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Sushruta SamhitaKarna Vyadha bandha vidhi adhyaya - Sushruta Samhita Sutrasthana Chapter 16

Karna Vyadha bandha vidhi adhyaya – Sushruta Samhita Sutrasthana Chapter 16

अथातः कर्णव्यधबन्धविधिमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥

Now we shall discuss the Chapter which treats of the piercing and bandaging of the lobules of ears (Karna-Vyadha-bandha-vidhi adhyaya). 1

रक्षाभूषणनिमित्तं बालस्य कर्णौ विध्येते । तौ षष्ठे मासि सप्तमे वा शुक्लपक्षे प्रशस्तेषु तिथिकरणमुहूर्त्तनक्षत्रेषु कृतमङ्गलस्वस्तिवाचनं धात्र्यङ्के कुमारधराङ्के वा कुमारमुपवेश्य बालक्रीडनकैः प्रलोभ्याभिसान्त्वयन् भिषग् वामहस्तेनाकृष्य कर्णं दैवकृते च्छिद्रे आदित्यकरावभासिते शनैः शनैर्दक्षिणहस्तेन ऋजु विध्येत्; प्रतनुकं सूच्या बहलमारया, पूर्व्व दक्षिणं कुमारस्य वामं कन्यायाः । ततः पिचुवर्त्ति प्रवेशयेत् ॥२॥

The lobules of the ears of an infant are usually pierced through for protecting it (from the evil influences of malignant stars and spirits) and for the purposes of ornamentation as well. The piercing should be performed on a day of bright fortnight marked by the auspicious lunar and astral combinations, and in the sixth or the seventh month of the year reckoned from its beginning (Bhadra). The child should be placed on the lap of its nurse, and benedictions should be pronounced over it. Then having soothed it and lured it with toys and playthings, the physician should draw down with his left hand the lobules of its ears with a view to detect, with the help of the reflected sun-light, (the closed up) apertures that are naturally found to exist in those localities. Then he should pierce them straight through with a needle held in his right hand, or with an awl (Ara), or with a thick needle where the appendages would be found to be too thick. The lobule of the right ear should be first pierced and then the left in the case of a male child, while the countrary should be the procedure in the case of a female. Plugs of cotton-lint should be then inserted into the holes of the pricked ear-lobules, which should be lubricated or rubbed with any unboiled oil. 2

शोणितबहुत्वेन वेदनया चान्यदेशविद्धमिति जानीयात्, निरुपद्रवतया तद्देशविद्धमिति ॥३॥

A copious bleeding attended with pain would indicate that the needle has passed through a place other than the natural (and closed up) fissure described above; whereas the absence of any serious aftereffect would give rise to the presumption that the piercing has been done through the right spot. 3

तत्राज्ञेन यदृच्छया विद्धासु सिरासु कालिकामर्मरिकालोहितिकासूपद्रवा भवन्ति । तत्र, कालिकायां ज्वरो दाहः श्वयथुर्वेदना च भवति । मर्मरिकायां वेदना ज्वरो ग्रन्थयश्च, लोहितिकायां मन्यास्तम्भापतानकशिरोग्रहकर्णशूलानि भवन्ति । तेषु यथास्वं प्रतिकुर्वीत | ॥४॥ –

Any of the local veins incidentally injured by an ignorant, bungling surgeon, may be attended with symptoms which will be described under the heads of Kalika, Marmarika, and Lohitika. Kalika is marked by fever and a burning pain in the affected part and swelling. Marmarika gives rise to pain and knotty (nodular) formations about the affected region, accompanied by (the characteristic inflammatory) fever; while in the last named type (Lohitika) symptoms such as Manya-Stambha (numbness to the tendons forming the nape of the neck), Apatanak (a type of tetanus), Sirograha (headache) and karna-sula (ear-ache) exhibit themselves, and they should be duly treated with medicinal remedies laid down under their respective heads. 4

क्लिष्टजिह्याप्रशस्तसूचीव्यधाद् गाढतरवर्त्तित्वाद् दोषसमुदाया दप्रशस्तव्यधाद् वा यत्र संरम्भो वेदना वा भवति, तत्र वर्त्तिमुपहृत्याशु मधुकैरण्डमूलमञ्जिष्ठायवतिलकल्कैर्मधुघृतप्रगाढैरालेपयेत् तावद्यावत् सुरूढ इति । सुरूढञ्चैनं पुनर्विध्येत्, विधानन्तु पूर्व्वोक्तमेव ॥५॥

