shalyachikitsa
ati praacheen kaal se hi chikitsa ke do pramukh vibhaag chale aa rahe hain - kaayachikitsa (Medicine) evam shalyachikitsa (Surgery). is aadhaar par chikitsakon mein bhi do paranparaaeain chalti hain. ek kaayachikitsak (Physician) aur doosra shalyachikitsak (Surgeon). yadyapi donon mein hi aushadho pachaar ka nyoonaadhik saamaanyaroopen mahatva hone par bhi shalyachikitsa mein chikitsak ke hastakaushal ka mahatva pramukh hota hai, jabki kaayachikitsa ka pramukh svaroop aushadhopachaar hi hota hai.
anukram
itihaas
aayurved mein bhi dhanvantari sanpradaaya, ya sushrut sanpradaaya, shalyachikitsa ke prateek hain jabki aatreya sanpradaaya ya charak sanpradaaya kaayachikitsa ke prateek hain. isi prakaar pashchim mein bhi jaaleenoos (Galenus) ke samay mein keval aushadh prayog karanevaalon, arthaat kaayachikitsakon, ko medimi (Medice) aur shastrakriya karanevaalon ko chirraji aur bladaneraari kehte the. aitihaasik evam shaastreeya paryaanlochan ke drushtikon se Bhaarat mein is vigyaan ko chaar pramukh kaalon mein vibhkt kiya ja sakta hai :
(1) ayurvedik kaal,
(2) yoonaani kaal,
(3) arabi, yoonaani evam
(4) pashchimi kaal (1200 E. se 1500 E. tatha uske baad ka unnat aadhunik kaal).
shaastreeya pramaanon se shalyachikitsa ka mool srot vedon mein milta hai, jahaaain Indra, agni aur som devata ke baad svarg ke do vaidyon ashvineekumaaron ki ganana ki gayi hai. inke kaayachikitsa evam shalyachikitsa sambandhi donon prakaar ke kaarya milte hain. shareer ki vyaadhiyon ko door karne ke liye tatha angabhang ki sthiti mein naveen aankhein evam naveen ang pradaan karne ke liye ashvineekumaaron ki praarthana ki gayi hai. garbhaashaya ko cheerakar garbh ko baahar nikaalne tatha mootravaahini, mootraashaya evam vrukkon mein yadi mootr ruka ho, to use vahaaain se shalya karm ya anya prakaar se baahar nikaalne ka ullekh milta hai. isi prakaar atharvaved mein kshat, vidradhi, vran, tooti ya kati asthiyon ko jodne, kate hue ang ko theek karne, pruthak hue maans majja ko svasth karanevaali oshadhi se praarthana ki gayi hai. raktasraav ke liye patti baaaindhane, apachi (gale ki granthi ka ek rog) ke liye vedhan chhedan aadi upachaaron ka ullekh milta hai. Bhagwan buddh ke kaal mein jeevak naamak chikitsak dvaara karoti evam udaragat bade shalyakarm safalataapoorvak kiye jaane ka varnan hai.
shalyakriya se sambandhit anya prasang hai- dadheechi ke sir ko hataakar usaki jagah ghode ke sir ka pratyaaropan aur fir use hataakar asli sir laga dena, rijraashvad ki andhi aaainkhon mein roshani pradaan karna, yagya ke kate sir ko pun: sandhaan karna, shraav ka kushth rog door kar use deerdhaayu pradaan karna, kaksheevaan ko pun: yuvak banaana, vruddh chyavan ko pun: yauvan dena, vaamadev ko maata ke garbh se nikaalna aadi.
susangathit evam shaastreeya roop se aayurvedeeya shalyachikitsa ki neenv Indra ke shishya dhanvantari ne daali. dhanvantari ke shishya sushrut ne is shaastr ko sarvaangopaang viksit kar vyavahaaropayogi svaroop diya. us samay bhi shalya ka kshetr saamaanya kaayik shalyachikitsa tha aur oordhvajatrugat rogon evam shalyakarm (arthaat netrarog, naasa, kanth, karn aadi ke rog ev tatsanbandhi shalyakarm) ka vichaar ashtaangaayurved ke shaalaakya naamak shaakha mein pruthak roop se kiya jaata tha.
