Treatment of Trans-Sphincteric Fistula-In-Ano with Combined Therapy of Laser and Kshara Sutra

Fistula-in-ano is most infectious disease among all the ano-rectal disorders since ancient times. Over the past few decades, various techniques are being evaluated in terms to prevent its recurrence and complications; it is still a challenging surgical disease. The sign and symptoms of fistula in ano resembles with Bhagandar described in Ayurvedic classics. Kshara sutra therapy (medicated thread) practiced in Ayurveda Since ancient time for the management of Naadi Vrana and Bhagandar. Kshara sutra therapy has revolutionized the treatment of fistula-in-ano, as it treat the main culprit of fistula that is cryptoglandular origin but the drawback of Kshara sutra therapy are as it takes more number of hospital visit, long anxiety period and discomfort. In present time LASER therapy is used in various medical surgery and also in proctology like in fistula as FILAC, DLPL etc. Diode LASER 980nm (Radial Fibre) burns unhealthy granulation tissues in 360° manner with less or minimal pain, LASER act as photo evaporation effect and leads to the shrinkage of the fistula tract. But if we do LASER in internal opening of fistula it provides a bare area for microbes and creates a chance to re-infects the crypts and anal glands, which further leads recurrent fistula formation. Therefore a novel technique for sphincter preserving surgery proposed as combined therapy of Kshara sutra ligation for main culprit that is cryptoglandular infection as SMAK (Sub Mucosal Application of Kshara Sutra) and LASER, shrink the remaining fistula tract instantly

A Role of Udumbara Ksheer Sutra in Ano Rectal Fistula: An Ayurvedic Review

Acharya Sushrut has involved Bhagandara among the Ashtamahagad (8 dreadful diseases). At first it is present as Pidika (boil/abscess) in Apakwa (non-suppurated) state, become Bhagandara when it becomes Pakwa (suppurated). As defined in modern science, it is associated with fistula in ano. An anal fistula is an abnormal track having an external opening in the perianal region and internal opening in the anal canal and/or rectum. Ayurveda has a special approach to fistula management. All anal fistulas counter well to different forms of Kshar and Ksheer Sutra therapy. They are nothing but the medicated seton. The Ksheer sutra mechanical and chemical action of drugs coated on the thread work jointly to cut, cure, drain and clean the fistulous tract, thereby promoting track/wound healing. Though Bhrihattrayi, (chief three texts of Ayurveda) stated the use of Kshar Sutra, there is no proper description of their method of preparation. In eleventh century, Chakrapani Datta mentioned the preparation method of Ksheer sutra in his book Chakradatta for the first time which is indicated in Arsha and Bhagandara. Apamarga Kshar Sutra is the standard Kshar Sutra, and but it has some disadvantages. A variety of other Kshar Sutra, as well as Ksheer Sutra, have been prepared to resolve these inconveniences of Apamarga Kshar Sutra. One of them is Udumbara Ksheer Sutra which was founded by Prof. P.J Deshpande and M.K Jalan in 1984. Udumbara is one among the Nyagradhadi Gana Dravya mentioned by Acharya Sushrut. He described in Bhagandara Chikitsa that the Nyagradhadi Gana Dravyas are Bhagandaranashak.

The issue of clarifying the content of the Lama gegeen’s biography and the “Gsal ba’i sgron me” sutra / Монголын эм зүй, эм судлал

