The main derivation takes shala and shvala in the sense of moving rapidly and derives shalya from shala. Variant explanations assign shala the sense of injuring or of causing pain.
Key terms
shalya
Derived here from shala and used for a foreign body or afflicting object; alternative root senses emphasize injury or pain.
Adhikarana ૩ (૪) · Śloka ૪
તદ્દ્વિવિધં શારીરમાગન્તુકં ચ ||૪||
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तद्द्विविधं शारीरमागन्तुकं च ||४||
Meaning of the śloka
Shalya is of two kinds: bodily or internal, and externally introduced.
Shalya is defined functionally as that which causes distress or injury anywhere in the body. The treatise receives its name because it teaches about such causes of affliction.
Key terms
shalyashAstra (shalyashastra)
The discipline concerned with shalya, defined here broadly as anything that afflicts the body.
Bodily shalya includes teeth, body hair, nails and related structures; the dhatus; waste products of food; and doshas when they are disturbed. External shalya includes, apart from bodily shalya, all things that enter from outside and produce pain.
The inclusive ending after teeth, hair and nails can cover beard hair, pus and eyelashes according to some interpreters. Dhatus means rasa and the subsequent bodily tissues. Waste products include urine, feces, ear waste, sweat and ocular waste. Vata and the other doshas become shalya when vitiated. The wording that distinguishes these bodily factors also allows inclusion of the upadhatus. External examples include grass, wood, stone, iron, clods of earth and similar objects when they cause pain.
Key terms
dhAtu (dhatu)
Rasa and the other bodily tissues, included among bodily shalya when they become afflicting.
mala
Bodily waste such as urine, feces, ear waste, sweat and ocular waste.
upadhAtu (upadhatu)
Subsidiary bodily structures included by implication in the commentary's reading.
अधिकारो हि लोहवेणुवृक्षतृणशृङ्गास्थिमयेषु; तत्रापि विशेषतो लोहेष्वेव , विशसनार्थोपपन्नत्वाल्लोहस्य; लोहानामपि दुर्वारत्वादणुमुखत्वाद्दूरप्रयोजनकरत्वाच्च शर एवाधिकृतः |
स च द्विविधः कर्णी , श्लक्ष्णश्च; प्रायेण विविधवृक्षपत्रपुष्पफलतुल्याकृतयो व्याख्याताः, व्यालमृगपक्षिवक्रसदृशाश्च ||७||
Meaning of the śloka
The present subject concerns external foreign bodies made of iron, bamboo, wood, grass, horn or bone. Iron is treated especially because it is commonly used for killing, and among iron objects the arrow is principal because it is difficult to resist, has a fine point and acts from a distance. Arrows are of two kinds, barbed and smooth or unbarbed. Their heads may resemble the leaves, flowers or fruits of plants, or the faces of wild beasts, deer and birds.
The qualifying sense represented by mayam applies separately to each material, indicating objects made from iron, bamboo and the others. The arrow is described together with its shaft. The reason for its prominence has textual alternatives: one reading says it is difficult to ward off, while others describe it as travelling outward or moving from place to place. Karni is a barbed arrow and shlakshna one without barbs; another reading uses karnavan for the barbed type. Examples of shapes include leaves of pippala and karavira; flowers of malati, kumuda and utpala; ela fruit; the faces of lion and tiger; a serpent's hood; the faces of jackal and cat; and those of crow and kanka.
An upward course describes an arrow entering from below, and a downward course one entering from above. Arvacin describes entry from behind, transverse entry comes from either side, and a straight course comes from the front. Other authorities reverse parts of this order or explain the courses differently, but the commentary omits those accounts to avoid excessive length. A variant reading begins with the words in the body, all foreign bodies.
तानि वेगक्षयात् प्रतिघाताद्वा त्वगादिषु व्रणवस्तुष्वतिष्ठन्ते, धमनीस्रोतोऽस्थिविवरपेशीप्रभृतिषु वा शरीरप्रदेशेषु ||९||
Meaning of the śloka
Foreign bodies remain lodged in the skin and other wound tissues when their momentum is exhausted or when they strike an obstruction. They may also lodge in cavities of arteries, channels or bones, between muscle segments, and in other body regions.
The passage explains how foreign bodies come to rest in the body: their force is stopped by protective structures such as armor, or simply becomes exhausted. 'Skin and the others' includes flesh, vessels, ligaments, joints, body cavities, bones and vital points. A further possibility is lodging in sites beyond these, including an opening in an artery, channel or bone, or within a muscle segment. The word 'or' marks this alternate range of locations.
