Shalyapanayaniya Adhyaya - 27th Chapter of Sushruta Samhita
Sushruta Samhita is one the oldest Surgical textbooks which is very important in medical sciences. Susruta Samhita is famous for describing the modern Rhinoplasty technique, known as the Father of Plastic Surgery. In 1907, in an Indian Epic, Mahabharata named Bhishagratna said that Susruta is one of the sons of Vishvamitra. Ayurveda science is a divine which is created and formulated by the creator which is learnt by Sages. Acharya Sushruta stands for the Ionic legend in the Surgical part of medicines.
Sushruta is the Devotee of Divodasa, the king of Kasi. Lord Dhanwantari taught Ayurveda to Sushruta and they lived in the Era of Ramayana. Sushruta explained the detailed description of Excision and Suturing which first should not be practised on the Human Body but first, they must deal with Flowers, Toys and Fruits. In this Topic, we are going to discuss The extraction of foreign bodies through different procedures in detail.
Sushruta Samhita is an ancient Ayurvedic text which is basically based both on Medicine and surgery, to cure the disease of the diseased person and preserve the health of the healthy person. One of the oldest Susruta Samhita is preserved in the Kaiser Library, Nepal. Shalya and Shaarira are the two aspects which are mentioned in Sushruta Samhita. It has 6 sections, which are known as Sthana as it has multiple chapters which are known as Adhyayas and there are 186 under various Sthanas.
Sthana—Number Of Adhyayas
There are eight udara rogas, eight types of suppression of urine, eight defects of breast milk, eight defects of semen, seven types of leprosy, seven diabetic boils, seven types of erysipelas, six types of diarrhoea, six types of udavarta, five types of gulma, five disorders of spleen, five types of cough, five types of dyspnea, five types of hiccup, five types of thirst, five types of vomiting, five types of anorexia, five head diseases, five heart disorders, five types of anaemia, five types of insanity, four types of epilepsy, four eye diseases, four ear diseases, four types of coryza, four mouth diseases, four diseases of grahani, four types of intoxication, four types of fainting, four types of wasting, four types of impotency, three types of swelling, three types of vitiligo, three types of internal haemorrhage, two types of fever, two types of wounds, two types of contractures, two types of sciatica, two types of jaundice, two types of ama, two types of vatarakta, two types of piles, one urustambha, one coma, one type of mahagada, twenty groups of krimis, twenty types of prameha, twenty types of yonivyapat. Thus forty eight disease syndromes have been mentioned in this context.
- Sutrasthana - 46
- Nidana Sthana - 16
- Sharirasthan - 10
- Chikitsa Sthan - 40
- Kalpasthan - 08
- Uttaratantra - 66
- TOTAL - 186
1. Dvidha Shalya (Two kinds of Foreign body)
There are two kinds of Foreign Bodies-
- Avabaddha - It is fixed or stuck up
- Anavabaddha - Not fixed and free
2. Shalya Aharanopaya (Method of removal of foreign body)
The methods of removal of foreign bodies are not fixed but are fifteen in number which are discussed below-
- Svabhava (by own nature)
- Pachana (ripening)
- Bhedana (cutting)
- Darana (bursting)
- Pidana (squeezing)
- Pramarjana (sweeping)
- Nirdhmapana (blowing)
- Vamana (vomiting)
- Virechana (purgation)
- Prakshalana (washing with water)
- Pratimarsha (injecting fluid into the nasal cavity)
- Pravahana (effort to expel out)
- Achushana (sucking)
- Ayaskanta (using a magnet to remove)
- Harsha (joy)
3. Procedures For Removing Foreign Body
- The foreign body which is present in the eyes, comes out during the act of tears, sneezing and expulsion of urine, faeces and flatus.
- The foreign body which is stuck inside the part of the muscles is not supported naturally but it is supported by applying pastes. Thus this suppuration is coming out due to the force of pus and blood which is due to heaviness.
- If the suppuration is not coming out, it must be torn or is made to burst and made to come out. If the pus is not coming out after bursting it must be squeezed with the applications of medicinal pastes.
- When the minute foreign bodies are stuck in the sense organs they must be removed and are further cleared with Water, blowing air and sweeping with hair and cloth of hand (usually fingertips)
- When the foreign body such as particles of food, when enter wrongly enters the respiratory tract due to other activities such as Speaking, laughing or the increased kapha which is not expelled out in spite of coughing, one must perform induced deep breathing and blowing air from the site
- When the particles of food (foreign body) enter are further removed by inducing vomiting by inserting the fingers (into the mouth)
- When the foreign body is present in Pakvashaya the process of purgation is induced
- When the Foreign body is in the form of wounds (vrana) the doshas must be removed by washing it with antiseptic liquids.
- The obstruction in the flatus, foetus and faeces must be removed with the help of straining
- The accumulation of gas, serous fluid and vitiated breast milk must be removed directly by sucking through the mouth or horn
- When the foreign body is facing downwards and not fixed, must be removed with the use of a Magnet
- There are many foreign bodies which are mainly caused by (Grief) which is present in the heart (mind) and must be removed by creating joy.
