Foreign Body Removal – Ashtanga Hrudaya Sutrasthana 28

This chapter deals with different techniques that were used in ancient times for foreign body removal. During ancient times, during war, arrows, and other sharp instruments were used. Hence, this topic had special significance. This is the 28th chapter of Ashtanga Hrudaya Sutrasthana, written by Acharya Vagbhata, son of Vaidyapathi Simhagupta.  The chapter name is Shalya aharana Vidhi. Shalya means a foreign body. Aharana means extraction, pulling out etc.

Shalya gati direction of entry of foreign bodies-
Vakra – Irregular – curved,
Ruju ­ – straight,
Tiryak – horizontal,
Urdhwa – upward and
Adha – downward are the five Shalyagati (directions of movement of the foreign bodies)

Shalya Vrana – ulcer with a foreign body inside:-
Blue discolouration, swelling, pain, frequent bleeding, elevated like a bubble, studded with eruptions and softening  of muscles are the features from which a wound having a foreign body should be recognized. 1-2

Tvak gata – When the foreign body is in the skin, there is discoloration, hard and large swelling;
Mamsagata (when it is in the muscle), there will be sucking pain, steady progress of the swelling, tenderness, suppuration and non- healing of the wounds of entry of the foreign body;
when it is in between two muscles (Peshi) the signs will be similar that residing inside the muscle except the swelling 3-4

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Snayugata shalya (tendons) – Convulsions, shock, stiffness, loss of movements and severe pain are the symptoms when the foreign body is in tendons. when foreign body is in the tendons and is difficult to remove;
Siragata shalya (veins) – there is distention of the vein; when  lodged in the veins, there is distention of the vein;
Srotogata Shalya (body channels) – there will be loss of their respective functions and qualities, Dhamanigata shalya (arteries) – bleeding with frothing, chest discomfort, nausea and body ache;
Sandhiagata (joints) – severe shock, pain and filling up of different types of fluids and swelling Asthigata (bones) – the signs are the same, with loss of movement also.

Koshtagata (abdomen) – there will be distention and appearance of food  faecal matter and   urine at the orifice of the wound.

Marmagata (vital spots) – appearance of signs of injury to such spots.

In addition to the general signs, enumerated so far, even their discharges- fluids coming out from them such as Lasika (Lymph) from skin, Rakta (blood) from veins and Arteries, Majja – marrow bones etc. should be observed. 5-9 ½

If foreign body is lodged in persons who have pure body – purified with therapies such as Panchakarma and if the foreign body enters in the same line of the organ, the chances of healing are good. If the body is not purified, it produces serves distress due to aggravation of Doshas. 10

Recognizing the site of foreign body beneath the skin –
The exact site of foreign bodies concealed in the skin, is recognized by
The appearance of redness,
pain, burning sensation and tenderness after anointing with oil, fomentation or massage;
by the melting of solid  ghee, placed at the site,
by quick drying of the paste of sandal wood etc.

Site of foreign body concealed in the muscle, joint and abdomen – can be recognized by clearing looseness, thinness of the muscles by Panchakarma therapies or by other methods of slimming the body and then observing for sites of pain, redness etc.

The site of those concealed in the bones is recognized by anointing with oil, fomentation, tying with rope or bandage squeezing and massaging;

The sites of those concealed in the joints by extending or folding of joint in addition to signs similar to lodged in bones.

Sites of those concealed in tendons, veins, channels and arteries are recognized by appearance of pain in such places, in a horse chariot, with broken wheels.

Features of those concealed, in vulnerable spots are not described separately because such spots are composed of muscles and other tissues only- the features of which have been described already.

Generally the site of the foreign body is determined by the appearance of distressing symptoms, abnormal movements etc. during activity and by the presence of pain. 17

The shape  of the invisible foreign body is determined by the shape of the wound, such as round – circular wide, with four Angula, with 3 edges. Etc.18

Shalyaharana- removal of foreign bodies:-
Method of their removal are though upward and downward directions;
those entering into the body from above and below should be taken out in the opposite directions respectively. 19

Those which have entered from sideward – horizontally should be removed by cutting it conveniently. 19 ½

Foreign bodies, arrowheads which are lodged in the chest, axillae, groins and Flanks, which can be cut and which have board blades should be pulled out.
Shalyas that should not be removed –
Those which lead to death soon after their removal, which are lost / invisible, which are absorbed by the body and those which do not produce complications- should not be removed. 20-21

