AH-Su-Chapter 28: Shalya Aaharan Vidhi शल्यआहरण विधि / Removal of Foreign Body

Shalya means a foreign body, Aharana means extraction/pulling out

Shalya gati - direction of entry of foreign bodies-

वक्रर्जुतिर्यगूर्ध्वाधः शल्यानां पञ्चधा गतिः

Vakra – Irregular – curved,
Ruju ­ – straight,
Tiryak – horizontal,
Urdhwa – upward and
Adha – downward are the five Shalyagati (directions of movement of the foreign bodies)

Shalya Vrana - ulcer with a foreign body inside:-

ध्यामं शोफरुजावन्तं शोणितं मुहुः
अभ्युद्गतं बुद्बुदवत्पिटिकोपचितं व्रणम्
मृदुमांसं च जानीयदन्तः शल्यं समासतः

Blue discolouration, swelling, pain, frequent bleeding, elevated like a bubble, studded with eruptions and softening  of muscles are the features from which a wound having a foreign body should be recognized. 1-2

विशेषात् त्वग्गते शल्ये विवर्णः कठिनायतः
शोफो भवति मांसस्थे चोषः शोफो विवर्द्धते
पीडनाक्षामता पाकः शल्यमार्गो न रोहति
पेश्यन्तरगते मांसप्राप्तवत् श्वयुथुं विना

Tvak gata – When the foreign body is in the skin, there is discoloration, hard and large swelling;

Mamsagata (when it is in the muscle), there will be sucking pain, steady progress of the swelling, tenderness, suppuration and non- healing of the wounds of entry of the foreign body;
when it is in between two muscles (Peshi) the signs will be similar that residing inside the muscle except the swelling 3-4

आक्षेपः स्नायुजालस्य संरम्भस्तम्भवेदना
स्नायुगे दुर्हरं चैतत्
सिराध्मानं सिराश्रिते
स्वकर्मगुणहानिः स्यात् स्रोतसां स्रोतसि स्थिते
धमनीस्थे अनिलो रक्तं फेनयुक्तमुदीरयेत् ६
निर्याति शब्दवान् स्याच्च हृल्लासः साङ्गवेदनः
सङ्घर्षो बलवानस्थिसन्धिप्राप्ते अस्थिपूर्णता ७
नैकरूपारुजो अस्थिस्थे शोफः तद्वच्च सन्धिगे
चेष्टा निवृत्तिश्च भवेत् आटोपः कोष्ठसंश्रिते ८
आनाहो अन्नशकृन्मूत्रदर्शनं च व्रनानने
विद्यान्मर्मगतं शल्यं मर्मविद्धोपलक्षणैः ९
यथास्वं च परिस्रावैः त्वगादिषु विभावयेत्

Snayugata shalya (tendons) – Convulsions, shock, stiffness, loss of movements and severe pain are the symptoms when the foreign body is in tendons. when foreign body is in the tendons and is difficult to remove;

Siragata shalya (veins) – there is distention of the vein; when  lodged in the veins, there is distention of the vein;

Srotogata Shalya (body channels) – there will be loss of their respective functions and qualities,

Dhamanigata shalya (arteries) – bleeding with frothing, chest discomfort, nausea and body ache;

Sandhiagata (joints) – severe shock, pain and filling up of different types of fluids and swelling

Asthigata (bones) – the signs are the same, with loss of movement also.

Koshtagata (abdomen) – there will be distention and appearance of food  faecal matter and   urine at the orifice of the wound.

Marmagata (vital spots) – appearance of signs of injury to such spots.

In addition to the general signs, enumerated so far, even their discharges- fluids coming out from them such as Lasika (Lymph) from skin, Rakta (blood) from veins and Arteries, Majja – marrow bones etc. should be observed. 5-9 ½

रुह्यते शुद्धदेहानामनुलोमस्थितं तु तत्
दोषकोपाभिघातादिक्षोभाद्भूयो अपि बाधते

If foreign body is lodged in persons who have pure body – purified with therapies such as Panchakarma and if the foreign body enters in the same line of the organ, the chances of healing are good. If the body is not purified, it produces serves distress due to aggravation of Doshas. 10

