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Sushruta SamhitaDrsti gata Roga Vijnaniya - Pathology of the diseases which are peculiar...

Drsti gata Roga Vijnaniya – Pathology of the diseases which are peculiar to the Drsti (pupil) of the eye – Sushrutasamhita Uttaratantra Chapter 7

सप्तमोऽध्यायः अथातो दृष्टिगतरोगविज्ञानीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥

Now we shall discourse on the chapter which deals with the pathology of the diseases which are peculiar to the Drsti (pupil) of the eye (Drsti-gata-Roga-Vijnaniya ). 1

मसूरदलमात्रान्तु पञ्चभूतप्रसादजाम् । तेजोभिरव्ययैः ॥२॥ खद्योतविस्फुलिङ्गाभामिद्धां आवृतां पटलेनाक्ष्णोर्बाह्येन विवराकृतिम् । शीतसात्म्यां नृणां दृष्टिमाहुर्नयनचिन्तकाः ॥ ३ ॥ रोगांस्तदाश्रयान् घोरान् षट् च षट् च प्रचक्ष्महे । पटलानुप्रविष्टस्य तिमिरस्य च लक्षणम् ॥ ४ ॥

Experts well-versed in the anatomy of the eye said that the Drsti (pupil) of the eye is the quintessence of the five material elements with that of the eternal light predominating there in this principle of light neit increasing nor decreasing in this case. It is naturally accustomed to cold from the very nature of its temperament and is covered by the outer coating (Patala) of the organ proper. It looks like a hole and is equal in dimension to that of a Masura seed or pulse¹. The pupil of the eye resembles in its action the phosphorescent flash of a glowworm or that of a minute particle of fire (in not burning the things coming in contact with it.) Now we shall describe the pathology of the twelve kinds of disease peculiar to the region of the Drsti (pupil), as well as of the one which is known as Timira (loss of vision) affecting the Patala (coating over the pupil). 2-4.

1. According to Nimi, quoted in Madhava’s commentary by Srkantha, the dimension of the Drsti is equal to only a half of that of a Masura- pulse.

First Patala (innermost coat) of pupil (Drsti)

सिराभिरभिसम्प्राप्य विगुणोऽभ्यन्तरे भृशम् । प्रथमे पटले दोषो यस्य दृष्टौ व्यवस्थितः ।

अव्यक्तानि स रूपाणि सर्वाण्येव प्रपश्यति ॥ ५ ॥

All external objects appear dim and hazy to the sight when the deranged Dosas of the locality passing through the veins (Sira) of the eye, get into and are incarcerated within the first Patala (innermost coat) of pupil (Drsti). 5.

Second Patala attacked

दृष्टिभृशं विह्वलति द्वितीयं पटलं गते । मक्षिका मशकान् केशान् जालकानि च पश्यति ॥ ६ ॥

मण्डलानि पताकाश्च मरीची: कुण्डलानि च । परिप्लवांश्च विविधान् वर्षमभ्रं तमांसि वा ॥७॥

दूरस्थान्यपि रूपाणि मन्यते च समीपतः । समीपस्थानि दूरे दूरे च दृष्टेर्गोचरविभ्रमात् । यत्नवानपि चात्यर्थं सूचीपाशं न पश्यति ॥ ८ ॥

second Patala attacked – False images of gnats, flies, hairs, nets or cob-webs, rings (circular patches), flags, earrings, appear to the sight, and the external objects seem to be enveloped in mist or haze or as if laid under a sheet of water or as viewed in rain and on cloudy days, and meteors of different colours seem to be falling constantly in all directions in the event of the deranged Dosas being similarly confined in the Second Patala (coat) of the Drsti. In such cases the near appearance of an actually remote object and the contrary (Myopia and Hypermetropia) also should be ascribed to some deficiency in the range of vision (error of refraction in the crystalline lens) which incapacitates the patient from looking through the eye and heven with great effort patient is unable to see the needle thread. 6-8.