The lint should be speedly taken out from a pierced hole which is marked by extreme pain and swelling, etc., on account of its being made with a blunt, crooked or stunted needle, or owing to its being plugged with a deep and inordinately large lint, or to its being disturbed by the aggravated bodily humours (Dosas), or to its being made at a wrong place. An unguent composed of Madhuka, Eranda roots, Marnjistha, Yava, Tila, honey and clarified butter pasted together, should be thickly plastered over the affected part until the unlcers are perfectly healed; after which the lobules of the ears should be again pierced through according to the directions laid down before. 5

तत्र सम्यग् विद्धामामतैलेन परिषेचयेत् । त्र्यहात् त्र्यहाच्च वर्त्ति स्थूलतरां दद्यात् परिषेकञ्च तमेव । अथ व्यपगतदोषोपद्रवे कर्णे वर्द्धनार्थं लघुवर्द्धनकं कुर्य्यात् ॥ ६ ॥

The lint should be removed, each third day, and a thicker one should be inserted in its stead on each successive occasion, and the part should be rubbed with (unboiled oil) as before. For the expansion of the fissures, (sticks of Nimba or Apamarga, or rods of lead) should be inserted into them after the subsidence of the accompanying symptoms and deranged bodily humours (in the locality). 6

भवति चात्र

एवं विवर्द्धितः कर्णश्छिद्यते तु द्विधा नृणाम् ।

दोषतो वाभिघाताद् वा सन्धानं तस्य मे श्रृणु ॥ ७ ॥

Metrical Text: The fissures thus expanded may ultimately bifurcate the lobules of the ears owing to the effects of the deranged bodily humours (Dosa), or of a blow. Now hear me discourse on the mode of adhesioning them (with suitable bandages). 7

तत्र समासेन पञ्चदशकर्णबन्धाकृतयः । तद्यथा- नेमिसन्धानक उत्पलभेद्यको वल्लूरक आसङ्गिमो गण्डकर्ण आहार्यो निर्व्वेधिमो व्यायोजिमः कपाटसन्धिकोऽर्द्धकपाटसन्धिकः संक्षिप्तो हीनकर्णो वल्लीकर्णो यष्टिकर्णः काकौष्ठक इति ॥८॥

These unions or adhesions admit of being briefly divided into fifteen different kinds; viz., the Nemi-sandhanaka, the Utpala-Bhedyaka the Valluraka, the Asangima, the Ganda karna, the Aharyaya, the Nirvedhima, the Vyayojima, the Kapata sandhika the Ardhakapatasandhika, the Samksipta, the Hina-karna, the Vallikarna, the Yastikarna, and the Kakausthaka. 8

तेषु, पृथुलायतसमोभयपालिर्नेमिसन्धानकः । वृत्तायतसमोभयपालिरुत्पलभेद्यकः । ह्रस्ववृत्तसमोभयपालिर्वल्लूरकः । अभ्यन्तरदीर्घेकपालिरासङ्गिमः । वाह्यदीर्घेकपालिर्गण्डकर्णः । अपालिरुभयतोऽप्याहार्य्यः । पीठोपमपालिरुभयतः क्षीणपुत्रिकाश्रितो निर्व्वेधिमः । स्थूलाणुसमविषमपालिर्व्यायोजिमः । अभ्यन्तरदीर्घेकपालिरितराल्पपालिः कपाटसन्धिकः । बाह्यदीर्घेकपालिरितराल्पपालिरर्द्धकपाटसन्धिकः । तत्र दशैते कर्णबन्धविकल्पाः साध्याः । तेषां नामभिरेवाकृतयः प्रायेण व्याख्याताः ॥९॥

