Sushruta Samhita, volume 1: Sutrasthana

by Kaviraj Kunja Lal Bhishagratna | 1907 | 148,756 words

This current book, the Sutra-sthana (english translation), is the first part of this voluminous medical work. It contains a large summary of the knowledge envelopig the medical aspects of Ayurveda. Descriptions of diseases, various diets and drugs, the duties of a surgeon, surgical procedures, medical training; these are only some of the numerous s...

Chapter XXVI - Knowledge of foreign bodies

Now we shall discourse on the Chapter which treats of the exploration of splinters lost or deep-seated in the organism (Pranashta-Shalya-Vijnaniya-adhyaya).

Definition:—

The term Shalya is derived from the root “Shala” or “Shvala” (to go swiftly) joined to the Unadi affix “Yat.” Shalyas may be divided into two kinds according as they are extrinsic "(Agantuka) or idiopathic (Sharira) in their origin.

A Shalya usually serves to act as an impeding or obstructing agent to the entire organism, and, hence, the science which deals with its nature and characteristics is called the Shalya-Shastram (Surgery). An idiopathic (Sharira) Shalya may be either a hair, nail, embolised blood (Dhatus)[1], etc., excrements (Mala), or deranged humours of the body (Dosha), while an extrinsic Shatyam should be regarded as one which afflicts the body and is originated from a source other than any of the preceding ones, including particles of iron and bone, stems of grass, scrapings of bamboo, and bits of horns, etc. But an Agantuka (extrinsic) Shalya specifically denotes an article of iron, inasmuch as it pre-eminently serves the purpose of killing and is the most irresistible of all metals. Since any amount of sharpness can be imparted to the point of an article made of iron and since it can be easily discharged from a distance, iron is the metal exclusively chosen in the construction of darts or arrows.

Classification of Shafts:—

Arrows (Shara) may be divided into two classes according as they are feathered or unfeathered; and their barbs are usually constructed in the shape of trees, leaves, flowers, or fruits, or are made to resemble the mouths of birds and wild and ferocious animals.

Flights of arrows:—

The flights or directions of an arrow (Shalya) may be divided into five different kinds, such as the upward, the downward, the backward (coming from the back), the oblique and the straight. Either through its diminished momentum, or through any external resistance, an arrow may drop down and penetrate into the skin, arteries, or any internal channel of the body, or into any bone or its cavity, causing a wound or an ulcer (Vrana) at the spot of its penetration.

Symptoms:—

Now hear me describe the symptoms which are exhibited in connection with an arrow-wound (Shalya-Vrana[2]). These symptoms may be grouped under two sub-heads, such as the specific and the general. The general characteristics are as follows:—The ulcer, which is marked by pain and swelling and presents a raised or bloated aspect like a water bubble, assumes a dark brown hue and appears soft to the touch. The seat of the ulcer is seen to be studded over with pustular eruptions and a constant bleeding sets in from its inside. The specific symptoms, which mark a Shalya lodged in the skin, are the hardness and extended character of the local swelling and the darkness (discolouring) of its skin.

In a case where the arrow (Shalya) is lodged in the flesh, the swelling increases in size and the incidental ulcer refuses to be healed and cannot bear the least pressure. Suppuration sets in and the ulcer is characterised by a sort of sucking pain.[3]

All the preceding symptoms, with the exception of swelling and sucking pain (thirst according to others), manifest themselves in a case where the arrow (Shalya) has penetrated into a muscle. Similarly, the distension, aching and swelling of a vein mark a case of an arrow-lodged vein. An upheaval and swelling of its fibres together with intense pain characterise a case where the shaft (Shalya) has lodged in a ligament. The internal passages or channels (Srota) of the body are choked up and become inoperative, when the shaft is lodged in any one of them. A flow of red and frothy blood with a gurgling sound, accompanied by thirst, nausea, and aching of the limbs, sets in when the arrow is lodged in an artery (Dhamani). Similarly, pain and swelling of diverse kinds mark a case where the shaft is embedded in a bone. The appearance of goose flesh on the skin, a stuffed sensation inside the cavity of the affected bone, and a violent piercing bone-ache, mark a case where the shaft has found a lodgment inside the cavity of a bone. A pierced joint exhibits the same symptoms as described in connection with an arrow-lodged bone, with the exception that the patient is incapable of flexing and expanding the affected joint. In a case where the shaft (Shalya) has lodged in the abdomen (Koshtha), the bowels become constipated; the abdomen becomes distended with a rumbling in the intestines and the suppression of flatus and urine; and ingested food matter, as well as urine and feces are found to ooze out of the fissure or mouth of the ulcer. Symptoms, similar to those above described, manifest themselves when the arrow is lodged in any of the vital parts (Marmas) of the body. The preceding symptoms are but faintly exhibited in a case of superficial penetration.

An ulcer incidental to the penetration of an arrow (Shalya), along the direction of the local hair, in[4] the throat, in any internal channel of the body, or in a vein, the skin, or a muscle, or into a cavity of the bone, and not in any way affected by the action of the deranged bodily humours, may speedily and spontaneously heal; but it may break open and become painful afresh if the bodily humours become deranged and aggravated by a blow or physical exercise.