Introduction@#The basis of the development of traditional Mongolian medicine in the 21st century is the importance of reading and studying the biographies of previous generations of ancient doctors and scientists, as well as old medical books and sutras. For example, it is important to gain a deeper understanding of the scientific basis of the ancient medical books, and to understand the manuals and treatment’s methods of doctors and maarambas.@*Research goal@#Studying the biography of Erdene Bandida Khutagt, Khamba Nomuun Khan Hanchen Choijal Luvsandanzanjantsan, and his medical book titled “gsal ba’i sgron me”.@*Research methods@#We used following study methods; manuscripts, primary source methods, hermeneutic method, matrifocal listing method, historical comparative method and analysis synthesis method.@*Result@#Erdene Bandida Khutagt, Khamba Nomuun Khan Hanchen Choijal Luvsandanzanjantsan, the first incarnation of the Lama Gegeen, was born on the 15th of January 1639, in Ulziit Ovoo, Sain Noyon Khan aimag. In 1643, at the age of five, he was initiated by Namkhaisodnomdagva and named Choijidorj. In 1644, at the age of six, he went to Tibet in order to study Tibetan script, calligraphy, and secret tantric rituals and other subjects including medicine taught by Luvsanyarpel, who came to Mongolia from the Dashlkhumbe Monastery of Tibet. Thus, from an early age, he was immersed in religious and medical teachings. Luvsandanzanjantsan has written five books in Tibetan. We selected the book titled “mkhan chen chos kyi rgyal poi gsung ‘bum las gso ba rig pa’i rtsa rgyud kyi’ grel pa gsal ba’i sgron me ces bya ba bzhugs so” as our main subject of study. The book clearly explains the “Root Tantra” of the “Four Medical Tantras”, clarifies the difficult words and content of the theory and makes it easier for people to learn. In addition, we have studied the structure, content, and concluding remarks of this book.@*Conclusion@#Luvsandanzanjantsan was not only a scientist who penetrated the five great sciences, but also made a valuable contribution to the expansion of Mongolian medical research field and the introduction of Tibetan medicine into Mongolia. He is credited with reviewing and commenting on the best medical works of Indian and Tibetan scholars.

An analysis of the anti-cold medicine in the khamba nomun khan’s “Man ngag bdud rtsi zegs ma” sutra / Монголын эм зүй, эм судлал

Introduction@#Luvsandanzanjantsan has written a total of 4 volumes, 79 collections and 220 classes in Tibetan, including 5 medical books. Luvsandanzanjantsan’s “man ngag bdud rtsi zegs ma” sutra, which was the main research material for our study. We made it easier to start studying the “Root Tantra” of the “Four Medical Tantras”, a classic work of Indian and Tibetan medicine. “Four Medical Tantras” was the main guide for medical students of traditional medicine at that time. The book “man ngag bdud rtsi zegs ma” has 18 pages sutra from the many works written by Khamba Nomun Khan. He summarized his experience and lessons learned in differential treatment of fever, some of the most common diseases in women, medical care for 22 diseases such as wind, bile and phlegm, measles, mumps, gonorrhea, edema, cold, and so on. We have studied the medicine treatment of colds from these treatments.@*Purpose@#Explain the meaning of the use of anti-cold medicine in the “man ngag bdud rtsi zegs ma” sutra by Lama Gegeen Luvsandanzanjantsan.@*Methods@#Methods of textual analysis for ancient books and analysis and synthesis were used in the study.@*Conclusion@#Luvsandanzanjantsan was not only a famous scientist who penetrated in many fields of knowledge, but also expanded the research work of Mongolian medicine and became the first Mongolian doctor to study medicine in outer Mongolia. There are three parts in the “man ngag bdud rtsi zegs ma” sutra by Lama Gegeen Luvsandanzanjantsan. For treatment to the anti-cold, Mana-4 tan and Norov-7 tan are used in preliminary stage, Tuglogunsel, Tushmel-3, Gajid-9, Erkhem-8, Gurgem-7, Rinchenshagba and Uvsun em-11 are used in hot stage.

Identifying the specialty and number of animal-oriented medicines in the “Mdzes mtshar mig rgyan” sutra / Монголын эм зүй, эм судлал

