शल्यापनयनीयाध्यायः
अथातः शल्यापनयनीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
"Now, we shall expound the chapter on the removal of foreign bodies."
"As declared by the venerable Dhanvantari."
This Shloka introduces the chapter dedicated to the techniques and methods for removing foreign bodies from the body, as taught by the revered sage Dhanvantari. It emphasizes the importance of understanding and mastering these procedures to ensure effective medical treatment and patient care.
शल्यं द्विविधमवबद्धमनवबद्धं च ||३||
"Foreign bodies (Śalya) are of two types: attached (avabaddha) and unattached (anavabaddha)."
This Shloka categorizes foreign bodies into two types based on their attachment within the body: attached (avabaddha), which are firmly lodged in tissues or structures, and unattached (anavabaddha), which are not firmly embedded. Understanding this distinction is crucial for determining the appropriate method of removal and treatment in medical practice.
तत्र समासेनानवबद्धशल्योद्धरणार्थं पञ्चदश हेतून् वक्ष्यामः |
तद्यथा- स्वभावः, पाचनं, भेदनं, दारणं, पीडनं, प्रमार्जनं, निर्ध्मापनं, वमनं, विरेचनं, प्रक्षालनं, प्रतिमर्शः, प्रवाहणम्, आचूषणम्, अयस्कान्तो, हर्षश्चेति ||४||
"Now, we shall briefly explain fifteen methods for removing unattached foreign bodies (anavabaddha Shalya). These methods are: natural expulsion, digestion, incision, tearing, pressing, wiping, blowing out, emesis, purgation, washing, wiping with fingers, flowing out, suction, using a magnet, and inducing excitement."
This Shloka introduces fifteen different techniques for the removal of unattached foreign bodies. These methods range from natural expulsion and digestion to more active procedures like incision, tearing, pressing, and the use of tools such as magnets. Each method is tailored to address specific types of foreign bodies and their locations, emphasizing the importance of diverse strategies in ensuring successful removal and patient care.
तत्राश्रुक्षवथूद्गारकासमूत्रपुरीषानिलैः स्वभावबलप्रवृत्तैर्नयनादिभ्यः पतति |
मांसावगाढं शल्यमविदह्यमानं पाचयित्वा प्रकोथात्तस्य पूयशोणितवेगाद्गौरवाद्वा पतति |
पक्वमभिद्यमानं भेदयेद्दारयेद्वा |
भिन्नमनिरस्यमानं पीडनीयैः पीडयेत् पाणिभिर्वा |
अणून्यक्षशल्यानि परिषेचनाध्मापनैर्बालवस्त्रपाणिभिः प्रमार्जयेत् |
आहारशेषश्लेष्महीनाणुशल्यानि श्वसनोत्कासनप्रधमनैर्निर्धमेत् |
अन्नशल्यानि वमनाङ्गुलिप्रतिमर्शप्रभृतिभिः |
विरेचनैः पक्वाशयगतानि |
व्रणदोषाशयगतानि प्रक्षालनैः |
वातमूत्रपुरीषगर्भसङ्गेषु प्रवाहणमुक्तम् |
मारुतोदकसविषरुधिरदुष्टस्तन्येष्वाचूषणमास्येन विषाणैर्वा |
अनुलोममनवबद्धमकर्णमनल्पव्रणमुखमयस्कान्तेन |
हृद्यवस्थितमनेककारणोत्पन्नं शोकशल्यं हर्षेणेति ||५||
"Tears, sneezing, belching, coughing, urination, defecation, and expulsion of wind naturally expel foreign bodies from the eyes and other parts. Foreign bodies embedded in the muscles, not causing inflammation, are expelled by suppuration and discharge of pus and blood due to increased pressure or weight. Incised and broken foreign bodies should be removed by pressing or squeezing with hands.
