प्रथमोऽध्यायः अथात: औपद्रविकमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the chapter which deals with the diseases, viz., of the eye, etc. (Aupadravika adhyaya). 1
अध्यायानां शते विंशे यदुक्तमसकृन्मया । वक्ष्यामि बहुधा सम्यगुत्तरेऽर्थानिमानिति ॥ २ ॥ इदानीं तत् प्रवक्ष्यामि तन्त्रमुत्तरमुत्तमम् । निखिलेनोपदिश्यन्ते यत्र रोगाः पृथग्विधाः ॥ ३ ॥ शालाक्यशास्त्राभिहिता विदेहाधिपकीर्तिताः । ये च विस्तरतो दृष्टाः कुमाराबाधहेतवः ॥ ४ ॥ षट्सु कायचिकित्सासु ये चोक्ताः परमर्षिभिः । उपसर्गादयो रोगा ये चाप्यागन्तवः स्मृताः ॥ ५ ॥ त्रिषष्टी रससंसर्गाः स्वस्थवृत्तं तथैव च। युक्तार्था युक्तयश्चैव दोषभेदास्तथैव च।
यत्रोक्ता विविधा अर्था रोगसाधनहेतवः ॥ ६ ॥
Here commences that portion of the Susruta Samhita which is known as the Uttara Tantra (the supplementary part) to which references have been often made in the preceding one hundred and twenty chapters, as the fit place wherein to revert in detail to the topics cursorily mentioned therein. This part comprises within it the specific descriptions of a large and a varied number of diseases, viz., those which form the subject matter of the Salakya-tantra (Diseases of the eye, ear, nose and throat) as narrated by the king of Videha; the aetiology and symptomatology, etc. of diseases peculiar to infants and women (Kaumrabhytya), the pathology, etc. of those diseases mentioned in the six books of the Practice of Medicine par excellence (Kaya-chikitsa) compiled by the holy sages of old and diseases known as Upasarga (e.g. Bhutopasarga – Demonology) as well as diseases of traumatic origin are also included in this supplementary text.¹ Herein are also mentioned the sixty-three combinations of the six different Rasas (tastes) as well as the laws of health and hygiene with their rationale, rules, interpretation and reasoning and the classifications of different Dosas and organic principles of the body and various accessories and remedial agents required for their successful treatment and cure.2-6.
महतस्तस्य तन्त्रस्य दुर्गाधस्याम्बुधेरिव । आदावेवोत्तमाङ्गस्थान् रोगानभिदधाम्यहम् ।
संख्यया लक्षणैश्चापि साध्यासाध्यक्रमेण च ॥ ७ ॥
I shall now begin with the description of the numbers, the pathology and the curability or incurability of those specific ailments of the body which are peculiar to the region of the head out of a myriad of other distempers reserved for treatment in this portion of the work (Uttara-tantra) which may be compared to the unfathomable sea in respect of the vastness of its depth and magnitude. 7.
Diseases of the eye and its appendages
विद्याद् द्व्यङ्गुलबाहुल्यं स्वाङ्गुष्ठोदरसम्मितम् । द्व्यङ्गुलं सर्वतः सार्द्धं भिषङ् नयनबुबुदम् ।
सुवृत्तं गोस्तनाकारं सर्वभूतगुणोद्भवम् । पलं भुवोऽग्नितो रक्तं वातात् कृष्णं सितं जलात् । आकाशादश्रुमार्गांश्च जायन्ते नेत्रबुद्बुदे ॥ ८ ॥
Diseases of the eye and its appendages — The eye-ball (Nayana-Budbuda) is two fingers (about an inch) in transverse diameter, about the breadth of one’s own thumb in depth (Sagittal diameter), and two fingers and a half all round (in circumference). The eyeball is almost round in shape and resembles the teat of a cow. It is made up of all the (five) elements of which the universe is built up. The element of the ‘solid’ earth (Bhu) contributes to the formation of its muscles, the element of ‘heat’ ( Agni or Tejas ) is in the blood (that courses in its veins and arteries), ‘the gaseous element’ (Vayu) contributes to the formation of the black part (Iris, etc.) in which the pupil is situated, the fluid element (Jala) preponderates-in the lucid (white) part (Vitreous body) and the void (ethereal) Space (Akasa) is there to form lachrymal or the other ducts of sacs (Asrumarga) through which the secretions are discharged. 8.