Out of these, the process, known as the Nemi – sandhanaka, should be used in cases where each of the bifurcated lobes of the ears would be found to be thick, extended, and equal in size. The process, known as the Utpala-Bhedyaka, should be used in cases where the severed lobes of the ears would be found to be round, extended, and equal in dimensions. The process, Valluraka should be resorted to in cases where the severed lobes of the ears would be found to be short, circulr and equal in size. The process, known as the Asangima,should be adopted in cases where the anterior surface of one of these severed appendages would have a more elongated shape than the other. The process, known as the Ganda-Karna, consists in slicing off a patch of healthy flesh from one of the regions of the cheeks and in adhering it to one of the severed lobes of the ears which is more elongated on its anterior side than the other (Plastic-operations). In the case of extremely short lobes, the flesh should be cut off from both the cheeks and adhered to them, the process being known as the Aharyaya. The lobes of the ears which have been completely severed from their roots are called Pithopamas. The process known as the Nirvedhima should b resorted to in such cases by piercing the two Putrikas (Tragus and Anti-tragus) of the ears. The process known as the Vyayojima should be made use of in cases where one of the bifurcated lobes of the ear should be found to be dissimilar to the other as regards its thickness or thinness. The process known as Kapata-Sandhika consists in bringing about an adhesion, on the posterior side, between one of the bifurcated lobes and another, which is elongated on the anterior side of the ear. The adhesion is so called from the fact of its resembling the closing of the two leaves of a door (Kapata). The process known as the Ardha-kapata-Sandhika consists in bringing about an adhesion on the anterior side between the shorter one of the two parts of a bifurcated ear-lobe with the part, elongated on the posterior side, like a half-closed door. The ten aforesaid processes of adhesion may be successfully brought about and their shapes can be easily pictured from the meanings of their respective names. 9

संक्षिप्तादयः पञ्चासाध्याः । तत्र शुष्कशष्कुलिरुत्सन्नपालिरितराल्पपालिः संक्षिप्तः । अनधिष्ठानपालिः पर्य्यन्तयोश्च क्षीणमांसो हीनकर्णः । तनुविषमाल्पपालिर्वल्लीकर्णः । ग्रथितमांसस्तब्धशिरासन्ततसूक्ष्मपालिर्यष्टिकर्णः । निर्माससंक्षिप्ताग्राल्पशोणितपालिः काकौष्ठक इति । बन्धेष्वपि तु शोफदाहरागपाकपिडकास्रावयुक्ता न सिद्धिमुपयान्ति ॥१०॥

The remaining five sorts such as the Samksipta etc., are seldom attended with success and hence are called impracticable (Asadhayas). The process Samksipta has its scope in the case where the auricle (Shashkuli) has been withered up and one of the bifurcated lobes is raised, the other being reduced and shortened. The process of Hinakarna should be adopted in cases where the supporting rim of the lobe (pinna) has been entirely swept away and its exterior sides and the cheeks are sunk and devoid of flesh. Similarly the adhesive process known as the Vallikarna is indicated in cases where the lobes are short, thin and unequal. The adhesion known as the Yasthi Karna is indicated in cases where the thin and severed ear-lobes are run across with veins and made of knotty or nodular flesh. The case in which the ear-lobe, being permeated with a little quantity of blood, is fleshless and ends in a narrow tip or end, furnishes the occasion for Kakausthaka pali.

The five abovesaid adhesions, if followed by swelling, inflammation, suppuration and redness of the affected part and found to be secreting a sort of slimy pus or studded over with pustular eruptions, may be apprehended as not to be attended with success. 10

भवन्ति चात्र ।

यस्य पालिद्वयमपि कर्णस्य न भवेदिह । कर्णपीठं समे मध्ये तस्य विद्ध्वा विवर्द्धयेत् ।।११।।

वाह्यायामिह दीर्घायां सन्धिराभ्यन्तरो भवेत् । आभ्यन्तरायां दीर्घायां बाह्यसन्धिरुदाहृता ।। १२ ।।

एकैव तु भवेत् पालिः स्थूला पृथ्वी स्थिरा च या । तां द्विधा पाटयित्वा तु छित्त्वा चोपरि सन्धयेत् ॥ १३ ॥

गण्डादुत्पाटय मांसेन सानुबन्धेन जीवता । कर्णपालीमपालेस्तु कुर्य्यान्निर्लिख्य शास्त्रवित् ।।१४।।

Authoritative verses on the subject: The exact middle point of the external ear should be pierced (with a knife) and the severed parts should be pulled down and elongated in the case where both the parts of a bifurcated ear-lobe would be found to have been entirely lost or eaten away, In the case where the posterior one of the two bifurcated parts would be found to be longer or more elongated, the adhesion should be effected on the anterior side; whereas the contrary should be the case where the anterior one would appear to be more elongated. Only the remaining one of the two bifurcated parts of an ear-lobe would be pierced, cut in two and adhesioned on the top, in the case where the othe part would be found to be gone. A surgeon well-versed in the knowledge of surgery (Sastras) should slice off a patch of living flesh from the cheek of a person devoid of ear-lobes in a manner so as to have one of its ends attached to its former seat (cheek). Then the part, where the artificial ear-lobe is to be made, should be slightly scarified (with a knife), and the living flesh, full of blood and sliced off as previously directed, should be adhesioned to it so as to resemble a natural ear-lobe in shape). 11-14

