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Abstract

Pranashta Shalya, or concealed foreign body, is a uniquely detailed concept in Ayurvedic surgery that reflects the

depth of clinical observation in ancient times. Described extensively in the Sushruta Samhita, it refers to foreign

bodies that are no longer externally visible but remain lodged within deeper tissues or organs, continuing to cause

localized or systemic disturbances. Sushruta classified these based on their nature, location, and mobility, and

provided systematic guidelines for their identification and removal through the concept of Nirharana Upaya—a

series of fifteen therapeutic and surgical methods. This review highlights the diagnostic precision of classical

Ayurvedic texts, which emphasized symptom provocation, site-specific signs, and even psychosomatic implications

under the concept of Manas Shalya. The surgical approach included both conservative and invasive strategies that

remain conceptually aligned with modern trauma and surgical protocols. Today, with the support of diagnostic tools

like X-rays, ultrasound, and MRI, the principles of Pranashta Shalya continue to offer valuable guidance in

identifying and managing retained or migrated foreign bodies.

The relevance of this ancient framework lies in its holistic view of patient care—integrating physical, functional,

and psychological domains. In contemporary surgical practice, especially in resource-limited settings, Ayurvedic

insights into concealed foreign bodies reinforce the importance of clinical acumen, patient-centred reasoning, and

minimally invasive interventions. Pranashta Shalya thus stands as a testament to Ayurveda’s timeless contribution

to surgical science.

Keywords - Pranashta Shalya, Foreign Body, Sushruta Samhita, Shalya Nirharan.

P

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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

Corresponding author: Dr. Aniruddha Pawar

Article Info: Published on : 15/07/2025

Impact Factor : 1.013

A Review Of Pranashta Shalya And Its Surgical Insights

Dr.Aniruddha Pawar

1

, Dr. Dwivedi Amarprakash

2

, Dr.Usman Gani Dhange

3

1

Assistant Professor, Shalya Tantra Department, D. Y. Patil School of Ayurved, Navi Mumbai, Maharashtra, India

2

Professor, Shalya Tantra Department, D. Y. Patil School of Ayurved, Navi Mumbai, Maharashtra, India.

3

P G Scholar, Shalya Tantra Department, D. Y. Patil School of Ayurved, Navi Mumbai, Maharashtra, India.

Cite this article as: - Dr. Aniruddha Pawar (2025) ; A Review Of Pranashta Shalya And Its Surgical Insights;Inter.J.Dignostics

and Research 2 (4) 122-127 , DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 6 0 4 3912

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Introduction :

Shalyatantra, the surgical limb of Ayurveda,

exhibits a remarkably advanced understanding of

trauma, foreign-body management and wound care.

Within this corpus, Pranashta Shalya literally “lost

or concealed foreign body” occupies special

attention because the offending object lies hidden

in deep tissues yet continues to provoke disease

 [1]

The generic term “Shalya” is derived from the root

Śal–Śval–Aśu-Gamana, signifying any exogenous

or endogenous matter that rapidly invades and

disturbs somatic or psychic equilibrium.

 [2]

When

such a foreign body (Agantuja Shalya) penetrates

beyond visual reach it is termed Pranashta Shalya,

a condition that receives dedicated coverage in

Sushruta Samhita—Pranashta Shalya Vijñāniya

and Shalyopanayaniya chapters (Su.Su. 26–27).

Acharya Sushruta’s battlefield milieu, replete with

arrow injuries (Sharabhighāta), prompted

meticulous descriptions of localization tests,

extraction paths (Anuloma vs Prātiloma), and

fifteen distinct Nirharana Upāya (removal

strategies) still conceptually relevant

today

 [3]

Modern clinicians continue to encounter

retained splinters, surgical remnants and migrating

projectiles; if undetected they may culminate in

abscess, necrosis, fistula formation, foreign-body

granuloma or sepsis

 [4]

. Sushruta’s emphasis on

provocative functional tests—jumping, climbing or

deep breathing to elicit pinpoint pain—mirrors

contemporary reliance on dynamic examination and

imaging-guided exploration

 [5]

. Equally striking is

Ayurveda’s extension of the concept to the mind:

emotions such as grief or fear are catalogued as

Manas Shalya, implying that concealed

psychological traumas can obstruct healing just as

surely as physical debris. Today, integrating these

classical insights with radiography, ultrasound, CT

or MRI enhances diagnostic precision while

honouring the primacy of clinical acumen.

