There are two kinds of Shalyas. A Shalya is either loose or firmly fixed to its seat within the body. We shall presently speak of the fifteen different modes of extracting a loose Shalyam, which are as follows, viz.: Extraction by natural expulsive functions of the body (Svabhaba), by suppuration or putrefication (Pachanam), by excising (Bhedanam), by bursting Daranam), by pressing Pidanam), by rubbing (Pramarjanam) by blowing with the mouth of medicinal powders into the affected part (Nirdhmapanam), by the administration of emetics (Vamanam), by an exhibition of purgatives (Virechanam) by washing Prakshalanam , by friction with the fingers (Pratimarsha), by straining as at the time of defecation (Pravahanam), by sucking (Achushanam), by applying a magnet (Ayaskanta) and by exhilarating (Harsham).
An embedded foreign matter is usually expelled from the eyes, etc, by inducing lachrymation, sneezing, eructation, coughing, micturition, defaecation, and the emission of flatus.
A Shalyam, or any other foreign matter which has penetrated into the deeper tissues of flesh, should be extracted by setting up suppuration in the affected locality. The putrid flesh would loosen the fixture of the Shalyam, the weight of the secreted pus and blood causing it to drop down.
The seat or the locality of a fixed Shalyam should be opened by an incision in the event of its not being ejected even after the establishment of the local suppuration. If the Shalyam fails to come out even after the incision, the affected part should be pressed with the fingers, or medicines, endued with the virtue of exerting pressure, should be applied over its surface. A particle of any fine matter, accidentally dropped into the eye, should be removed with sprays of cold water, or by blowing into it with the mouth, or by rubbing it with hair or the fingers.
A residue of digested food or mucous, a remnant of any food matter (Aharashesha) misdirected into the nostrils, or any small splinter loosely pricking thereto (Anu-shalyam), should be expelled by breathing hard, or by coughing upward through the nostrils (Utkasha), or by blowing through the nose. A morsel of food, acting as an obstructing Shalyam in the cavity of the stomach (Amashaya), should be ejected by rubbing (Pratimarsha) the fingers against the lining of the throat, or against the region of the epiglottis, while such a morsel brought down into the intestines, should be evacuated by administering purgatives (Virechanam).
The pus or any other morbid matter found within the cavity of an ulcer should be removed by washing it, while incarcerated flatus, or obstructed scybala or retained urine, or obstructed foetus, should be borne down and expelled by means of straining.
A loose, unbarbed arrow, lodged in a wound with a broad mouth and lying in an Anuloma direction, should be withdrawn by applying a magnet to its end. A shaft of grief, driven into the heart by any of the multifarious emotional causes, should be removed by exhilaration and merry-making.
A shaft (Shalyam), whether large or small, may be withdrawn from its place in either of the two ways known as the Anuloma and Pratiloma. The Anuloma consists in withdrawing a Shalyam through a way other than that of its penetration, while the contrary is called the Pratiloma.
A Shalyam lodged in a place lying close to the spot of its penetration (Arvacheenam) should be extracted through the way by which it has entered (Pratiloma). On the other hand, a shaft or Shalyam, piercing deep into any part of the body, but not coming out by the other side (Paracheenam), should be drawn out through a way other than that of its penetration (Anuloma).
A shaft, piercing deep into any part of the body so as to reach the other side of the wounded limb or part, (but not cutting out clean through it owing to the diminution of its original momentum), and remaining protruded in the heaved up flesh, should be extracted through a channel other than that by which it has originally penetrated (Anuloma), and by stirring or striking it with the hand or a hammer. The heaved up flesh should be opened with an incision, when found possible of being so opened, and the embedded Shalyam should be drawn out by stirring or striking it with the hand as laid down before.
A Shalyam, lodged in any soft part of the abdomen, chest, arm-pits, inguinal regions or ribs, should not be cut open or struck with hammer, but should be tried to be removed with the hands through the way of its penetration (Pratiloma), in failure whereof the Shalyam should be extracted with surgical appliances (Shastra) or any other surgical instruments (Yantras).
A patient, fainting away (during the course of such a surgical operation), should be enlivened by dashing cold water over his face. He should be solaced with many a hopeful and cheering word, and a nourishing diet such as, milk, etc. should be given him, and his vital parts should be protected.
Then having extracted the Shalyam, the incidental wound or ulcer, the blood having been wiped of, should be fomented with heat or by applying warm clarified butter to its surface in the event of it being found fit to be so treated i.e., devoid of pain and unattended with further bleeding). Cauterisation should be resorted to where the condition of the wound would indicate such a measure. After that, the wound should be plastered (Pradeha.) with honey and clarified butter, and bandaged with a piece of clean linen; and directions as to the diet and nursing of the patient should be given (as previously laid down).
A Shalyam, lodged in a vein or a ligament (Snayu), should be extracted with the help of a probe. The shaft (Shalyam), lodged in the body and lying buried under the incidental swelling, should be extracted by firmly tying blades of Kusha grass around its body. A shaft (Shalyam), lodged in a spot situated anywhere close to the heart, should be withdrawn by the way by which it has entered; and the patient should be enlivened with sprays of cold water, etc. during the operation.