Aharana Vidhi- means and methods of removal
Those which can be held with the hand should be removed by the hand itself.
While others which are visible should be held by instruments such Simha- lion faced Varmimukha- fish faced, karkata mukha –crab faced etc. 22

Those which are invisible but can be grasped by instruments, through the wound, should be pulled out by instruments having faces like the Kankha – heron, Bhringa- Shrike, Kurara- osprey, Sharari- a kind of heron and Vayasa –crow. 23

Those which are lodged in the skin should be removed with the help of Sandamhsa- Yantra (forceps);
Those which are hollow, with the help of Tala Yantra- instruments with flat discs,
Those which are lodged in hollow spaces, by using Naraka Yantra- tubular instruments and the rest by other convenient instruments. 24

Those which cannot be held by instruments should be removed by cutting open the site with sharp instruments, the wound is next cleared of the blood, soaked with ghee, fomented and then bandaged;
The patient is advised to follow the prescribed regime – described in verses. 30-42 of the next chapter. 25

Those lodged in the veins and tendons – including nerves, should be pulled out after loosing them with the help of Salaka – rod like instruments.

If foreign body is in the chest (Hrudaya), patient  should be sprinkled with ice water (himambu). 26-27

Foreign body, arrow head, lodged in the bones should be removed by holding the patient tight by the legs of the physician, if not possible by this method, it should be pulled out by attendants who are strong. 28

If not possible even by that method, the tail end (feather tied end of the arrow) should be bent and fastened tight to the string of a bent bow, and the bow tied to the bridle bit of a horse should then be whipped so that it raises its head suddenly and with force by this method the arrow is removed. 29-30

Likewise, the branches of trees may be made use of; in case of arrows with thin or fragile tail ends, thin bamboo poles can be made use. 31

If the tail end of the arrow is surrounded by a elevation, it should be pulled out after cutting off the elevated part suitably; if the arrowhead has caused a bulging on the body, it should be removed with the help of a Nadiyantra (tubular instrument) after shaking / hitting the bulging with a hammer.32

By the hammer, the arrow which has no clear passage of exit, should be brought into a passage, suitable for pulling out;
Those which have earlike projection should be pulled out after cutting off their ears or by fixing them inside tubular instruments. 33

The arrow heads without earlike projections, which have created a wide opening in the body and lodged straight, can be removed by making use of a magnet.

Foreign bodies which have entered the large intestine can be removed by inducing purgations. 34

Bad air- gas, poison, breast milk, blood, fluids etc. which are acting foreign bodies should be removed by sucking by using animal horn (Shrunga) etc. 34 ½

If the foreign body has gone into the passage of the throat, a lotus stalk / sponge like portion, tied with a thread should be passed into the throat, and when the foreign body gets stuck to the stalk, the thread should be pulled out slowly. 35

If the foreign body in the throat is made up of Lac, a heated iron rod should be passed through a tubular instrument and made to touch the foreign body and then removed out; those which are not made of Lac should be removed by making use of food smeared with Lac,at its tip. 36

Thorn like, hook like bodies – which are in the throat should be removed by inserting a ball of hair fastened with a thread, making the patient vomit the water which he has been made to drink earlier, the foreign body sticking to the ball of hair during vomiting is removed by pulling the thread quickly .
In the same way hair and other foreign bodies should be removed by making use of the hook. 37

Those foreign bodies which are lodged in the mouth and nose, if not possible to be removed out though respective orifices, should be pushed back, making them to enter into the wider tract. 38

If a bolus of food is stuck up in the throat, it should be removed by using thread, cloth of flax, silk, hair or water. 39

The person who has swallowed water to his full stomach – by drowning should be held with his head down and legs up and shaken well, on laid on the round with the face bent down and then made to vomit all the water; he should then be immersed in heap of ash. 40

If the ears are full with water, it should be removed inserting the finger and oil removers put into the ears or the ears should be kept facing  downwards and the head given the blow from the side. Or the water can be sucked out with the help of tubular instruments 41

If any insect has entered into ears, the ears should be filled with warm salt water or sour gruel (Sukta), when the insect is dead, dehydration measures should be adopted or the ears should be filled with water. 42

Foreign bodies of Lac, and other metals remaining for long time inside the body get dissolved the heat of the body. 43

Foreign body composed of Mud, Bamboo, wood, horn bone, tooth and hair of animals or man, stone do not get dissolved by body heat;
Those composed of horn, Bamboo Iron, wood of palm tree or remaining for long periods inside the body generally get distorted, remain un-dissolved and produce putrefaction in the muscles and blood . 44- 44 ½