अतोऽन्यतमं बन्धं चिकीर्षुरग्रोपहरणीयोक्तोपसम्भृतसम्भारं विशेषतश्चात्रोपहरेत् सुरामण्डं क्षीरमुदकं धान्याम्लं कपालचूर्णञ्चेति । ततोऽङ्गनां पुरुषं वा ग्रथितकेशान्तं लघु भुक्तवन्तमाप्तैः सुपरिगृहीतञ्च कृत्वा, बन्धमुपधार्य्य, छेद्यभेद्यलेख्यव्यधनैरुपपन्नैरुपपाद्य, कर्णशोणितमवेक्षे तदुष्टमदुष्टं वेति । तत्र वातदुष्टे धान्याम्लोष्णोदकाभ्यां पित्तदुष्टे शीतोदकपयोभ्यां श्लेष्मदुष्टे सुरामण्डोष्णोदकाभ्यां प्रक्षाल्य कर्णी, पुनरवलिख्यानुन्नतमहीनमविषमञ्च कर्णसन्धिं सन्निवेश्य, स्थितरक्तं सन्दध्यात्। ततो मधुघृतेनाध्यज्य, पिचुप्लोतयोरन्यतरेणावगुण्ठ्य, सूत्रेणानवगाढ़मनतिशिथिलञ्च बद्धवा, कपालचूर्णेनावकीर्य्याचारि कमुपदिशेद, द्विव्रणीयोक्तेन च विधानेनोपचरेत् ॥१५॥

A surgeon, whishing to effect any sort of adhesion other than those described before, should first collect the articles enumerated in the chapter on Preliminary Measures to Surgical Operations, together with milk, water, Dhanyamla (fermented rice boilings), Suramanda (transparent surface-part of wine) and powders of earthen vessel. Then the hair of the patient, whether male or female, should be gathered and tied up in a knot, and the patient should be given a light food (so as to keep up his strength without hampering his digestion); after which his friends and relations should be asked to hold him firm. Then having ascertained the particular nature of adhesion to be effected in the case, the surgeon should examine the local blood by incising, excising, scarifying or puncturing the affected lobes as found necessary, and determine whether the same is pure or vitiated. Then having washed the blood with Dhanyamla and tepid water, if found vitiated through the action of the deranged (Vayu), or with milk and cold water in the event of the same being contaminated by the deranged Pitta, or with Suramanda and warm water in the case of its being vitiated by the action of the disorderded Kapha, the surgeon shall bring about the adhesion by again scarifying the affected parts of the ear, so as not to leave the adhesioned parts elevated (raised), unequal and short. Of course the adhesion should be affected with the blood being still left in the parts that had been scraped. Then having anointed them with honey and clarified butter, they should be covered with cotton and linen, and tied with strings of thread, neither too loose nor too tight, and dusted over with powders of baked clay. Then directions should be given as regards the diet and nursing of the patient, who may be as well treated with the regimen laid down in the chapter on Dvi-vraniya.

भवति चात्र

विघट्टनं दिवास्वप्नं व्यायाममतिभोजनम् । व्यवायमग्निसन्तापं वाक्श्रमञ्च विवर्ज्जयेत् ।।१६।।

आमतैलेन त्रिरात्रं परिषेचयेत्, त्रिरात्राद्य पिचुं परिवर्तयेत् ।।१७।।

Authoritative verses on the subject: The patient should be careful not to disturb the bandage and avoid physical exercise, overeating, sexual intercouse, exposure to, or basking in, the glare of fire, fatiguing talk, and sleep by day. For three cconsecutive days the ulcer should be anointed with unboiled oil; and cotton soaked in the same substance should be placed over it, which is to be altered, each third day, till healing. 16-17