Introduction@#More than 30 years have passed since the revived and developed of traditional medicine, and dozens of textbooks and publications on traditional medicine have been published and qualified personnel have been trained. However, there is a need to drastically improve the quality of traditional medical care and the knowledge and skills of doctors. Therefore, it is important to translate, study books written by ancient physicians, maaramba, and scholars, and to apply theory, diagnosis, and treatment methods in training and practice.@*Research materials and methods@#Basic research materials: Naiman toin Jambaldorj (1792-1855). གསོ་བྱེད་མཛས་མཚར་ མིག་རྒྱན། Tibetan scripture of a wooden printing block.@*Method@#We used germenevtic method and checklist method.@*Result@#In the frame of this research, we used the medical sutra written by Jambaldorj as the main material in order to clarify the specialty and number of animal-oriented medicines in the “mdzes mtshar mig rgyan”. During the research, it was possible to clarify the structure, general content, and specialty of the sutra written by Jambaldorj, classify animal-oriented medicines according to the cyrillic alphabet, and make allegory names for some of the raw materials of animal origin. In addition, the study of animal-oriented medicines in the sutra showed that many issues were important, such as their identification, usages, and new production. As a result of the first study, we identified the characteristics and usages of some essential animal-oriented medicines.@*Conclusion@#Jambaldorj began writing the “mdzes mtshar mig rgyan” before leaving for Tibet, and later, during his pilgrimage to Tibet, he enriched and completed it in his book. It was found to correspond to the period 1817-1823. A selection of 124 animal-oriented medicines from the book “mdzes mtshar mig rgyan” was made. In this way, it is possible to interpret and explain the hidden meanings of animal-oriented medicines in this sutra, and to determine the usages of pharmacology and drug formulations.

Sutras of Black Dhom / Монголын Анагаах Ухаан

Introduction@#Due to the dhom zasal is Mongolian’s root medicine, it contains rich of nomadic historical knowdledge regarding traditional medicine. Although during the recent years, studies regarding scripts of dhom zasal have been conducting frequently and collecting and saving several number of dhom scriptures, there is lack of studies regarding their content. Therefore, we decided to conduct the current study to identify causes, conditions and evidences related to historical development of dhom zasal.@*Goal@#We aimed to integrate and compare more than 20 studies in a range of title “Study regarding Script of traditional Mongolian medicine and its ingredients in Sutra of Black Dhom”@*Method@#We conducted the study by using manuscripts, primary source methods, checklist method, historical comparative method and analysis synthesis method.</br> We have used following materials khukh khutsiin uvdis orshvoi, sutras of dhom, dhom related research papers, and books.</br> We took a permission to conduct the current study from the National University of Inner Mongolia and the study subject and methods were confirmed. Due to the study was conducted by historical source method, in each and every citation we took from scripts, we put the author’s name to not infringe any copyright.@*Results@#Within in the study, we reviewed more than 20 Sutra of Dhom and from all the sutras, the sutra titled “khukh khutsiin uvdis orshvoi” attracted our attention inconsiderably due to the decree of Great Chinggis khan dedicated to Chaghatai khan was included in the script. Furthermore, the script was written in Mongolian script and it was studied not thoroughly as well as contains a wide range of information. </br> The decree in the sutra of Dhom is the historical, rare record which contains novel information related to traditional Mongolian medicine history. Although the exact issue date of decree is still unknown, while thinking back about the state status when the decree issued, it was assumed that could be issued during the time between 1226-1227 years. During this time, many of Sartuul nationalities, civilizations was highly developed and many therapists were working and Medicine was well developed in that time. Moreover, Chaghatai khan was introduced as a khan for a period of time, due to that he could aware of culture, and achievements of medicine of his country. Due to that the Great Chinggis khan could have sent a decree to Chaghatai khan to find an effective treatment method. But there was lack information regarding who got which disease and what medicine was needed. Therefore, they assumed that disease have occurred among soldiers who are the most significant part of guarding the state and sent therapeutic Dhoms according to most prevalent disease among soldiers. @*Conclusion@#We translated whole of sutra titled “Khukh khutsiin uvdis orshvoi” as an example due to the sutra contains wide range of information and was written in Mongolian script. Also, the decree of Great Chinggis khan was included in the sutra. Due to the reasons above, we have chosen the sutra from many others. Furthermore, we made an explanation regarding some of complicated words and dhoms were classified according to their dedicated disorders.

