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 28^th 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.

Shloka recitation video

Direction of entry of foreign body

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)

Ulcer with foreign body inside

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 recognised. 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 to that of foreign body residing inside the muscle except the swelling 3-4

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 it is difficult to remove;
Siragata shalya (veins) – there is distension of the vein; when lodged in the veins, there is distension 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;
Sandhigata  shalya (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 distension 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

Signs of foreign body in situ

Beneath the skin

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.

In the muscle, joint and abdomen

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.

In bones, joints

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 is recognized by extending or folding of joint in addition to signs similar to foreign body lodged in bones.

In tendons, veins, channels and arteries

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

Foreign body removal

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 sideways – 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.

Foreign bodies that shouldn’t be removed

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

Method of foreign body removal

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 Sandamsha 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 loosening 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, which 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 an 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 bulge 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 ear-like projection should be pulled out after cutting off their ears or by fixing them inside tubular instruments. 33

The arrow heads without ear-like 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 like foreign bodies should be removed by sucking 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 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 a heap of ash. 40

If the ears are full with water, it should be removed by 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 the 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 by 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 undissolved 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  smoothing therapies, use of strong, hot poultices, warm foods and drinks, incising and other methods, use 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- the twenty eight of Sutrasthana of Astanga Hrudaya.