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AYANAACADEMYby Dr Vijaya Dwarampudi
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१६. कर्णव्यधबन्धविध्यध्यायः

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Adhikarana १ (१-२) · Śloka २

अथातः कर्णव्यधबन्धविधिमध्यायं व्याख्यास्यामः ||१|| यथोवाच भगवान् धन्वन्तरिः ||२||

Meaning of the śloka

Now the chapter concerning the method of piercing and repairing the ear will be explained, as taught by Bhagavan Dhanvantari.

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अत्राधिकारानुवृत्तिः सम्बन्धहेतुः| कथं? स्वस्थाधिकारः; स्वस्थस्य निर्दोषशरीरस्य कर्णव्यधः कर्तव्यः| तदुक्तं भोजे- “कालेष्वेतेष्वदोषाणां बालानां कर्णयोर्व्यधे| सह गात्रैर्विवर्धन्ते कर्णपाल्यश्च खानि च” इति| तस्मादत्र स्वस्थवृत्तानुवृत्तिरेव सम्बन्धकारणम्| पञ्चैव हि सम्बन्धकारणान्युक्तानि; तद्यथा- अधिकारानुवृत्तिः, शेषत्वं, तादर्थ्यं, जात्यभेदो, नामसङ्कीर्तनं चेति| भवति चात्र- “तादर्थ्यं जात्यभेदश्च शेषत्वं नामकीर्तनम्| अधिकारानुवृत्तिश्च पञ्च सम्बन्धहेतवः”- इति||१-२||

Meaning of the commentary

The connection with the preceding subject is continuation of the topic of health: ear piercing is to be performed in a healthy child whose body is free from dosha disturbance. A verse from Bhoja says that when the ears of healthy children are pierced at the prescribed times, the ear lobes and openings grow along with the limbs. The commentary therefore identifies continuation of healthy conduct as the basis of connection. It lists five grounds that connect topics: continuation of the governing topic, treatment as a remainder, purpose, identity of class and mention by name.

Key terms

karNavyadhabandhavidhi (karnavyadhabandhavidhi)
The prescribed method of piercing the ear and repairing or joining it.

Adhikarana २ (३) · Śloka ३

रक्षाभूषणनिमित्तं बालस्य कर्णौ विध्येते | तौ षष्ठे मासि सप्तमे वा शुक्लपक्षे प्रशस्तेषु तिथिकरणमुहूर्तनक्षत्रेषु कृतमङ्गलस्वस्तिवाचनं धात्र्यङ्के कुमारधराङ्के वा कुमारमुपवेश्य बालक्रीडनकैः प्रलोभ्याभिसान्त्वयन् भिषग्वामहस्तेनाकृष्य कर्णं दैवकृते छिद्र आदित्यकरावभासिते शनैः शनैर्दक्षिणहस्तेनर्जु विध्येत्, प्रतनुकं सूच्या, बहलमारया, पूर्वं दक्षिणं कुमारस्य, वामं कुमार्याः; ततः पिचुवर्तिं प्रवेशयेत् ||३||

Meaning of the śloka

A child's two ears are pierced for protection and ornamentation. This is done in the sixth or seventh month, during the bright fortnight, on an auspicious lunar day, karana, muhurta and nakshatra. After auspicious rites and blessings, the child is seated on the lap of the wet nurse or a child-holder, enticed and soothed with toys. The physician draws the ear with the left hand and, using the right hand, slowly pierces straight through the naturally formed opening illuminated by sunlight. A very thin ear is pierced with a needle and a thick ear with an awl. The right ear is pierced first in a boy and the left first in a girl. A cotton wick is then inserted.

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किन्निमित्तं बालस्य कर्णौ विध्येदित्याह- रक्षेत्यादि| रक्षाभूषणनिमित्तमिति निमित्तशब्दो रक्षाभूषणाभ्यां सह प्रत्येकं सम्बध्यते; अन्ये तु रक्षणार्थं भूषणानि रक्षाभूषणानि,तन्निमित्तमित्यर्थः| यद्यपि विद्धकर्णत्वाद्व्रणिनि बाले रक्तमांसप्रियत्वाद्रक्षोभयमस्त्येव, तथाऽपि व्रणस्याल्पकालत्वाद्दैवकृतच्छिद्रत्वाद्वा रक्षणार्थं भवति| कस्मिन् काले कर्णस्य व्यधः कर्तव्य इत्याह- तौ षष्ठे मासि सप्तमे वा शुक्लपक्ष इति; ताविति तौ कर्णौ, षष्ठे मासे सप्तमे वेति नायं जन्मकालादूर्ध्वं किन्तु संवत्सरादेर्भाद्रपदाद्यः षष्ठो मासो माघः सप्तमः फाल्गुनस्तयोर्मध्य एकस्मिन्निति| मङ्गलं गीतादि| स्वस्तिवाचनमाशीर्वादोच्चारणम्| धात्र्यङ्के इति धात्री कुमारस्य स्तनपायिनी स्त्री तस्या अङ्के, कुमारधराङ्के वेति बालग्राहिपुरुषस्योत्सङ्गे| बालक्रीडनकैरिति कृत्रिमहस्त्यश्वबलीवर्दशुकादिभिः| अस्याग्रे‘भक्ष्यविशेषैर्वा’ इति केचित् पठन्ति, भक्ष्यविशेषैर्मोदकादिभिः| दैवकृते छिद्र इति प्राक्तनजन्मकर्मकृते इत्यर्थः| ऋजु अवक्रम्| कर्णविशेषेण सूचीविशेषविषयं नियमयन्नाह- प्रतनुकं सूच्येति|- प्रकर्षेण तनुं कर्णं सूच्या विध्येदित्यर्थः; बहलमारयेति स्थूलकर्णमारया विध्येदित्यर्थः; आरा चर्मकाराणां चर्मभेदनं शस्त्रं, बहलं कठिनमिति लक्ष्मणटिप्पणकेनोक्तम्| पुरुषस्त्रीभेदेन प्राक्कर्णव्यधने प्रशस्तत्वेन विशेषमाह- पूर्वं दक्षिणमित्यादि| कर्णे विद्धे सति किं कार्यमित्याह- तत इत्यादि| विद्ध्वा च पिचुवर्तिं प्रवेशयेत्||३||

