अथातश्छेद्यरोगप्रतिषेधं व्याख्यास्यामः, भगवान् धन्वन्तरिः ॥ १ ॥ यथोवाच
Now we shall discourse on the curative treatment of eye-diseases, which should be cured with excisions (Chedya – Roga-Pratisedha). 1
Treatment of Armas
स्निग्धं भुक्तवतो ह्यन्नमुपविष्टस्य यत्नतः । संरोषयेत् तु नयां भिषक् चूर्णैस्तु लावणैः ॥ २ ॥ ततः संरोषितं तूर्णं सुस्विन्नं परिघट्टितम् । अर्म यत्र बलीजातं तत्रैतल्लगयेद् भिषक् ॥ ३ ॥ अपाङ्गं प्रेक्षमाणस्य बडिशेन समाहितः । ततः मुचुण्ड्याऽऽदाय मेधावी सूचीसूत्रेण वा पुनः ॥ ४ ॥ न चोत्थापयता क्षिप्रं कार्यमभ्यु (त्यु ) नतन्तु तत् । शस्त्रपातभयाच्चास्य वर्त्मनी ग्राहयेद् दृढम् ॥ ५ ॥ प्रशिथिलीभूतं त्रिभिरेव विलम्बितम् । उल्लिखन् मण्डलाग्रेण तीक्ष्णेन परिशोधयेत् ॥ ६ ॥ विमुक्तं सर्वतश्चापि कृष्णाच्छुक्लाच्च मण्डलात् । नीत्वा कनीनकोपान्तं छिन्द्यान्नातिकनीनकम् ॥ ७ ॥ चतुर्भागस्थिते मांसे नाक्षि व्यापत्तिमर्हति । कनीनकबधादस्त्रं नाडी चाप्युपजायते । हीनच्छेदात् पुनर्वृद्धिं शीघ्रमेवाधिगच्छति ॥८॥
Treatment of Armas – The patient should be first treated with a Sneha-predominating food before being surgically operated upon in a case of Arma marked by the manifest vegetation of polypus (on the affected eye). The patient should then be made carefully to sit at ease and the affected eye should then be irritated by casting powdered Saindhava-salt into its cavity after which the eye-ball, without any loss of time, should be duly fomented and rubbed with the hand. The intelligent physician will then ask patient to look at his Apanga (the interior corner of his own affected eye) and the cyst or the polypus (thus turned up), should be carefully secured with a hook (Badisa) and held with a Mucundi instrument or with a thread needle. it is dangerous to suddenly uplift the eye-lid under the circumstances. The two eyelids should be firmly drawn as under so as to guard against their being anywise hurt during the operation. The polypus, thus made flabby and pendent with the means of the three aforesaid accessories, should be fully got rid of by scraping it with a sharp Mandalagra instrument. The root of the polypus should be pushed as under from the Krsnamandala (Sclerotic region) and the Sukla-mandala (region of the cornea), to the extremity of the Kaninaka (pupil) and then removed the Kaninaka (pupil) should be duly guarded so as not to be hurt. A quarter layer of the flesh (of the polypus) should be left back and then the operation would not in any way hurt or injure the eye. An operation at a point beyond the aforesaid limit of the Kaninaka (might hurt the pupil and) would set up a hoemorrhage and beget a sinus (as well as pain) in the locality. The vegetation or polypus is sure to grow up again to its former size if it is cut off insufficiently. 2-8.
अर्म यज्जालवद् व्यापि तदप्युन्मार्ण्य लम्बितम् । छिन्द्याद् वक्रेण शस्त्रेण प्रतिसारणमक्ष्णोस्तु यावनालस्य चूर्णेन स्वेदयित्वा ततः पश्चाद् वध्नीयात् कुशलो भिषक् । दोष (देश) र्त्तुबलकालज्ञः स्नेहं दत्त्वा यथाहितम् । व्रणवत् संविधानन्तु तस्य कुर्यादतः परम् । त्र्यहान्मुक्त्वा करस्वेदं दत्त्वा शोधनमाचरेत् ॥ ११ ॥ वर्त्मशुक्लान्तमाश्रितम् ॥ ९ ॥ कार्यमनन्तरम् । च ॥ १० ॥ ततः त्रिकटोलवणस्य त्रिकटोर्लवणस्य
“
A shreddy or netted Arma in the form of a membranous growth (Jala) in the eye should be made pendent by rubbing it (with Saindhavasalt) and then cut with a bent Badisa instrument at the junction of the Sukla-mandala (cornea) and the Vartma-mandala (conjunctiva or eyelid). The affected part should then be rubbed with a compound consisting of Yava-ksara, Trikatu and Saindhava-salt ( pounded together) and then (duly) fomented and bandaged up by the skilful physician. Lardaceous or oily (Sneha) application should thereafter be prescribed with due regard to the nature of the place’, the season, the time (day or night) and the strength of the patient, and the incidental wound should be treated as an ulcer. The bandage should be removed after three days and the affected part should be (mildly) fomented with the application of heated palms of the hands and treated with corrective or purifying remedics. 9-11.