1. The text has agantuka (traumatic diseases). Gayadasa explains to mean Apasmara, Unmada, etc. (Hysteria, insanity, etc.)
Drasti – The central part of Retina – Macula Lutea
दृष्टिञ्चात्र तथा वक्ष्ये यथा ब्रूयाद् विशारदः । नेत्रायामत्रिभागन्तु कृष्णमण्डलमुच्यते ।
कृष्णात् सप्तममिच्छन्ति दृष्टिं दृष्टिविशारदाः ॥ ९॥
मण्डलानि च सन्धींश्च पटलानि च लोचने । यथाक्रमं विजानीयात् पञ्च षट् च षडेव च ॥ १० ॥
I shall now proceed to describe the Drsti (the central part of Retina—’Macula Lutea’) as set forth by expert ophthalmic physicians. The black portion of the eye ( Krsna-mandala— Choroid) forms one third part of its whole extent while the Drsti, according to them, occupies only one-seventh part of the Krsna-mandala. The mandalas or sub-divisions of circles of the eye-ball, the Sandhis or Joints (parts where these sub-divisions meet with one another) and the Patalas (layers or coats) of the eye are respectively five, six and six in number. 9-10.
Mandala and Sandhi
पक्षवर्त्मश्वेतकृष्ण-दृष्टीनां मण्डलानि तु । अनुपूर्वन्तु ते मध्याश्चत्वारोऽन्त्या यथोत्तरम् ॥ ११ ॥
पक्ष्मवर्त्मगतः सन्धिर्वर्त्मशुक्लगतोऽपरः । शुक्लकृष्णगतस्त्वन्यः कृष्णदृष्टिगतोऽपरः । ततः कनीनकगतः षष्ठश्चापाङ्गगः स्मृतः ॥ १२ ॥ Mandala and Sandhi- The Mandalas of the eye , viz., (1) the Paksma-mandala (the circle of the eye- are the following lashes), (2) the Vartma-mandala (the eye-lid) (3) the Sveta-mandala (the Sclerotic and Cornea ), the Krsna-mandala (the choroid) and (4) the Drstimandala (the pupil). These circles are so arranged that the one preceding lies within the next in the list.’ the Sandhis (which serve as lines of demarcation of the circles) already pointed out are six in number, the first binding the eye-lashes (Paksa-mandala) with the eyelids (Vartmamandala), the second the eye lids and the Sclerotic coat (Svetamandala), the third binding the latter with the Krsna-mandala (choroid), the fourth situated between the latter and the Drsti-mandala, the fifth lying in the interior corner (kaninikas) and the last (sixth) in the exterior (posterior) corner (Apangas) of the eye. 11-12.
The Patalas
द्वे वर्त्मपटले विद्याच्चत्वार्य्यन्यानि चाक्षिणि जायते तिमिरं येषु व्याधिः परमदारुणः ॥ १३॥
तेजोजलाश्रितं बाह्यं तेष्वन्यत् पिशिताश्रितम् | मेदस्तृतीयं पटलमाश्रितं त्वस्थि चापरम् । पञ्चमांशसमं दृष्टेस्तेषां बाहुल्यमिष्यते ॥ १४ ॥
The Patalas — Of the Patalas, two are in the eye-lid (Vartmamandala) and four in the eye proper, wherein occurs the dreadful disease known as the Timira (loss of vision). Of these four the first or anterior coat (Patala) supports the humour. Jala and light (Tejas), the socond coat or Patala (choroid) is supported by muscles; the third coat or Patala ( Sceroim and Cornea ) consists of Medas (lit, fat) and there is the fourth which is a fifth part of the whole and is known as the Drsti. There are, however, divisions and subdivisions of these coats. 13-14.