Recognizing the site of foreign body beneath the skin – 

त्वङ्नष्टे यत्र तत्र स्युरभ्यङ्गस्वेदमर्दनैः
रागरुग्दाहसंरम्भा यत्र चाज्यं विलीयते
आशु शुष्यति लेपो वातत्स्थानं शल्यवद्वदेत्
मांसप्रणष्टं संशुध्या कर्शनाच्छ्लथतां गतम्
क्षोभाद्रागादिभिः शल्यं लक्षयेत् तद्वदेव च
पेश्यस्थिसन्धिकोष्ठेषु नष्टमस्थिषु लक्षयेत्
अस्थ्नामभ्यञ्जनस्वेदबन्धपीडनमर्दनैः
प्रसारणाकुञ्चनतः सन्धिनष्टं तथा अस्थिवत्

The exact site of foreign bodies concealed in the skin, is recognized by
The appearance of redness,
pain, burning sensation and tenderness after anointing with oil, fomentation or massage;
by the melting of solid  ghee, placed at the site,
by quick drying of the paste of sandal wood etc.

नष्टे स्नायुशिरास्रोतोधमनीष्वसमे पथि
अश्वयुक्तं रथं खण्डचक्रमारोप्य रोगिणम्
शीघ्रं नयेत्ततस्तस्य संरम्भाच्छल्यमादिशेत्

Site of foreign body concealed in the muscle, joint and abdomen – canbe recognized by clearing looseness, thinness of the muscles by Panchakarma therapies or by other methods of slimming the body and then observing for sites of pain, redness etc.

The site of those concealed in the bones is recognized by anointing with oil, fomentation, tying with rope or bandage squeezing and massaging;

The sites of those concealed in the joints by extending or folding of joint in addition to signs similar to lodged in bones.

Sites of those concealed in tendons, veins, channels and arteries are recognized by appearance of pain in such places, in a horse chariot, with broken wheels.

मर्मनष्टं पृथङ्नोक्तं तेषां मांसादिसंश्रयात्

Features of those concealed, in vulnerable spots are not described separately because such spots are composed of muscles and other tissues only- the features of which have been described already.

सामान्येन सशल्यं तु क्षोभिण्या क्रियया सरुक्

Generally the site of the foreign body is determined by the appearance of distressing symptoms, abnormal movements etc. during activity and by the presence of pain. 17

वृत्तं पृथु चतुष्कोणं त्रिपुटं च समासतः
अद्दृष्यशल्यसंस्थानं व्रणाकृत्या विभावयेत्

The shape of the invisible foreign body is determined by the shape of the wound, such as round – circular wide, with four Angula, with 3 edges. Etc.18

Shalyaharana- removal of foreign bodies:-

तेषामाहरणोपायौ प्रतिलोमानुलोमकौ
अर्वाचीनपराचीने निर्हरेत्तद्विपर्ययात्

Method of their removal are though upward and downward directions;
those entering into the body from above and below should be taken out in the opposite directions respectively. 19

सुखाहार्यं यतश्च्छित्वा ततस्तिर्यग्गतं हरेत्

Those which have entered from sideward – horizontally should be removed by cutting it conveniently. 19 ½

शल्यं न निर्घात्यमुरः कक्षावङ्क्षणपार्श्वगम्
प्रतिलोममनुत्तुण्डं छेद्यं पृथुमुखं च यत्
नैवाहरोदिशल्यघ्नं नष्टं वा निरुपद्रवम्

Foreign bodies, arrowheads which are lodged in the chest, axillae, groins and Flanks, which can be cut and which have board blades should be pulled out.

Shalyas that should not be removed -
Those which lead to death soon after their removal, which are lost / invisible, which are absorbed by the body and those which do not produce complications- should not be removed. 20-21

Aharana Vidhi- means and methods of removal

अथाहरेत्करप्राप्यं करेणेव इतरत्पुनः
दृश्यं सिंहाहिमकरवर्मिकर्कटकाननैः

Those which can be held with the hand should be removed by the hand itself.
While others which are visible should be held by instruments such Simha- lion faced Varmimukha- fish faced, karkata mukha –crab faced etc. 22

अदृशयं व्रणसंस्थानाद्गृहीतुं शक्यते यतः
कङ्कभृङ्गाह्वकुररशरारीवायसाननैः

Those which are invisible but can be grasped by instruments, through the wound, should be pulled out by instruments having faces like the Kankha – heron, Bhringa- Shrike, Kurara- osprey, Sharari- a kind of heron and Vayasa –crow. 23

सन्दंशाभ्यां त्वगादिस्थम् तालाभ्यां सुषिरं हरेत्
सुषिरस्थं तु नलैकः शेषं शेषैर्यथायथम्