Identifying the Diagnostic Method of Children›s Illness in the Sutra of “Ngo mtshardga› stongtermdzod” / Монголын Анагаах Ухаан

@#Choijamts,the Buddhist image-maker and gelon of the Niislel Khuree (Capital Camp), lived during the last period of the 19th and early 20th centuries. He wrote a book “Gsorig zhungmangbsduspa›ibdudrtsi›isnyingpotshagrangzug rnguselba›ingomtshardga› stongtermdzodzhesbyababzhugs so” in short ngomtshardga› stongtermdzod. This is the comprehensive book about Traditional Mongolian medicine in Tibetan language and written by Mongolian scholar. In his book, the general diagnostic methods of traditional medicine consists of 3 parts: interrogation, pulse diagnosis, and analyzing patient’s urine. The diagnostic method in pediatrics in traditional medicine is based on the general method but different in some ways in consistence with the classification of diseases in children. For instance, there are 3 diagnostic methods in “Ngo mtshardga› stongtermdzod” are as follows:</br> 1. Inquire the symptoms of children from parents and examine the children’s faces</br> 2. Research the method of examining ear veins, identify its scientific nature, and open up possibility to use it in training</br> 3. Define the content and characteristics of methods of examining hot and cold quality of child’s ear by touching, and checking color and shape of veins and include these in curriculum of universities that offers traditional medicine program.</br> There are a number of interesting approaches to the diagnostic of children›s illnesses in the scope of the Sutra of “Ngo mtshardga› stongtermdzod”. In the future, there is a need for detailed study of each of these methods and input it into the curriculum,and teaching for medical students are essential.

Function on Stable Angina Pectoris Patients on Electroacupuncture Heart Sutra and Pericardial Sutra Point / 世界科学技术-中医药现代化

Objective: to compare the immediate effects of electroacupuncture (EA) on electrocardiogram and cardiac function in patients with stable angina pectoris by comparing the anti-myocardial ischemia effects of the EA and pericardial meridians (PC) with heart, the heart meridians (HS) and heart. To explore the correlations and differences between cardio, pericardial and cardiac, and to provide some clinical basis for the clinical treatment of this disease.Methods: 45 patients who met the criteria were divided into three groups by single blind randomized reference method:15 cases of pericardial therapy group, 15 cases of pericardial therapy group, and 15 cases of non-acupoint control group.The heart group, according to the meridians following the direction of acupuncture polar spring, Shaohai, Lingdao, Shimen; Heart bag group, according to the direction of the meridians needle Tianquan, Quze, Neiguan, Daling; Non-nonpoint group acupuncture is not non-point F1, F2, F3, F4. Compare the changes in heart rate and the value of the heart rate and the value of the heart rate of the 15 min electrocardiogram, and the value of the body Doppler Tei in the group before and immediately after the acupuncture and the end of the acupuncture. Results: Compared with the preacupuncture, there was no significant change in the cardiac and pericardial groups in the 15 minutes immediately after the acupuncture and the end of the acupuncture (P＞ 0.05), and the heart rate was significantly slower (P＞ 0.05) . The value of was significantly increased (P ＜ 0.05), and the tissue Doppler Tei index was significantly reduced (P ＜ 0.05) .There was no significant change before and after the non-point group indicators (P＞ 0.05) . Compared with the pericardial group, the two groups had the same effect on electrocardiogram and cardiac function (P＞ 0.05) . Compared with the immediate after the end of acupuncture, the 15 min, cardio group and pericardial group after the end of acupuncture slowed the heart rate, increased the T value and reduced the tissue Doppler Tei index (P ＜ 0.05) .Conclusion: Electroacupuncture and pericardial points can specifically slow the heart rate of patients with stable angina pectoris, restore the changes of T wave ischemia, and reduce the tissue Doppler Tei index, indicating that acupuncture of both acupuncture points has an immediate effect against myocardial ischemia. The effects of electroacupuncture and pericardial meridians on heart rate and T and tissue Doppler Tei indices are quite similar, suggesting that the immediate effects of acupuncture and pericardial meridians against myocardial ischemic injury are comparable. Electroacupuncture heart meridians and pericardial meridians have a certain post-acupuncture effect.