Fine particles and minute foreign bodies should be wiped off using irrigation, blowing, and wiping with a soft cloth. Residual food particles and phlegm-free small foreign bodies should be blown out by exhalation, stretching, and blowing techniques. Food-related foreign bodies should be removed by emesis, finger applications, and similar methods. Those in the lower digestive tract should be removed by purgation. Wound-related foreign bodies should be washed out.
In cases of wind, urine, feces, and embryo blockages, expulsion is advised. In cases of wind, water, poison, blood impurities, and contaminated breast milk, suction with the mouth or a horn is recommended.
For unattached foreign bodies that are aligned, soft, and have a small wound opening, a magnet is used. For deep-seated foreign bodies caused by grief in the heart, inducing excitement is recommended."
This Shloka elaborates on the various methods for removing different types of unattached foreign bodies (anavabaddha Shalya) based on their location and nature. It highlights the importance of selecting appropriate techniques, such as natural expulsion, emesis, purgation, washing, and the use of magnets or suction, to ensure effective removal and alleviate the associated symptoms.
सर्वशल्यानां तु महतामणूनां वा द्वावेवाहरणहेतू भवतः- प्रतिलोमोऽनुलोमश्च ||६||
"For all types of foreign bodies, whether large or small, there are two methods of removal: against the direction (Pratiloma) and along the direction (Anuloma)."
This Shloka explains that the removal of foreign bodies, regardless of their size, can be done using two primary methods: Pratiloma, which involves removal against the direction of the natural path, and Anuloma, which involves removal along the direction of the natural path. Understanding these methods is essential for effective and safe extraction of foreign objects from the body.
तत्र प्रतिलोममर्वाचीनमानयेत् , अनुलोमं पराचीनम् ||७||
"For against the direction (Pratiloma), bring it forward; for along the direction (Anuloma), push it backward."
This Shloka clarifies the two methods of foreign body removal. Pratiloma involves extracting the foreign object by bringing it forward, opposite to its natural path, while Anuloma involves pushing the foreign object backward, along its natural path. Understanding and applying these methods are essential for effectively managing and removing foreign bodies from the body.
उत्तुण्डितं छित्त्वा निर्घातयेच्छेदनीयमुखम् ||८||
"When the tip is elevated, cut and remove the foreign body using a cutting instrument."
This Shloka provides guidance on the procedure for removing a foreign object when its tip is raised. It advises using a cutting instrument to sever and extract the object effectively. This method ensures precise removal while minimizing damage to the surrounding tissues.
छेदनीयमुखान्यपि कुक्षिवक्षःकक्षावङ्क्षणपर्शुकान्तरपतितानि च हस्तशक्यं यथामार्गेण हस्तेनैवापहर्तुं प्रयतेत ||९||
"Even foreign bodies that have fallen into the abdomen, chest, armpits, groin, and spaces between the ribs, if accessible by hand, should be removed by hand in the proper manner."
This Shloka instructs that foreign bodies lodged in areas like the abdomen, chest, armpits, groin, and spaces between the ribs should be removed by hand, using the correct technique, provided they are reachable. It emphasizes the importance of manual extraction in cases where it is feasible and safe, ensuring minimal complications and effective treatment.
हस्तेनैवापहर्तुमशक्यं विशस्य शस्त्रेण यन्त्रेणापहरेत् ||१०||
"When manual removal is not possible, the foreign body should be extracted using surgical instruments or devices."
This Shloka emphasizes that if a foreign body cannot be removed by hand, it is necessary to use surgical instruments or devices for extraction. It highlights the importance of employing appropriate tools to ensure effective and safe removal of foreign objects from the body.
भवति चात्र-
शीतलेन जलेनैनं मूर्च्छन्तमवसेचयेत् |
संरक्षेदस्य मर्माणि मुहुराश्वासयेच्च तम् ||११||
"In this context, one should pour cold water over a fainting person, protect their vital organs, and repeatedly reassure them."
This Shloka advises on the immediate steps to take when someone faints or loses consciousness. Pouring cold water helps to revive the person, while protecting their vital organs ensures their safety. Offering reassurance and comfort is also essential for their recovery and well-being.