isi prakaar pashchim mein aseeriya, bebiloniya evam misr ke baad yoonaan aur rom mein sabhyata evam anya gyaan vigyaan ke saath chikitsaavijnyaaan tatha tadantargat shalyachikitsa ka vikaas hua. E. poo. 301 mein misr desh mein shalyatantr unnat avastha mein tha. misr desh mein bhoogarbh se mile shavon ke shareer mein kapaalabhed ke sandhaan ke chihr milte hain. praarambh mein rom nagar ke sabhi chikitsak sikandiriya ya uske poorv ke nivaasi the. kelasas ka "di medisina", jo isavi san 29 mein prasiddh hua, poornataya greek pranaali ka tha. ukt mahaagranth aath khandon mein hai. saatavein khand mein shalyashaastr aur chhathe khand ke chhathe adhyaaya mein aur saatavein khand ke saatavein adhyaaya mein netrarogon ka vivechan hai. is mahaagranth mein varnit arm (agrees roman terijiym) pothaki tatha motiyaabind (cataract) ki shalyachikitsa bahut kuchh sushrut se milti julati hai.
jaaleenoos ne jo ek prakaar se yoonaani parampara ka antim vidvaan chikitsak tha, anek bade bade granth chikitsa shaastr par likhe. uske granth saare greek vaidyak ke vishvakosh hain. pashchimi kaal ke poorvavarti yug (700 E se 1,200 E.) mein arabon ne chikitsa vigyaan ka deepak prajvalit kiya aur shalyachikitsa mein bhi prashansaneeya unnati ki, jiska prabhaav Spain tak tha. isi gyaan ko aadhaar maankar aadhunik shalyachikitsa aaj paraakaashtha par pahuainch rahi hai. abul kaasim jaharaavi ka prasiddh granth, attasareef, Europe mein shalyatantr ki unnati ki aadhaarbhoot neenv hai. aadhunik shalyachikitsa ki adbhut unnati ki pradhaan kaaran uttam chetanaahar evam sanvedanaahar oshadhiyon (anaesthetics) tatha vishvasaneeya raktastanbhak dravya (haemostatics), pootirodhi evam pratijaivik padaarth ki sulabhata hai, jinki suvidha vikt yugon mein praaya: naheen si thi. ataev vichaarakon ke liye yeh ek nitaant jijnyaaasaapoorn vishay bana raha ki in saadhanon ke abhaav mein praacheen log gambhir svaroop ke shalyakarm (operation) kaise karte the.
aadhunik shalyachikitsa
aadhunik unnat shalyachikitsa ka aarambh Europeeya deshon mein jarraahi ke roop mein hua, jisse pradhaanat: hastakarm dvaara saadhaaran shalyachikitsa (minor surgery), yatha asthibhang (fracture) sandhichyuti (dislocation) ki dakshata, daaaint ukhaadna tatha ukt kriyaaon evam kshatopayogi malaham (ointment), gudaavasti (enema) tatha rechak aadi ke nirmaan evam prayog aadi ka hi samaavesh hota tha. samaaj mein bhi kaayachikitsak is kaarya ko heen drushti se dekhte the. isi ke parinaamasvaroop madhyakaaleen yug mein France, Germany tatha England mein naapit sarjanon (barber surgeons), vran chikitsakon (wound surgeons) ev jarraah bheshajajnya (surgeon apothecaries) ki utpatti hui. England mein pehle shalyakarm hajjaam ya naapit ke vyavasaaya ke saath mila hua tha. henari ashtam ke shaasan kaal mein surgeon ya shalyachikitsakon ke sangathan mein baarbar (jarraanh) sanvidhaanik maanyata dvaara sammilit the aur donon ke svaroopabhed ko spasht karne ke liye inke kaaryakshetr ka spashteekan vidhaan dvaara kiya gaya tha. naai ko keval raktamokshan tatha daaaint ukhaadna aadi saadhaaran shalyakarm ki aajnyaa thi aur surgeon ke liye baarbar ke vyaavasaayik karm nishiddh the. vikaas evam unnati ke saath san 1745 mein George dviteeya ke shaasanakaal mein ukt donon samudaaya poornat: pruthak hokar, do mitr sanghon mein sangathit hue. aaj ka royal college ov surgeon isi ka viksit roop hai.