न चासंशुद्धरक्तमतिप्रवृत्तरतं क्षीणरक्तं वा सन्दध्यात्। स हि वातदुष्टरक्ते रूढोऽपि परिपुटनवान्, पित्तदुष्टे दाहपाकरागवेदनावान्, श्लेष्मदुष्टे स्तब्धः कण्डूमान् अतिप्रवृत्तरक्ते श्यावशोफवान् । क्षीणोऽल्पमांसो न वृद्धिम् उपैति । स यदा सुरूढो निरुपद्रवः सवर्णो भवति तदैनं शनैः शनैरभिवर्द्धयेत् ॥१८॥ “

अतोऽन्यथा संरम्भदाहपाकरागवेदनावान् पुनश्छिद्यते वा, अथास्याप्रदुष्टस्याभिवर्द्धनार्थमभ्यङ्गः । तद्यथागोधाप्रतुदविष्किरानूपौदकवसामज्जानौ पयः सर्पिस्तैलं गौरसर्षपजञ्च यथालाभं सम्भृत्यार्कालर्कबलातिबलानन्तापामार्गाश्ववगन्धाविदारिगन्धाक्षीरशुक्लाजलशूकमधुरवर्गपस्याप्रतीवापं तैलं वा पाचयित्वा स्वनुगुप्तं निदध्यात् ॥१९॥

The incidental ulcer should not be tried to be healed up as long as the local blood (blood in the ulcer) is not fully purified; or so long as there is haemorrhage from the seat of the affection or the local blood continues feeble. An ulcer, adhesioned with the least of the Vayuvitiated blood continuing in its inside, will spontaneously burst or break open afresh, it will be again attended with pain, burning, redness and suppuration in the event of its being closed with a little quantity of Pitta-deranged blood incarcerated in its inside. Adhesioned even with a little quantity of Kapha fouled blood in its cavity an ulcer is marked by itching and numbness. An ulcer adhesioned with the continuance of an active haemorrhage from its inside is marked by a brown or blackish yellow swelling. An ulcer, adhesioned at a time when the local blood, though otherwise good or pure, has been thinned or weakened through excessive bleeding, is followed by a corresponding emaciation (thinness) of the adhesioned part. The lobule of the ear thus adhesioned should be gradually pulled down and elongated after the complete healing of the local ulcer and the subsidence of its concomitant symptoms, and after the cicatrix has assumed the colour of the skin of the surrounding part. Otherwise the adhesioned part may be characterised by pain, swelling, inflammation, burning and suppuration, or the adhesion may again fall off. An adhesioned ear-lobe, un-accompanied by any of the distressing or unfavourable symptoms, should be gradually elongated by rubbing it with an unguent composed of the milk, fat, and marrow of any such animals and birds as the Godha, the Pratudas. the Viskiras, the Anupas, or the Audakas as would be available, and clarified butter and the oil expressed out of the seeds of white mustard, boiled with the decoction or Kvatha of Arka, Alarka, Bala, Atibala, Ananta, Apamarga, Asvagandha, Vidarigandha, Ksira-Sukla,.. Jalasuka and the drugs forming the group known as the Madhura, which should be previously prepared and carefully stowed in a covered receptacle. 18-19 स्वेदितोन्मर्द्दितं कर्णं स्नेहेनैतेन योजयेत् ।

अथानुपद्रवः सम्यग् बलवांश्च विवर्द्धते । यवाश्वगन्धायष्टयाह्रैस्तिलैश्चोद्वर्त्तनं हितम् । ॥ २० ॥

शतावर्य्यश्वगन्धाभ्यां पयस्यैरण्डजीवनैः। तैलं विपक्वं सक्षीरमभ्यङ्गात् पालिवर्द्धनम् ॥ २१ ॥

Metrical texts : Then the above medicinal unguent should be applied or rubbed over the lobe of the affected ear, whereby all the disturbing or unfavourable symptoms would be subsided, thus favouring its firm and steady growth. Similarly a plaster composed of Yava, Asvagandha, Yastyahva, and Tila, pasted together might be rubbed over the affected ear-lobe with advantage. Oil prepared and boiled with the essence of Satavari and Asvagandha, or Payasya, Eranda, Jivana and milk increases the growth of an ear-lobe. 20-21

ये तु कर्णा न वर्द्धन्ते स्वेदस्नेहोपपादिताः । तेषामपाङ्गदेशे तु कुर्य्यात् प्रच्छानमेव तु । बाह्यच्छेदं न कुर्वीत व्यापदः स्युस्ततो ध्रुवाः ॥ २२ ॥