An Aspect of the History of Medicine in Ancient Korea as Examined through Silla Buddhist Monks'Annotations on the “Chapter on Eliminating Disease (除病品)”in the Sutra of Golden Light (金光明經, Suvarṇabhāsa-sūtra) / 의사학

Nearly nothing is known of medicine in ancient Korea due to insufficient materials. With several extant prescriptions and esoteric methods of treating diseases alone, it is impossible to gauge in depth the management of medicine during this period. If one exception were to be cited, that would be the fact that the annotations for understanding the contents on Indian medicine in the “Chapter on Eliminating Disease” in the Sutra of Golden Light, a Buddhist sutra originating from India, reflected the medical knowledge of Buddhist monks from Silla (新羅, 57 BC-935 AD) who were active immediately after the nation's unification of the two other kingdoms on the Korean Peninsula (668 AD) such as Wonhyo (元曉, 617-686 AD), Gyeongheung (憬興, 620?-700? AD), and Seungjang (勝莊, 684-? AD). Along with those by other monks, these annotations are collected in the Mysterious Pivot of the Sutra of Golden Light (金光明經最勝王經玄樞), which was compiled by Gangyō(願曉, 835-871 AD), a Japanese monk from the Heian era (平安, 794-1185 AD). Representative versions of the “Chapter on Eliminating Disease” in the Sutra of Golden Light include: a classical Chinese translation by the Indian monk Dharmakṣema (曇無讖, 385-433 AD); the eight-volume edition by Chinese monk Baogui (寶貴), which differs little from the preceding work in terms of the contents of the “Chapter on Eliminating Disease”; and the ten-volume edition by Yijing (義淨, 635-713 AD), who had full-fledged knowledge of Indian medicine. When the contents of the annotations thus collected are examined, it seems that Wonhyo had not been aware of the existence of the ten-volume edition, and Gyeongheung and Seungjang most certainly used the ten-volume edition in their annotations as well. Especially noteworthy are Wonhyo's annotations on the Indian medical knowledge found in the “Chapter on Eliminating Disease” in the Sutra of Golden Light. Here, he made a bold attempt to link and understand consistently even discussions on Indian and Buddhist medicine on the basis of the traditional East Asian medical theory centering on the yin-yang (陰陽) and five phases (五行, wuxing). In accordance with East Asia's theory of the seasonal five phases, Wonhyo sought to explain aspects of Indian medicine, e.g., changes in the four great elements (四大, catvāri mahā-bhūtāni) of earth, water, fire, and wind according to seasonal factors and their effect on the internal organs; patterns of diseases such as wind (vāta)-induced disease, bile (pitta)-induced disease, phlegm (śleṣman)-induced disease, and a combination (saṃnipāta) of these three types of diseases; pathogenesis due to the indigestion of food, as pathological mechanisms centering on the theory of the mutual overcoming (相克, xiangke) of the five phases including the five viscera (五藏, wuzang), five flavors (五味, wuwei), and five colors (五色, wuse). They existed in the text contents on Indian medicine, which could not be explicated well with the existing medical knowledge based on the theory of the five phases. Consequently, he boldly modified the theory of the five phases in his own way for such passages, thus attempting a reconciliation, or harmonization of disputes (和諍, hwajaeng), of the two medical systems. Such an attempt was even bolder than those by earlier annotators, and Wonhyo's annotations came to be accepted by later annotators as one persuasive explanation as well. In the case of Gyeongheung and Seungjang, who obtained and examined the ten-volume edition, a new classical Chinese translation produced following Wonhyo's death, annotated the “Chapter on Eliminating Disease” based on their outstanding proficiency in Sanskrit and knowledge of new Indian and Buddhist medicine. This fact signifies that knowledge of the eight arts (八術) of Ayurvedic medicine in India was introduced into Silla around the early 8th century. The medical knowledge of Wonhyo, Gyeongheung, and Seungjang demonstrates that intellectual circles in contemporary Silla were arenas in which not only traditional East Asian medicine as represented by works such as the Inner Canon of the Yellow Emperor (黃帝內經, Huangdi Neijing) but also Indian medicine of Buddhism coexisted in almost real time.