Key terms
vegakShayAt (vegakshayat)
Because the foreign body's momentum or force has been exhausted.
pratighAtAt (pratighatat)
Because its movement has been checked by striking an obstruction.
Signs of a retained foreign body are general and site-specific. In general, the wound is dusky, covered with pustules, swollen and painful, repeatedly discharges blood, rises like a bubble and has soft flesh. In skin, there is an elongated, hard swelling with altered color. In flesh, swelling increases, the foreign-body track fails to heal, pressure is intolerable, and sucking pain and suppuration occur. The same signs occur between muscle segments except sucking pain and swelling. In a vessel there is distension, pain and swelling along the vessel. In a ligament there is elevation of the ligament network, swelling and severe pain. In a channel, its normal function and qualities are impaired. In an artery, vata emerges audibly while propelling frothy blood, with bodily aching, thirst and nausea. In bone, varied pains and swelling arise. Within a bone cavity there is a sense of bone fullness, bone-pricking and powerful samharsha. In a joint the signs resemble those in bone, together with loss of movement. In a body cavity there are gurgling and obstruction, and urine, feces or food may appear at the wound opening. In a vital point, the person shows the signs of injury to that vital point. When the foreign body has entered by a very fine path, these same signs are indistinct.
Samrambha includes redness and swelling. A blister that has spread over the area is meant by the pustular general sign. Cosha is a particular pain as though the part were being sucked; others gloss it as thirst. The muscle-space signs omit sucking pain and swelling because suppuration is absent. Elevation of the ligament network means upward displacement of a group of ligaments. Impairment of a channel includes loss of its transport function and of features such as the colors assigned to channels carrying vata and other materials. Angamarda is the pain called sphutanika, and hrllasa involves repeated spitting. Samharsha is a vata complication, often a horripilation-like pain; others interpret it as collision or friction. Loss of joint movement means impairment of flexion, extension and similar actions. Atopa is disturbed vata with pricking, while anaha is obstruction of flatus, urine, feces and similar evacuations. In a vital point, the applicable signs are those described for injury to vessels and other structures composing that vital point. Fine-track foreign bodies have the same signs in a less evident form.
Key terms
sAmAnyam (samanyam)
The general signs shared by retained foreign bodies across sites.
vaisheShikam (vaisheshikam)
Signs specific to the tissue or anatomical site in which the foreign body is lodged.
saMharShaH (samharshah)
A powerful vata-associated, often horripilation-like pain; alternatively, collision or friction.
महान्त्यल्पानि वा शुद्धदेहानामनुलोमसन्निविष्टानि रोहन्ति विशेषतः कण्ठस्रोतःसिरात्वक्पेश्यस्थिविवरेषः |
दोषप्रकोपव्यायामाभिघाताजीर्णेभ्यः प्रचलितानि पुनर्बाधन्ते ||११||
Meaning of the śloka
Large or small foreign bodies that enter in the natural direction may become covered by healing tissue in a body not affected by doshas, especially when lodged in the throat, channels, vessels, skin, between muscle segments or in a bone cavity. Even after healing over, they again cause trouble when displaced by dosha aggravation, exercise, injury or indigestion.
A body free from doshic disturbance heals over the object because suppuration does not occur. Anuloma means that it entered along the direction of the hair. The statement that such objects heal over applies especially to those in the throat and the other named sites. Some witnesses read 'soft and small' in place of 'large or small.' The final sentence explains why recognizing and removing an object still matters even if it has healed without initially causing harm.
Key terms
anulomasanniviShTAni (anulomasannivishtani)
Entered and lodged in the natural direction, explained as along the direction of the hair.
pranaShTa (pranashta)
A concealed foreign body that has become covered by healed tissue and is no longer readily evident.
For a concealed foreign body in skin, the skin is first made unctuous and fomented, then coated with softened clay, masha, barley, wheat or cow dung; the site where redness, swelling or pain appears indicates the object. Alternatively, the skin is coated with congealed ghee, clay or sandalwood paste; where the ghee quickly melts or the coating dries from the foreign body's heat is the site. For one concealed in flesh, the patient is subjected to compatible unctuous and fomenting measures and related procedures; after the patient is reduced and the object becomes loose, unattached and mobile, its site is where swelling or pain arises. The same general method is used for body cavities, bones, joints and spaces between muscles. For a concealed object in a vessel, artery, channel or ligament, the patient is placed in a vehicle with a damaged wheel and rapidly taken over uneven ground; swelling or pain reveals the site. For one concealed in bone, bones prepared with oleation and fomentation are strongly treated with binding and pressure; for one in a joint, prepared joints are strongly moved through extension and flexion and subjected to binding and pressure. The location is identified where swelling or pain appears. For a concealed object in a vital point, the examination already given for skin and the other tissues is used because vital points exist within those tissues.