18veen shataabdi se shalyachikitsopayogi shaastron yatha shareerarachana-vigyaan, shareer-kriya-vigyaan evam kriyaatmak (operative) shalyachikitsa aadi ke vikaas ke saath saath shalyachikitsa mein bhi teevrataapoorvak vikaas, sudhaar evam unnati hone lagi, jisse kaayachikitsa ki bhaaainti samaaj mein shalyachikitsa ke liye bhi samaan badhne laga. kintu shalyakarm mein vedana evam shastrakarmottar pooti (surgical infection), in do mahaan kathinaaiyon ke kaaran shalyachikitsa ki safalta bahut kuchh seemit rahi. paistyar naamak rasaayanajnya dvaara baikteeriya evam tajjanya vishisht upasarg ka sambandh pramaanit kiye jaane par, uske siddhaanton se prerana lekar 1867 E. mein Joseph listar dvaara pratirodhi shalyakarm (antiseptic surgery) ke anusandhaan evam tatpashchaat sanjnyaaahar evam sanvedanaahar dravyon tatha saadhanon ke aagaman ke saath, aadhunik unnat shalyachikitsa ka praarambh hua. is prakaar vaigyaaniko dvaara shalyachikitsa ki aadhaabhoot kathinaaiyon par vijay praapt kar lene ke baad, usamein dinondin sudhaar hone laga aur san 1930 ke baad se to sanvedanaaharan ek svatantr vigyaan nishchetanaavijnyaaan (Anesthesiology) ke roop mein viksit ho gaya hai aur aaj praaya: sabhi prakaar ki shareer evam rog sthiti tatha shalyakarm ke anuroop sanjnyaa haran evam sanvedanaaharan upakaran, dravya evam saadhan upalabdh hai. inke kaaran honevaale upadravon evam tatsanbandhi anya jnyaaatavya ka bhi paryaapt adhyayan kiya ja chuka hai. listeriyn ainsisetik surgery ki disha mein bhi isi prakaar ki unnati aaj upalabdh salfaavarg evam aintibaayotik varg jaisi oshadhiyon ke kaaran ho gayi hai. isse shalyakarmottar pootidosh (sepsis) evam sankraman (infection) tatha tajjanya upadravon evam dushparinaamon ka pratishat naganya ho gaya hai. iske pratyaksh laabh ka anubhav dviteeya mahaayuddh evam Korea yuddh mein hua, jabki pehle ke yuddhon ki apeksha ghaayalon ka samay se shalyopachaar hone par, sankraman evam pootijnya durghatanaaeain apekshaakrut atyant kam huin. ukt saadhanonnati ke parinaamasvaroop aaj bade se bade shalyakarm pehle ki apeksha adhik vishvaas evam nishchitta se kiye jaate hain. yahi naheen, shalyakarmottar upachaar (post operative care), jo pehle nitaant satarkata evam chinta ka vishay hua karta tha, aaj upalabdh saadhanon ke kaaran atyant sukar ho gaya hai.
shalyachikitsa mein sankshobh (surgical shock) bhi ek vishisht evam mahatva ka vishay hai. sankshobh mein tvacha ka rang feeka pad jaata hai tatha yeh svedakledya evam sparsh mein thandhi maaloom hoti hai. praaya: iska mukhya kaaran hrudaya ka apna vaastavik dosh na hokar, baahya ya aantarik rudhirsraavajanya, rakt-parimaan-ksheenata hoti hai, jisse hrudaya ki rudhirkshepanashakti saamaanya hone par bhi dhamaniyon ka rudhirsanbharan heen koti ka hota hai. yuddh mein graahaton mein yeh sthiti praaya: pai jaati hai. ab aisi sthiti mein rakt ki tatkaalapoorti rudhiraadhaan dvaara, athva anya sthaanaapann upaayon yatha sagadaabi lavanajal (normal saline) ke shiraant: pravesh aadi dvaara ki jaati hai. ab bade sthaanon mein samruddh rudhir bank (blood bank) ki vyavastha bhi hai, jahaaain se pratyek rogi ke upayukt rudhir tatkaal praapt ho sakta hai. iske atirikt anya sthaanaapann dravya (substitules) bhi sulabh hain.
