle, and changes the evidence for it: stone-hardness rather than mere hardness, plus an explicit warning that the visible signs will not come. The intensifier is the whole diagnosis.

Verses 8 and 9 give raktapaka as cold, uncoloured, barely painful and hard. The comparison the text reaches for is stone.

Darana and patana: two ways to open, and who is exempt

Verse 10 introduces a fork. Patana is opening with a sharp instrument; darana is opening by application — the text says by alkalies and others — without one. The verse lists five situations in which patana is not to be used, and they are a revealing set:

• Those of weak mind.
• The debilitated.
• Children.
• A swelling raised by accumulated pus within the vrana.
• A site at a marma or at a joint.

Three of the five are properties of the patient rather than of the swelling — the same pattern the Bhagna chapter of the Sushruta Samhita shows when it grades a case on temperament, age and habits rather than on the break. In everything else, verse 10 concludes, patana is the line to adopt. On the marma exemption there is a separate page on the hundred and seven vital points.

Verses 11 and 12 state the two failures directly. An ama sopha must not be opened: the named consequences are injury to the sira and snayu, severe bleeding, severe pain, a gaping wound and spread. And if pus is not completely evacuated from a pakva sopha it increases and damages sira, snayu, rakta and mamsa — similar to the spark of fire fed with grass. One error is cutting too early, the other finishing too little; both are given a consequence and neither is given a way back.

Verse 13, the harshest line in the chapter

Then comes a verse that is not clinical at all. In this translation: a physician who opens an un-ripened vrana, and who neglects a ripened one through ignorance, can be considered as mean fellow.

The placement is deliberate. The two errors named are exactly the two the preceding verses were written to forestall, and the verse pairs them as one failing. Both are errors of timing; neither is an error of technique. A surgeon here can be condemned without his hands ever being mentioned.

Six qualities of the surgeon, and what is missing from the list

Verse 21 sets out what the operator should be. Six items:

• Courage in doing surgery.
• Quickness in conducting the procedure.
• Keeping his instruments sharp.
• Not sweating while he works.
• Not letting his hands shake.
• Not becoming confused.

Read the list for what it leaves out: no knowledge, no training, no scriptural learning, no character in the ethical sense. Five of the six concern the body's behaviour under pressure and the sixth concerns the instrument. It describes composure, not competence — competence having been settled by the twelve diagnostic verses already. That sixth item sends the reader back to chapter 26 on the sharp instruments.

The operative verses, and what this page withholds

Verses 15 to 22 are the procedure: the shortest major block in the chapter, and the one block this page will not reproduce.

What is in them, described only as subject matter: verse 15 covers what the patient is given beforehand, including a draught whose purpose the text states plainly — discussed separately on this site in its page on anaesthesia in classical Indian surgery — with four conditions in which food is withheld instead. Verse 16 lists the tray to be assembled and the orientation of the patient. Verses 19 and 20 give the dimensions and spacing of incisions and the means of tracing the track of the pus. Verse 22 names the regions where the cut runs across rather than along.

None of the specifics are given here. No measurement, no direction, no sequence, no instrument, no material, no draught, no dose. The same applies to the passages on suturing technique, packing, the medicated powders and pastes applied afterwards, the fumigation, and the handling of an infested vrana. Those are withheld in full, for one reason: they are the parts a reader could attempt, and every one would cause harm if attempted.

After: the chapter turns to the covering

From verse 24 onwards chapter 29 changes subject and does not change back. Everything to the colophon concerns the period after the procedure: what covers the wound, what the patient eats, what he must not do, how often the dressing changes, and how long the restrictions last. More than two-thirds of the chapter.

Verse 29 shows the level of attention. It specifies the cloth — clean, thin, strong — and the wick: cotton threads, fumigated, soft, smooth and free of folds. Six qualities for a piece of cloth, in a chapter that gave the surgeon six.

Verse 30 is stranger. Potent herbs are held near the patient's head — lakshmi, guha and atiguha, jatila, brahmacharini, vacha, chatra and atichatra, durva, siddharthaka — and the room and bed fumigated twice a day. The edition's note adds the sprinkling of water and an oblation, against insects and against spirits in the same breath. The protective and the hygienic are not separated.