The lobe of an ear, which refuses to grow in size in spite of being formented and lubricated as above indicated, should be scarified with slight longitudinal incisions on its anterior side (that is on the side nearest to the cheeks) and not on the posterior one, as such a precedure might be attended with dreadful results. 22

बद्धमात्रन्तु यः कर्ण सहसैवाभिवर्द्धयेत् । आमकोशी समाध्मातः क्षिप्रमेव विमुच्यते ।। २३ ।।

जातरोमा सुवर्मा च श्लिष्टसन्धिः समः स्थिरः । सुरूढोऽवेदनो यस्तु तं कर्ण वर्द्धयेच्छनैः || २४ ।।

An ear-lobe should not be tried to be elongated just after the adhesion of its two severed parts, inasmuch as the centre of the adhesion, still being raw, might cause them to fall off again. Thus an ear-lobe under the circumstance should be gradually elongated, only when it would be found to be marked by the growth of hair on its surface, and the hole or the perforation has assumed a circular look, and the adhesion has become firmly effected, well-dried, painless, even and level in its entire length. 23-24

अमिता: कर्णबन्धास्तु विज्ञेयाः कुशलैरिह | यो यथा सुविशिष्ट: स्यात् तं तथा विनियोजयेत् । ॥ २५ ॥

The modes of bringing about an adhesion of the two severed parts of an ear-lobe are innumerable; and a skilled and experienced surgeon should determine the shape and nature of each according to the exigencies of a particular case. 25

कर्णपाल्यामयानॄणां कर्णपाल्यां पुनर्वक्ष्यामि सुश्रुत। वातपित्तकफास्त्रयः ।। २६ ।।

प्रकुपिता द्विया वाऽप्यथ संसृष्टाः कुर्वन्ति विविधा रुजः । विस्फोट: स्तब्धता शोफः पाल्यां दोषे तु वातिके | ॥ २७ ॥

दाहविस्फोटजननं शोफः पाकश्च पैत्तिके। कण्डूः सश्वयथुः स्तम्भो गुरुत्वञ्च कफात्मके | ॥२८ ।।

यथादोषं च संशोध्य कुर्य्यात्तेषां चिकित्सितम् । स्वेदाभ्यङ्गपरीषेकैः क्रियां क्रियां प्रलेपासृग्विमोक्षणैः ।।२९ ।।

भोजनैस्तथा । मृद्वीं बृंहणीयैर्यथास्वं य एवं वेत्ति दोषाणां चिकित्सां कर्त्तुमर्हति ।।३०।।

Additional Text: O Susruta, again I shall deal with diseases which affect the lobule of an ear under the circumstance described above The deranged bodily Vayu, Pitta and Kapha, either jointly or severally, give rise to several types of diseases which affect the lobule of an ear. The deranged Vayu produces numbness and an erysipelatous sweeling and ulcer about the affected ear-lobe, while an erysipelatous ulcer in the locality accompanied by swelling, burning, suppuration, etc., should be ascribed to the action of the deranged Pitta. heaviness, numbness and swelling of the ear-lobe accompanied by constant itching in the affected locality mark the action of the deranged Kapha. The medical treatment in these cases consists in effecting a subsidence of the particular deranged humour by means of diaphoresis, lubrication, Parisekas (medicated plasters) or blood-letting as the case may be. These measures should be moderately applied and a nutritive and invigorating food should be prescribed for the patient. The physician who is well familiar with the actions of the deranged bodily humours as described above, should be looked upon as alone entitled to take in hand a case, which falls under the head of one of the preceding types. 26-30

अत ऊर्ध्वं नामलिङ्गैर्वक्ष्ये पाल्यामुपद्रवान् । उत्पाटकश्चोत्पुटकः श्यावः कण्डूयुतो भृशम् ॥ ३१ ॥

अवमन्थः सकण्डूको ग्रन्थिको जम्बुलस्तथा । स्त्रावी च दाहवांश्चैव श्रृण्वेषां क्रियाम् | ॥ ३२ ॥

Now I shall enumerate the names of the several diseases which affect a severed lobe of the ear and describe the symptoms which each of them develops in succession. They are known as Utpataka, Utputuka, Syava, Bhrsam kanduyuta, Avamantha, Sakanduka, Granthika, Jambula, Sravi and Dahavana. Now hear me discourse on the nature of medicinal treatment to be adopted in each of them. 31-32

