प्रनष्टशल्यविज्ञानीयाध्यायः
अथातः प्रनष्टशल्यविज्ञानीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
"Now, we shall expound the chapter on the recognition of lost foreign bodies."
"As declared by the venerable Dhanvantari."
This Shloka introduces the chapter on identifying foreign objects that are lost within the body, as taught by the revered sage Dhanvantari, emphasizing the significance of understanding and diagnosing such conditions in medical practice.
‘शल’ ‘श्वल’ आशुगमने धातूः; तयोराद्यस्य शल्यमिति रूपम् ||३||
"The roots 'Śala' and 'Śvala' denote swift movement; the form of the word 'Śalya' is derived from the first root."
This Shloka explains the etymology of the word 'Śalya', which is derived from the roots 'Śala' and 'Śvala', both signifying swiftness. It highlights the linguistic origins and meanings that contribute to the term used in medical contexts for a foreign object or instrument.
तद्द्विविधं शारीरमागन्तुकं च ||४||
"It is of two types: endogenous (originating within the body) and exogenous (coming from outside the body)."
This Shloka categorizes foreign objects into two types: those that originate within the body (endogenous) and those that come from outside the body (exogenous). It underscores the need to distinguish between these types to provide appropriate medical intervention.
सर्वशरीराबाधकरं शल्यं, तदिहोपदिश्यत इत्यतः शल्यशास्त्रम् ||५||
"A foreign body (Śalya) causes affliction to the entire body; hence the science of dealing with foreign bodies (Śalyashastra) is expounded here."
This Shloka stresses the detrimental impact of foreign bodies on the entire body, underscoring the importance of Śalyashastra, the branch of science dedicated to the study and management of these foreign objects to ensure proper medical treatment and patient care.
तत्र शारीरं दन्तरोमनखादि धातवोऽन्नमला दोषाश्च दुष्टाः; आगन्त्वपि शारीरशल्यव्यतिरेकेण यावन्तो भावा दुःखमुत्पादयन्ति ||६||
"There, endogenous (originating within the body) substances include teeth, hair, nails, body tissues, impurities from food, and vitiated doshas; while exogenous (coming from outside the body) foreign bodies cause various kinds of pain apart from the ones originating within the body."
This Shloka enumerates the types of endogenous substances that can cause harm within the body, such as teeth, hair, nails, tissues, impurities from food, and vitiated doshas. It also mentions that exogenous foreign bodies, which come from outside the body, can cause different forms of pain and discomfort, highlighting the importance of understanding both types to manage and alleviate suffering effectively.
अधिकारो हि लोहवेणुवृक्षतृणशृङ्गास्थिमयेषु; तत्रापि विशेषतो लोहेष्वेव , विशसनार्थोपपन्नत्वाल्लोहस्य; लोहानामपि दुर्वारत्वादणुमुखत्वाद्दूरप्रयोजनकरत्वाच्च शर एवाधिकृतः |
स च द्विविधः कर्णी , श्लक्ष्णश्च; प्रायेण विविधवृक्षपत्रपुष्पफलतुल्याकृतयो व्याख्याताः, व्यालमृगपक्षिवक्रसदृशाश्च ||७||
"The application pertains to foreign objects made of metal, bamboo, wood, grass, horn, and bone. Particularly, it focuses on metal objects due to their sharpness and suitability for piercing. Metal objects are difficult to manage, have small openings, and can cause long-distance injuries; hence, the arrow is predominantly considered. Arrows are of two types: barbed and smooth, and they are typically described as resembling various tree leaves, flowers, fruits, or resembling the curves of serpents, animals, and birds."
This Shloka highlights the types of foreign objects made from various materials like metal, bamboo, wood, grass, horn, and bone that can affect the body. It emphasizes the focus on metal objects due to their sharpness and the challenges they present in medical treatment. The Shloka also categorizes arrows into two types, barbed and smooth, and describes their typical shapes and comparisons to natural elements and animals, stressing the need to recognize and manage these foreign objects effectively in medical practice.