ततः शल्यमुद्धृत्य निर्लोहितं व्रणं कृत्वा स्वेदार्हमग्निघृतप्रभृतिभिः संस्वेद्यावदह्य प्रदिह्य सर्पिर्मधुभ्यां बद्ध्वाऽऽचारिकमुपदिशेत् |
(सिरास्नायुविलग्नं शलाकादिभिर्विमोच्यापनयेत्; श्वयथुग्रस्तवारङ्गं समवपीड्य श्वयथुं; दुर्बलवारङ्गं कुशादिभिर्बद्ध्वा|) ||१२||
"Then, after extracting the foreign body and stopping the bleeding, treat the wound with fomentation using materials like fire and ghee until it is properly heated. Apply ointment of ghee and honey, and bandage the wound, providing the necessary post-treatment care.
If the foreign body is lodged in the veins or ligaments, it should be removed with needles or similar instruments. For a limb affected by swelling, the swelling should be pressed out. If the limb is weak, it should be bandaged with materials like grass."
This Shloka explains the post-extraction treatment of a wound after the removal of a foreign body. It emphasizes the importance of stopping the bleeding, applying proper heat treatment, using ointments like ghee and honey, and bandaging the wound for optimal healing. It also provides specific instructions for removing foreign bodies lodged in veins or ligaments and managing swelling or weakness in affected limbs.
हृदयमभितो वर्तमानं शल्यं शीतजलादिभिरुद्वेजितस्यापहरेद्यथामार्गं; दुरुपहरमन्यतोऽपबाध्यमानं पाटयित्वोद्धरेत् ||१३||
"A foreign body located around the heart should be irritated with cold water and removed in the natural direction. If it is difficult to remove and causing obstruction from another direction, it should be extracted by cutting."
This Shloka provides instructions for the removal of foreign bodies located around the heart. It advises the use of cold water to induce irritation and then removing the foreign object in its natural direction. If the object is challenging to remove and is causing obstruction, it should be extracted by making an incision. This emphasizes the importance of careful and precise techniques in managing foreign bodies near vital organs like the heart.
अस्थिविवरप्रविष्टमस्थिविदष्टं वाऽवगृह्य पादाभ्यां यन्त्रेणापहरेत्, अशक्यमेवं वा बलवद्भिः सुपरिगृहीतस्य यन्त्रेण ग्राहयित्वा शल्यवारङ्गं प्रविभुज्य धनुर्गुणैर्बद्ध्वैकतश्चास्य पञ्चाङ्ग्यामुपसंयतस्याश्वस्यवक्त्रकविके बध्नीयात्, अथैनं कशया ताडयेद्यथोन्नामयञ् शिरो वेगेन शल्यमुद्धरति; दृढां वा वृक्षशाखामवनम्य तस्यां पूर्ववद्बद्ध्वोद्धरेत् ||१४||
"For a foreign body that has entered a bone cavity or been bitten by a bone, it should be grasped firmly and extracted with a tool using the feet for leverage. If this is not possible, the patient should be tied securely with strong ropes and the affected limb attached to a fixed object. The patient is then struck with a whip to induce movement, which helps in extracting the foreign body with force. Alternatively, bending a strong tree branch and securing the patient to it, then allowing the branch to spring back, can also aid in the extraction."
This Shloka provides instructions for removing foreign bodies lodged in bone cavities. It emphasizes the use of tools, strong ropes, and mechanical leverage to extract the foreign body. The techniques mentioned involve using the patient's movement or the spring action of a bent tree branch to aid in the extraction process, ensuring effective removal of the foreign object.
अदेशोत्तुण्डितमष्ठीलाश्ममुद्गराणामन्यतमस्य प्रहारेण विचाल्य यथामार्गमेव यन्त्रेण ||१५||
"A foreign body lodged incorrectly can be dislodged using the impact of a fist, stone, or mallet and then extracted using a tool in the correct direction."