Applying the Methodology and Practice of Microhistory: The Diary of a Confucian Doctor, Yi Mun-gon (1495-1567) / 의사학

Since microhistory's approach to the past is based on an understanding of and a sympathy for the concrete details of human lives, its area of interests overlaps with the history of medicine and medical humanities, which examine illness and health. If we put a specific region and society in a specific period under a microscope and increase the magnifying power, we can understand the numerous network connections among the body, illness management, and medicine and how multilayered were the knowledge and power applied to them. And this approach of using microhistory to illuminate medical history can be more effective than any other historical approach. This article focuses on Yi Mun-gon's extensive volumes of Mukchaeilgi (Mukchae's diary) in approaching medical history from the perspective of microhistory. Simply defined, this work is a Confucian scholar-doctor's diary. Its author, Yi Mun-gon, played the role of a Confucian doctor, although not professionally, during his 23-year exile, after serving in a high governmental office on the senior grade of the third court rank. Thanks to this extensive and detailed diary, we can now get adetailed andthorough picture of his medical practice in the Songju region, 270 kilometers southeast of Seoul, where he was exiled. This article aims to understand the state of medical practice in the Songju region in the 16thcentury through the"zoom-in" method adopted by microhistory. In particular, I will focus on the following three aspects: 1)Yi Mun-gon's motivation for and method of medical study, 2)the character of Yi Mun-gon'spatient treatment as hwarin (the act of life-saving), and 3) the plural existence of various illness management methods, including pyongjom (divination of illness), sutra-chanting, exorcism, and ch'oje (ritual toward Heaven). All three aspects are closely related to Confucianism. First, Yi Mun-gon decided to acquire professional-level medical knowledge in order to practice the Confucian virtue of filial piety. He sharpened his medical knowledge during the process of caring for his ill mother. In Confucian Choson society, a patient was encouraged to be deeply involved in the process of his or her medical treatment and the space of clinical treatment was not an exclusive domain for the doctor, but for public discussion, where both doctor and patient participated in making the best medical choices. In this atmosphere, a patient's family members would also naturally learn the clinical process, not unlike today's interns learning from renowned doctors. Second, after studying medicine up to a professional level, Yi Mun-gon administered the "life-saving" medicine to many people, yet he did not open his doors to all individuals. His medicine was practiced within his social network of blood, regional, and intellectual relations, where priority was established according to the level of closeness to himself, according to Confucian ideology. Nevertheless, because he did partially accept patients outside of these networks, his practice setin motion the symbolic system of Confucian ideal of universal "life-saving." Third, in the Songju region during the 16thcentury, various methods of treating illnesses-such as medicine, divination, sutra-chanting, exorcism, and kumyongsisik (life-saving, food-offering ritual)-co-existed and were selected according to individual conditions. Confucianism did not want to either acknowledge or outright reject most of these methods, except for officially acknowledged medicine, at that time. In fact, this co-existence was inevitable because there was not one entirely effective means of curing illness at that time. Also, the system of Confucian ideology was not powerful enough to enforce what it championed. On the contrary, behind the outer austerity of Confucian society, people sought out unorthodox methods, such as exorcism, Buddhism, and Taoism-ironically, in order to practice the important Confucian values of filial piety and patrilineage in the face of their parents' or sons'illnesses. It was only after the emergence of modern ideology and methodology of hygiene, which had the ability to control epidemics and prioritize the preservation of the life of individuals and the population, following the opening of the port in the late 19th century, that this pluralistic culture for illness management became much less prevalent.

