Shalyaharana Vidhi in Ashtanga Hridaya Sutrasthana 28: Vagbhata's Ten Methods, and the One Shalya He Says Never to Remove

इस लेख को हिंदी में पढ़ें: शल्यहरण विधि: अष्टांग हृदय सूत्रस्थान अध्याय 28 और विशल्यघ्न

📖 26 min read · Ashtanga Hridaya, Sutrasthana 28, verses 1–47

Shalyaharana Vidhi: Where Chapter 28 Sits

The Ashtanga Hridaya takes its name from the eight limbs of Ayurveda, and the third of those eight is shalyapahartrika, the limb that deals with the extraction of lodged objects. The Charaka Samhita lists all eight in its Sutrasthana, chapter 30, verse 28, and gives the third as the branch concerned with drawing out what has entered the body from outside. So when Vagbhata reaches chapter 28 of his first section, he is not writing an appendix. He is writing the operating manual of one of the eight limbs his book is named after.

The chapter's own opening sentence places it in sequence: athatah shalyaharana-vidhim adhyayam vyakhyasyamah, "now we shall expound the chapter on the method of removing the shalya", said, the text adds, by Lord Atreya and the other great sages. It follows Siravyadha Vidhi, chapter 27, whose colophon closes on the previous page, and it is followed by Shastrakarma Vidhi, chapter 29. Its own colophon reads iti ... prathame sutrasthane shalyaharana-vidhir nama ashtavimsho adhyayah, the twenty-eighth chapter, in the Sutrasthana, of the Ashtanga Hridaya Samhita composed by Acharya Vagbhata. Anyone looking for Ashtanga Hridaya Sutrasthana chapter 28 by that name will find it printed as pages 388 to 396 in the Vidyanath edition used throughout this article.

The word shalya is usually rendered "foreign body", though it is wider: a dart, a splinter, a thorn, an arrow-head, a stone, anything lodged where it does not belong and unable to come out by itself. The whole surgical tradition, Shalya Tantra, is named from it.

Shalyagati: Five Directions That Vagbhata Immediately Makes Two

The chapter's first technical verse is a bare enumeration. Vakra-rju-tiryag-urdhvadhah shalyanam panchadha gatih: the gati, the movement or travel, of lodged objects is fivefold. The five are vakragati, curved; rjugati, straight; tiryakgati, transverse or sideways; urdhvagati, upward; and adhogati, downward.

Then, in the very next line, the text collapses its own list. They are again of two kinds, it says: straight and curved. Five names, two kinds.

It is worth pausing on why that is not a contradiction. The five are not five members of one set. Rju and vakra describe the shape of the path a shalya took, straight or bent. Tiryak, urdhva and adhah describe the orientation of that path in the frame of the standing person, across, up or down. A shalya that went in sideways went in either straight-sideways or curved-sideways. The second sentence is not withdrawing the first; it is telling the reader which axis actually governs the extraction, and the answer is the shape, not the compass bearing. Everything later in the chapter confirms it: the two withdrawal routes of verse 19 are defined by direction of entry, and the special instruction for tiryaggata in the prose after verse 19 is simply to take it out whichever of those two ways is easier.

This habit of counting and then re-sorting is characteristic, as readers of our article on Ashtanga Hridaya Sutrasthana 14 will recognise. Vagbhata states a list at full length for completeness, then gives the smaller number actually worked with.

Five gatis, two kinds. The chapter names five directions of travel and then says the working distinction is straight against curved.

The General Lakshanas of a Vrana Holding a Shalya

Before any question of extraction, the chapter asks a prior one: how do you know there is something in there at all? Verses 1 and 2 give the general signs. The vrana is dirty; it carries clots; there is shopha, swelling; there is pain; it bleeds repeatedly; it is raised like a bubble; and the flesh around it is soft.