Symptoms when third Patala attacked

ऊर्ध्वं पश्यति नाधस्तात् तृतीयं पटलं गते । महान्त्यपि च रूपाणि च्छादितानीव वाससा ॥ ९ ॥ कर्णनासाक्षियुक्तानि विपरीतानि वीक्षते । यथादोषञ्च रज्येत दृष्टिर्दोषे बलीयसि ॥ १० ॥ अधःस्थिते समीपस्थं दूरस्थञ्चोपरिस्थिते । पार्श्वस्थिते तथा दोषे पार्श्वस्थानि न पश्यति ॥ ११ ॥ समन्ततः स्थिते दोषे सङ्कलानीव पश्यति । दृष्टिमध्यगते दोषे स एकं मन्यते द्विधा । द्विधास्थिते त्रिधा पश्येद् बहुधा चानवस्थिते ॥ १२ ॥

Symptoms— when third Patala attacked— Objects situated high above are seen and those piaced below remain unobserved when the deranged Dosa are infiltrated into the Third Patala (coat) of the Drsti. The Dosas affecting the Drsti (crystalline lens ), if highly enraged, impart their specific colours to the objects of vision. Even large objects seem to be covered with a piece of cloth. The images of objects and persons with ears and eyes, etc., seem to be otherwise i.e., bereft of those organs. The deranged Dosas situated at and obstructing the lower, upper and lateral parts of the Drsti (crystalline lens) respectively shut out the view of near, distant and laterally-situated objects. A dim and confused view of the external world is all that can be had when the deranged Dosas spread over and affect the whole of the Drsti (crystalline lens). A thing appears to the sight as if cut into two (bifurcated) when the deranged Dosas affect the middle part of the lens, and as triply divided and severed when the Dosas are scattered in two parts; while a multifarious image of the same object is the result of the manifold distributions of movability of the Dosas over the Drsti. 9-12.

Symptoms when fourth Patala attacked

तिमिराख्यः स वै दोषश्चतुर्थपटलं गतः । रुणद्धि सर्वतो दृष्टिं लिङ्गनाशः स उच्यते ॥ १३ ॥ तस्मिन्नपि तमोभूते नातिरूढे महागदे । चन्द्रादित्यौ सनक्षत्रावन्तरीक्षे च विद्युतः ॥ १४ ॥ निर्मलानि च तेजांसि भ्राजिष्णूनि च पश्यति । स एव लिङ्गनाशस्तु नीलिकाकाचसंज्ञितः ॥ १५ ॥

Symptoms when fourth Patala attacked— Loss of vision (Timira) results from the fact of the deranged bodily Dosas being confined within the fourth Patala (choroid) of the organ. When the vision is completely obstructed by the aforesaid cause, it is called a case of Linga-nasa (blindness ). Only a faint perception of the images of the sun, the moon and the stars, the heaven, a flash of lightning or any other such highly brilliant objects is possible in a case of superficial (not deep-seated) Linga-nasa. The Linga-nasa (blindness) is also called Nilika and kaca. 13-15.

Specific traits of Timira

वातेन तत्र रूपाणि भ्रमन्तीव स पश्यति । आविलान्यरुणाभानि व्याविद्धानि च मानवः ॥ १६ ॥ पित्तेनादित्यखद्योत-शक्रचापतडिद् गुणान् । च ॥ १८ ॥ शिखिबर्हविचित्राणि नीलकृष्णानि पश्यति ॥ १७ ॥ कफेन पश्येद्रूपाणि स्निग्धानि च सितानि च । गौरचामरगौराणि श्वेताभ्रप्रतिमानि पश्येदसूक्ष्माण्यत्यर्थं व्यभ्रे चैवाभ्रसंप्लवम् । सलिलप्लावितानीव परिजाड्यानि मानवः ॥ १९ ॥ तथा रक्तेन रक्तानि तमांसि विविधानि च । हरितश्यावकृष्णानि धूमधूम्राणि चेक्षते ॥ २० ॥ सन्निपातेन चित्राणि विप्लुतानीव पश्यति । बहुधा वा द्विधा वाऽपि सर्वाण्येव समन्ततः । हीनाधिकाङ्गान्यथवा ज्योतींष्यपि च पश्यति ॥ २१ ॥