Sun Xi-miao in The Biography of The Avatamsaka-Sutra / 의사학

This paper aimed to introduce and examine the biography of Sun Xi-miao (581-682) which I found in The Biography of The Avatamsaka-Sutra, that Fazang (643-712) wrote in 692 A.D. This document was neglected to understand Sun who was the famous medical writer of the collection of prescriptions, the Bei ji qian jin yao fang. His life is rather well documented, because he has his own biographies in Jiu Tang shu and Xin Tang shu which cited from Da Tang sin yu, published in 807. But I found several new informations about Sun in The Biography of The Avatamsaka-Sutra, such as he use to be a military medicine in the troops of Li Yuan who became the first emperor Kao Tsu of Tang dynasty and treat Sun with great favour. This document let us know that the Bei ji qian jin yao fang was dedicated to Kao Tsu, known as published in 652 A.D. MY CONCLUSIONS ARE AS FOLLOWS: First, it was written by Fazang in 692 A.D, who was the real establisher of the fraternity of the Avatamsaka in China, for the purpose of encouraging to copy the Avatamsaka-Sutra. According to this biography, Sun made 750 copies to persuade the monks and the peoples, and that's the reason Fazang wrote his biography. Secondly, it was not conveyed to posterity, such as Sun was good looking, tall and use to be the medicine of Kao Tsu and dedicated his medical book to the first emperor. It might be left out for Tai Tsung's sake in the official records, who murdered his brother, the heir apparent to the throne and became the second emperor by himself. On the contrary, it was written in Da Tang sin yu, Jiu and Xin Tang shu that Sun made a prediction that his collection of prescriptions would help the holyman after 50 years from Xuan Di (578-579) of Northern Chou Dynasty. Holyman meant Tai Tsung. It shows that Sun's biographies in the Da Tang sin yu, Jiu and Xin Tang Shu were based on the documents that might be fabricated and embellished for Tai Tsung. Thirdly, this biography let us know that Sun wote the Bei ji qian jin yao fang under the circumstances that the epidemic disease was spreaded in Changan at 618 A.D. and the population of Kao Tsu era (618-626) was decreased rapidly. I think that's why he wrote down the medical morals as the first chapter, and the prescriptions about the gynecology and pediatrics as the second chapter.

Treatment of Fistula in ano by Kshara Sutra

PURPOSE: Sushrutra (BC 5th century) advocated a conservative management by applying Kshara Sutra (phyto-chemically processed thread) for the treatment of anal fistulas in India. In 1965, this technique was introduced by Deshpande and 40 cases were treated on an "outpatient" ambulatory basis. The purpose of this study is to determine the result of Kshara Sutra (KS) in treatment of fistula in ano. METHODS: One hundred and five patients with anal fistula were treated with KS. Excision of the primary lesion and fistula tract was done externally and KS was passed around the tract. Tissue gripped within the thread was the anoderm, mucosa, and sphincter. Finally, the thread encircled the part of the anal wall that needed excision and an additional clamp for loose tying. RESULTS: The range of age was from 21 to 59 years while the sex ratio was 6.5:1 (M:F). In 94 patients, the average cutting time was about two weeks, and the other were three to four weeks. KS thread was applied only once for primary operation in 98 cases, and a successive change was required in 7 cases. The mean hospital stay after operation was 4.2 days. In 76 cases, the mean period of follow up was 23 (range 7~32) months. There were no recurrences, but there were 4 mild deformities of the anus, 2 mild soilings, 1 delayed cutting, and 5 delayed healings. CONCLUSIONS: Kshara Sutra is a technically easy, safe, and simple method and does not require a long hospitalization.

Effect of Hymn and Sutra-Chanting on the Preanesthetic Patient Anxiety in the Operating Room / 대한마취과학회지

BACKGROUND: Most surgical patients experience preoperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contribute to postoperative pain. Music has been recognized as a way to reduce anxiety and fear. The effect of hymn and sutra-chanting on the preanesthetic patient's anxiety in the operating room were studied. METHODS: 98 patients were divided into two groups according to the religionist or atheism. Group I(n=50, religionist) and Group II(n=48, atheism) listened to hymn or sutra-chanting according to the patient's religion and choice. At ward, hemodynamic variables including systolic and diastolic blood pressure and pulse rate were measured as control values. Hemodynamic variables and measurements of anxiety score with Hamilton anxiety rating scale were made at pre-music and post-music in the operating room. Also, patient's response to the music was measured on the postoperative 5-6th day. RESULTS: There were no difference between ward, pre-music, and post-music in terms of systolic pressure, diastolic pressure and pulse rate except the systolic pressure at pre-music that is grater than that of controls in both groups. Both group, anxiety score at post-music was significantly lower than that of pre-music (10.2+/-3.4 vs 4.4+/-2.9, 11.0+/-3.2 vs 5.7+/-3.1). At post-music, anxiety score in Group I showed significant reduced compaired with Group II (p<0.05). Patients showed relatively good satisfaction with music in both groups. CONCLUSION: The results suggest that music with hymn and Sutra-chanting were effective to reduce preanesthetic anxiety in both religionist group and atheism group.