PRANASHTA SHALYA AND ITS NIRHARANA

प्रनष्ठशल्य (PRANASHTA SHALYA)

  • शल्य निरूक्ति

शल’, ‘श्वल’ आशुगमने धातू; तयोराद्यस्य शल्यमिति रूपम् ॥३॥

  • Sala’ and ‘svala’ are the verb-roots in the sense of ‘moving fast’, ‘salya’ is the form derived from the former.

तद्विविध शारीरमागन्तुकं च ॥४॥

  • It is of two types –
    Endogenous – produced within the body.
    Exogenous – coming from outside.
  • परिभाषा (PRANASHTA SHALYA)-

सर्वशरीराबाधकरं शल्यं ।
Salya (foreign body) is that which causes pain all over the body.

तत्र शारीरं दन्तरोमनखादि धातवोऽन्नमला दुष्टाश्च दोषाः आगन्त्वपि शारीरशल्यव्यतिरेकेण यावन्तो भावा दुःखमुत्पादयन्ति ॥६॥

  • The intrinsic foreign bodies are-teeth, hair, nail etc. vitiated dhātus, malas(excreta) and dosas while exogenous ones, apart from the above all those factors which cause pain.
    शल्यगतिशल्यगति –

Acco.to सुश्रुत आचार्य (PRANASHTA SHALYA)

सर्वशल्यानां तु महतामणूनां वा पञ्चविधी गतिविशेष ऊर्ध्वमधोऽर्वाचीनस्तिर्यगृजुरिति ॥८॥

  • All the शल्य big or small, there are five types of movement-
    ऊर्ध्व-upward, Upward movement of शल्य coming from below;
    अधो-downward, Downard movement of शल्य coming from above;
    अर्वाचीनं – forward, Forward movement of शल्य coming from behind;
    तिर्यक्– oblique and Oblique movement of शल्य coming from sides;
    ऋजु गति– straight. Straight movement of शल्य coming from front.

Acco.to वाग्भट आचार्य (PRANASHTA SHALYA)

3 types of शल्यगति –
ऊर्ध्व
अधो
तिर्यक्

  • These, due to loss of velocity and resistance, are lodged in wound matrixskin etc., or parts of body such as orifice, dhamani, channel, bone and muscles etc.

    शल्य लक्षण (PRANASHTA SHALYA)-

तद्वदिविघं सामान्यं , वैशेषिकं च।

  • The signs and symptoms of the foreign body as described below.
  • They may be divided into two-general and specific.

सामान्य लक्षण (PRANASHTA SHALYA)

श्यावं पिडकाचित शोफवेदनावन्तं महमहः शोणितास्राविणं बदबदवनतं मृदुर्मासं च वर्ण जानीयात्सशल्योऽयमिति; सामान्यमेतल्लक्षणमुक्तम्।

  • Blackish, surrounded by boils, having inflammatory swelling and pain, now and then bleeding, raised like bubble and soft-muscled wound should be known as having foreign body-this is the general feature.

    विशेष लक्षण (PRANASHTA SHALYA)

त्वक्गत – विवर्णः शोफो भवत्यायतःकठिनश्च

  • If foreign body situated in skin, there is inflammatory swelling of abnormal colour, diffused and hard;

 मांसगत- शोफाभिवृद्धिः शल्यमार्गानुपसरोहः पीडनासहिष्णुता चोषपाकी च;

  • If it is situated in muscle, there are excessive inflammatory swelling, non-healing of the track of the foreign body, tenderness, sucking pain and suppuration

पेश्यन्तरस्थेऽप्येतदेव चोषशोफवर्ज;

  • if it is situated in muscle, there are excessive inflammatory swelling, non-healing of the track of the foreign body, tenderness, sucking pain and suppuration

सिरागते सिराध्मानं सिराशूलं सिराशोफश;

  • if it is lodged in blood vessel, there is dilatation, pain and inflammatory swelling

 स्नायुगते स्नायुजालोत्क्षेपणं संरम्भश्चोग्रा रुक् च;

  • if located in ligaments, the ligamentary network is displaced upwards with hyperaemia and severe pain;

स्रोतोगते स्रोतसां स्वकर्मगुणहानिः;

  • in chennels it causes loss of their functions.