Specific traits of Timira- All external objects are viewed as cloudy, moving, crooked and red coloured in the Vataja type (of Timira), while in the Pittaja type they appear to be invested with the different colours of the spectrum or of the rain-bow, of the glowworm, of the flash of lightning, or of the feathers of the pea-cock, or with a dark blue tint bordering on black; while in a case of kaphaja Timira, a thick white coat like that of a pack of white clouds or a deep white chowri (Camara) seems to intervene in everything which look white and oily and dull and appear hazy and cloudy in a fine day, or as if laid under a sheet of water. In a case of the Raktaja type of Timira, all objects appear red or envoloped in gloom, and they assume a greenish, greyish or blackish colour. In a case of Sannipatika Timira, the outer world looks vareigated and confused, appears as doubled or trebled to the vision (of the patient), and stars and planets, either defective or supplied with additional limbs, seem to float about in the vision. 16-21.

पित्तं कुर्यात् परिम्लायि मूर्च्छितं रक्ततेजसा । पीता दिशस्तथोद्यन्तमादित्यमिव पश्यति ।

विकीर्यमाणान् खद्योतैर्वृक्षांस्तेजोभिरेव च ॥ २२ ॥

Parimlayi-The quarters of the heaven look yellow and appear to the sight as if resplendent with the light of the rising sun, and trees seem as if sparking with the tangles of fire-flies in a case of Parimlayi, which should be ascribed to the action of the deranged Pitta in concert with the vitiated blood. 22.

The different colours of the pupil in cases of Linga nasa

वक्ष्यामि षड्विधं रागैर्लिङ्गनाशमतः परम् ॥ २३ ॥ रागोऽरुणो मारुतजः प्रदिष्टः पित्तात् परिम्लाय्यथवाऽपि नीलः । कफात् सितः शोणितजस्तु रक्तः समस्तदोषोऽथ विचित्ररूपः ॥ २४ ॥ रक्तजं मण्डलं दृष्टौ स्थूलकाचानलप्रभम् । परिम्लायिनि रोगे स्यान्म्लाय्यानीलञ्च मण्डलम् ॥ २५ ॥ दोषक्षयात् कदाचित् स्यात् स्वयं तत्र च दर्शनम् ॥ २६ ॥

The different colours of the pupil in cases of Linga-nasa— Now we shall describe the colours of the pupil in the six different types of Linga-nasa. The pupil assumes a reddish (Aruna) colour in the Vataja type of the disease; looks blue or bluish yellow in the pittaja, white in the Kaphaja and bloodred in the blood-origined one, while it assumes a variegated hue in the Sannipatika type of Linga-nasa. A circular patch (Mandala) tinged with a shade of bluish or bluish yellow colour and looking like fire or piece of thick grass, is formed on the pupil owing to the diseased and aggravated condition of the blood (with Pitta). In a case of Parimlayi pupil becomes hazy and bluish coloured and patient is sometimes able to catch faint glimpses of the external objects owing to the spontaneous and occasional filtering way of the deranged Dosas obstructing the vision. 23-26.

Specific Traits of Linga nasa

अरुणं मण्डलं वाताच्चञ्चलं परुषं तथा । पित्तान्मण्डलमानीलं कांस्याभं पीतमेव वा । श्लेष्मणा बहलं स्निग्धं शङ्खकुन्देन्दुपाण्डुरम् ॥ २७॥ चलत्पद्मपलाशस्थ: शुक्लो बिन्दुरिवाम्भसः | मृद्यमाने च नयने मण्डलं तद् विसर्पति ॥ २८ ॥ प्रवालपद्मपत्राभं मण्डलं’ शोणितात्मकम् । दृष्टिरागो भवेच्चित्रो लिङ्गनाशे त्रिदोषजे । यथास्वं दोषलिङ्गानि सर्वेष्वेव भवन्ति हि ॥ २९ ॥