Localisation:—

The exact position of a shaft (Shalya) embedded in the skin should be ascertained by applying a plaster composed of clay, Masha-pulse, Yava, Godhuma and cow-dung over the injured limb or part. The part (limb) should be duly lubricated with oil, and diaphorised (by fomenting or applying heat to its surface) before the plaster is applied. The shaft (Shalya) should be considered as lodged in that part which would be marked by pain, redness, or swelling (Samrambha) after such application. As an alternative, the affected part should be plastered with clarified butter, common clay and sandal paste. The embedded shaft (Shalya) is then exactly located at the spot where, owing to the heat of the affected part, the clarified butter, or earth, or sandal paste would be found to have melted, or dried up.

Similarly, the mode of localising a shaft (Shalya), embedded in the flesh is as follows:—First, the patient should be duly lubricated and diaphorised with medicinal agents suited to the requirements of his case. Then, the part or the limb having been thus reduced with depletive measures, the shaft would be found to have been dislodged from its seat and to be moving about (within the deeper tissues of the affected part), giving rise to pain, redness and swelling. In such a case the exact location of the shaft should be fixed at the spot where the pain and swelling, etc. would occur. The same measures should be adopted in the case of a shaft (Shalya) which lies embedded in the cavity of the abdomen (Kostha), or in a bone, or joint, or muscle

In the case of a Shalya lodged in a vein, in an artery, in any external channel (Srota) of the body, or in a ligament, the patient should be made to ride in a carriage with a broken or lopped off wheel and dragged up and down in it on an undulating road The pain and swelling, etc. incidental to the jolting, would occur at that part of his body, where the shaft (Shalya) is embedded.

In the case of a shaft (Shalya) lodged in a bone, the affected bone should be lubricated and diaphorised with oil and heat respectively, after which it should be firmly pressed and bound up. The seat of the pain or swelling, caused by such a procedure, would mark the exact locality of the embedded Shalya. Similarly, in the case of a shaft (Shalya) lodged in a joint, the same lubricating, diaphorising, compressing, and expanding measures should be adopted, and the painful swelling caused thereby would indicate its exact locality. No definite method can be laid down as regards ascertaining the exact location of a Shalya lodged in any of the vital parts of the body (Marma), inasmuch as they are co-existing with (the eight different locations of ulcers, such as, the skin, the flesh, the bone, etc.)[5]

General rule:—

A painful swelling, occurring at any part of the body and incidental to such physical or natural endeavours of the patient, as riding on an elephant or on horse-back, climbing a steep hill, bending of a bow, gymnastic exercises, running, wrestling, walking, leaping, swimming, high-jumping, yawning, coughing, singing, expectorating, eructating, laughing, practising of Pranayama (regulating the breath preliminary to the practice of Yoga), or an emission of semen, urine or flatus, or defecation, would clearly indicate the exact location of the embedded shaft (Shalya).

Authoritative Verses on the Subject:—

The part of the body, which is marked by pain and swelling, or which seems heavy and is marked by complete anaesthesia, or the part which the patient repeatedly handles, or constantly presses with his own hand, or which exudes any sort of secretion, and is marked by a sort of excruciating pain, or which he involuntarily withdraws from, or constantly guards against (an imaginary painful contact), should be regarded as clearly indicative of the exact location of the embedded Shalya.

A physician, having tested with a probe the cavity of the incidental ulcer or the interior of the affected locality, and found it to be characterised by little pain and absence of any aching discomfort or unfavourable symptoms and swelling, after a course of proper treatment, and after having been satisfied as to its healthy look and the softness of its margin, and after having ascertained that any remnant of the embedded arrow can not be perceived with the end of the director by moving it to and fro, should pronounce it free from any embedded foreign matter (Shalya), which would be further confirmed by the full flexion and expansion of the affected limb or organ.

A particle of soft bone, horn or iron, in anywise lodged in the body, assumes an arched shape; whereas bits of wood, grass-stems, or chips of bamboo-bark, under the same circumstances, putrify the blood and the local flesh, if not speedily extracted from their seats of lodgment. Bits of gold, silver, copper, brass, zinc, or lead, anyhow inserted into a human organism, are soon melted by the heat of the Pitta and are assimilated and transformed into the fundamental principles of the body. Metals or substances of kindred softness, and which are naturally cold, are melted and become amalgamated, under such circumstances, with the elements of the organism. A hair, or a particle of hard bone, wood, stone, bamboo scraping, or clay, which remains lodged in the body as a Shalya, does not melt, nor undergo any change or deterioration.

The physician, who is fully conversant with the five different courses or flights of an arrow (Shalya), whether feathered or unfeathered, and has minutely observed and studied the symptoms due to its lodgment in any of the eight different seats of ulcers (Vrana) in the human organism (such as, the skin, etc.), is alone worthy of attending on kings and nobles.

 

Thus ends the twenty-sixth Chapter of the Sutrasthana in the Sushruta Samhita which treats of exploration of splinters.

Footnotes and references:

[1]:

Embolism and Thrombosis have been included within Shalya by the Ayurvedic Pathologists.

[2]:

An arrow or an iron barb, from “Shala” to kill.

[3]:

According to certain authorities the patient is tormented with a sort of unquenchable thirst.

[4]:

So as not to obstruct the coursing of the blood or serum in the locality.

[5]:

Accordingly measures enjoined to be adopted in connection with a shaft (Shalya) lodged in any one of them should be applied mutatis mutandis to cases in which these Marmas would be found to be similarly affected.

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