These are deliberately unremarkable. Not one is unique to a lodged object, which is why the chapter spends the next fifteen verses on signs specific to a seat: the general list screens, the special lists locate. Vrana management is the subject of Sushruta's Chikitsa Sthana 1. Chapter 28 assumes all of it and asks one question: is something still inside?

Twakgata, Mamsagata, Snayugata: The Outer Seats

The chapter now walks inward through the tissues, and for each seat it names the sign that betrays a shalya sitting there. The sequence follows the classical order of the coverings, which we set out from Sushruta in our article on the sapta twacha.

Twakgata, lodged in the skin: vivarnah kathinayatah shopho bhavati, discolouration of the skin, with a hard and extended swelling.

Mamsagata, lodged in the muscle: severe swelling, a track of entry that does not close, an inability to bear pressure, burning and ulceration. And then a precise qualifier, at verse 4, that shows how carefully the list was made. If it is deep in the muscle, every one of those signs is present except the swelling. The deeper seat produces fewer signs, not more. That single exception is the most clinically sophisticated sentence in the first half of the chapter.

Snayugata, lodged in the snayu: constriction of the snayu, uneasiness, stiffness, severe pain. The text adds a note that is practical rather than diagnostic. When a shalya is deeply seated in snayu, it is simply not easy to remove. Vagbhata says so plainly and moves on.

Sira, Srotas, Dhamani, Asthi, Sandhi, Koshtha, Marma

The deep seats are given in rapid succession, each with its own tell.

Siragata: swelling of the siras and pain. Srotogata: the channels stop performing their normal function, which is a functional sign rather than a visible one. Dhamanigata gets the longest description of the group: forceful bleeding driven by vata, with sound and froth, severe pain over the whole body, and oppression in the chest.

Asthigata: pains of different kinds, and swelling. Asthi-sandhigata, in a bony joint: a filling-up of the bones and a severe grinding friction. Sandhigata, in a joint: the signs of bone, plus obstruction of the joint's movement. The distinction between those last two is fine and the text keeps it, which tells you something about how seriously the classical anatomists took the sandhi as a category distinct from the asthi.

Koshthagata, in the abdominal cavity: gurgling, distension, and the passage of urine, faeces and swallowed food through the mouth of the wound. Marmagata, at a vital point: the signs of damage to that marma, with exudation. The chapter then lists what damage to a marma looks like, and the list is grave: loss of sensation, heaviness, fainting, a craving for cold things, sweating, convulsion, vomiting and laboured breathing.

Verse 10 closes the diagnostic section with an admission. The exact site of a shalya lodged inside cannot be known from the general signs at all. It can be known only from the specific signs given for each seat, and from what the wound discharges.

Taila, Ghrita and Alepa: Three Tests for a Hidden Shalya

Verses 11 and 12 are, to a modern reader, the most surprising part of the chapter, because they are not about extraction at all. They are about provocation. Vagbhata wants a buried shalya to declare itself, and he proposes three ways of making it do so.

The first is sneha and sveda. After oleation and fomentation over a suspect area, the concealed site announces itself by redness, pain, burning and distress. The second is a ghrita test: a solid lump of ghee placed on the area is watched, and the site is inferred from where it melts. The third is an alepa test: a paste smeared over the area is watched, and the site is inferred from where it dries first.

All three read the same variable, local heat, the second and third being two indicators of it, one that liquefies and one that evaporates. A lodged object produces a warm focus; ghee melts faster over a warm spot and a smeared paste dries faster over one. Whatever one makes of the physiology, the instrument is ingenious: two ordinary kitchen materials used as thermometers, centuries before there were any.

The same logic extends to the other seats: in muscle, by where the flesh is flabby, mobile and painful after purificatory measures; in bone, by pain on oleation, fomentation, bandaging and pressure; in a joint, by those plus extension and flexion of the joint itself.

The Broken-Wheeled Chariot of Verse 16

And then comes verse 16, which is unlike anything else in the Sutrasthana.