Specific Traits of Linga-nasa- The circular patch ( over the pupil) in a case of Vataja Linga-nasa is red-coloured, and is moving and rough to the touch, while that in a case of Pittaja linga-nasa is bluish or yellow or coloured like bell-metal. The circular patch in a case of Kaphaja Linga-nasa is thick, oily and as white as a conchshell, a Kunda flower or the moon- resembling a white drop of water on the moving lotus leaf and moving away to and fro when the eye is rubbed. The circular patch over the pupil in a case of Raktaja (bloodorigined) Linga-nasa is red-coloured like a coral or a (red) lotus-petal. A Sannipatika type of the disease is marked by a variegated colour of the Drsti (pupil) and by the specific symptoms of the different Dosas. 27-29.

षड्लिङ्गनाशा: षडिमे च रोगा दृष्ट्याश्रयाः षट् च षडेव च स्युः । तथा नरः पित्तविदग्धदृष्टिः कफेन चान्यस्त्वथ धूमदर्शी |

यो ह्रस्वजात्यो नकुलान्धता च गम्भीरसंज्ञा च तथैव दृष्टिः ॥३०॥

The total number of diseases peculiar to the Drsti is twelve. The six types of Linga-nasa (Drsti) have been described above. The six other forms of the disease, peculiar to the Drsti (Pupil) are named as Pitta-vidagdha-Drsti, Slesma-vidagdha-Drsti, Dhuma-darsi, Hrasvajatya, Nakulandhyata and Gambhirika. 30.

पित्तेन दुष्टेन गतेन दृष्टिं पीता भवेद्यस्य नरस्य दृष्टिः । पीतानि रूपाणि च मन्यतेः यः स मानवः पित्तविदग्धदृष्टिः ॥ ३१ ॥ प्राप्ते तृतीयं पटलन्तु दोषे दिवा न पश्येन्निशि वीक्षते च । रात्रौ स शीतानुगृहीतदृष्टिः पित्ताल्पभावादपि तानि पश्येत् ॥ ३२ ॥

The disease in which the region of the Drsti (pupil) assumes a yellowish colour, and all external objects appear yellow to the sight owing to the presence of the vitaited (and augmented) Pitta in the region of the Drsti is called Pitta-Vidagdha-Drsti. It is due to an accumulation of the deranged Dosa (Pitta) in the third Patala (coat) of the eye, and the patient cannot see anything in the day, but can see only in the night. 31-32.

त्रिषुस्थितोऽल्पः पटलेषु दोषो नक्तान्ध्यमापादयति प्रसह्य ।

दिवा स सूर्यानुगृहीतदृष्टिर्वीक्षेत रूपाणि कफाल्पभावात् ॥ ३३ ॥

The external objects appear white to the sight when it is affected by the accumulation of the deranged Kapha. The deranged Dosa (Kapha), in this case, is simultaneously divided over all the three Patalas (coats) of the eye. In consequence of this the patient is attacked with nocturnal blindness, being able to see only in the daytime owing to the (melting and) decrease of the deranged Kapha through the heat of the sun. This is known as Slesma-vidagdha-Drsti. 33.

शोकज्वरायासशिरोऽभितापैरभ्याहता यस्य नरस्य दृष्टिः ।

स धूमकान् पश्यति सर्वभावांस्तं धूमदर्शीति वदन्ति रोगम् ॥ ३४ ॥

The external objects appear dusky or smoke-coloured when the sight is affected through grief, (high and protracted) fever, over-straining or excessive physical exercise, or injury to the head, etc. The affection of vision thus engendered is called Dhuma-Drsti (smoky sight). 34.

स ह्रस्वजाड्यो दिवसेषु कृच्छ्रादहस्वानि रूपाणि च येन पश्येत् ॥ ३५ ॥

The disease in which small things can be viewed only with the greatest difficulty ( even) in the daytime, but can be viewed (easily and clearly) in the night owing to the subsidence of the deranged Pitta through the coldness of the atmosphere (and a general cooling of the Earth’s surface)’ is called Hrasva-jatya.2 35.