धमनीस्थे सफेर्नरक्तमीरयन्ननिलः सशब्दो निर्गच्छत्यङ्गमर्दः पिपासा हल्लासश्च;

  • if lodged in dhamani, air comes out with sound andfrothy blood and there are body-ache, thirst and nausea;

अस्थिगते विविधवेदनाप्रादुर्भावः शोफश्च;

  • in bone it produces various types of pain and inflammatory swelling and

अस्थिविवरगतेऽस्थिपूर्णताऽस्थिनिस्तोदः संहर्षो बलाश;

  • if it is in medullary cavity there is fullness of bone with pricking pain and severe horripilation;

सन्धिगतेऽस्थिवच्चेष्टोपरमश्च;

  • if in joints, the features are like that in bone in addition to loss of movements.

 कोष्ठगत आटोपानाही मूत्रपुरीयाहारदर्शनं च व्रणमुखात्;

  • if the foreign body is situated in abdomen, it gives rise to flatulance, hardness of bowels and discharge of urine, facces and food from the opening of wounds;

महान्त्यल्पानि वा शुद्धदेहानामनुलोमसन्निविष्टानि रोहन्ति, विशेषतः कण्ठस्त्रोत:-

सिरात्वक्पेश्यस्थिविवरेषु; दोषप्रकोपव्यायामाभिघाताजीर्णेभ्यः प्रचलितानि पुनर्वाधन्ते ॥११॥

  • The foreign bodies big or small, entered in direction of hair and in persons with pure physique (unvitiated dosas) heal up particularly in throat,channels, blood vessels, skin, muscle and medullary cavity of bones they, however, create troubles when excited by vitiation of dosas, physical exercise, injury and indigestion.

    अधिष्ठानगत शल्य उपाय (PRANASHTA SHALYA)
  • If hidden in skin, the part should be uncted and fomented and then pasted with mud, black gram, barley, wheat and cowdung; now when hyperaemia or pain appears, the foreign body should be known there itself or  solid ghee or mud or sandal paste be applied to the part, it ghee liquifies and spreads or the paste is dried by the heat of the foreign body it should be known to be existing there.
  • if hidden in muscle, the patient should be treated with proper measures like unction ,fomentation etc., when person is emaciated and the foreign body gets loosened and unimbedded and the part, if excited, exhibits hyperaemia or pain, it should be known as located there.
  • in the same way that situated in viscera and in the cavity of bone, joints and muscles should be examined
  • If hidden in sira, dharani, channels and ligaments, the patient should be seated in a cart with broken wheel and be made to move fast on uneven path, the part, where redness or pain is observed, should be known as having the foreign body.
  • In case of its hiding in bones, it should be treated with unction and fomentation and then subjected to binding and pressure, if somewhere redness or pain appears, the foreign body should be known as situated therein;
  • If hidden in joints, they should be uncted and fomented and then subjected to extension, flexion, binding and pressure, the part which shows redness or pain should be known as the site of the foreign body

    प्रनष्ठशल्य सामान्य उपाय (PRANASHTA SHALYA)

हस्तिस्कन्धाश्वपृष्ठपर्वतमारोहणधनुर्व्यायामद्वतयाननियुद्धाध्वगमनलङ्गनप्लवनप्रतरणव्यायामैजुम्भोद्गारकासक्षवथष्ठीवनहसनप्राणामैर्वातमत्रपुरीषशक्रोत्सर्गैर्वा यत्र संरम्भो वेदना वा भवति तत्र शल्यं विजानीयात् ॥१३॥

  • Generally, the part where congestion or pain appears by the following should be known as the site of the foreign body-
  • Riding on elephant or horse, climbing on hill or tree, archery, fast movements, wrestling, wayfaring, leaping, jumping, swiming, other physical exercises, yawing, belching, coughing, sneezing, spitting,laughing, holding respiration; expulsion of wind, urine, facces or semen.

    शल्य स्थान लक्षण (PRANASHTA SHALYA)

यस्मिंस्तोदादयो देशे सुप्तता गुरुताऽपि च ॥घट्टते बहुशो यत्र शूयते रुज्यतेऽपि च ॥१४॥

आतुर्श्चापि यं देशमभीक्षणं परिरक्षति ॥संवाहामानो बहुशस्तत्र शल्यं विनिर्दिशेत् ॥१५॥

  • The part which has pricking pain, numbness and heaviness; on rubbing frequently, swelling and pain on pressure and is always protected by the patient should be known as the site of the foreign body.