Verse 15 names the seats in question: nashte snayu-shira-sroto-dhamanishu, when the shalya is lost in the snayu, the sira, the srotas or the dhamani. These are the four soft structures whose contents cannot be palpated and whose signs, as the chapter has just conceded, are the vaguest of all. For these, verse 16 prescribes something extraordinary.

Ashvayuktam ratham khanda-chakram aropya roginam, shighram nayet tatas tasya samrambhat shalyam adishet. Seat the person in a horse-drawn chariot with a broken wheel, drive it fast over uneven ground, and from the samrambha, the flare of irritation that results, declare where the shalya is.

Verse 17 then generalises it into a principle, and the principle is the useful part: samanyena sashalyam tu kshobhinya kriyaya saruk. In general, where a shalya is present, a disturbing action produces pain. The chariot is one instance. The rule is that you find a hidden thing by agitating the body and watching where it complains.

Vritta, Prithu, Chatushkona, Triputa

Verse 18 classifies the shalya itself, and does it in a single line: vrittam prithu chatushkonam triputam cha samasatah. Briefly, it says, there are four shapes. Vritta, round. Prithu, broad or flat. Chatushkona, four-cornered. Triputa, three-sided.

The second half of the verse is the part that matters: adrishya-shalya-samsthanam vranakritya vibhavayet. The shape of an invisible shalya is to be inferred from the shape of the vrana. The opening is read as a cast of the object that made it. A round opening implies a round shaft, a three-cornered one implies a triputa.

Put verse 18 beside verse 16 and the method of the whole chapter becomes visible. Neither verse can see the shalya. One infers its place from where the body protests; the other infers its form from the shape of the opening. Between them they give the physician a location and a profile for an object nobody has laid eyes on, and only then does the chapter start talking about tools.

Vritta, prithu, chatushkona, triputa. Verse 18 infers the shape of an unseen shalya from the shape of the opening it made.

Pratiloma and Anuloma: The Only Two Routes Out

Verse 19 is the hinge of the chapter. Tesham aharanopayau pratiloma-anulomakau. For all of them, there are two means of withdrawal, and only two.

Pratiloma is withdrawal against the grain: the shalya entered, and it is drawn back out the way it came, in the reverse direction. Anuloma is withdrawal with the grain: the shalya is pushed on and taken out at the far side, continuing the direction of entry.

Everything in the rest of the chapter is a variation on that binary. The instruction for a transverse shalya is to take it out by whichever of the two is easier. The instruction for something in the mouth or nose that cannot be brought back out through those openings, at verse 38, is anuloma taken to its logical end: send it onward into the digestive tract. The instruction at verse 34, for a shalya that has reached the pakvashaya, is anuloma again.

Two routes, and an entire chapter of technique hanging off them. It is a good example of how the classical texts prefer a small number of governing categories to a long list of cases, a habit we examined in the tantra yukti of Sushruta's Uttara Tantra 65.

Visalyaghna: The Shalya Never to Be Drawn Out

Verses 20 and 21 are where a chapter about taking things out turns, for a moment, into a chapter about not taking things out.

Verse 20 sets a first limit. Shalyam na nirghatyam urah-kaksha-vankshana-parshvagam: a shalya lodged in the chest, the axilla, the groin or the flank is not to be driven out by percussion. Verse 21 adds a second: a shalya that entered against the grain, with a broad base and a tip that is not visible and would have to be cut down upon, is likewise not to be hammered.

And then the verse ends on a word that changes the register entirely. Naivaharet vishalyaghnam nashtam va nirupadravam.

Read plainly, that is a doctrine of restraint, and an unusually mature one. The chapter has spent twenty verses building an apparatus for finding buried objects and is about to spend twenty more on the force needed to extract them. Between the two it inserts a rule: some of what can be found, and some of what could be extracted, is not to be touched. The criterion is not reachability. It is whether the object is currently doing harm.