अपामार्गः सर्जरसः पाटलालकुचत्वचौ । उत्पाटके प्रलेपः स्यात्तैलमेभिश्च पाचयेत् ।।३३ ।।

शम्पाकशिग्रुपूतीकान् गोधामेदोऽथ तद्वसाम् । वाराहं गव्यमैणेयं पित्तं सर्पिश्च संसृजेत् । लेपमुत्पुटके दद्यात्तैलमेभिश्च साधितम् | ॥ ३४ ॥

गौरीं सुगन्धां सश्यामामनन्तां तण्डुलीयकम् । श्यावे प्रलेपनं दद्यात्तैलमेभिश्च साधितम् ।।३५ ।।

पाठां रसाञ्जनं क्षौद्रं तथा स्यादुष्णकाञ्जिकम् । दद्याल्लेपं सकण्डूके तैलमेभिश्च साधितम् ।।३६ ।।

Remedies: A plaster composed of the drugs known as Apamarga, Sarjarasa, Patala bark and Lakuca bark pasted togather, or a medicated oil prepared and boiled with the preceding substances should be applied in a case of the Utpataka type, whereas a case of the Utputuka type would prove amenable to a medicinal plaster consisting of Sampaka, Sigru, Puti-Karanja the fat and marrow of a Godha, and the milk and bile of a she-deer, she-buffalo or sow, pasted together; or to a medicated unguent composed of the abovesaid substances duly boiled with oil. Similarly, a medicinal plaster composed of the drugs known as Gauri (Haridra), Sugandha, Syama, Ananta, Tanduliyaka, or an oil prepared and boiled with the extract of the preceding drugs, would prove beneficial in a case of the Syava type of the desease. In a case of the bhrsam-Sakandukam type, the affected part should be rubbed or lubricated with an unguent or medicated oil prepared with the boiled extract of Patha, Rasanjana, Ksaudra, and warm Kanjika, or a plaster composed of the same drugs and substances should be applied over the diseased locality. 33-36

व्रणीभूतस्य देयं स्यादिदं तैलं विजानता ।।३७ ।।

मधुकक्षीरकाकोलीजीवकाद्यैर्विपाचितम् गोधावराहसर्पाणां वसाः स्युः कृतबृंहणे ॥ ३८ ॥

प्रलेपनमिदं दद्यादवसिच्यावमन्थके। प्रपौण्डरीकं मधुकं समङ्गां धवमेव च ।।३९।।

तैलमेभिश्च सम्पक्वं श्रृणु कण्डूमतः क्रियाम् । सहदेवा विश्वदेवा अजाक्षीरं ससैन्धवम् ।। ४० ।।

एतैरालेपनं दद्यात्तैलमेभिश्च साधितम् ।।४१ ।।

ग्रन्थिके गुटिकां पूर्वं स्त्रावयेदवपाटच तु। ततः सैन्धवचूर्णन्तु घृष्ट्वा लेपं प्रदापयेत् ।।४२ ।।

लिखित्वा तत् स्रुतं घृष्ट्वा चूर्णैरोध्रस्य जम्बुले | क्षीरेण प्रतिसार्यैनं शुद्धं संरोपयेत्ततः ।।४३।।

मधुपर्णी मधूकञ्च मधुकं मधुना सह । लेपः स्त्राविणि दातव्यस्तैलमेभिश्च साधितम् ॥४४॥

पञ्चवकैः समधुकैः पिष्टैस्तैश्च घृतान्वितैः। जीवकाद्यैः ससर्पिष्कैर्दह्यमानं प्रलेपयेत् ।।४५ ।।

