षड्विंशोऽध्यायः अथातः प्रनष्टशल्यविज्ञानीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discourse on the Chapter, which treats of the exploration of splinters lost or deep-seated in the organism (PranastaSalya-Vijnaniya adhyaya). 1
शल् श्वल् आशुगमने धातुस्तस्य शल्यमिति रूपम् । तद् द्विविधं शारीरमागन्तुकञ्च॥२॥
“Sal” or Definition: The term Salya is derived from the root “sval” (to go swiftly) joined to the Unadi affix “Yat.” Shalyas may be divided into two kinds according as they are extrinsic (Agantuka) or idiopathic (Sarira) in their origin. 2
सर्व्वशरीराबाधकरं शल्यं, तदिहोपदिश्यत इत्यतः शल्यशास्त्रम् । तत्र शारीरं रोमनखादि धातवोउन्नमला दोषाश्च दुष्टाः । आगन्त्वपि शारीरशल्यव्यतिरेकेण यावन्तो भावा दुःखमुत्पादयन्ति । अधिकारो हि लोहवेणुवृक्षतणश्रृङ्गास्थिमयेषु तत्रापि विशेषतो लोहेष्वेव विशसनार्थोपपन्नत्वाल्लोहस्य लोहानामपि दुर्व्वारत्वादणुमुखत्वाद् दूरप्रयोजनकरत्वाच्च शर एवाधिकृतः ॥३॥
A Salya 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 Salya-sastram (Surgery). An idiopathic (Sarira) Salya may be either a hair, nail, embolised blood (Dhatus)’, etc., excrements (Mala), or deranged humours of the body (Dosa), while an extrinsic Salya 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) Salya 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. 3
स द्विविधः कर्णी श्लक्ष्णश्च प्रायेण विविधवृक्षपत्रपुष्पफलतुल्याकृतयो व्याख्याता व्यालमृगपक्षिवकासदृशाश्च ॥४॥
Classification of Shafts : Arrows (Sara) 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. 4
सर्व्वशल्यानान्तु महतामणूनां वा पञ्चविद्ये गतिविशेष ऊर्द्धवमघोऽर्व्वाचीनस्तिर्य्यगृजुरिति । तानि यदा वेगक्षयात् प्रतिघाताद् वा त्वगादिषु व्रणवस्तुष्ववतिष्ठन्ते, धमनीस्रोतोऽस्थिविवरपेशीप्रभृतिषु वा शरीरप्रदेशेषु॥५॥
Flights of arrows: The flights or directions of an arrow (Salya) 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. 5
तत्र शल्यलक्षणमुच्यमानमुपधारय । तत् तु द्विविधं सामान्यं
Embolism and Thrombosis have been included within Salya by the Ayurvedic Pathologists.
वैशेषिकञ्च । श्यावं पिडकाचितं शोफवेदनावन्तं मुहुर्मुहुः शोणितास्राविणं बुद्बुद्वदुन्नतं मृदुमांसञ्च व्रणं जानीयात् सशल्योऽयमिति । सामान्यलक्षणमेतदुक्तम् । वैशेषिकन्तु त्वगूगते विवर्णः शोफो भवत्यायतः कठिनश्च ॥ ६ ॥
Symptoms : Now hear me describe the symptoms which are exhibited in connection with an arrow-wound (Salya’ – Vrana). 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 Salya lodged in the skin, are the hardness and extended character of the local swelling and the darkness (discolouring) of its skin. 6
मांसगते शोफाभिवृद्धिः शल्यमार्गानुपसंरोह: पीड़नासहिष्णुता चोषपाकौ च । पेश्यन्तरस्थेऽप्येतदेव चोषशोफवर्ज्जम् । सिरागते सिराध्मानं सिराशूलं सिराशोफच। स्नायुगते स्नायुजालोत्क्षेपणं संरम्भलोग्रा रुक् च । स्रोतोगते स्रोतसां स्वकर्म्मगुणहानिः ॥७॥
In a case where the arrow (Salya ) 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.