सिराणां कण्डराणाञ्च मेदसः कालकस्य च । गुणाः कालात् परः श्लेष्मा बन्धनेऽक्ष्णोः सिरायुतः ॥ १५ ॥ सिरानुसारिभिर्दोषैर्विगुणैरूर्ध्वमागतैः नेत्रभागेषु रोगाः परमदारुणाः ॥ १६ ॥ जायन्ते
1. Evidently some line or lines are missing here as the line cannot give a complete sense by itself. Ed.
2. By “Jala” is meant here the serum (Rasa) in the skin, and by “Tejas” the blood in the veins (sira) carrying the ( Tejas) known as the A’locaka.
The different parts of the eye-ball are held together by the blood-vessels, the muscles, the Vitreous body and the choroid.¹ Beyond the choroid, the eye-ball is held (in the orbit) by a mass of slesma (viscid substance-capsule of Tenon ) supported by a number of vessels. The deranged Dosas which pass upward to the region of the eyes through the channels of the up-coursing veins and nerves give rise to a good many dreadful diseases in that region. 15-16.
Eye Diseases Purva rupa
तत्राविलं । ॥१७॥ ससंरम्भमश्रुपूर्णोपदेहवत् गुरूषातोदरागाद्यै-र्जुष्टञ्चाव्यक्तलक्षणैः सशूलं वर्त्मकोषेषु शूकपूर्णाभमेव च । विहन्यमानं रूपे वा क्रियास्वक्षि यथा पुरा | दृष्ट्वैव धीमान् बुध्येत दोषेणाधिष्ठितंतु तत् ॥ १८ ॥ तत्र सम्भवमासाद्य यथादोषं भिषग्जितम् । विदध्यान्नेत्रजा रोगा बलवन्तः स्युरन्यथा ॥ १९ ॥ सङ्क्षेपतः क्रियायोगो निदानपरिवर्जनम् । वातादीनां प्रतीघातः प्रोक्तो विस्तरतः पुनः ॥ २० ॥
Purva-rupa, etc — Cloudiness of vision, slight inflammation, lachryamation, mucous accumalation, heaviness, burning sensation, sucking pain (D. R. aching pain) and redness in the eyes are indistinctly manifest ( in the incubatory stage ) in such cases. In cases of an inflammation of the Vartmas (eye-lids) the eye seems as if studded with the bristles of worms (Suka) and attended with pain (as if pricked into with thorns) and a sensible impairment of the faculty of the eyes in detecting colours and in closing and opening the eye-lids freely. An intelligent physician will conclude from these symptoms that the eyes have been affected by the (deranged) Dosas, with a due consideration of remedies should be (carefully) administered, otherwise the eye-diseases might become too serious. The simple maxim of principle to be followed in the treatment of disease in simply to forego to primary pathological causes of that disease. The special remedial measures that would pacify the different Dosas vayu etc. have been described in detail. 17-20.
1. D. r. Vessels muscles and aqueous humor (Medas) are most important for the maintenance of Krsna-mandala.
Causes of Eye disease
उष्णाभितप्तस्य जलप्रवेशाद् दूरेक्षणात् स्वप्नविपर्ययाच्च । प्रसक्तसंरोदनशोककोप-क्लेशाभिघातादतिमैथुनाच्च ॥ २१ ॥
वेगविनिग्रहाच्च । शुक्तारनालाम्लकुलत्थमाष-निषेवणाद् स्वेदाद्रजोधूमनिषेवणाच्च छर्देर्विघाताद् वमनातियोगात्। बाष्पग्रहात् सूक्ष्मनिरीक्षणाच्च नेत्रे विकारान् जनयन्ति दोषाः ॥ २२ ॥
Causes of Eye disease – The local Dosas deranged and aggravated by such causes as diving in water immediately after an exposure to the heat and the glare of the sun, (constant) gazing at distant objects, sleep in the day time and keeping at distant objects, sleep in the day time and keeping up late hours in the night, fixed and steady gaze, excessive weeping or over-indulgence in grief, anger and fatigue, a blow or a hurt, sexual excesses, the partaking (in inordinate quantities) of Sukta, Aranala (fermented rice-water) acid gruel, Masa pulse, and Kulattha pulse, voluntary repression of any call of nature, exposure (of the eyes) to smoke or dust, trickling down of the drops of sweat (into the eyes), excessive or impeded vomiting, repression of tears, constant contraction of the eyes to adjust the sight to extremely small objects, etc., beget dosorders of the organs of vision. 21-22.