सर्वशल्यानां तु महतामणूनां वा पञ्चविधो गतिविशेष ऊर्ध्वमधोऽर्वाचीनस्तिर्यगृजुरिति ||८||
"For all objects, whether large or minute, there are five distinct types of movement: upward, downward, forward, lateral, and zigzag."
This shloka outlines the categorization of the movements or pathways of foreign objects (Śalya) within the body or external environment. It emphasizes five specific directions in which objects might move or be displaced.
तानि वेगक्षयात् प्रतिघाताद्वा त्वगादिषु व्रणवस्तुष्वतिष्ठन्ते, धमनीस्रोतोऽस्थिविवरपेशीप्रभृतिषु वा शरीरप्रदेशेषु ||९||
"These objects, due to a decrease in velocity or impact, lodge in the skin and other tissues, or in areas such as blood vessels, channels, bone cavities, and muscles."
This Shloka describes how foreign objects can become embedded in various parts of the body, including the skin, tissues, blood vessels, channels, bone cavities, and muscles, either due to a reduction in their speed or as a result of an impact. It highlights the diverse locations within the body where such objects can cause complications, underscoring the importance of precise diagnosis and treatment.
तत्र शल्यलक्षणमुच्यमानमुपधारय |
तद्द्विधं सामान्यं वैशेषिकं च |
श्यावं पिडकाचितं शोफवेदनावन्तं मुहुर्मुहुः शोणितास्राविणं बुद्बुदवदुन्नतं मृदुमांसं च व्रणं जानीयात् सशल्योऽयमिति; सामान्यमेतल्लक्षणमुक्तम् |
वैशेषिकं तु- त्वग्गते विवर्णः शोफो भवत्यायतः कठिनश्च; मांसगते शोफाभि(ति)वृद्धिः शल्यमार्गानुपसंरोहः पीडनासहिष्णुता चोषपाकौ च; पेश्यन्तरस्थेऽप्येतदेव चोषशोफवर्जं; सिरागते सिराध्मानं सिराशूलं सिराशोफश्च; स्नायुगते स्नायुजालोत्क्षेपणं संरम्भश्चोग्रा रुक् च; स्रोतोगते स्रोतसां स्वकर्मगुणहानिः; धमनीस्थे सफेनं रक्तमीरयन्ननिलः सशब्दो निर्गच्छत्यङ्गमर्दः पिपासा हृल्लासश्च; अस्थिगते विविधवेदनाप्रादुर्भावः शोफश्च; अस्थिविवरगतेऽस्थिपूर्णताऽस्थितोदः संहर्षो बलवांश्च; सन्धिगतेऽस्थिवच्चेष्टोपरमश्च; कोष्ठगत आटोपानाहौ मूत्रपुरीषाहारदर्शनं च व्रणमुखात्; मर्मगते मर्मविद्धवच्चेष्टते |
सूक्ष्मगतिषु शल्येष्वेतान्येव लक्षणान्यस्पष्टानि भवन्ति ||१०||
"Now, listen to the symptoms of foreign objects (Śalya). They are of two types: general and specific. A wound containing a foreign object will appear dark, swollen, painful, frequently bleed, and have bubbles, and the flesh around it will be soft. These are the general symptoms.
Specific symptoms are as follows: If the object is in the skin, the swelling will be discolored, elongated, and hard. If it is in the muscle, there will be excessive swelling, delayed healing in the path of the object, intolerance to pressure, and suppuration. If it is in the intermuscular spaces, these symptoms are the same except for the absence of suppuration and swelling. If it is in the veins, there will be dilation, pain, and swelling of the veins. If it is in the ligaments, there will be lifting of the ligament structures, strong irritation, and severe pain. If it is in the channels (srotas), they will lose their normal function and quality. If it is in the arteries, air will escape with a frothy blood flow, causing bodily pain, thirst, and nausea. If it is in the bones, various kinds of pain and swelling will occur. If it is in the bone cavities, the bones will feel full and produce a creaking sound, leading to strong pain. If it is in the joints, it will restrict movement, similar to a condition affecting the bones. If it is in the chest or abdomen, there will be distension and bloating, and food and waste will be visible at the wound site. If it is in a vital organ, the symptoms will mimic the injury of that particular organ. Subtle foreign objects will show these symptoms indistinctly."