All the preceding symptoms, with the exceptior of swelling and sucking pain (thirst according to others), manifest themselves in a case where the arrow (Salya) has penetrated into a muscle. Similarly, the distension, aching and swelling of a vein mark a case of an arrowlodged vein. An upheaval and swelling of its fibres together with intense pain characterise a case where the shaft (Salya) has lodged in a ligament. The internal passages or channels (Srota) or the body are choked up and become inoperative, when the shaft is lodged in any one
1. An arrow or an iron barb, from “sala” to kill.
2. According to certain authorities the patient is tormented with a sor of unquenchable thirst.
धमनीस्थे सफेनं रक्तमीरयन्ननिलः सशब्दो निर्गच्छत्यङ्गमईः पिपासा हल्लासश्च । अस्थिगते विविधवेदनाप्रादुर्भावः शोफञ्च । अस्थिविवरगतेऽस्थिपूर्णताऽस्थिनिस्तोदः संहर्षो बलवांश्च । सन्धिगते अस्थिवच्चेष्टोपरमच। कोष्ठगते आटोपानाहौ मूत्रपुरीषाहारदर्शनञ्च व्रणमुखात्। मर्म्मगते मर्म्मविद्धवच्चेष्टते। सूक्ष्मगतिषु शल्येष्वेतान्येव लक्षणान्यस्पष्टानि भवन्ति ॥८॥
A flow or 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 (Salya) has lodged in the abdomen ( Kostha), 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. 8
महान्ति स्वल्पानि वा शुद्धदेहानामनुलोमसन्निविष्टानि रोहन्ति विशेषतः कण्ठस्रोतः सिरात्वक्पेश्यस्थिविवरेषु । दोषप्रकोपव्यायामाभिघातेभ्यः प्रचलितानि पुनर्बाधन्ते ॥ ९ ॥
An ulcer incidental to the penetration of an arrow (Salya), along the direction of the local hair, in 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
1. So as not to obstruct the coursing of the blood or serum in the locality and become painful afresh if the bodily humours become deranged and aggravated by a blow or physical exercise. 9
तत्र त्वक्प्रनष्टे स्निग्धस्विन्नायां मृन्माषयवगोधूमगोमयमृदितायां त्वचि यत्र संरम्भो वेदना वा भवति तत्र शल्यं जानीयात् । स्त्यानघृतमृच्चन्दनकल्कैर्वा प्रदिग्धायां शल्योष्मणाशु विसरति घृतमुपशुष्यति वा लेपो यत्र तत्र शल्यं विजानीयात् । मांसप्रनष्टे स्नेहस्वेदादिभिः क्रियाविशेषैरविरुद्धैरातुरमुपपादयेत् । कर्शितस्य तु शिथिलीभूतमनवबद्धं क्षुभ्यमाणं यत्र संरम्भं वेदनां वा जनयति, तत्र च शल्यं विजानीयात् । कोष्ठास्थिसन्धिपेशीविवरेष्ववस्थितमेवमेव परीक्षेत। सिराधमनीस्रोतःस्नायुप्रनष्टे खण्डचक्रसंयुक्ते याने व्याधितमारोप्याशु विषमेऽध्वनि यायाद् यत्र संरम्भो वेदना वा भवति, तत्र शल्यं जानीयात् । अस्थिप्रनष्टे स्नेहस्वेदोपपन्नान्यस्थीनि बन्धनपीडनाभ्यां भृशमुपाचरेद् यत्र संरम्भो वेदना वा भवति, तत्र शल्यं जानीयात् । मर्म्मप्रनष्टे त्वनन्यभावान्मर्म्मणामुक्तं परीक्षणं भवति ॥ १० ॥
Localisation : The exact position of a shaft (Salya) embedded in the skin should be ascertained by applying a plaster composed of clay, Masa-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 (Salya) should be considered as lodged in that part which would be marked by pain, redness, or swelling (Sanrambha) after such application. As an alternative, the affected part should be plastered with clarified butter, common clay and sandal paste. The embedded shaft (Salya) 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 (Salya), 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 occour. The same measures should be adopted in the case of a shaft (Salya) which lies embedded in the cavity of the abdomen (Kostha), or in a bone, or joint, or muscle.