Classification of the eye diseases
वाताद् दश तथा पित्तात् कफाच्चैव त्रयोदश । रक्तात् षोडश विज्ञेया सर्वजाः पञ्चविंशतिः ।
तथा बाह्यौ पुन च रोगाः षट्सप्ततिः स्मृता ॥ २३ ॥
Classification of the eye diseases — Seventy-six different kinds of eye-diseases have been come across in practice; of these ten are originated by the deranged Vayu, ten by Pitta and thirteen by Kapha. Sixteen are produced by vitiated blood, and twenty-five by the concerted action of the deranged Dosas (Tri-Dosaja), and lastly, two are produced by external causes i. e., they are traumatic in their origin.23.
Prognosis of the Vataja Type
याप्योऽथ तन्मयः काचः साध्याः स्युः सान्य ( स्यन्द ) मारुताः । शुष्काक्षिपाकाधिमन्थ-सान्य ( स्यन्द ) मारुतपर्ययाः ॥ २४ ॥
Prognosis of the Vataja Type — Of the diseases of the eyes which are due to the action of the deranged Vayu, those known as Hatadhimantha, Nimisa, Gambhirika aftecting the vision, any Vatahatavartma (Vayu-affected Sclerotic coat) is said to be incurable. A Temporary cure (Yapya) is all that can be effected in a case of Kaca (cataract) due to the action of the deranged bodily Vayu; while the affection of the eyes known as the Anyato-Vata, Adhi-mantha (ophthalmia), Suskaksi-paka, Abhisyanda and Maruta-paryaya are curable. 24.
Prognosis of the Pittaja Type
असाध्यो ह्रस्वजाड्यो या जलस्त्रावश्च पैत्तिकः । परिम्लायी च नीलश्च याप्यः काचोऽथ तन्मयः ॥ २५ ॥ अभिष्यन्दो ऽधिमन्थोऽम्लाध्युषितं शुक्तिकाह्वया । दृष्टिः पित्तविदग्धा च धूमदर्शी च सिध्यति ॥ २६ ॥
Prognosis of the Pittaja Type – Of the diseases due to the deranged action of the Pitta known as Hrasva jadya and jala-srava should be deemed incurable; and palliative measures are the only remedies in cases of kaca, Parimlayi and Nila, while Abhisynda, Adhimantha Amladhyusita suktika, Pitta-vidagdha-Drst and Dhumdarsi are curable. 25-26.
Prognosis of Kaphaja Type
असाध्यः कफज: स्त्रावो याप्य: काचोऽथ तन्मयः ।
अभिष्यन्दोऽधिमन्थश्च दृष्टिः श्लेष्मविदग्धा च पोथक्यो लगणश्च यः । क्रिमिग्रन्थिपरिक्लिन्न – वर्त्मशुक्लार्मपिष्टकाः – ।
श्लेष्मोपनाहः साध्यास्तु कथिताः श्लेष्मजेषु तु ॥ २८ ॥ बलासग्रथितञ्च यत् ॥ २७ ॥
Prognosis of Kaphaja Type — Of the diseases due to the aggravation of Kapha, the one known as the Srava-roga is incurable and (Kaphaja) Kaca (cataract) admits of only palliative treatment, while a cure may be effected in the following cases, viz., Abhisyanda (conjunctivitis), Adhi-mantha, Balsasa, Grathita, Slesma-VidagdhaDrsti, Pothaki, Lagana, Krimi-granthi, Pariklinna-Vartma, Suklarma, Pistaka, Slesmo-panaha. 27-28.