Verses 31 to 33 give the prohibitions, and one is unexpectedly precise. Day sleep is forbidden and the consequences itemised: swelling, itching, redness, pain and pus all increase. Excessive exertion swells the site; keeping vigil reddens it; day sleep brings pain. Sexual activity is forbidden, and the verse adds that recollection, touch or sight of a beloved woman is enough to produce the effects it is trying to avoid.

Hearing stories, and the company of friends

Verse 41 heads a short section the edition calls Vranopacara, the tending of the wound. Most is about protecting the site: it is fanned, with a bunch of animal-tail hair or with ushira; not beaten, poked or scratched with the nails; and guarded while the patient goes about his business.

Then the verse says something else. One who wishes his wound to close quickly should be engaged himself in hearing stories and spending time with the company of friends, elders and brahmins.

That is a prescription for company and diversion inside a surgical chapter, in the same verse as the instruction not to scratch — not framed as consolation or piety, but placed among the measures that affect the outcome, with the same grammar as the fanning and the fingernails.

The third day, not the second

Verse 44 gives the dressing interval as a rule with a floor. The bandage comes off on the third day and the site is re-dressed after washing. It is not to be opened on the second: doing so is said to bring severe pain, growths, and delay.

Set this beside the Bhagna chapter of the Sushruta Samhita, which indexes the same decision on a different variable: Sushruta sets the interval by season, once a week in cold weather, every fifth day in temperate, every fourth in heat. Vagbhata sets one number and calls the second day an error. They are not in conflict — one is dressing a broken asthi, the other an opened sopha — but Sushruta's rule varies with the world outside the patient and Vagbhata's does not vary at all. He keeps his variation for the bandage's tension instead.

Verses 45 to 47 specify the pack on two axes, neither too unctuous nor too dry and neither too thick nor too thin, with a named consequence at each extreme; verse 47 names one wick, vikesika. Verses 49 to 53 add a short taxonomy of sivana, suturing, in four kinds — gosphanika, tunna sevani, vellitaka and rju granthi, glossed as irregular, continuous, spiral and interrupted. Three of the four names are shapes rather than techniques — the same naming habit the Bhavaprakasha uses for the sixteen kandara, where sevani names a seam in the body rather than one made in it. The materials and the methods are not given here.

The fifteen bandhas of Ashtanga Hridaya 29

Verses 59 to 61 give the chapter's largest list: fifteen kinds of bandha. It is the block the edition's own closing summary singles out, in its only sentence about detail: 15 types of bandages have been discussed in detail.

After the list the text adds a line that reads almost as an apology for having made one: the physician should apply the suitable bandha at the appropriate place by applying his mind. The fifteen follow, with the gloss and the region each is named for. No method of application is given in the text, nor here.

1. Kosa — the sheath; a hollow cylinder, for the joints of the thumb and fingers.
2. Svastika — the cross; for rounded joints, between the great and second toes, the inter-mammary region, the glabella, the soles, the palms and the ears.
3. Pratoli, also Muttoli — the recurrent; a broad band, for the neck.
4. Cina — the banner; for the inner angles of the eyes.
5. Dama — from the tail of a four-footed animal; a large one, for a part in pain or cramp.
6. Anuvellita — the encircling; for the limbs, and named for oblique, deep and long cuts.
7. Khatva — the four-tailed, from the four-legged cot; for the temples, cheeks and lower jaw.
8. Vibandha — the circular chest binding; for the back, abdomen and chest.
9. Sthagika — the supporter; it encloses, and is named for the ends of the thumb and fingers.
10. Vitana — the canopy; a large one, for the head.
11. Utsanga — the sling; for parts that hang.
12. Gosphana — from the cowherd's sling; a concave one, for the chin, nose, lips and shoulders.
13. Yamaka — the twin; a pair, for two vranas on one part.
14. Mandala — the circle; for the rounded parts — arms, flanks, abdomen, thighs, back.
15. Pancangi — the five-limbed; for the parts above the clavicle.

Svastika, the cross, is the second of the fifteen bandhas. Every one of the fifteen is named for a shape, never for a wound.

Named by shape only, and why that matters

The text states the principle of the list explicitly: Nomenclature of the bandages is given due to their shape only.