In a case of ulceration, the ulcerated ear-lobe should be rubbed with the oil prepared and boiled with the drugs known as Madhuka and Ksirakakoli, or with those which form the group known as the Jivakadi-Varga; while in a case where Brmhana measures are to be adopted, lard prepared from the fat of a Godha, boar, or snake might be used with advantage. In the Avamanthaka type of the diseased earlobe should be washed and covered with a plaster composed of the drugs known as Prapaundarika, Madhuka, Samanga and Dhava, or rubbed with oil prepared and boiled with the same drugs. Similarly a case of Kandu-Yuta (accompanied with itching) would yield to a plaster composed of the drugs known as Sahadeva, Visvadeva, and Saindhava salt pasted with goat s milk, or to the medicated oil boiled and prepared with the same drugs and substances. In a case of the Granthika type (accompanied by the formation of knotty growth in its inside) the knotty growths or glandular formations should be first removed, and the affected locality should be bled with a surgical instrument and dusted with powdered Saindhava salt. Likewise, in a case of Jambula type, blood-letting should be resorted to by sacrifying the seat of the disease, which should be then washed with a spray of milk. The ulcer should be healed after the perfect purification of its internal morbid contents. A case of the Sravi (secreting) type would readily yield to a medicinal plaster composed of the drugs known as Madhuparni, and Madhuka, or of Madhuka pasted with honey, or to the medicinal oil prepared and boiled with the same drugs and substances. A case of the Dahamana (burning) type should be treated with a plaster composed of the drugs known as the five Kalkas and Madhuka pasted together and mixed with clarified buffer, or with a pasted compound of the drugs which form the group of the Jivakadi Varga with a quantity of clarified butter added to it. 37-45

विश्लेषितायास्त्वथ नासिकाया वक्ष्यामि सन्धानविधिं यथावत् । नासाप्रमाणं पृथिवीरुहाणां पत्रं गृहीत्वा त्ववलम्बि तस्य ।। ४६ ।।

तेन प्रमाणेन हि गण्डपार्श्वादुत्कृत्य बद्धन्त्वथ नासिकाग्रम् | विलिख्य चाशु प्रतिसन्दधीत तत् साधुबन्धैर्भिषगप्रमत्तः।।४७।।

सुसंहितं सम्यगतो यथावन्नाडीद्वयेनाभिसमीक्ष्य बध्द्धा ! प्रोन्नम्य चैनामवचूर्णयेच्च पत्तङ्गयष्टीमधुकाञ्जनैश्च ।। ४८ ।।

संछाद्य सम्यक् पिचुना सितेन तैलेन सिञ्चेदसकृत् तिलानाम् । घृतञ्च पाय्यः स नरः सुजीर्णे स्निग्धो विरेच्यः स यथोपदेशम् ।।४९ ।।

रूढञ्च सन्धानमुपागतं स्यात् तदर्द्धशेषन्तु पुनर्निकृन्तेत् । हीनां पुनर्वर्द्धयितुं यतेत समाञ्च कुर्य्यादतिवृद्धमांसाम् ॥५०॥

नाडीयोगं विनौष्ठस्य नासासन्धानवद् विधिम् । य एवमेव जानीयात् स राज्ञः कर्तुमर्हति ।।५१ ।।

Rhinoplastic operations : Now I shall deal with the process of affixing an artificial nose. First the leaf of a creeper, long and broad enough to fully cover the whole of the severed or clipped off part, should be gathered; and a patch of living flesh, equal in dimension to the preceding leaf, should be sliced off (from down upward) from the region of the cheek and, after scarifying it with a knife, swiftly adhered to the severed nose. Then the cool-headed physician should steadily tie it up with a bandage decent to look at and perfectly suited to the end for which it has been employed (Sadhu bandha). The physician should make sure that the adhesion of the severed parts has been fully effected and then insert two small pipes into the nostrils to facilitate respiration, and to prevent the adhesioned flesh from hanging down. After that, the adhesioned part should be dusted with the powders of Pattanga, Yastimadhuka and Rasanjana pulverised together; and the nose should be enveloped in Karpasa cotton and several times sprinkled over with the refined oil of pure sesamum. Clarified butter should be given to the patient for drink, and he should be anointed with oil and treated with purgatives after the complete digestion of the meals he has taken, as advised (in the books of medicine). Adhesion should be deemed complte after the incidental ulcer had been perfectly healed up, while the nose should be again scarified and bandaged in the case of a semi or partial adhesion. The adhesioned nose should be tried to be elongated whete it would fall short of its natural and previous length, or it should be surgically restored to its natural size in the case of the abnormal growth of its newly formed flesh. The mode of bringing about the adhesion of severed lips is identical with what has been described in connection with a severed nose with the exception of the insertion of pipes. The physician, who is well conversant with these matters, can be alone entrusted with the medical treatment of a King. 46-51

इति सुश्रुतसंहितायां सूत्रस्थाने कर्णव्यधबन्यविधिर्नाम षोड़शोऽध्यायः ॥१६॥

Thus ends the sixteenth chapter of the Sutra-Sthana in the Susruta Samhita which treats of the Piercing and Bandaging of ear-lobes.


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