विते येन नरस्य दृष्टिर्दोषाभिपन्ना नकुलस्य यद्वत् । चित्राणि रूपाणि दिवा स पश्येत् स वै विकारो नकुलान्ध्यसंज्ञः ॥ ३६॥

1. The latter part of the text here seems to be incongruous. Madhava does not read the last line in his Nidana, nor does Dalhana include it in his commentary. Dalhana, on the other hand, says that some read this line, but holds, on the authority of Videha, that the reading is incongruous, in as much as “Hrasva-jatya” is said to cause one of the four types of night-blindness.

2. Some read Hrasva-jadya in place of Hrasva-jatya.

याति । तज्ज्ञाः दृष्टिर्विरूपा श्वसनोपसृष्टा सङ्कुच्यतेऽभ्यन्तरतश्च रुजावगाढा च तमक्षिरोगं गम्भीरिकेति प्रवदन्ति ॥ ३७ ॥

The form of occular affection in which the colour of Drsti (Pupil) of a man affected by the Dosas resembles (and is found to emit (Luminous flash like) that of a mungoose in consequence of which the external objects appear multi-coloured in the day time,’ is called Nakulandhya. The form of occular affection due to the action of the deranged Vayu, and in which the Drsti (pupil) is contracted and deformed and sinks into the socket, attended with an extreme pain in the affected parts, is called Gambhirika. 36-37.

बायौ पुनर्द्वाविह सम्प्रदिष्टौ निमित्ततश्चाप्यनिमित्ततश्च । निमित्ततस्तत्र शिरोऽभितापाज्ज्ञेयस्त्वभिष्यन्दनिदर्शनश्च ॥ ३८ ॥ सुरर्षिगन्धर्व्वमहोरगाणां सन्दर्शनेनापि च भास्वराणाम् । हन्येत दृष्टिर्मनुजस्य यस्य स लिङ्गनाशस्त्वनिमित्तसंज्ञः ॥ ३९ ॥ तत्राक्षि विस्पष्टमिवावभाति वैदूर्यवर्णा विमला च दृष्टिः । विदीर्यते सीदति हीयते वा नृणामभीघातहता तु दृष्टिः ॥ ४० ॥

Besides the above, there are two more forms of Linga-nasa of traumatic origin, vis., Sa-nimitta (of ascertainable origin) and A-nimitta (without any manifest or ascertainable cause). Under the first group may be put those which are produced by such causes as an over-heated² condiiton of the head (brain, etc.), and marked by the specific symptoms of (blood-origined) Abhisyanda, while the second comprises of those in which the loss of one’s vision is due to causes, such as the witnessing of divine halo or effulgence emanating from the ethereal person of a god, or a Gandharva (demigod), a holy saint, a celestial serpent, or such other highly bright object. In this case the eye is not outwardly affected and the pupil (Drsti) looks as bright and clear as a Vaidurya gem, while in the former case (of ascertainable origin) the eye is characterised by a sunken or pierced or impaired aspect of the pupil. 38-40.

1. This shows that a man affected with this form of disease cannot see anything in the night.

2. The head is liable to be over-heated by the smelling of poison or poisonous objects or any other strong-scented flower, etc.

इत्येते नयनगता मया विकाराः संख्याताः पृथगिह षट् च सप्ततिश्च । एतेषां पृथगिह विस्तरेण सर्वं वक्ष्येऽहं तदनु चिकित् सितञ्च तावत् ॥ ४१ ॥

We have thus finished describing separately the diagnostic traits of the seventy-six forms of disease which affect the organ of vision. We shall hereafter separately deal with the nature of the medical treatment to be pursued in each case. 41.

इति सुश्रुत संहितायामुत्तरतन्त्रे दृष्यिगतरोगविज्ञानीयो नाम सप्तमोऽध्यायः ॥७॥

Thus ends the seventh chapter of the Uttara-Tantra in the Susruta Samhita which treats of the pathology of the eye diseases peculiar to the pupil of the eye.


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