करञ्जबीजामलकमधुकैः साधितं पयः | हितमाश्च्योतनं शूले द्विरह्नः क्षौद्रसंयुतम् ॥ १२॥
मधुकोत्पलकिञ्जल्कदूर्वाकल्कैश्च मूर्धनि । प्रलेपः सघृतः शीतः क्षीरपिष्टः प्रशस्यते ॥ १३ ॥
Milk duly cooked with Karanja seed, Amalaka and Yasti-madhu and mixed with honey (when cold), should be dropped twice a day (morning and evening) into the affected eye in the event of there being any pain in it. A cold plaster composed of Yasti madhu, polens of lotus (Utpala) and Durva-grass pasted together with milk and mixed with clarified butter is recomended in such cases to be applied to the scalp. 12-13.
लेख्याञ्जर्नैरपहरेदर्मशेषं भवेद् यदि ॥ १४ ॥ अर्म चाल्पं दधिनिभं नीलं रक्तमथापि वा। धूसरं तनु यच्चापि शुक्रवत् तदुपाचरेत् ॥ १५ ॥ चर्माभं बहलं यत् तु स्त्रायुमांसघनावृतम् । छेद्यमेव तदर्म स्यात् कृष्णमण्डलगञ्च यत् ॥ १६ ॥
1. In place of ‘देश’ – the particular part and nature of the country, some read ‘दोष’- the particular Dosa involved in each case.
विशुद्धवर्णमक्लिष्टं क्रियास्वक्षि गतक्लमम् । छिन्नेऽर्मणि भवेत् सम्यग् यथास्वमनुपद्रवम् ॥ १७ ॥
Any residue of Arma, left after the excision, should be removed with the application of Lekhya¹ (scraping) Anjana or eye-salve. An Arma (Cyst-like papilla or protruberance) which is as white as curdled milk (Dadhi), or which looks blood-red or blue or grey, should be treated like a case of Sukrarma (Opacity of the cornea or a filmy and fleshy growth in the eye). An Arma which is very thick and looks like a piece of skin and covered over with fibres of flesh and Nerves². as well as one occurring on the Krsna-mandala (region of the iris) should be excisioned. The eye assunes its former and natural colour and function, and becomes free from pain and other complications by the proper excision of an Arma. 14-17.
Treatment of Sira jala and Sira pidaka
सिराजाले सिरा यास्तु कठिनास्ताश्च बुद्धिमान् । उल्लिखेन्मण्डलाग्रेण सिरासु पिडका जाता या न सिध्यन्ति भेषजैः । अर्मवन्मण्डलाग्रेण तासां बडिशेनावलम्बिताः ॥ १८ ॥ छेदनमिष्यते ॥ १९ ॥ रोगयोश्चैतयोः कार्यमर्मोक्तं प्रतिसारणम् । विधिश्चापि यथादोषं लेखनद्रव्यसम्भृतः ॥ २० ॥
Treatment of Sira-jala and Sira-pidaka- In a case of Sirajala, the hardened veins (Sira) should be hung down with a hook (Badisa) and scraped with a Mandalagra (round-topped) instrument. Cysts or pimples (Pidakas) appearing on the diseased veins in a case of the aforesaid Sira-Jala and not proving amenable to the application of medicines, should be excisioned as in a case of Arma with a Mandalagra instrument. Pratisarana ( rubbing) as in a case of Arma and Lekhana (scraping) with due regard to the nature of the deranged Dosas involved in each case, are also recommended in both the diseases (Sira- Jala and Sira- Pidaka) under discussion 18-20.
1. For Lekhya anjana see Chapter XII, para 16 of this Uttara-Tantra. 2. Some here read ‘सिरा’ (veins) in place of ‘घन’।
Treatment of Parvanika
सन्धौ संस्वेद्य शस्त्रेण पर्वणीकां विचक्षणः । उत्तरे च त्रिभागे च बडिशेनावलम्बिताम् ॥ २१ ॥ छिन्द्यात् ततोऽर्धमग्रे स्यादश्रुनाडीं ह्यतोऽन्यथा । प्रतिसारणमत्रापि सैन्धवक्षौद्रमिष्यते । लेखनीयानि चूर्णानि व्याधिशेषस्य भेषजम् ॥ २२ ॥
Treatment of Parvanika – In a case of Parvanika the place of junction’ (of the lachrymal sac and the cornea) should be duly fomented. A quarter part only of the protuberance of growth should be kept apart, while the remaining upper three quarters should be secured with a hook and cut with a knife. Half of the aforesaid quarter part should then be cut away (very carefully), as lachrymal sinus (and consequent lachrymation) would otherwise set in. The seat of operation should be subsequently rubbed (Pratisarana) with a compound of honey and Saindhava-salt. Scarifying (Lekhana) powders should then be applled to the affected part for the complete recovery of the disease (if any complaint still remaining). 21-22.