This Shloka describes the general and specific symptoms caused by foreign objects (Śalya) lodged in various parts of the body. It details how the presence of such objects affects the skin, muscles, veins, ligaments, channels, arteries, bones, joints, chest, abdomen, and vital organs, emphasizing the importance of identifying and managing these symptoms for effective medical treatment.
महान्त्यल्पानि वा शुद्धदेहानामनुलोमसन्निविष्टानि रोहन्ति विशेषतः कण्ठस्रोतःसिरात्वक्पेश्यस्थिविवरेषः |
दोषप्रकोपव्यायामाभिघाताजीर्णेभ्यः प्रचलितानि पुनर्बाधन्ते ||११||
"Large or small foreign bodies, when naturally lodged in clean bodies, particularly in the throat, channels, veins, skin, muscles, and bone cavities, heal well. However, when disturbed by aggravated doshas, exercise, trauma, or indigestion, they cause trouble again."
This Shloka explains that foreign bodies, whether large or small, tend to heal well when they are naturally lodged in a clean and healthy body, especially in areas like the throat, channels, veins, skin, muscles, and bone cavities. However, if these foreign bodies are disturbed by factors such as aggravated doshas, excessive exercise, trauma, or indigestion, they can cause problems once more, highlighting the importance of maintaining overall health and avoiding aggravating factors to ensure proper healing.
तत्र, त्वक्प्रनष्टे स्निग्धस्विन्नायां मृन्माषयवगोधूमगोमयमृदितायां त्वचि यत्र संरम्भो वेदना वा भवति तत्र शल्यं विजानीयात्, स्त्यानघृतमृच्चन्दनकल्कैर्वा प्रदिग्धायां शल्योष्मणाऽऽशु विसरति घृतमुपशुष्यति चालेपो यत्र तत्र शल्यं विजानीयात्; मांसप्रनष्टे स्नेहस्वेदादिभिः क्रियाविशेषैरविरुद्धैरातुरमुपपादयेत्, कर्शितस्य तु शिथिलीभूतमनवबद्धं क्षुभ्यमाणं यत्र संरम्भं वेदनां वा जनयति तत्र शल्यं विजानीयात्; कोष्ठास्थिसन्धिपेशीविवरेष्ववस्थितमेवमेव परीक्षेत; सिराधमनीस्रोतःस्नायुप्रनष्टे खण्डचक्रसंयुक्ते याने व्याधितमारोप्याशु विषमेऽध्वनि यायात् यत्र संरम्भो वेदना वा भवति तत्र शल्यं विजानीयात्; अस्थिप्रनष्टे स्नेहस्वेदोपपन्नान्यस्थीनि बन्धनपीडनाभ्यां भृशमुपाचरेत्, यत्र संरम्भो वेदना भवति तत्र शल्यं विजानीयात्; सन्धिप्रनष्टे स्नेहस्वेदोपपन्नान् सन्धीन् प्रसरणाकुञ्चनबन्धनपीडनैः भृशमुपाचरेत्, यत्र संरम्भो वेदना वा भवति तत्र शल्यं विजानीयात्, सन्धिप्रनष्टे स्नेहस्वेदोपपन्नान् सन्धीन् प्रसरणाकुञ्चनबन्धनपीडनैर्भृशमुपाचरेत्; यत्र संरम्भो वेदना वा भवति तत्र शल्यं विजानीयात्, मर्मप्रनष्टे त्वनन्यभावान्मर्मणामुक्तं परीक्षणं भवति ||१२||
"Therefore, for foreign objects in the skin, after oil application and sweating, if there is irritation or pain in the area where mud, mash, barley, wheat, or cow dung has been applied, it indicates the presence of a foreign object. If the ointment of stagnant ghee, earth, and sandalwood paste dries quickly due to the heat of the foreign object, it indicates its presence.