This Shloka provides guidance on dealing with foreign bodies that are improperly lodged. It recommends dislodging them by applying a strong impact with a fist, stone, or mallet. Once loosened, the foreign body can be extracted using a suitable tool, ensuring it is removed in the proper direction to avoid further complications.
विमृदितकर्णानि कर्णवन्त्यनाबाधकरदेशोत्तुण्डितानि पुरस्तादेव ||१६||
"Foreign bodies with smooth or rounded ends that are not deeply embedded should be removed from the front, without causing further damage to the surrounding tissues."
This Shloka suggests a careful approach when dealing with foreign bodies that have smooth or rounded ends and are not deeply lodged. It emphasizes removing them from the front to avoid causing additional harm to the surrounding area, ensuring a safe and effective extraction process.
जातुषे कण्ठासक्ते कण्ठे नाडीं प्रवेश्याग्नितप्तां च शलाकां, तयाऽवगृह्य शीताभिरद्भिः परिषिच्य स्थिरीभूतं शल्यमुद्धरेत् ||१७||
"When a foreign body is stuck in the throat, insert a tube and use a heated instrument to grasp it, then solidify it with cold water and remove it."
This Shloka describes a method for removing a foreign body lodged in the throat. It suggests inserting a tube and using a heated instrument to secure the foreign object. After solidifying it with cold water, the object can then be safely extracted. This method ensures effective removal while minimizing harm to the surrounding tissues.
अजातुषं तु जतुमधूच्छिष्टप्रलिप्तया शलाकया पूर्वकल्पेनेत्येके ||१८||
"For a non-pitch foreign body, it should be coated with a mixture of pitch, honey, and leftover food, and then extracted using the same method described earlier."
This Shloka provides an alternative method for removing foreign bodies that are not coated with pitch. It suggests coating the foreign body with a mixture of pitch, honey, and leftover food before following the previously described method for extraction. This approach helps to ensure a more effective and safe removal process.
अस्थिशल्यमन्यद्वा तिर्यक्कण्ठासक्तमवेक्ष्य केशोण्डुकं दृढैकदीर्घसूत्रबद्धं द्रवभक्तोपहितं पाययेदाकण्ठात् पूर्णकोष्ठं च वामयेत्, वमतश्च शल्यैकदेशसक्तं ज्ञात्वा सूत्रं सहसा त्वाक्षिपेत्; मृदुना वा दन्तधावनकूर्चकेनापहरेत् प्रणुदेद्वाऽन्तः |
क्षतकण्ठाय च मधुसर्पिषी लेढुं प्रयच्छेत्त्रिफलाचूर्णं वा मधुशर्करामिश्रम् ||१९||
"If a foreign body made of bone or any other material is lodged sideways in the throat, prepare a tuft of hair tied with a strong long thread and soaked in liquid food. Have the patient drink until the stomach is full, then induce vomiting. While the patient is vomiting, observe the part of the foreign body that is grasped and quickly pull the thread. Alternatively, remove it with a soft toothbrush or push it inside. For a wounded throat, provide a mixture of honey and ghee to lick, or Triphala powder mixed with honey and sugar."
This Shloka offers a detailed method for removing foreign bodies stuck sideways in the throat. It involves using a tuft of hair tied with a strong thread and soaked in liquid food to induce vomiting and then swiftly extracting the foreign body. The Shloka also provides guidance on soothing a wounded throat with a mixture of honey, ghee, or Triphala powder.
उदकपूर्णोदरमवाक्शिरसमवपीडयेद्धुनीयाद्वामयेद्वा भस्मराशौ वा निखनेदामुखात् ||२०||
"For a person with a stomach full of water, press their abdomen while they are bent forward, causing them to vomit, or bury their face in a heap of ashes."
This Shloka suggests a method to induce vomiting by pressing the abdomen of a person whose stomach is full of water while they are bent forward. Alternatively, burying their face in a heap of ashes can also help in expelling the contents of the stomach. These techniques aim to remove any foreign bodies or harmful substances ingested by the person.