Those which are lodged in the skin should be removed with the help of Sandamhsa- Yantra (forceps);
Those which are hollow, with the help of Tala Yantra- instruments with flat discs,
Those which are lodged in hollow spaces, by using Naraka Yantra- tubular instruments and the rest by other convenient instruments. 24

शस्त्रेण वा विशस्यादौ ततो निर्लोहितं व्रणम्
कृत्वा घृतेन संस्वेद्य बद्ध्वा आचारिकमादिशेत्

Those which cannot be held by instruments should be removed by cutting open the site with sharp instruments, the wound is next cleared of the blood, soaked with ghee, fomented and then bandaged;
The patient is advised to follow the prescribed regime – described in verses. 30-42 of the next chapter. 25

सिरास्नायुविलग्नं तु चालयित्वा शलाकया

Those lodged in the veins and tendons – including nerves, should be pulled out after loosing them with the help of Salaka – rod like instruments.

हृदये संस्थितं शल्यं त्रासितस्य हिमाम्बुना
ततः स्थानान्तरं प्राप्तमाहरेत्तद्यथायथम्
यथामार्गं दुराकर्षम् अन्यतो अप्येवमाहरेत्

If foreign body is in the chest (Hrudaya), patient should be sprinkled with ice water (himambu). 26-27

अस्थिदष्टे नरं पद्भयां पीडयित्वा विनिर्हरेत्
इत्यशक्ये सुबलिभिः सुगृहीतस्य किङ्करैः

Foreign body, arrow head, lodged in the bones should be removed by holding the patient tight by the legs of the physician, if not possible by this method, it should be pulled out by attendants who are strong. 28

तथा अप्यशक्ये वारङ्गं वक्रीकृत्य धनुर्ज्यया
सुबद्धं वक्त्रकटके बध्नीयात्सुसमाहितः
सुसंयतस्य पन्चाङ्ग्या वाजिनः कशया अथ तम्
ताडयेदिति मूर्धानं वेगेनोन्नमयन् यथा
उद्धरेच्छल्यम्

If not possible even by that method, the tail end (feather tied end of the arrow) should be bent and fastened tight to the string of a bent bow, and the bow tied to the bridle bit of a horse should then be whipped so that it raises its head suddenly and with force by this method the arrow is removed. 29-30

एवं वा शाखायां कल्पयेत्तरो
बद्ध्वा दुर्बलवारङ्गं कुशाभिः शल्यमाहरेत्

Likewise, the branches of trees may be made use of; in case of arrows with thin or fragile tail ends, thin bamboo poles can be made use. 31

श्वयथुग्रस्तवारङ्गं शोफमुत्पीड्य युक्तितः
मुद्गराहतया नाड्या निर्घात्योत्तुण्डितं हरेत्

If the tail end of the arrow is surrounded by an elevation, it should be pulled out after cutting off the elevated part suitably; if the arrowhead has caused a bulging on the body, it should be removed with the help of a Nadiyantra (tubular instrument) after shaking / hitting the bulging with a hammer.32

तैरेव चानयेन्मार्गममार्गोत्तुण्डितं तु यत्
मृदित्वा कर्णिनां कर्णं नाड्यास्येन निगृह्य वा

By the hammer, the arrow which has no clear passage of exit, should be brought into a passage, suitable for pulling out;
Those which have earlike projection should be pulled out after cutting off their ears or by fixing them inside tubular instruments. 33

अयस्कान्तेन निष्कर्णं विवृतास्यमृजुस्थितम्

The arrow heads without earlike projections, which have created a wide opening in the body and lodged straight, can be removed by making use of a magnet.

पक्वाशयगतं शल्यं विरेकेण विनिर्हरेत्

Foreign bodies which have entered the large intestine can be removed by inducing purgations. 34

दुष्टवातविषस्तन्यरक्ततोयादि चूषणैः

Bad air- gas, poison, breast milk, blood, fluids etc. which are acting foreign bodies should be removed by sucking by using animal horn (Shrunga) etc. 34 ½

कण्ठस्रोतोगते शल्ये सूत्रं कण्ठे प्रवेशयेत्
बिसेनात्ते ततः शल्ये बिसं सूत्रं समं हरेत्

If the foreign body has gone into the passage of the throat, a lotus stalk / sponge like portion, tied with a thread should be passed into the throat, and when the foreign body gets stuck to the stalk, the thread should be pulled out slowly. 35