A reader accustomed to modern surgical writing will recognise the shape of this. Asymptomatic retained objects are frequently left in place today precisely because the extraction carries more risk than the object does. The classical text reaches the same policy from a different direction, and states it in four words.

Sushruta Names Them: Three Marmas Out of 107

Vagbhata gives the rule but does not say which points he means. For that, the tradition sends the reader to Sushruta, and the answer is remarkably narrow.

The Sushruta Samhita, Sharira Sthana, chapter 6, sorts the marmas into five classes by what an injury to them produces: sadya-pranahara, fatal within a day; kalantara-pranahara, fatal later; vishalyaghna, defined there as "fatal as soon as a dart or any other imbedded foreign matter is extracted therefrom"; vaikalyakara, maiming; and rujakara, merely painful.

The counts are given at paragraph 15 and they close exactly:

And Sushruta names them. To the vishalyaghna class belong the two Utkshepas and the one Sthapani. Three points. The edition's own footnote adds that they are sira-marmas half a finger's breadth in extent.

So Vagbhata's most dramatic prohibition governs three sites out of a hundred and seven, under three per cent of the marma map. That is worth stating clearly, because the rule is easy to inflate into something it is not. It is a narrow, specific carve-out, and the narrowness is what makes it credible. The classical authors were not warning the physician away from surgery. They were marking three places on a chart.

By the Hand Alone: Verse 22 and the Order of Escalation

Verse 22 opens the extraction half of the chapter with a line that could serve as a motto for the whole of Shalya Tantra. Athaharet kara-prapyam karenaiva: what the hand can reach, take out with the hand alone.

Only then, itarat punah, for the rest, does the text reach for instruments. The order is explicit and it runs from least to most: the bare hand first; then blunt yantras; then, at verse 25, and only if the blunt ones fail, an incision with a sharp shastra.

This is the same hierarchy Vagbhata sets out two chapters earlier. Our articles on Yantra Vidhi in Sutrasthana 25 and Shastra Vidhi in Sutrasthana 26 cover the instruments themselves, the hundred and one yantras and the twenty-six shastras. Chapter 28 does not re-describe them. It assumes the reader has them and asks a different question: given this shalya, in this seat, which one?

Simhamukha, Ahimukha, Makaramukha: Yantras for the Visible

Verse 22 names the blunt yantras to be used when the hand will not serve, and the names are all animals. Simhamukha, lion-faced. Ahimukha, serpent-faced. Makaramukha, crocodile-faced. Varmimukha, after a fish. Karkatakamukha, crab-faced.

These are the instruments for a drishya shalya, one that can be seen. And the five creatures have something in common: every one of them is a jawed predator that seizes and holds at close quarters. A lion, a snake, a crocodile, a crab. The instrument is named for the grip, and the grip is the whole point, because a visible shalya needs holding, not hunting.

Kankamukha, Bhringa, Kurara, Vayasamukha: For the Invisible

Verse 23 turns to the shalya that cannot be seen, and the animals change.

Adrishyam vrana-samsthanad grahitum shakyate yatah: since an invisible shalya can be grasped only by reasoning from the shape of the wound, the instruments named are the kanka, the heron; the bhringa; the kurara, the osprey or fish-hawk; the sharari; and the vayasa, the crow.

We looked at the full roster of these instruments, and at Vagbhata's claim of a hundred and one yantras, in the Yantra Vidhi article. What chapter 28 adds is the selection rule, and the rule is unexpectedly simple: can you see it or not.

Jawed beasts for a shalya that can be seen, long-billed birds for one that cannot. The naming tracks visibility, not size.

Sandamsha, Tala and Nalaka: Matching Yantra to Seat

Verse 24 gives the seat-by-seat assignments in a single compressed line. Sandamshabhyam tvagadistham talabhyam sushiram haret, sushirastham tu nalakaih shesham sheshair yathayatham.