    निःशल्य स्थान लक्षण –

अल्पाबाधमशूनं‌ च नीरुजं निरुपद्रवम् ॥प्रसन्नं मृदुपर्यन्तं निराघट्टमनुन्नतम् ॥१६॥

एषण्या सर्वतो दृष्ट्वा यथामार्ग चिकित्सक: ॥प्रसाराकुज्ञनानूनं निःशल्यमिति निर्दिशेत्

॥१७॥

  • The part should be known as free from foreign body when it has little discomfort; no swelling, pain, complications and rubbing; with soft surroundings and is clear and unelevated; the surgeon should diagnose it after examining with probe all around and respective channels and also by extension and flexion.

    प्रनष्ठशल्यस्य (PRANASHTA SHALYA) परिणाम –

अस्थ्यात्मकं भज्यते तु शल्यमन्तश्च शीर्यते ॥

प्रायो निर्भुज्यते शाईमायसं चेति निश्चयः ॥१८॥

  • The bony foreign body is broken inside and gets decomposed while the horny and that made of iron often bends and becomes crooked.

वाक्क्षवैणवताणांनि निर्हियन्ते तु नो यदि ।।

पचन्ति रक्तं मांसं च क्षिप्रमेतानि देहिनाम् ॥ १९॥

  • If those made of tree, bamboo and grass are not extracted, they cause suppuration in blood and muscle soon.

कानकं राजतं तानं रैतिकं पुसीसकम् ॥

चिरस्थानाद्विलीयन्ते पित्ततेज:प्रतापनात् ॥२०॥

  • The foreign bodies made of gold, silver, copper, brass, tin and lead get dissolved on long stay by the heat of pitta.

स्वभावशीता मृदवो ये चान्येऽपीदृशा मताः ॥

द्रवीभूताः शरीरेऽस्मिन्नेकत्वं यान्ति धातुभिः ॥२१॥

  • Other similar ones which are cold by nature and soft get liquified in the body and are absorbed in dhatus.

विषाणदन्तकेशास्थिवेणुदारूपलानि तु ॥

शल्यानि न विशीर्यन्ते शरीरे मृन्ययानि च ॥२२॥

  • But the foreign bodies made of teeth, hair, bone, bamboo, wood, stone and earth are never decomposed in the body.

शल्यापनयनीय

Extraction of foreign bodies

शल्यं द्विविधमवबद्धमनवबद्धं च ॥३॥

  • Foreign body is of two types-
    अवबद्ध – entangled and
    अनवबद्ध – unentangled.

    अनवबद्ध शल्यापनयनीयविधी –

तत्र समासेनानवबद्धशल्योद्धरणार्थ पञ्चदश हेतून् वक्ष्यामः।

तद्यथा-स्वभावः , पाचनं , भेदनं, दारणम् , पीडनं, प्रमार्जनं, निर्ध्मापन, वमनं, विरेचनम्, प्रक्षालनं, प्रतिमर्श, प्रवाहणम् , आचुषण, अयस्कान्त, हर्षश्चेति ।॥४॥

  • Briefly, there are fifteen factors for extraction of unentangled foreign bodies

स्वभाव – natural urges
पाचन-maturation or suppuration of immature foreign bodies by applying ripening drugs.
भेदन-incision with sharp instruments knife etc.
दारण-tearing by applying drugs chirabilva.
पीडन -pressing with drugs chirabilva.
प्रमार्जन – cleaning with hairs (brush), cloth etc.
निर्ध्मापन – blowing as of the powder of pippali, katphala etc with tube within nostrils.
वमन – Emesis
विरेचन – purgation
प्रतिमर्श -rubbing with finger etc.
प्रवाहणम् – straining
आचुषण – sucking by mouth with a horn-pipe
अयस्कान्त – a particular stone
हर्ष – Happiness

  • The foreign body falls down with tears, sneezing, eructation, cough, urine, stool and flatus induced by the force of nature.
  • Which are deeply in muscles, not being transformed, should be subjected to suppuration by which, on decay, falls down by the impulse of pus and blood or due to heaviness.
  • If it is mature but not bursting, it should be incised or tom; not coming out even after being incised it should be pressed with local applications or hands.
  • In case of minute foreign bodies in sense organs, it should be cleaned with washing and blowing and with hairs, cloth and hands; remnants of food, mucus, mild and minute foreign bodies should be expelled with expiring, coughing and blowing.
  • The food becoming a foreign body should be treated with emesis, rubbing with fingers etc.
  • Those situated in intestines should be removed by purgations
  • Which in wound pus and others should be washed out.
  • Straining is recommended in sticking of flatus, urine, stool and foetus, air, water, poisoned blood and vitiated breast milk should be sucked out by mouth or with horns one pointed outwards.
  • Unembedded, unprojecting and having wide wound-opening should be managed with magnetic stone and the painful arrow of grief situated in heart and caused by various factors should be eliminated with exhilaration.