शङ्खं समुद्रफेनञ्च मण्डूकीञ्च समुद्रजाम् । स्फटिकं कुरुविन्दञ्च प्रवालाश्मन्तकं तथा ॥ २३ ॥ वैदूर्यं पुलकं मुक्तामयस्ताम्ररजांसि च । समभागानि सम्पिष्य सार्धं स्त्रोतोऽञ्जनेन तु ॥ २४ ॥ चूर्णाञ्जनं कारयित्वा भाजने मेषशृङ्गजे संस्थाप्योभयतः कालमञ्जयेत् सततं बुधः ॥ २५ ॥ अर्माणि पिडकां हन्याच्छिराजालानि तेन वै ॥ २६ ॥
Curna-Anjana— Powders of Sankha (conch-shell), Samudraphena, marine oyster-shell, crystal, ruby, coral, Asmantaka, Vaidurya (Lapis lazuli), pearl, iron, copper and Srotonjana (Antimony) taken in equal parts and mixed together, should be stuffed in a ram’s horn² and then let the intelligent one apply this Curna-anjana (powder) to the affected locality, morning and evening everyday, as such applications are extremely efficacious in all types of Armas, Pidakas, Sira-jala, Arsas, Suskarsas and Arbuda etc. in the eye. 23-26.
1. The ‘Junction” is the junction of the Krsna mandala and the Sukla-mandala of the eye. – Dalhana. 2. Dalha explains ‘Mesa-srnga as a kind of Ingudi tree.
Treatment of inner part of the eye lids
अर्शस्तथा यच्च नाम्ना शुष्कार्शोऽर्बुदमेव च । अभ्यन्तरं वर्त्मशया विधानं तेषु वक्ष्यते ॥ २७ ॥ वर्मोपस्वेद्य निर्भुज्य सूच्योत्क्षिप्य प्रयत्नतः । मण्डलाग्रेण तीक्ष्णेन मूले च्छिन्द्याद् भिषग्वरः ॥ २८ ॥ ततः सैन्धवकासीस कृष्णाभिः प्रतिसारयेत् । स्थिते च रुधिरे वर्त्म दहेत् सम्यक् शलाकया ॥ २९ ॥ क्षारेणावलिखेच्चापि व्याधिशेषो भवेद् यदि । तीक्ष्णैरुभयतो भागैस्ततो दोषमधिक्षिपेत् ॥ ३० ॥ वितरेच्च यथादोषमभिष्यन्दक्रियाविधिम् । शस्त्रकर्मण्युपरते मासञ्च स्यात् सुयन्त्रितः ॥ ३१ ॥
Treatment of inner part of the eye-lids- The mode of treatment in a case of any affection in the inner lining of the Vartma (eye-lid) is given below. The affected part should be first fomented and then the eye-lid should be over-turned (held at an angle), and the diseased growth or swelling should be carefully lifted up with a needle, then an experienced physician should cut it at its root or base with the help of a sharp Mandalagra instrument. After that the affected part should be rubbed with a pulverised compound consisting of Saindhava, Kasisa (Sulphate of iron) and Pippali. The affected eye-lid should then be carefully cauterised with a (red-hot) rod after a (complete) cessation of the bleeding. The residue of its root or base, if any, should be scarified with a scarifying alkaline (caustic) preparation. Decoctions of strong emetic and purgative drugs’ should be (internally) administered for the elimination of the Dosas (from of Vrana—ulcer). The measures and remedies mentioned in connection with Abhisyanda (Ophthalmia) should also be prescribed with regard to the nature of the bodily Dosas involved in the case. The patient shall observe strict regimen of diet and conduct for a month after the surgical operation. 27-31.
1. Some commentators say that emetics and purgatives should be internally administered, but Dalhana and the Panjika-kara oppose this view.
इति सुश्रुत संहितायामुत्तरतन्त्रे च्छेद्यरोगप्रतिषेधो नाम पञ्चदशोऽध्यायः ॥ १५ ॥
Thus ends the fifteenth chapter in the Uttara-Tantra of the Susruta Samhita which treats of the remedies of eye-diseases requiring excisions or surgical operation.
