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 Table of Contents  
ORIGINAL RESEARCH
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 48-52

Documentation and scientific validation of a Siddha ethnic practice Suttigai (cauterization) in Pudukottai district


1 JSA Medical College for Siddha and Research, Ulundurpet, Tamil Nadu, India
2 Siddha Regional Research Institute, Puducherry, India
3 Department of Kuzhandhai Maruthuvam, National Institute of Siddha, Chennai, Tamil Nadu, India
4 Department of Pothu Maruthuvam, Govt. Siddha Medical College, Palayamkottai, Tamil Nadu, India

Date of Submission27-Feb-2022
Date of Acceptance16-Mar-2022
Date of Web Publication30-May-2022

Correspondence Address:
Dr. Chitra Balasubramanian
Siddha Regional Research Institute (Central Council for Research in Siddha), Kuyavarpalayam, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrsm.jrsm_3_22

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  Abstract 

Introduction: Siddha system of medicine deals with the surgical as well as external application methods that are categorized under Pura Maruthuvam. In Siddhar Aruvai Maruthuvam, 32 types of treatment methods such as Kattu muraikal (splints), keeral (blood-letting), Komburinjal (Type of blood-letting through horns), and Attai vidal (Leech therapy) are described. The external therapy Suttigai (Cauterization) method is being practiced by Siddha physicians to cure chronic ailments which the internal drugs alone do not cure. There are many number of suttigai methodologies specified in Siddha Literatures and through inheritance by folklore practitioners.
Materials and Methods: This study aimed to document the procedure of suttigai practiced by a traditional healer family in Pudukottai district, Tamil Nadu, which was being taught through their inheritance. They used to treat children with chest wall deformity in their surroundings for many generations.
Results: The practitioner claims that as witnessed through their indigenous suttigai practices the treated children have not shown any significant post-treatment complications. The chest wall deformity is being rectified spontaneously along with the cauterized wound reconciliation. An image of a male aged 76 years, who was treated by his father of the practitioner, had a scar in his chest which was done at his age of 2 years for the congenital chest wall abnormality is illustrated here.
Conclusion: In this paper, we attempt to substantiate the scientific rationale behind the traditional suttigai practice.

Keywords: Cauterization, chest wall deformity, folklore medicine, pigeon chest, Tamil literature


How to cite this article:
Vadivel S, Balasubramanian C, Ezhumalai G, Muthumalai N, Jayaraman J. Documentation and scientific validation of a Siddha ethnic practice Suttigai (cauterization) in Pudukottai district. J Res Siddha Med 2020;3:48-52

How to cite this URL:
Vadivel S, Balasubramanian C, Ezhumalai G, Muthumalai N, Jayaraman J. Documentation and scientific validation of a Siddha ethnic practice Suttigai (cauterization) in Pudukottai district. J Res Siddha Med [serial online] 2020 [cited 2022 Aug 16];3:48-52. Available from: http://www.jrsm.in/text.asp?2020/3/2/48/346335


  Introduction Top


Siddha system of medicine is widespread in Tamil Nadu, especially in rural areas. People are deep-rooted with traditional Siddha physicians and their health traditions for many decades.

Siddha system is a holistic lifestyle of Tamil populaces and it encompasses the medicinal system that dates back many centuries ago. Siddha system of medicine is evolved through the knowledge obtained from the experience and through the observation of surroundings and existing creatures. In Siddha, treatment methods are divided into internal and external therapeutic methods. One of the 32 types of external therapies is Suttigai (cauterization), which commonly aids to promote wound healing and correcting unwanted bony growth or birth deformity.[1] There are five types of Suttigai namely kaanthi suttigai, kaal suttigai, mann suttigai, mara suttigai, and uloga suttigai.[2] These methods are practiced with the available resources in that particular vicinity. Uloga suttigai (cauterization done with metal probe) is a unique method that is being done for persons with chest deformity by birth or later that occured due to chest wall injury, for example, Ravi, a native Suttigai practitioner from the Pudukottai district, whose family has the tradition of handling chronic ulcers, bony deformities, corns, and callous with the suttigai method for many decades in the Kothamangalam region. Locally he is called as vannaan Ravi, whose work is washing clothes. This article is an attempt to explore and document the suttigai practice, which is practically extinct nowadays. He has given his consent to publish his methods in the public arena so as to disseminate and make the practice alive.