For foreign objects in the muscle, perform treatments involving oil and sweat and observe the patient. In a weakened patient, if the foreign object remains loose and causes irritation or pain, it indicates the presence of a foreign object. Check similarly for foreign objects lodged in the abdomen, bones, joints, and muscle spaces.
For foreign objects in the veins, arteries, channels, or ligaments, place the patient in a cart with broken wheels and travel on a rough path. If irritation or pain occurs, it indicates the presence of a foreign object.
For foreign objects in the bones, treat with oil and sweat, and apply bandages and pressure. If irritation or pain occurs, it indicates the presence of a foreign object.
For foreign objects in the joints, treat with oil and sweat, and apply extension, flexion, bandaging, and pressure. If irritation or pain occurs, it indicates the presence of a foreign object.
For foreign objects in vital organs, the examination method described earlier should be applied."
This Shloka details the procedures for diagnosing foreign objects (Śalya) in various parts of the body, such as the skin, muscles, abdomen, bones, veins, arteries, channels, ligaments, joints, and vital organs. It highlights the importance of observing specific symptoms, such as irritation, pain, and changes in the application of treatments, to accurately identify the presence of foreign objects and ensure proper medical intervention.
सामान्यलक्षमपि च हस्तिस्कन्धाश्वपृष्ठपर्वतद्रुमारोहणधनुर्व्यायामद्रुतयाननियुद्धाध्वगमनलङ्घनप्लवनप्रतरण-
व्यायामैर्जृम्भोद्गारकासक्षवथुष्ठीवनहसनप्राणायामैर्वातमूत्रपुरीषशुक्रोत्सर्गैर्वा यत्र संरम्भो वेदना वा भवति तत्र शल्यं विजानीयात् ||१३||
"Even during ordinary activities like climbing onto an elephant's back, riding a horse, ascending mountains and trees, practicing archery, fast travel, wrestling, walking, running, jumping, swimming, stretching exercises, yawning, belching, coughing, sneezing, spitting, laughing, and breathing exercises, or during the discharge of wind, urine, feces, or semen, if there is irritation or pain, it indicates the presence of a foreign object."
This Shloka highlights that common physical activities, such as riding animals, climbing, practicing archery, traveling, engaging in physical exercises, and even everyday actions like yawning or sneezing, can reveal the presence of a foreign object if they cause irritation or pain. It emphasizes the importance of observing these symptoms during various activities to detect and address any foreign objects within the body.
भवन्ति चात्र-
यस्मिंस्तोदादयो देशे सुप्तता गुरुताऽपि च |
घट्टते बहुशो यत्र शूयते रुज्यतेऽपि च ||१४||
आतुरश्चापि यं देशमभीक्ष्णं परिरक्षति |
संवाह्यमानो बहुशस्तत्र शल्यं विनिर्दिशेत् ||१५||
"The place where there are symptoms like piercing pain, numbness, heaviness, frequent irritation, swelling, or pain, and the patient continuously protects that area and frequently requests massages, one should identify the presence of a foreign object (Śalya) there."
This Shloka outlines the symptoms and indicators of a foreign object (Śalya) in the body, such as piercing pain, numbness, heaviness, irritation, swelling, and pain in a specific area. It also highlights the behavior of the patient, who will often protect that area and seek frequent massages, pointing to the likely presence of a foreign object that needs medical attention.
अल्पाबाधमशूनं च नीरुजं निरुपद्रवम् |
प्रसन्नं मृदुपर्यन्तं निराघट्टमनुन्नतम् ||१६||
एषण्या सर्वतो दृष्ट्वा यथामार्गं चिकित्सकः |
प्रसाराकुञ्चनान्नूनं निःशल्यमिति निर्दिशेत् ||१७||
"If the area shows minimal distress, no swelling, no pain, no complications, appears healthy, soft at the edges, unaffected by rubbing, and not elevated, then, after thoroughly examining with a probe and observing the normal function of extension and flexion, the physician should declare it as free from a foreign object."
This Shloka describes the characteristics of a wound free from foreign objects. It should show minimal distress, no swelling, pain, or complications, and appear healthy with soft edges. The area should not be affected by rubbing or elevated. After a thorough examination using a probe and observing normal movement, the physician can confidently declare the wound as free from any foreign objects, ensuring proper healing and recovery.