That line says what kind of list this is. These are not fifteen procedures but fifteen shapes, each named for an object that already had that shape in ordinary life — a sheath, a cross, a banner, an animal's tail, a cot, a canopy, a sling, a circle, a twin, a five-fold thing. Nothing in the naming refers to a wound, a dosha, a season or a stage of ripeness: the nomenclature comes entirely from the household and the farmyard.

Khatva, the four-tailed bandha, takes its name from the four-legged cot that stood in every courtyard.

It is also why this page can carry the taxonomy at all: a list of shapes and the regions they are named for is vocabulary, not instruction — and the chapter supplies no instruction either, so a reader who came looking for how these were wound will not find it in Vagbhata.

The table of tension inverts on the dosha

Verses 62 to 65 hold the chapter's conditional logic, and the structure matters more than any value in it. The text first sorts the regions of the body into three tiers of tension: tight, moderate, loose. Those site lists are not reproduced here, for the same reason the operative verses are not. What can be reported is what the chapter does to the table next. The tiers are not fixed; they shift one step, in opposite directions, according to which doshas are involved.

The last cell is the remarkable part. Under pitta and rakta the loosest tier does not become looser; it disappears. A rule about how firmly to bind ends, at one extreme, in an instruction not to bind — in the chapter that spends seventeen verses arguing that binding is beneficial.

Hemanta and shishira against grishma and sharad

The dosha pairing carries a season and a frequency with it. Where vata and shleshma are involved the bandage is removed once in three days, and the seasons named are hemanta, shishira and vasanta. Where pitta and rakta are involved it comes off twice a day, morning and evening, in grishma and sharad. So the same two dosha groups govern three things at once: how tightly the cloth goes on, whether it goes on at all, and how often it comes off — a sixfold difference in frequency. The ritu is not an independent variable; it travels with the dosha pair, as classical seasonal reasoning usually does.

Mandala is simply the circle. The chapter states that the nomenclature of the fifteen is given by their shape alone.

Sheep's wool is hot, flax is cold

Verses 57 and 58 — which precede the list but read better after it — classify the bandage material as a dravya with a virya, exactly as a herb is classified.

• Sheep's skin and silk are hot in potency, and produce heat at the site.
• Flax is cold in potency, and produces cold.
• Shalmali, cotton, and animal tendon are both — they can go either way.

A dressing is not inert packaging in this chapter; it is a substance with a thermal property, selected as a decoction would be. That is the ordinary dravyaguna apparatus applied to cloth, and it lines up with the rule above: a cold-potency material and a loosened binding belong to the same pitta-and-rakta case.

Verse 71 extends the idea to leaves. For a chronic vrana with little flesh and no moisture, applications are wrapped in leaves — arka, bhurja, arjuna, kadamba — chosen by dosha and season: snigdha and ushna guna leaves where vata predominates and in hemanta and shishira; shita guna where pitta predominates and in grishma; ruksha and ushna guna where kapha predominates and in the hot season. The same three-way logic applied to foliage.

Verse 73 closes the topic with the cases in which no bandage is applied at all: among them lesions of kushtha, sites of kshara and agnikarma, the carbuncles that accompany prameha, rat-bite and poisoned wounds, and those that spread. Named here strictly as the contents of a classical list.

Vitana, the canopy, is the large bandha the text names for the head.

The case for the cloth: five kinds of vrana, one claim

Verses 66 and 67 argue for bandaging by describing its absence, and the list is largely environmental. An uncovered vrana is exposed to flies, mosquitoes, grass, dust, cold, breeze and heat, and becomes chronic. The medicine applied to it cannot stay in place and dries. It does not close quickly. And — the detail that suggests someone was watching outcomes — though it may close, discoloration is found afterwards. That last clause is the most empirical sentence in the chapter: it separates an endpoint reached from an endpoint reached well, using a cosmetic criterion to do it.

Verses 68 and 69 state the benefits, pitched wider than one might expect: a bandage is said to shorten the course and reduce pain even where bones are crushed, joints displaced, snayu and sira severed, or the site opened by the surgeon. Then a fivefold classification appears once and is never used again — vranas are uneven, hard, soft, painful and painless, and all five become clean and close quickly if bandaged.

The chapter divides vrana five ways and then makes exactly the same claim about every division, so the classification does no work where it is introduced. Compare the Sushruta Samhita's first Chikitsa chapter, where the fifteen kinds of vrana and the sixty upakramas are matched in detail. Here the five exist only to be covered by one statement — which is, in its way, the strongest form the claim could take.