These are the source's historical methods for locating concealed foreign bodies in different tissues. Samrambha means the appearance of redness and swelling. The ghee is said to spread by melting quickly, while the paste dries. For flesh, the patient is joined to compatible procedures; after reduction of the patient, the implied foreign body becomes loose and moves. 'In the same way' applies the preceding principle to cavities, bones, joints and muscle spaces. The vehicle test uses a cart with a broken wheel over an uneven, raised-and-depressed road. Prepared bones or joints means treated with oleation and fomentation. Because vital points occur only within the eight wound tissues beginning with skin, no separate examination is given for them.
Key terms
pranaShTe (pranashte)
When a foreign body has become concealed within healed or overlying tissue.
saMrambhaH (samrambhah)
The appearance of redness and swelling used in the source as a locating sign.
सामान्यलक्षमपि च हस्तिस्कन्धाश्वपृष्ठपर्वतद्रुमारोहणधनुर्व्यायामद्रुतयाननियुद्धाध्वगमनलङ्घनप्लवनप्रतरण- व्यायामैर्जृम्भोद्गारकासक्षवथुष्ठीवनहसनप्राणायामैर्वातमूत्रपुरीषशुक्रोत्सर्गैर्वा यत्र संरम्भो वेदना वा भवति तत्र शल्यं विजानीयात् ||१३||
Meaning of the śloka
A general test for a retained foreign body is to observe the site during climbing on an elephant's shoulder or a horse's back, climbing a mountain or tree, drawing a bow, rapid travel, wrestling, walking a long road, leaping, jumping, swimming and other exertion; during yawning, belching, coughing, sneezing, spitting, laughing and breath restraint; or during release of flatus, urine, feces or semen. The foreign body is known to be at the site where swelling or pain arises.
This general test applies to an object lodged in any of the eight wound tissues beginning with skin. The verb climbing applies separately to elephant, horse, mountain and tree. Bow exercise is strain produced by drawing a bow; rapid travel is swift movement; niyuddha is hand-to-hand combat; langhana is jumping across a wall or similar obstacle; plavana is jumping upward; and pratarana is swimming across a river. Exercise means an activity causing bodily strain. The commentary separately defines yawning, belching, cough, sneezing, spitting, laughter and breath restraint in terms of classical physiology. Release applies separately to flatus, urine, feces and semen. Some witnesses instead read that where pricking and other signs arise during these releases, a foreign body should be known. 'Other signs' then includes suppuration, redness and swelling. The earlier general signs, such as dusky color and pustules, are immediately observable, whereas these activity-provoked tests reveal them indirectly, so the two general accounts are not redundant.
Key terms
sAmAnyalakShaNam (samanyalakshanam)
A general locating method applicable to concealed foreign bodies in all eight wound tissues.
prANAyAma (pranayama)
Extension or restraint of the breath in this passage's diagnostic activity list.
A foreign body should be suspected at a site with pricking or related pain, numbness, heaviness, repeated involuntary movement or repeated aching. It should also be identified where a patient repeatedly protects the same area whenever that patient is massaged or rubbed.
These verses add signs for confirming a concealed foreign body. 'Pricking and related signs' also includes redness, suppuration and others. Numbness means lack of awareness of touch. Repeated movement means that the person repeatedly moves or agitates the affected region. The reference to being struck or hurt emphasizes intensity of pain rather than repeating the same sign. A patient who repeatedly guards one site each time the body is rubbed or massaged indicates the concealed object there.
Key terms
suptatA (suptata)
Numbness or absence of normal awareness of touch.
abhIkShNaM parirakShati (abhikshnam parirakshati)
Repeatedly guards or protects the same body region when it is handled.
A site free of a foreign body has little distress, no swelling or pain, no complication, a clear appearance, soft margins, no abnormal movement and no elevation. After examining it everywhere with a probe along the direction of the tract, and finding no distress during extension or flexion, the physician may declare with certainty that no foreign body remains.