If the foreign body is concealed deep inside fleshy parts, purification should be created in such parts by squeezing, fomentation, thinning  measures and  smoothening therapies, use of strong, hot poultices warm foods and drinks, incising and other methods, of sharp instrumentation, trampling by feet etc. and then the foreign bodies removed by excision, probing or cutting. 45-46

Keeping in mind the different and peculiar features of the foreign bodies, their place of lodging and instruments of removal, the intelligent physician should recognized them and remove them by appropriate methods. 47- 47 ½

Thus ends the chapter named Salyaharana Vidhi- te twenty eight of Sutrasthana of Astanga Hrurdaya.


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Comments

  1. Gilbert Hadley says:

    Dear Dr.Sri J.V.Hebbar, namaste,

    Thank you so much for the precious information you are making available to the followers of this blog.

    Could you kindly inform me about, how the Ashtang Hridayam is tauhgt in Sanksritam according to the ancient tradition for Vaidyas. E.g. does the student memorize and recite everyday several schlokas? What is the exact procedure that they follow when learning the Sanksrit text.

    Also when it comes to studying the Sanskrit Ayurveda Shastras, would it be advisable to study the Charaka Samhita, or the two texts in Sanskritam (A.Hridayam and Charaka) will serve more or less the same purpose.

    Thanking infinitely, Gilbert.

    • Dr JV Hebbar says:

      Dear Sri Gilbert,
      There are two major Ayurveda school of thoughts in India.
      Kerala (South Indian) Ayurveda Style follows Ashtanga Hrudayam and Sahasrayoga (a textbook with Ayurvedic medicine description).
      In Kerala, many students by heart all the Verses of Ashtanga Hrudayam. But most of the students would by heart the Shlokas that I have written in the chapters. and for the rest part of the chapters, they just get to know the meaning in English.

      In North Indian practice, Ashtanga Hrudaya Sutrasthana is definitely followed. But for treatment aspects, Sushruta and Charaka samhitas are folowed.
      From general practice point of view, It is sufficient to study Ashtanga Hrudaya and Charaka Samhita.
      But it will be advisable to go through other text books like Sushruta Samhita, Bhaishajya Ratnavali, Sharangdhara Samhita, Bhava Prakasha etc.
      The latter once are recent and have many formulations that we commonly use in general practice. Hence, for a detailed knowledge of Ayurveda, it will not be ideal to restrict yourself to AH and Charaka.S.
      Hope I have answered your query.

      • Gilbert says:

        Dear Dr.Sri J.V.Hebbar, namaste,

        Thank you indeed so much for your enlightening comments, I appreciate deeply.
        I have a further short question related to the topic, if you can kindly spare a few minutes.
        I can read devanagari, but always the sanskrit terms and words are difficult to decipher for a foreighter. I need a text for the Charaka and Ashtang Hridayam that gives word by word english meanings for each Sanskrit word, not just a general translation.(e.g. like; suvarnam=gold, samalaah=with impurities, pancha-lohah=5 metals etc. / this I got from a website which gives only part of caraka).
        In the versions of Charak and Ashtang Hridaym that I have, this is not available, only Devanagari and then a general English translation.
        Does such a version of A.Hridayam and Caraka exist?
        I could find available, 4 different versions of Caraka;
        – 7 Volume set by , Dr. Ramakaran Sharma & Vaidya Bhagvan Das
        – 4 Volume set by P.V.Sharma (which I have)
        – 4 Volume set by, K.R. Srikant Mutrhy
        And a book called;
        Carak Samhita : Anvaya ( Natural word order) transliteration, annotation along with English Equivalantes. Trans. & Commentry in English based on cakrapani’s Ayurveda Dipika Vol. 1, Vidya Bhagvan Das
        I found one version of Ashtang Hridyam by Prof.K.R.Srikantha Murthy, which I have and which does not have the word by word equivalent meanings.
        Could you kindly advise me, if such a text is available, so that I can continue my studies using that text.

        With lots of thanks and deep respect, Gilbert.
        P.S.: I have been studying A.Ved for quite some years, but since some time I have started to study the original Shastras.

        • Dr JV Hebbar says:

          Dear sir, regarding Ashtang Hridayam, I do not know of any such book.
          regading Charaka samhita, I think, the last one that you have quoted contains word by word translation.

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