• A shalya in the skin and the tissues below it: the sandamsha, the forceps.
• A hollow shalya: the tala yantras.
• A shalya lodged in a hollow space of the body: the nalaka, the tubular instruments.
• For a shalya in sira or snayu, the prose after verse 25 adds the shalaka, the rod, used first to loosen.

And then the line closes with four words that are the chapter in miniature: shesham sheshair yathayatham. The rest, by the rest, each as is fitting. Vagbhata declines to enumerate further. He has given the principle and four worked examples, and he trusts the reader with the remainder. The same formula returns at the very end of the chapter, at verse 47, where a wise physician is told to consider the kinds of shalya, the places they lodge, and the variety of instruments, and to proceed by whatever technique fits.

The Ten Methods of Verses 28 to 33

For a shalya driven into bone, which is the hardest case in the chapter, the text gives a numbered series of escalating methods. In this edition the translator brackets them in pairs, because each verse generally carries two, and the series runs to ten across six verses, 28 to 33.

Read the series in order and a shape appears. Methods I through IX escalate steadily in applied force: two feet, then several men, then the neck of a whipped horse, then the stored energy of a bent tree, then cutting, then breaking. It is a ladder of leverage, and by method IX the chapter is using tools to manufacture a path where the body did not provide one.

And then method X arrives and the ladder simply stops.

Ayaskanta: The Method That Uses No Force

Ayaskantena nishkarsham vivritasyam rjusthitam. A shalya standing straight, with an open mouth, is drawn out by the ayaskanta, the lodestone.

It is a half-line, carrying no verse number of its own in this printing and sitting in the run before verse 34. After a horse and a bent tree, the chapter's final answer for the most obstinate case in its repertoire is a stone that is simply brought near.

One point of method is worth making plainly. Method X is the gentlest technique in the sequence and the text places it last, after the most violent. Methods I to IX are general and apply to any shalya in bone; method X applies to one narrow class of object. The series is ordered by breadth of application, from universal to specific, not by rising force.

Ayaskanta, the iron-lover. The tenth and last extraction method of chapter 28, and the only one in the series that applies no force.

Iron on Both Lists: Verses 43 and 44

Near its close the chapter turns to the shalya that was never taken out, and asks what becomes of it. It answers with two lists.

Verse 43: jatusham hema-rupyadi-dhatujam cha chirasthitam, ushmana prayashah shalyam dehajena viliyate. A shalya of jatusha, lac; or made of hema and rupya, gold and silver, and the other metals; long lodged, is mostly dissolved by the heat born of the body. The hedge, prayashah, is Vagbhata's own.

Verse 44 gives the contrary list: mrid-venu-daru-shringa-asthi-danta-vala-upalani na. Earth, bamboo, wood, horn, bone, tooth, hair and stone: not. These are not dissolved, and if they stay long they turn the surrounding flesh and blood putrid.

Set that beside method X and the two passages answer each other. Iron is the one material the chapter says the body will never absorb, and iron is the one material the chapter gives a dedicated tool for. The ayaskanta is not a curiosity tucked into the end of a list of extraction methods. It is the response to the problem verse 44 states: this is the shalya that will not go away on its own, therefore this is the shalya that must come out, therefore here is the instrument that takes it out without force.

Whether gold and silver dissolve in the body is not a claim modern materials science supports, and we will not pretend otherwise. What the passage shows is a classical author sorting lodged materials by whether time would solve the problem for him. The sorting principle is sound even where an entry is wrong.

Verse 43 against verse 44: what the heat of the body was said to dissolve, and what the text says it never will.

What This Article Withholds, and Why

Chapter 28 does not end at bone and metal. Its last dozen verses move to the openings of the body, and they are the reason the warning at the top of this page is worded as strongly as it is.

The chapter takes up, in order: an obstruction in the throat; a thorn in the throat; lac in the throat; a small object in the eye; a person pulled from water after drowning; water in the ear; and an insect in the ear. For each of the seven it gives a specific technique, and several of those techniques would be actively dangerous if copied today.