Little distress means little discomfort, and painless means that pricking and other pain has ceased. Soft margins means softness at the edges, and niraghata means stable or without abnormal movement. The physician examines the entire site using a metal or similar probe, following rather than deviating from the tract. Certainty rests on the absence of even slight distress during extension and flexion. Others read 'little heat' in place of 'little distress.' Some omit 'not elevated' because they consider its meaning already covered by absence of swelling.
Key terms
niHshalyam (nihshalyam)
Free from a retained foreign body.
eShaNyA (eshanya)
With a metal or similar probe used along the existing tract in the historical examination.
A foreign body made of bone may break, and its inner portion may crumble. One made of horn generally bends, as does one made of iron; this is the stated determination.
The verse describes how retained foreign bodies differ by material, information relevant to extraction. Bone-derived material may divide by itself into two or three pieces, so the operator should consider separate fragments during removal. Shiryate means crumbles. This does not contradict the later statement that bone foreign bodies do not disintegrate, because 'and' indicates differing cases: only some bones crumble, not all. Nirbhujyate means becomes bent; sharnga is made of horn, and iron also bends.
Varkshya means wooden, vainava bamboo-made and tarna grass-made. Non-removal is understood specifically when the object lies in a vishalyaghna marma, where extraction is dangerous. The statement about suppuration implies that these materials may then fall out by themselves.
Foreign bodies made of gold, silver, copper, raitika metal, tin or lead dissolve after remaining for a long time, through the heating action attributed to pitta.
The verse explains why failure to extract these metals from sites such as vishalyaghna regions is said not to cause the same fault. Raitika is made from riti, described as a type of brass. Some omit raitika and instead read black iron, tin and lead.
Key terms
raitikam
Made from riti, identified by the commentary as a variety of brass; omitted in another reading.
The commentary extends the property just attributed to gold and related metals to other materials such as bronze.
Adhikarana ૧૯ (૨૨) · Śloka ૨૨
વિષાણદન્તકેશાસ્થિવેણુદારુપલાનિ તુ |
શલ્યાનિ ન વિશીર્યન્તે શરીરે મૃન્મયાનિ ચ ||૨૨||
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विषाणदन्तकेशास्थिवेणुदारुपलानि तु |
शल्यानि न विशीर्यन्ते शरीरे मृन्मयानि च ||२२||
Meaning of the śloka
Foreign bodies made of horn, tooth, hair, bone, bamboo, wood, stone or clay do not disintegrate within the body.
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અપરેષાં ચિરકાલસંસ્થિતાવપિ ન શરીરધાતુભિરેકત્વમિતિ દર્શયન્નાહ- વિષાણેત્યાદિ|- વિષાણં શૃઙ્ગં, દારુ કાષ્ઠં, ઉપલઃ પાષાણઃ, ન વિશીર્યન્ત ઇતિ ન શટન્તીત્યર્થઃ| મૃન્મયાનિ મૃત્તિકામયાનિ||૨૨||
Meaning of the commentary
These materials are said not to unite with bodily dhatus even after remaining a long time. Vishana means horn, daru wood, upala stone, and mrinmaya clay-made; na vishiryante means they do not crumble or decay.
द्विविधं पञ्चगतिमत्त्वगादिव्रणवस्तुषु |
यो वेत्ति विष्टितं शल्यं स राज्ञः कर्तुमर्हति ||२३||
Meaning of the śloka
One who understands the two kinds of foreign body, their five possible directions, and their varied lodgment in the eight wound structures beginning with skin is fit to treat a king.
One interpretation divides foreign bodies into barbed and smooth types; another divides them into bodily and externally introduced types. The five directions are upward, downward, backward or toward the near side, transverse and straight. The eight sites begin with skin. Mention of a king includes other important patients. 'Is fit to do' means qualified to perform treatment. Some read adhishthita, lodged, instead of vishtita, variously situated.
Key terms
pa~jcagatimat (panchagatimat)
Having one of five courses: upward, downward, backward or nearward, transverse, or straight.
Adhikarana પુષ્પિકા · Śloka ૨૬
ઇતિ સુશ્રુતસંહિતાયાં સૂત્રસ્થાને પ્રનષ્ટશલ્યવિજ્ઞાનીયો નામ ષડ્વિંશતિતમોઽધ્યાયઃ ||૨૬||
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इति सुश्रुतसंहितायां सूत्रस्थाने प्रनष्टशल्यविज्ञानीयो नाम षड्विंशतितमोऽध्यायः ||२६||
Meaning of the śloka
Thus ends the twenty-sixth chapter, called Pranashtashalyavijnaniya, in the Sutrasthana of the Sushruta Samhita.