अस्थ्यात्मकं भज्यते तु शल्यमन्तश्च शीर्यते |
प्रायो निर्भुज्यते शार्ङ्गमायसं चेति निश्चयः ||१८||
"Foreign objects made of bone are likely to break and disintegrate inside; similarly, arrows made of bone and iron generally do not break."
This Shloka explains that foreign objects made of bone are prone to breaking and disintegrating within the body. In contrast, arrows made of bone and iron are generally robust and do not break easily, indicating the need for careful management and removal of these different types of foreign objects in medical practice.
वार्क्षवैणवतार्णानि निर्ह्रियन्ते तु नो यदि |
पचन्ति रक्तं मांसं च क्षिप्रमेतानि देहिनाम् ||१९||
"If foreign objects made of wood, bamboo, or reed are not removed, they quickly damage the blood and flesh of the body."
This Shloka highlights the urgency of removing foreign objects made of materials like wood, bamboo, and reed. If these objects are not promptly extracted, they can quickly cause significant harm to the blood and flesh, emphasizing the importance of timely medical intervention to prevent further complications.
कानकं राजतं ताम्रं रैतिकं त्रपु सीसकम् |
चिरस्थानाद्विलीयन्ते पित्ततेजःप्रतापनात् ||२०||
"Gold, silver, copper, brass, tin, and lead, when remaining in the body for a long time, dissolve due to the heating effect of bile and heat."
This Shloka emphasizes that foreign objects made of metals like gold, silver, copper, brass, tin, and lead, if left in the body for an extended period, tend to dissolve due to the body's bile and heat. It highlights the importance of timely removal of such foreign objects to prevent their dissolution and subsequent harm to the body.
स्वभावशीता मृदवो ये चान्येऽपीदृशा मताः |
द्रवीभूताः शरीरेऽस्मिन्नेकत्वं यान्ति धातुभिः ||२१||
"Naturally cold and soft objects, as well as others considered similar, when liquefied in the body, become one with the bodily tissues."
This Shloka describes that foreign objects which are naturally cold and soft, along with similar objects, tend to liquefy within the body and integrate with the bodily tissues. This highlights the body's ability to assimilate certain types of foreign objects over time, underscoring the complexity of managing such cases in medical practice.
विषाणदन्तकेशास्थिवेणुदारुपलानि तु |
शल्यानि न विशीर्यन्ते शरीरे मृन्मयानि च ||२२||
"Foreign objects made of horn, teeth, hair, bone, bamboo, wood, and clay do not disintegrate in the body."
This Shloka emphasizes that foreign objects composed of materials like horn, teeth, hair, bone, bamboo, wood, and clay remain intact and do not break down within the body. It highlights the durability of these materials, which requires careful attention and appropriate medical intervention to manage and remove them effectively.
द्विविधं पञ्चगतिमत्त्वगादिव्रणवस्तुषु |
यो वेत्ति विष्टितं शल्यं स राज्ञः कर्तुमर्हति ||२३||
"He who knows the two types of foreign objects (Śalya) and their five locations within the skin and other tissues is fit to be appointed as the king's physician."
This Shloka emphasizes the importance of a physician's knowledge in recognizing the two types of foreign objects and understanding their five specific locations within the body, such as the skin and other tissues. It highlights that a physician with such expertise is deemed capable and worthy of being appointed as the king's physician, underscoring the value of specialized medical knowledge in ancient times.
इति सुश्रुतसंहितायां सूत्रस्थाने प्रनष्टशल्यविज्ञानीयो नाम षड्विंशतितमोऽध्यायः ||२६||
"Thus ends the twenty-sixth chapter named 'Recognition of Lost Foreign Bodies' in the Sutrasthana of the Sushruta Samhita."
This concluding Shloka signifies the end of the twenty-sixth chapter in the Sutrasthana section of the Sushruta Samhita, which is dedicated to the recognition and management of lost foreign bodies. It highlights the comprehensive nature of ancient medical knowledge and practices as compiled in this classic text.