We are also leaving out the formulary of verses 45 and 46, which lists the measures used to bring a deeply buried shalya to the surface before excision. Naming those measures in a usable sequence would serve no scholarly purpose that the rest of this article does not already serve, and it would read as a procedure.

This is a judgement we have made before on this blog, and the principle is consistent: when a classical chapter is something a reader could physically attempt, the risk that matters is imitation, not vocabulary.

What Ashtanga Hridaya Sutrasthana 28 Does Not Say

It is as useful to record the gaps as the contents, and we did not find the following anywhere in the chapter.

• It does not classify the shalya by origin. Sushruta, in Uttara Tantra 65, divides shalya into sharira, arising from the body itself, and agantu, arriving from outside. Vagbhata's chapter 28 gives shape, direction and seat, but never that division.
• It does not name the vishalyaghna marmas. Verse 21 states the prohibition and leaves the identification to the marma literature. We did not find the two Utkshepas or the Sthapani named anywhere in this chapter.
• It gives no count of instruments. The hundred and one yantras belong to chapter 25 and the twenty-six shastras to chapter 26. Chapter 28 names about a dozen by function and does not total them.
• It offers no prognosis and no timeline. Nothing here says how long a retained shalya may safely be observed, which is the obvious next question after nirupadravam.
• It says nothing about pain control during extraction, a silence shared with most of the surgical chapters of the Brihat Trayi.

We also want to be candid about search data. We checked Google Search Console for our own site over the ninety days to 20 September 2026, and terms such as shalyaharana, visalyaghna and ayaskanta returned no rows at all. Search volume for them is unknown, not low. The related cluster that does show real demand is the chapter-by-chapter one: queries of the form "ashtanga hridaya sutrasthana chapter 12" and "charaka samhita sutrasthana chapter 16" drew 1,927 impressions across 92 queries in that window, at an average position between three and seven. This article is written for the reader behind that second kind of query.

Between Siravyadha Vidhi and Shastrakarma Vidhi

Chapter 28 sits in a run of four consecutive surgical chapters, and the sequence is deliberate. Chapter 25 gives the blunt instruments. Chapter 26 gives the sharp ones and, in its second half, raktamokshana with leeches, horn and gourd. Chapter 27 is Siravyadha Vidhi, venesection, whose colophon closes on the page facing our chapter's opening. Chapter 29 is Shastrakarma Vidhi, which opens with a rule that reads like a summary of the whole group: in disorders both external and internal, go to surgery only when the medical approach has failed.

Instruments first, then the vessels, then extraction, then operative procedure. Chapter 28 is where the tools of 25 and 26 meet an actual object, which is why it can afford to name a dozen yantras without describing any of them.

One point of bibliography: this printing's running headers are not reliable across this stretch, so the chapter number was taken from the colophon on page 396, not the header. It gives ashtavimsho adhyayah, the twenty-eighth.

Why Sushruta Reached for the Shalya to Explain His Own Method

There is a curious footnote to all of this. When Sushruta, in Uttara Tantra 65, sets out the thirty-two tantra yuktis, the technical devices by which a medical treatise states things, he needs worked examples. Three times in a row he reaches for the shalya.

For uddesha, statement in brief, his example at paragraph 9 is the single word "Salya". For nirdesha, statement in detail, his example at paragraph 10 is "Salya is of two kinds, sharira and agantu". And for pradesha, inferring a present action from a past one, his example at paragraph 13 is: this man extracted Devadatta's shalya, therefore he will extract Yajnadatta's too.

Three of the thirty-two devices are taught with the same noun. When the tradition needed an example everyone would immediately grasp, the lodged object was what came to hand, which is a fair measure of how central Shalya Tantra was, and the context in which chapter 28 should be read. The full list is in our article on the thirty-two tantra yuktis, alongside Sushruta's surgical legacy.

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