4. Shalya Aharana Marga (Routes Of Pulling Out The Foreign Body)
For all kinds of foreign bodies (whether small or big) the extraction must be in two forms-
- Pratiloma - Pratiloma (It is in the backward direction)
- Anuloma - Anuloma (It is in the Forward direction)
5. Yuddha Bhoomi Chikitsa (Battlefield Surgery)
- When the face (tip part) of the foreign body protrudes outside, it should be cut or must be shaken and pulled out in an Anuloma and Pratiloma Direction.
6. Method Of Removing The Foreign Body Which Is Stuck In The Abdomen Region Of The Body
- In place of the Abdomen, Chest, Axilla or the space between two ribs the foreign body protrudes outside, if it is possible it must be removed with the hand in the same direction.
- If it is not removed then it must be sharply cut and further pulled out with Blunt Instruments.
7. Paschat Karma (Post-operative techniques)
- If the Patient who is fainted there must be a sprinkling of cold water.
- The vital organs must be protected and they must be kept assured.
- When the Foreign body is removed, the wound must be cleaned and made free from blood, then the person is suitable for sudation and then the cauterization is done with Fire or ghee which is smeared with ghee and honey then the wound is bandaged with the further regimen of food and other activities.
8. Technique of foreign body stuck in veins and ligaments
- The Foreign body is stuck in Veins, ligaments must be freed by using metal rods and then it is pulled out.
- If the handle of the shaft is kept embedded then there is swelling and it must be squeezed out
- If the handle is weak it must be quickly tied with a Splint and must be pulled out
9. When The Foreign Body Is Stuck In The Heart
- When the foreign body (arrow) is near the heart it must be taken or pulled out in the same direction as its entry and the patient must use Cold water for comfort.
10. Procedure Of Removing Foreign Body Stuck In Bone
- When the Foreign body (arrow) has entered the cavity of the bone or gets stuck tightly in the region of the bone.
- The Physician must hold the position of the foreign body by interacting with both legs and pulling the arrow using a blunt instrument.
- If the foreign body is easy to remove by this method then the patient must be tightly held by a strong person and the shaft of the arrow must be bent with an instrument and fastened with a five-tail bandage to a string of bow at one end and reins of horse on the other end.
- The horse must be whipped and the head must be lifted with a sudden force which results in the pulling of the arrow out.
- Alternatively, a strong branch of the tree should be bent down and the arrow must be pulled forward and the shaft is released freely. This results in easy pulling out of the arrow.
11. Procedure To Remove The Foreign Body From Follow Cavity
- The foreign body (arrow) when stuck in the wrong places (where it is forbidden) such as in the Abdomen, Chest which is protruding outside and must be in the same method of entry, should be loosened by being struck with a stone hammer.
12. Procedure Of Removing The Foreign Body From Ear
- The Foreign Body (arrows) in ears which are not disturbing in nature but are protruding outside like an ear attachment, should be bent and the arrow must be pulled outside from the front.
13. Foreign Body In The Throat
- When the foreign body(made of shell lac) is stuck in the throat, to remove this lac, the hollow tube must be introduced and the metal rod inserted through it must touch the foreign body.
- When the Foreign body is adhered to that metal rod (as it is melting), then it should be sprinkled with cold water and make it stable and must be pulled out.
14. Foreign Body Stuck Horizontally In Throat
- When a piece of bone is stuck horizontally in the throat then the patient must swallow a ball of hair and till the stomach is full, attached to a strong, long thread with liquid meal.
- Then he is made to vomit, by tickling his throat.
- During vomiting, one must see that the foreign body is stuck to the ball of hair and it should be quickly removed, or you might use a gentle toothbrush.
- If by these acts the foreign body does not come out, it should be pulled deep inside the oesophagus.
- During this act, if the throat gets injured then the mixture of honey and ghee with added triphala must be given to lick.
15. Udaka Nirharana (Removing Water)
- When the person whose abdomen is filled (drowning accidentally) must hold his head downwards and the abdomen must be pressed, shake his body and make him vomit or bury his body in ash heaps up till his face.
16. Annagrasa Shalya (Food Bolus Acting As Foreign Body)
- When the bolus of food is blocking the throat which acts as the foreign body, the person must bend forward and his neck must be hit hard with a fist as the foreign body must come out and then he must drink (oil or ghee) as it will enter the stomach.
- This must be done without his knowledge.
- When the Throat is tightly held by rope, creepers lead to aggravation of the Vata doshas
- This aggravated Vata Doshas increases the Kapha doshas (sleshma)
- Both doshas cause blockage in the throat region.
- Blockages cause froth and saliva in the mouth with loss of consciousness.
- This person must be given herbal oil massage with sudation therapy and soup of meat to reduce Vata doshas.
Below Are Some Verses
- The intelligent physician carefully observes the shape of the foreign body along with its lodging place so that the foreign body must be pulled out by using a particular instruments
- The foreign bodies which are attached to the ears must be removed while using specific methods
- If the foreign body is not removed by the above method then it must be removed using skilled blunt instruments
- The foreign bodies which are not removed and cause swelling, formation of pus, severe types of pain, various deformities and even death must be removed carefully with all efforts.
Acharya Sushruta stands for the Ionic legend in the Surgical part of medicines. It has 6 sections, which are known as Sthana as it has multiple chapters which are known as Adhyayas and there are 186 under various Sthanas. In this chapter, we discussed the details of various foreign bodies which get stuck on the wrong side with their procedures. Then we discussed the qualities of a good physician who observes the quality and shape of the Foreign body.