  Materials and methods Top


Pectus carinatum (PC) is the second most common chest wall deformity observed in children referred to as pigeon chest that represents the feature of protrusion of sternum or anterior chest wall with acute angulation of the attached costal cartilages. This is thought to be due to a defect at the manubrio-sternal junction.[3] The Tamil terminology practiced in their area is Kozhi koodu nenju/ Nenju koodu kattiyiruththal. In Siddha system, it is classified under Kanai noi which is dealt in Baala vaagadam. The shape of the chest in pectus carinatum is said to resemble that of a pigeon, hence the term “pigeon chest” or “pigeon breast.” The term carinatum refers to the keel of a boat in Latin. The age group in children with pectus carniatum is wide, but characteristically at the time of puberty, the deformity becomes more prominent during the adolescent growth spurt. It typically consists of cosmetic concerns even though the condition can cause symptoms such as pain and breathlessness, most children opt for surgical correction.[4] The treatment for this ailment in conventional medical therapies remains controversial. This documentation helps to analyze the classical treatment methodologies, and to put forth the treatment for its resurgence. It might pave the way to arrive at a less invasive remedy for PC.

Standard operative procedure for suttigai therapy

Required tools

  1. Kadhupulikol (Cautery probe) [Figure 1]


  2. Veppam pattai (Dried Tamarind bark) [Figure 2]


  3. Puliyam pattai (Dried Neem bark) [Figure 3]
Figure 1: Kathupulikol instrument

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Figure 2: Dried tamarind bark

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Figure 3: Dried neem bark

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A cautery probe is a long rod-like instrument made up of iron metal, which is known as Kadhupulikol [Figure 1]. One end of the probe is sharp and the other end is divided into three segments that looks like a Tamil letter “akku”(ஃ). The sharp end is used as a handle; the other end is used for cauterization. This Suttigai (Instrumental cauterization) is usually planned to conduct on an afternoon of the no moon day. Before that the iron cautery probe, Kadhupulikol is preheated for 7 consecutive no moon days (Amaavaasai) with the fire of neem and tamarind barks. During the suttigai treatment, the probe is heated with tamarind bark alone. [Figure 4]. The heated end of the Kadhupulikol is made to touch on the sternum and costal cartilage. After an even and rapid touch, a healthy man’s saliva will be applied immediately in the cauterized spot. After an hour of the procedure, the ulcer is dressed with neem oil. By proper wound dressing for 7 to 10 days, the wound heals and the chest deformity is corrected.
Figure 4: Preparation of Suttigai instrument for application

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  Discussion Top


Traditional folklore practices are based on subjective, empirical experience, even though it proves its consistent efficacy for many centuries,[5] People are more reluctant to adopt these practices as regular treatment module, as it lacks scientific credentials. Here we attempt to relate the scientific aspects of the procedure to the efficacy in curing this disease. Recent evidence confirms that children with PC have an uneven physical appearance and a reduced quality of life. Current treatment options are the reverse Nuss or Abramson procedures, and the classic Ravitch procedure or modifications of it. For the past 20 years, external bracing has been the gold standard treatment for this condition.[6] In Siddha medicine, suttigai is a broadly used procedure when internal medicine does not respond to the diseases. However, among the surgical instruments defined in Aruvai Maruthuvam textbook by K.S Uthamarayan, the instrument is not mentioned.[2] This is unique and personalized to the Ravi’s family. Suttigai is meant for Vazhi and Iyyam related diseases depending upon the disease and severity. Pigeon chest is an extra developed costal cartilage, termed as an Iya disease in Siddha.[7]Iya diseases can be treated with suttigai therapy effectively, as this disease cannot be cured through internal medicine. Cartilage is covered by perichondrium and also blood supply is found for cartilage. During the cauterization process, blood vessels and extra developed cartilage are voluntarily stung. Physiological changes that could support the correction of chest deformity are substantiated that changing the local temperature both in the skin and in the subcutaneous tissues may decrease the sensitivity of the muscle spindles to stretch. The muscle spindles and their reflex response to stretch are an important element in the development of increased muscle tone that can occur in abnormalities such as chest wall deformities. Furthermost these external therapy techniques are established on the stimulation–reaction principle. For traditional naturopathic procedures, in particular, there is a rule that weak stimulation promotes, strong stimulation inhibits and the strongest stimulation inhibits life activity.[5]

Accordingly, the stung portions of winged chest areas can heal with the reformed shape by the natural body shape that can cosmetically correct the deformity in the growing child. The strength of the stimulation depends on the individual physique state and the patient’s age. Local heating of body parts, either superficial or deep, can change muscle blood flow. The rate of metabolism of tissues is dependent in part on temperature. The metabolism of skin or muscle has increased an average of 13 percent for each rise in degree centigrade. On the other hand, metabolism is decreased when the temperature drops. Heating beyond 45 degrees centigrade causes irreversible damage of tissue proteins and death of the tissues. Local dilatation can take place in the skin by heating independently of the nervous system and may be propagated away from the local area of stimulation by a non-neural pathway.[6] It is a common notion that abnormal costal cartilage growth is the underlying pathology in PC.[3]