ग्रासशल्ये तु कण्ठासक्ते निःशङ्कमनवबुद्धं स्कन्धे मुष्टिनाऽभिहन्यात्, स्नेहं मद्यं पानीयं वा पाययेत् ||२१||
"When a foreign body like a piece of food is stuck in the throat, without hesitation and with proper knowledge, strike the patient's back with a fist. Alternatively, make them drink oil, liquor, or water."
This Shloka provides immediate first aid techniques for removing a foreign body, such as food, lodged in the throat. It advises striking the patient's back with a fist to dislodge the object or making the patient drink oil, liquor, or water to help push the object down.
बाहुरज्जुलतापाशैः कण्ठपीडनाद्वायुः प्रकुपितः श्लेष्माणं कोपयित्वा स्रोतो निरुणद्धि, लालास्रावं फेनागमनं सञ्ज्ञानाशं चापादयति; तमभ्यज्य संस्वेद्य शिरोविरेचनं तस्मै तीक्ष्णं विदध्याद्रसं च वातघ्नं दद्यादिति ||२२||
"When the wind (vayu) is agitated due to the pressure of ropes, knots, or other restraints around the throat, it aggravates the phlegm (shleshma), obstructing the channels and causing drooling, frothing, and loss of consciousness. Massage and apply heat to the affected area, administer a strong head-cleansing treatment, and provide a medication that pacifies the wind (vayu)."
This Shloka describes the effects of external pressure on the throat, which can lead to serious symptoms like drooling, frothing, and loss of consciousness due to the obstruction of bodily channels. It emphasizes the importance of using massage, heat application, and appropriate medicinal treatments to alleviate these symptoms and restore balance to the body.
भवन्ति चात्र-
शल्याकृतिविशेषांश्च स्थानान्यावेक्ष्य बुद्धिमान् |
तथा यन्त्रपृथक्त्वं च सम्यक् शल्यमथाहरेत् ||२३||
कर्णवन्ति तु शल्यानि दुःखाहार्याणि यानि च |
आददीत भिषक् तस्मात्तानि युक्त्या समाहितः ||२४||
एतैरुपायैः शल्यं तु नैव निर्यात्यते यदि |
मत्या निपुणया वैद्यो यन्त्रयोगैश्च निर्हरेत् ||२५||
शोथपाकौ रुजश्चोग्राः कुर्याच्छल्यमनाहृतम् |
वैकल्यं मरणं चापि तस्माद्यत्नाद्विनिर्हरेत् ||२६||
"In this context:
An intelligent physician should consider the specific characteristics and locations of the foreign bodies, as well as the appropriate instruments, to remove the foreign bodies properly.
Foreign bodies that are difficult to remove and those that cause pain should be carefully extracted by a skillful physician with the appropriate technique.
If the foreign bodies cannot be removed by these methods, a proficient physician should use advanced techniques and instruments to extract them.
Foreign bodies left untreated can cause severe inflammation, intense pain, disability, and even death; therefore, they must be removed with great care."
These Shlokas emphasize the importance of understanding the characteristics and locations of foreign bodies for their effective removal. They highlight the need for skillful techniques and appropriate instruments to ensure the proper extraction of foreign bodies and prevent severe complications such as inflammation, pain, disability, and death.
इति सुश्रुतसंहितायां सूत्रस्थाने शल्यापनयनीयो नाम सप्तविंशतितमोऽध्यायः ||२७||
"Thus ends the twenty-seventh chapter named 'Removal of Foreign Bodies' in the Sutrasthana of the Sushruta Samhita."
This Shloka signifies the conclusion of the twenty-seventh chapter in the Sutrasthana section of the Sushruta Samhita, which is dedicated to the various methods and techniques for the removal of foreign bodies. It underscores the comprehensive approach and detailed knowledge encapsulated in this ancient medical text.