    शल्यापनयनीय उपाय –

सर्वशल्यानां तु महतामणूनां वा द्वावेवाहरणहेतू भवत:- प्रतिलोमोऽनुलोमश्च ॥६॥

Of all foreign bodies, there are only two ways of extraction:
अनुलोम – regressive and
प्रतिलोम – progressive.

मंत्र प्रतिलोमर्वाचीनमान येत, अनुलोम प्राचीन ॥७॥

  • Of all the foreign bodies having five types of movements two types of extraction:
  • According to regular or irregular direction, are prescribed which is extracted by the passage of entry is pratiloma (regressive) while the reverse is anuloma (progressive).
  • Out of these, the proximate should be taken out in the regressive direction while the remote one by the progressive way.

उत्तुण्डितं छित्त्वा निर्घातयेच्छेद नीयमुखम् ॥८॥

  • In case of that having piercing end , the bulging part should be cut and then moved.
  • Those with piercing ends, if situated in abdomen, thorax, armpit, groin and between ribs and reachable by hands should be tried to extract by respective passage.

हस्तेनैवापहर्तुमशक्यं विशस्य शस्त्रेण यन्त्रेणापहरेत् ॥१०॥

  • That which can not be extracted by hand should be cut with a sharp instrument and then removed with a blunt instrument.

    पश्चात कर्म –
  • After removing the foreign body and making the wound free from blood, it should be sudated.
  • If necessary, with fire, ghee etc., cauterized and pasted with honey and ghee.

    अधिष्ठान अनुसार शल्यापनयन –
  • The foreign body situated in cardiac region should be extracted by the same passage after agitating the patient with cold water ; that which is difficult to be extracted, situated in other parts and afflicting should be taken out after incising.
  • That penetrated into bone-cavity or externally embedded in bone should be held by feet and removed by an instrument.
  • If not extractable in this way, it should be held by strong persons and catching the handle with instrument and crookening its handle should be fixed at one end in bow-string and at the other in the bridle in the mouth of a horse tied in pancangi position, then one should strike it with a whip so that by raising head with force it takes out the foreign body; or
  • By bending a firm branch of tree it should be tied and extracted in the same way.
  • Those having ear-like projections, if bulged in non-vital sites, should be extracted in forward direction after softening their projections.

    जातुष शल्याहरण –

जातुषे कण्ठासत्ते कण्ठे नाडीम् प्रवेश्याग्नितप्तां च शलाकां, तयाऽवगृह्य शीताभिरद्धिः

परिषिच्य स्थिरीभूतं शल्यमुद्धरेत् ॥१७॥

  • If the foreign body made of lac is attached to throat, a tubular instrument be introduced in throat along with a heated rod by which it should be held and sprinkled with cold water and when solidified taken out.

    अजातुष शल्याहरण –

अजातुषं तु जतुमधूच्छिष्टप्रलिप्तया शलाकया पूर्वकल्पनेत्येके ॥१८॥

  • The non-lacy material should be treated with a rod pasted with lac and bee wax by the above method.

    अस्थि शल्य –
  • On observing the bony or other material attached obliquely to throat a hairball tied at one end to a string and long thread should be made to swallow along with liquid diet full upto the throat and then vomited.
  • While vomiting, when it touches a portion of the foreign body, the thread should be pulled up suddenly .
  • If throat is injured, honey and ghee or triphala powder mixed with honey and sugar shouldbe given to lick

    उदक शल्य –

उदकपूर्णोदरमवाक्शिरसमवपीडयेदधुनीयाद्वामयेद्वा भस्मराशी वा निखनेदामुखात् ॥२०॥

  • In case of abdomen being filled with water (drowning) the patient should be made upside down while pressing his abdomen and shaking the body or should be vomited or may be dug into the heap of ash upto neck.

    ग्रासशल्य –

ग्रासशल्ये तु कण्ठासक्ते निःशङ्कमनवबुद्धं स्कन्धे मुष्टिनाऽभिहन्यात, स्नेहं मद्यं पानीयं वा पाययेत् ॥२१॥

If bolus of food, as foreign body, is attached to throat one should strike with fist on patient’s shoulder fearlessly and without his knowledge or  should be given to drink unctuous material, wine or water.

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