Suttigai method can be well compared with Continuous Short Wave Diathermy which is used to relieve pain and muscle spasm, relieves inflammation and swelling, promote vasodilation, and increase soft tissue extensibility and joint range of movement. SWD is contraindicated to children as it is having established bone penetration, SWD-induced heating of the epiphyseal plates in the long bones of children may disturb growth.[7] Likewise, the heat can penetrate the sternal costal cartilages of young children after the abnormal wall has been heated with the rod, the stimulus might induce the efferent pathway of stretch receptors in muscle and can reduce the cartilage bulge which in turn corrects the deformity.

The aim of the intervention is usually to activate the patient’s power of self-healing and stimulate the body to regulate itself. The adaptation processes stimulated must be regarded as a central biological mechanism. The specificity of the stimulus is not always in evidence but is also not always accepted in a theoretical context.[5] In general, following repair of PC outcome was good. There were around 50–75 cases in a year attended by his forefathers before 50 years, however, in recent days, there were 1–2 cases are being done. Regardless of the invasiveness of this technique, the people who have undergone this procedure are being satisfied with the results of this procedure. This procedure has been practiced by this family tradition for many years together and it is being taught and learned by generation after generation of their family members. The family is also named as vannaan veedu (washermen) doing soodu vaithiyam in that region. The people around that vicinity are modestly familiar and have faith in that method for healing this disease. This treatment is easy to perform as it is available very near to their vicinity and cost-effective as compared to the surgical procedures in the modern system of medicine. The Suttigai vaidyars had the habit of not demanding the monetary charge for their treatment as it is considered as service to humanity. People who are able to offer cash as datchinai are being accepted. The photograph of a male aged 76 years, who was treated by the father of Mr. Ravi, had a linear scar in his left sixth and seventh costal cartilage area of chest wall. He was born with this chest wall abnormality, and he was treated with Suttigai method at the age of 2 years. His image [Figure 5] represents the well-being of the said patient. Appropriate patient selection and shared decision-making with the patient and their family are the major concern.
Figure 5: An old scar of a Suttigai in 76-year-old male person of Pudukottai zone

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  Conclusion Top


The protrusion of the sternum in the congenital chest wall deformity corrected by the Suttigai procedure in the Kothamangalam region of the Pudukottai district is documented and the operating methods are discussed here. The less invasive and traditional method of treatment for chest wall anomalies can safeguard the quality of life in pediatric cases. This methodology might pave way for the newer insights into the treatment modalities for Pectus carinatum.

Declaration of patient consent

The authors certify that they have obtained the patient consent form. The patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Authors contribution

Dr. Senthilkumar Vadivel has conceived the work and identified the practice and finalised the draft and approval was also been given for the version to be submitted. Dr. Chitra Balasubramanian has drafted the article and revised it critically for its content and final draft was done and communicated to the journal. Dr. E. Gowsalya has collected the information for this documentation and contributed in writing the article. Dr. M. Nagalakshmi has collected the information for this work and followed the people in that area. Dr. J. Jayapriya has collected the information in field and also contributed to the grammatical checking and drafting.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sridhar S, Senthilvel G. Efficacy of classical Siddha external therapy “Suttigai” (thermal cauterization) on Azal Keel Vaatham. IOSR J Dent Sci 2018;17:01-11.  Back to cited text no. 1
    
2.
Utthamarayan. Aruvai Maruthuvam. 3rd ed. Chennai: Department of Indian Medicine and Homeopathy; 2003. p. 173.  Back to cited text no. 2
    
3.
Desmarais TJ, Keller MS. Pectus carinatum. Curr Opin Pediatr 2013;25:375-81.  Back to cited text no. 3
    
4.
Ridley LJ, Han J, Ridley WE, Xiang H. Pectus carinatum: Chest deformity. J Med Imaging Radiat Oncol 2018;62:147.  Back to cited text no. 4
    
5.
Irnich D. Myofascial Trigger Points, Comprehensive Diagnosis and Treatment. Treatment of Myofascial Pain Complementary and Alternative Therapies and Naturopathic Treatments. Edinburgh: Elsevier Ltd.; 2013. p. 233-44.  Back to cited text no. 5
    
6.
Downey JA. Physiological effects of heat and cold. Phys Ther 1964;44:713-7.  Back to cited text no. 6
    
7.
Shanmugavel M. Siddha Maruthuva Noi Nadal Noi Muthal Nadal Thirattu. Part-I, 1st ed. Chennai: Department of Indian Medicine and Homeopathy; 2014. p. 255.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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