नाड्या अग्नितापितां क्षित्वाशलाकामप्स्थिरीकृताम्
आनयेज्जातुषं कण्ठात् जतुदिग्धामजातुषम्

If the foreign body in the throat is made up of Lac, a heated iron rod should be passed through a tubular instrument and made to touch the foreign body and then removed out; those which are not made of Lac should be removed by making use of food smeared with Lac, at its tip. 36

केशोन्दुकेन पीतेन द्रवैः कण्टकमाक्षिपेत्
सहसा सूत्रबद्धेन वमतः तेन चेतरेत्

Thorn like, hook like bodies – which are in the throat should be removed by inserting a ball of hair fastened with a thread, making the patient vomit the water which he has been made to drink earlier, the foreign body sticking to the ball of hair during vomiting is removed by pulling the thread quickly .
In the same way hair and other foreign bodies should be removed by making use of the hook. 37

अशक्यं मुखनासाभ्यामाहर्तुं परतो नुदेत्

Those foreign bodies which are lodged in the mouth and nose, if not possible to be removed out though respective orifices, should be pushed back, making them to enter into the wider tract. 38

अप्पानस्कन्धघाताभ्यां ग्रासशल्यं प्रवेशयेत्

If a bolus of food is stuck up in the throat, it should be removed by using thread, cloth of flax, silk, hair or water. 39

सूक्ष्माक्षिव्रणशल्यानि क्षौमवालजलैर्हरेत्

The person who has swallowed water to his full stomach – by drowning should be held with his head down and legs up and shaken well, on laid on the round with the face bent down and then made to vomit all the water; he should then be immersed in heap of ash. 40

अपां पूर्णं विधुनुयादवाक्शिरसमायतम्
वामयेच्चामुखं भस्मराशौ वा निखनेन्नरम्

If the ears are full with water, it should be removed inserting the finger and oil removers put into the ears or the ears should be kept facing  downwards and the head given the blow from the side. Or the water can be sucked out with the help of tubular instruments 41

कीटे स्रोतोगते कर्णंपूरयेल्लवणाम्बुना
सूक्तेन वा सुखोष्णेन मृते क्लेदहरो विधिः

If any insect has entered into ears, the ears should be filled with warm salt water or sour gruel (Sukta), when the insect is dead, dehydration measures should be adopted or the ears should be filled with water. 42

जातुषं हेमरूप्यादिधातुजं च चिरस्थितम्
उष्मणा प्रायशः शल्यं देहजेन विलीयते

Foreign bodies of Lac, and other metals remaining for long time inside the body get dissolved the heat of the body. 43

मृदेवेणुदारुशृङ्गास्थिदन्तवालोपलानि च
विषाणवेण्वयस्तालदारुशल्यं चिरादपि
प्रायो निर्भुज्यते तद्धि पचत्याशु पलासृजी

Foreign body composed of Mud, Bamboo, wood, horn bone, tooth and hair of animals or man, stone do not get dissolved by body heat;

Those composed of horn, Bamboo Iron, wood of palm tree or remaining for long periods inside the body generally get distorted, remain un-dissolved and produce putrefaction in the muscles and blood . 44- 44 ½

शल्ये मांसावगाढे चेत्स देशो न विदह्यते
ततस्तं मर्दनस्वेदशुद्धिकर्षणबृंहणैः
तीक्ष्णोपनाहपानान्नघनशस्त्रपदाङ्गनैः
पाचयित्वा हरेच्छल्यं पाटनैषणभेदनैः

If the foreign body is concealed deep inside fleshy parts, purification should be created in such parts by squeezing, fomentation, thinning  measures and  smoothening therapies, use of strong, hot poultices warm foods and drinks, incising and other methods, of sharp instrumentation, trampling by feet etc. and then the foreign bodies removed by excision, probing or cutting. 45-46

शल्यप्रदेशयन्त्राणामवेक्ष्य बहुरूपताम्
तैस्तेरुपायैर्मतिमान् शल्यं विद्यात्तथा आहरेत्

Keeping in mind the different and peculiar features of the foreign bodies, their place of lodging and instruments of removal, the intelligent physician should recognized them and remove them by appropriate methods. 47- 47 ½

Thus ends the twenty eighth chapter called Salyaharana Vidhi in sutrasthana of Astanga hrudaya composed by Vaghata.