shalyachikitsopayogi upakaran
shalyachikitsa ki safalta evam shalyakarm mein abheesht ki upalabdhi ke liye, yathaasamaya aavashyak yantrashastr evam anya upakaranon ki sulabhata apna vishisht mahatva rakhati hai. upakaranon ke prayog mein shalyachikitsak ka hastakaushal sarvapramukh hai, kyonki sabhi shalyakarm surgeon ke hastakaushalaadheen hain. shalyakarm ke kshetr, svaroop evam tatsanbandhi kriyaaon ki naanaavidhiroopata hai. aitihaasik yugon ke saath saath yantr aur upakaranon ke nirmaan hetu prayukt padaarthon mein bhi sudhaar hota raha aur sanprati achhe shalyachikitsopayogi yantr upalabdh hain, jinmein rogaanunaashan evam nirjeevaanukaran ki shodhan prakriyaaon ka koi kuprabhaav naheen padta. chikitsa vigyaan ke anya angon ke vikaas tatha aadhaarbhoot vaigyaanik vishyon evam dhaatukarm tatha aushadhanirmaan aadi anya takaneeki vijnyaaanon ki unnati evam vikaas ke saath saath, in upakaranon mein bhi adbhut sudhaar kiye ja rahe hain. safalataapoorvak shalyakarm evam anya shalya prakriyaaon ke liye aavashyak saajasajja se yukt operation theatre evam usi se sanlagn nirjeevaanukaran, dreinsig evam shalyakarmottar tatkaal dekharekh ke hetu rogi ko rakhane evam tatsanbandhi anya aavashyakataaon ki bhi vyavastha honi chaahiye. sanprati is disha mein bhi paryaapt sudhaar ho gaya hai.
vartamaan kaal mein rediyaulauji (Radiology) evam nyookliyr medisin ke vikaas ne bhi shalyachikitsa ki pragati mein paryaapt sahaayata ki hai. aiks kiran chitran dvaara ab ant:sthit, shalya, vikruti evam shalyakarmopayukt sthal ka nirdhaaran nishchit roopen evam sugamata se kar liya jaata hai. visheshat: viklaangachikitsa evam asthibhangachikitsa mein aiks kiran pradhaan sahaayak hota hai. nyukliyr medisin bhautikvidon (nuclear physicists) ne bhi anek mahatvapoorn tatvon ki khoj ki hai, jinka vishisht upayog kaayachikitsa mein bhi kiya jaata hai. is prakaar aadhaarbhoot vijnyaaanon (basic sciences) evam chikitsa vigyaan ke anya vibhaagon ki unnati ke saath shalyachikitsa ne bhi atyant viksit hokar, vishesh vibhaag ke roop mein svatantr astitv praapt kar liya hai, jaise netrarog vigyaan (Ophthalmology), naasa-karn-kanth rog vigyaan (E. N. T. Surgery), viklaang chikitsa (Orthopaedics), plastic shalyachikitsa (Plastic Surgery), urogat shalyachikitsa (Thoracic Surgery), mootrasansthaani shalyachikitsa, tantrika shalyachikitsa (Neuro-surgery), streerog vigyaan (Gynaecology), dantarog vigyaan (Dental Surgery) aadi. vibhinn deshon mein inke vishesh prashikshan ke liye adhikrut sansthaan evam visheshagyon ki sansthaaeain sthaapit ho gayi hain, jo prashikshan ka niyantran karti hain tatha visheshagya ke roop mein chikitsa karne ka adhikaar pradaan karti hain, jaise England ka royal college ov gaainirkaanlaaji, royal college ov sarjans, amareekan college ov sarjans aadi. pareekshanaatmak shalyachikitsa (Experimental Surgery) bhi vartamaan yug ki ek den hai.