In the case of a Salya 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 (Salya) is embedded.
In the case of a shaft (Salya) 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 Salya. Similarly, in the case of a shaft (Salya) lodged in a joint, the same lubricating, diaphorising, compressing, and expanding measures should be adopted, and the painful swelling caused thereby would indicate is exact locality. No definite method can be laid down as regards ascertaining the exact location of a Salya 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.)¹ 10
सामान्यलक्षणमपि च हस्तिस्कन्धाश्वपृष्ठपर्व्वतद्रुमारोहणधनुर्व्यायामद्रुतयाननियुद्धाध्वगमन-लङ्घन-प्रतरणप्लवनव्यायामैर्जुम्भोद्गारकास-क्षवथुष्ठीवनहसनप्राणायामैर्वातमूत्रपुरीषशुक्रोत्सर्गैर्वा यत्र संरम्भो वेदना वा भवति, तत्र शल्यं जानीयात् ॥ ११॥
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
1. Accordingly measures enjoined to be adopted in connection with a shaft (Salya) lodged in any one of them should be applied mutatis mutandis to cases in which these Marmas would be found to be similarly affected.
emission of semen, urine or flatus, or defecation, would clearly indicate the exact location of the embedded shaft (Salya). 11
भवन्ति चात्र यस्मिंस्तोदादयो देशे सुप्तता गुरुताऽपि च । घट्टते बहुशो यत्र शूयते तुद्यतेऽपि च || १२ ।। च आतुरश्चापि यं देशमभीक्ष्णं परिरक्षति । संवाह्यमानो बहुशस्तत्र शल्यं विनिर्द्दिशेत् ॥ ॥१३॥
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 Salya. 12-13
अल्पबाधमशूनञ्च नीरुजं निरुपद्रवम् । निराधट्टमनुन्नतम् ।।१४।।
प्रसन्नं मृदुपर्य्यन्तं एषण्या सर्व्वतो दृष्ट्वा यथामार्गं चिकित्सकः । प्रसाराकुञ्चनान्नूनं निःशल्यमिति निर्द्दिशेत् ।। १५ ।।
A physicial, 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 from should pronounce it free from any embedded foreign matter (Salya), which would be further confirmed by the full flexion and expansion of the affected limb or organ. 14-15
अस्थ्यात्मकं भज्यते तु शल्यमन्तच शीर्य्यते । प्रायो निर्भुज्यते शार्ङ्गमायसञ्चेति निश्चयः ।।१६।।
वार्क्षवैणवतार्णानि निर्हियन्ते तु नो यदि । पचन्ति रक्तं मांसञ्च क्षिप्रमेतानि देहिनाम् ।। १७ ।।
कानकं राजतं ताम्रं रैतिकं त्रपुसीसकम् । चिरस्थानाद् विलीयन्ते पित्ततेजः प्रतापनात् । । १८ ।।
स्वभावशीता मृदवो ये चान्येऽपीदृशा मताः । द्रवीभूताः शरीरेऽस्मिन् नेकत्वं यान्ति धातुभिः ।। १९ ।।
विषाणदन्तकेशास्थिवेणुदारूपलानि तु। शल्यानि न विशीर्य्यन्ते शरीरे मुन्मयानि च || २० ||
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 Pittam 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 Salya, does not melt, nor undergo any change or deterioration. 16-20
द्विविधं पञ्चगतिमत् त्वगादिव्रणवस्तुषु । विश्लिष्टं वेत्ति यः शल्यं स राज्ञः कर्त्तुमर्हति ॥ २१ ॥
The physician, who is fully conversant with the five different courses or flights of an arrow (salya), 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. 21
इति सुश्रुतसंहितायां सूत्रस्थाने प्रनष्टशल्यविज्ञानीयो नाम षडूविंशोऽध्यायः॥२६॥
Thus ends the twenty-sixth Chapter of the Sutrasthana in the Susruta Samhita which treats of exploration of splinters.