Revisiting Pranashta Shalya therefore not only

illuminates historical surgical sophistication but

also reinforces timeless principles—observe

keenly, localize accurately, remove completely, and

restore structural as well as psychosomatic

balance.

[6]

Thus, this article attempts to revisit the

ancient yet clinically relevant knowledge of

Pranashta Shalya, exploring its definitions,

classifications, diagnostic parameters, and removal

methods, while aligning them with present-day

surgical practice.

2. Literature review :

This review is based on a textual exploration of

classical Ayurvedic sources, critical analysis of

relevant commentaries, and interpretative

correlation with contemporary surgical

understanding. The approach is both literary and

conceptual, aiming to draw clinical relevance from

ancient methods described for Pranashta Shalya

(concealed foreign body).

2.1 Classical Source Review:

Primary references were drawn from:

Sushruta Samhita, particularly Su. Su. 26 –

Pranashta Shalya Vijnaneeya Adhyaya and Su. Su.

27 – Shalyopanayaneeya Adhyaya, which explicitly

focus on the pathophysiology, localization, and

extraction of foreign bodies hidden within deeper

tissues. Accompanying classical commentaries

such as Dalhanacharya’s Nibandha Sangraha,

which clarify the terms like Shar, Gati, and Sthiti of

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the Shalya and outline its surgical consequences.

These sources provide an exhaustive list of clinical

signs (Lakshanas), directions of movement (Gati),

and types of foreign bodies, from superficial to

medullary and even organ-invading entities.

2.2 Contemporary Ayurvedic Literature:

Recent scholarly contributions were reviewed to

understand:

Reinterpretation of classical Shalya types in the

context of trauma care, musculoskeletal injuries,

and medico-legal contexts. Comparative evaluation

of Ayurvedic diagnostic methods with modern

techniques (e.g., using radiology or endoscopy to

identify concealed foreign bodies).Studies

elaborating Nirharana Upayas as a therapeutic

protocol encompassing both conservative and

operative strategies were also considered.

2.3 Clinical Cross-reference :

Modern trauma surgery frequently deals with cases

of retained foreign bodies—glass, splinters,

shrapnel, bone fragments—making it appropriate to

juxtapose Ayurvedic principles with contemporary

management protocols.

Therefore, this review emphasizes:

The diagnostic parallels between classical signs

such as Vedana, Vaivarnya, Shotha and

radiological findings.The conceptual continuity

from Ayurvedic procedures like Peedan, Bhedan,

Ayaskant Upayoga to modern minimally invasive

extraction methods (e.g., magnet-assisted removal,

guided biopsy forceps).Psychosomatic perspectives

as addressed by Manas Shalya, linking traditional

observations with contemporary mental health

frameworks.

3. Discussion:

3.1 Definition and Classification:

According to Sushruta Samhita, a Pranashta Shalya

refers to a foreign body that is no longer visible

externally and is concealed within the deeper

tissues or organs of the body (Su.Su. 26/3). These

may enter the body through trauma, battle injuries

(e.g., arrows), surgical mishaps, or penetrating

wounds. Based on nature and origin, they are

categorized as:

 Agantuja Shalya (Exogenous) – e.g., thorns,

metal, bamboo, bone, stone.

 Nija Shalya (Endogenous) – e.g., nails,

teeth, bone fragments, hair, Dosha-Mala

aggregates.

Types based on fixity:

 Avabaddha (Fixed / impacted): Lodged

within tissues and immobile.

 Anavabaddha (Loose / mobile): Can

migrate or be expelled spontaneously.

3.2 Direction of Migration – Shalya Gati

Sushruta has meticulously described the potential

directions of foreign body movement:

 Urdhva Gati – upward,

 Adho Gati – downward,

 Tiryak Gati – transverse,

 Vakra or Arvachin Gati – reverse,

 Ruju Gati – straight or through-and-through.

These descriptions correlate with modern concepts

of ballistic trauma, where the trajectory of a

projectile or retained object affects the site of

impaction, internal injury patterns and

complications.

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3.3 Clinical Manifestations – Lakshana

A. Samanya Lakshana (General Features):

 Localized discoloration (Shyavata),

 Swelling and nodular induration (Shotha),

 Persistent sero-bloody discharge from entry

site,

 Dead and softened flesh (Mriduta of

Maamsa),

 Cord-like tract tenderness and budbuda-like

pustules .

B. Vishesh Lakshana (Site-specific Features):

The nature of signs indicates which tissue or organ

houses the FB:

 Twakgata Shalya – skin discoloration and

pain.