Prognosis of the Raktaja Type
रक्तस्त्रावोऽजकाजातं शोणितार्शोव्रणान्वितम् । शुक्रं न साध्यं काचश्च याप्यस्तज्जः प्रकीर्तितः ॥ २९ ॥
मन्थस्यन्दौ क्लिष्टवर्त्म हर्षोत्पातौ तथैव च। सिराजाताऽञ्जनाख्या च सिराजालञ्च यत् स्मृतम् ॥ ३० ॥
पर्वण्यथाव्रणं शुक्रं शोणितार्माजुनश्च यः । एते साध्या विकारेषु रक्तजेषु भवन्ति हि ॥ ३१ ॥
Prognosis of the Raktaja Type Of the diseases of the eyes due to the vitiated condition of the blood, those known as Raktasrava, Ajakajata, Avalambita (Pendent), Sonitarsas and sukra-roga should be regarded as incurable, and the type of Kaca (Cataract) due to the same cause admits of only palliative measures, while the diseases known as Adhi-mantha, Abhisyanda, Klista-vartma, Sira-harsa and Sirotpata, Anjana, Sira-jala, Parvani, Avrana (non-ulcerated), Sukraroga, Sonitarma and Arjuna may be included within the group of curables. 29-31.
Prognosis of the Tridosaja
पूयास्त्रावो नाकुलान्ध्यमक्षिपाकात्ययोऽलजी । असाध्याः सर्वजा याप्या: काचः कोपश्च पक्ष्मणः ॥ ३२ ॥
वर्त्मावबन्धो यो व्याधिः सिरासु पिडका च या । प्रस्तार्यर्माधिमांसार्म स्नाय्वर्मोत्सङ्गिनी च या ॥ ३३ ॥
पूयालसश्चार्बुदञ्च श्यावकर्दमवर्त्मनी । तथाऽर्शोवर्त्म शुष्कार्श: शर्करावर्त्म यच्च वै ॥ ३४ ॥
सशोफश्चाप्यशोफश्च पाको बहलवर्त्म च । अक्लिन्नवर्त्म कुम्भीका बिसवर्त्म च सिध्यति ॥ ३५ ॥
सनिमित्तोऽनिमित्तश्च द्वावसाध्यौ तु बाह्यजौ ॥ ३६ ॥
Prognosis of the Tridosaja Type, etc — Of the eye-diseases due to the concerted action of the three aggravated Dosas, those known as Puyasrava, Nakulandhya, Aksipakatyaya and Alaji are incurable and palliative measures are only possible in cases of Kaca (cataract) or Paksma-kopa; while those known as Vartmavabandha, Siraja-pidaka, Prastaryarma, Adhi-mansarma, Snayvarma, Utsangini, Puyalasa, Arbuda, Syava-vartma, Kardama-vartma, Arsovartma, Sukrarsas, Sarkara-vartma the two forms of inflammation with or without local swelling known as Sasopha-paka and Asopha-paka, Bahala-vartma, Kumbhika and visa-vartma yeild to the curative efficacy of appropriate remedial agents. Both the forms of eye-diseases due to the external causes’ should be considered as incurable. 32-36.
षट्सप्ततिर्विकाराणामेषा संग्रहकीर्तिता ॥ ३७॥
नवसन्ध्याश्रयास्तेषु वर्त्मजास्त्वेकविंशतिः । शुक्लभागे दशैकश्च चत्वारः कृष्णभागजाः ॥ ३८ ॥
सर्वाश्रयाः सप्तदश दृष्टिजा द्वादशैव तु । बाह्यजौ द्वौ समाख्यातौ रोगौ परमदारुणौ ।
भूय एतान प्रवक्ष्यामि संख्यारूपिचिकित्सितैः ॥ ३९ ॥
Their Localities – Thus we have finished enumerating the seventy-six types of eye-diseases, of which nine are confined to the Sandhis (binding unions), twenty-one to the Vartma (eye-lids), eleven to the Sukla-bhaga (the Vitreous body), four to the Krsna bhaga (the region of the Choroid), seventeen to the entire region (eye-ball) and twelve to the region of the Drsti (pupil or the crystalline lens, etc.). The two cases due to the extraneous cause (are chiefly located in the Drsti though affecting the whole of the eye-ball and are very painful and incurable. The characteristic symptoms and treatment of all these will be hereafter described in detail. 37-39.
इति सुश्रुत संहितायामुत्तरतन्त्रे औपद्रविको नाम प्रथमोऽध्यायः॥१॥ –
Thus ends the first chapter of the Uttura-Tantra in the Susruta Samhita which deals with the diseases, viz, of the eye, etc.
