A History of Indian Medical Literature v1.c23.127

v1.c23.127

The subjects dealt with are: the two types of śalya: fixed (avabaddha) and loose (anavabaddha) (27.3); the fifteen measures for the removal (uddharaṇa) of loose śalyas: svabhāva (natural bodily functions), pācana (maturation), bhedana (incision), dāraṇa (causing a burst), pīḍana (squeezing), pramārjana (cleansing), nirdhmāpana (blowing), vamana (emesis), virecana (purgation), prakṣālana (irrigation), pratimarśa,281 pravāhaṇa (straining), ācūṣaṇa (sucking), ayaskānta (a magnet), and harṣa (cheering) (27.4); indications for each of these measures (27.5); two ways of removing (āharaṇa) a śalya: in the opposite direction (pratiloma) or in the direction of entry (anuloma);282 indications for the pratiloma and anuloma techniques (27.6–7); a sharp-pointed (chedanīyamukha) śalya, if protruding (uttuṇḍita), should be manually removed after making an incision (27.8); the same type of śalya283 is to be removed manually through its own track if lodged in the belly (kukṣi),284 chest, an armpit (kakṣa), groin (vaṅkṣaṇa), or intercostal space (parśukāntara) (27.9); if manual removal proves to be impossible, then the track should be widened with a sharp instrument and the śalya removed with a blunt instrument (27.10); measures to be taken if the patient faints (27.11); post-operative care; the techniques to be employed in some difficult cases (27.12);285 the removal of a śalya located in the vicinity of the heart (27.13); the removal of a śalya that has penetrated into the cavity of a bone or has got a stuck in a bone; the shaft (vāraṅga) of such a śalya should be tied to a bow-string, the other end of which is to be fastened to the rein of a horse with a pañcāṅgī bandage;286 the horse should be whipped, and, when it lifts its head forcibly, the śalya comes out; or, a strong branch of a tree should be bent and tied to the śalya, which comes out when the branch straightens (27.14);287 a protruding (uttuṇḍita) śalya, located where it cannot be removed surgically, should be loosened by strokes of an aṣṭhilā,288 stone or mallet (mudgara), and removed through its own track by means of a blunt instrument (27.15); the extraction of barbed arrows (27.16); the removal of lac (jātuṣa) from the throat by means of a heated śalākā inserted into a hollow tube; a related method for the removal of other substances (27.17–18); the removal of a śalya consisting of bone or a similar substance when stuck up in the throat (27.19); treatment of a patient whose belly is filled up with water (27.20); 289 the treatment to be applied when a morsel of food (grāsaśalya) is arrested in the throat (27.21); treatment of strangling (27.22). The chapter ends with some general directions (27.23–26).