Pathya and apathya: the chapter's longest list

Verses 34 to 39 are the diet, and they are longer than the operative section. The pathya side names shali and shashtika rice with barley and wheat; soups of masura, mudga and tuvara; vegetables including jivanti, sunishannaka, vartaka, tanduliyaka, vastuka, karavella, karkota and patola; pomegranate and amalaki; saindhava and ghrita; and the soup of jangala animals.

The apathya side is equally specific: newly harvested grain, sesame and black gram, alcohol, the meat of animals that are not jangala, preparations of milk and sugarcane juice, anything sour, salt, pungent or alkaline, and foods that are constipating, burning, cold or heavy.

Underneath the lists sits one principle, and it is why the section is so long. Food taken in limited quantity at the proper time digests easily; food that is not digested vitiates vata; and vitiated vata produces swelling, pain, suppuration, burning and distension — it reproduces the original problem. The diet here is not nutrition but a second front in the same campaign, and its logic is the logic of agni rather than of the wound. The same governing pair appears in the page on the ten times for taking medicine.

None of the above is dietary advice. It is a report of what two pages of an old text contain.

Six to seven months after it has closed

Verse 79 is the last substantive verse, and it has the longest time horizon in the chapter. Even after the vrana has closed, the patient is to avoid undigested food, exercise, sexual activity, over-excitement, anger and fear — for at least six to seven months.

Set that against the rest of the chapter's arithmetic: the procedure is one occasion, the dressing cycle three days, the diet and prohibitions run through convalescence — and then a further half-year in which four of the six restricted items are states of mind.

Verses 77 and 78 make the point from the other direction: a vrana still holding pus and residual doshas is not to be closed in haste, because although it may close there is every possibility of reversion. Closure is not the goal in this chapter; a closure that holds is.

The chapter's final line hands the rest to a later section: other states of a vrana are managed according to dosha, desha, kala and bala, in the light of the Uttara Tantra. Then the colophon.

The arithmetic: five verses for the cut, seventeen for the cloth

Here is the count, checkable against the margins of the printed text.

Five verses on the incision, seventeen on the bandage, thirteen on whether to proceed. A chapter titled Surgical Procedure gives three times as much space to the cloth as to the cut, and two and a half times as much to the judgement beforehand.

It is tempting to read that as an accident of compilation, but it is more likely a statement of priorities. Verse 1 says operate only when medicine has failed; verse 13 condemns the surgeon for mistiming rather than clumsiness; the tension table ends in an instruction not to bind; verse 79 extends the case by half a year after closure. The chapter is consistent with itself throughout, and the hands are the least of it.

What we did not find in this chapter

It is as useful to record what fifteen pages do not contain as what they do.

• No count of vrana types to match the neighbouring literature. The fivefold set at verse 69 is the only classification of vrana here, and it exists only to be covered by a single claim. The systematic taxonomy sits in the Sushruta Samhita's Chikitsa Sthana 1.
• No prognosis. Unlike the fracture chapter, this one never says how long anything takes apart from the dressing interval and the closing six to seven months. There is no expected duration for the closure itself.
• No instrument named. For a chapter about sastrakarma, not one shastra is named individually; the twenty-six named blades are all in chapter 26.
• No argument between kshara and the knife. Darana at verse 10 is the alkali route and the following chapter is devoted to it, but chapter 29 never compares the two.
• No number in the title position. The chapter has fifteen bandhas and four sutures but announces no total for itself, unlike the hundred and one yantras next door.

On search demand we will be equally plain. We checked Google Search Console for this site over the ninety days to 27 September 2026. Sastrakarma, shastrakarma and sastrakarma vidhi return no rows at all, and so do the fifteen bandha names. That makes the volume unknown, not low: a page that does not exist cannot register impressions. What does earn measurably here is the chapter-and-text query form — queries containing Ashtanga Hridaya or Vagbhata drew 21,650 impressions across 402 queries in that window, at positions 4 to 10 and a click-through rate under one per cent, with a further 12,847 across 630 adhyaya, sthana, chapter and shloka queries. One live oddity is worth recording as the only query in ninety days pointing at this chapter's subject: bowl shaped bandage of ancient india, five impressions, position 6.2. We have not estimated a number for anything.

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