 Mamsagata Shalya – tenderness and

suppuration.

 Sira/Snayu Gata Shalya – varicosity, pain,

contractures.

 Asthigata/Asthi-vivar Gata Shalya – deep

pain, mental restlessness (like in

intramedullary nails).

 Koshtagata Shalya – abdominal distension,

passage of stool or urine from abnormal

sites (e.g., in vesico-vaginal or recto-vesical

fistulas).

 Marma Gata Shalya – signs of vital organ

injury, possibly fatal.

These clinical signs act as diagnostic indicators,

much like modern red flags in concealed trauma or

surgical complications.

3.4 Diagnostic Methodologies :

A. Classical Provocative Tests:

 Pain elicited during climbing, jumping,

horse-riding, exercise, yawning, sneezing,

defecation, or urination indicates the

presence and site of FB.

 Observation of protective limb postures and

guarding behavior are highlighted as signs

of internal impaction.

B. Modern Correlation:

 Radiological tools like X-ray, Ultrasound,

CT scan, MRI, and Endoscopy are used

today to detect concealed or migrating FBs.

 These tools align with Ayurvedic principles

of localization through dynamic functional

testing and anatomical reasoning.

3.5 Nirharana Upaya – Techniques of Removal

In Su.Su. 27/4, Sushruta enumerates 15 techniques

to remove concealed foreign bodies (particularly

Anavabaddha Shalya), ranging from natural to

surgical which demonstrate a graduated protocol—

from conservative expulsion to interventional

removal, closely resembling modern surgical

pathways (e.g., conservative management →

guided exploration → surgical extraction):

Category

Classical

Term

Technique

6. Mechanical

Pramarjan

Wiping, irrigation

(esp. for ocular FBs)

7–9. Expulsion

Nirdhmapan,

Vaman,

Virechan

Expelling via

respiratory or GI

tract

10–15.

Specialized

Prakshalana,

Pratimarsa,

Ayaskanta,

Harsha

Irrigation, sneezing

drugs, magnet, and

even psychological

counseling for

Manas Shalya

3.6 Post-operative Management :

After removal, the focus shifts to:

 Achieving hemostasis,

 Use of Ghrita or honey-based applications,

 Swedana (fomentation) and if needed, Agni-

karma (cauterization).

These methods emphasize local wound hygiene,

immune modulation, and tissue healing,

corresponding with modern aseptic wound care and

physiologic dressing protocols.

3.7 Complications of Retained Foreign Bodies

Unremoved Pranashta Shalya may result in:

 Persistent pain, infection, or abscess,

 Vitiation of doshas leading to chronic non-

healing wounds,

 Deformity, toxemia, or death in severe

cases,

 Internal dissolution or integration with

tissue (as with bamboo, bone, or metallic

fragments).

This underscores the urgency of early detection and

complete removal, a principle universally accepted

in both Ayurvedic and allopathic surgical sciences.

4. Conclusion :

Pranshta Shalya exemplifies Ayurveda’s ability to

blend keen clinical observation with step-wise,

rational intervention. By recognizing that a hidden

foreign body can jeopardise both physical tissues

and mental harmony, the tradition underscores a

truly holistic surgical outlook. Even today, its

graded strategies—from natural expulsion to

precise extraction—mirror best-practice pathways

in modern trauma care. Revisiting these classical

insights reminds us that effective surgery is as

much about thoughtful diagnosis and

patient-centred judgement as it is about technical

skill.

References :

1. Bhishagratna KL (tr.). Sushruta Samhita –

Sutrasthana 26–27. Calcutta:

Kuppuswami Shastri Institute; 1916.

2. Dalhanacharya. Nibandha Sangraha

commentary on Sushruta Samhita,

Sutrasthana 26.

3. Wasnik SV, Naik TM. “A literary review on

Pranashta Shalya with special reference to

foreign body.”

World J Adv Res Rev. 2022;14(2):573-579.

4. Saini P, et al. “Pranashta Shalya and its

Nirharana – a review article.”

World J Pharm Life Sci. 2018;4(10):78-83.

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Copyright @ : - Dr. Aniruddha Pawar Inter. J.Digno. and Research IJDRMSID00058 |ISSN :2584-2757

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5. Shukla R, Gupta A. “Sushruta: The Father of

Surgery and Ancient Medical Innovations.”

J Tradit Compl Med. 2024;14(1):12-18.

6. Patil S, et al. “An introduction to concepts

and diagnosis of Pranashta Shalya.”

World J Pharm Res. 2024;13(9):241-248.

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