Meaning of the commentary

Protection and ornamentation may each be understood as a separate purpose; others interpret the compound as ornaments that serve protection. Although a pierced wound might attract harmful beings because they favour blood and flesh, its short duration, or piercing through the naturally formed opening, makes the act protective. The commentary does not count the sixth or seventh month from birth. It identifies them as Magha and Phalguna, the sixth and seventh months when the year is counted from Bhadrapada, and directs selection of one of these. Mangala includes song and similar rites, while svastivacana is the utterance of blessings. Dhatri is the woman who breastfeeds the child; kumaradhara is a man who holds the child. Toys include artificial elephants, horses, bulls and parrots. Some add special foods such as modaka after the reference to toys. The natural opening is attributed to action from a former birth. Rju means straight. A needle is prescribed for a markedly thin ear and an ara, the leatherworker's piercing instrument, for a thick ear; Lakshmana's note glosses thick as firm. The passage also specifies the auspicious sex-based order of piercing and insertion of the cotton wick afterward.

Key terms

daivakRuta chidra (daivakrita chidra)
The naturally formed opening in the ear, explained by the commentary as produced by prior-birth action.
picuvarti
A cotton wick inserted into the newly pierced opening.

Adhikarana ३ (४) · Śloka ४

शोणितबहुत्वेन वेदनया चान्यदेशविद्धमिति जानीयात्, निरुपद्रवतया तद्देशविद्धमिति ||४||

Meaning of the śloka

Piercing at an incorrect site is recognised by profuse bleeding and pain. Piercing at the proper site is recognised by the absence of complications.

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अन्यदेशविद्धस्य विज्ञानोपायमाह- शोणितबहुत्वेनेत्यादि| दैवकृतच्छिद्रविद्धस्य विज्ञानमाह- निरुपद्रवतयेत्यादि| तद्देशविद्धमिति दैवकृतच्छिद्रविद्धं, 'जानीयात्' इत्यनुवर्तते||४||

Meaning of the commentary

The first signs provide the means of recognising that an improper site has been pierced. Absence of complications indicates that the naturally formed opening has been pierced. The instruction to recognise is understood as carrying forward into the second statement.

Adhikarana ४ (५) · Śloka ५

तत्राज्ञेन यदृच्छया विद्धासु सिरासु कालिकामर्मरिकालोहितिकासूपद्रवा भवन्ति | तत्र, कालिकायां ज्वरो दाहः श्वयथुर्वेदना च भवति; मर्मरिकायां वेदना ज्वरो ग्रन्थयश्च; लोहितिकायां मन्यास्तम्भापतानकशिरोग्रहकर्णशूलानि भवन्ति | तेषु यथास्वं प्रतिकुर्वीत ||५||

Meaning of the śloka

When an unskilled person pierces the ear indiscriminately and injures the vessels called Kalika, Marmarika or Lohitika, complications arise. Injury to Kalika produces fever, burning, swelling and pain. Injury to Marmarika produces pain, fever and nodules. Injury to Lohitika produces stiffness of the neck, convulsive bending, stiffness or restraint of the head, and ear pain. Each condition is to be treated with its appropriate remedy.

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सिरासु दोषं वक्तुमाह- तत्राज्ञेनेत्यादि| ज्ञेन तु कालिकालोहितिकयोवर्णेनैव परिहारः कर्तव्यः, मर्मरिकायास्तु वर्णानुक्तौ दैवकृतच्छिद्रव्यधनेनेति| प्रत्येकमुपद्रवान् वक्तुमाह- तत्र कालिकायां ज्वर इत्यादि| कालिकादिव्यधोपद्रवचिकित्सामाह- तेषु यथास्वमित्यादि| तेषु ज्वरादिषु व्याधिषु; यथास्वं प्रतिकुर्वीतेति यस्य ज्वरादिव्याधेर्यः प्रतीकारस्तेन तं प्रतिकुर्वीतेत्यर्थः||५||

Meaning of the commentary

A knowledgeable practitioner is to avoid Kalika and Lohitika by recognising their colour. Because no colour is stated for Marmarika, it is avoided by piercing through the naturally formed opening. The passage then sets out the complications of injury to each vessel. Treating each appropriately means applying to fever and the other resulting disorders the remedy proper to that particular disorder.

Key terms

kAlikA, marmarikA, lohitikA (kalika, marmarika, lohitika)
Three named vessels in the ear whose accidental piercing is said to produce distinct complications.

Adhikarana ५ (६) · Śloka ६

क्लिष्टजिह्माप्रशस्तसूचीव्यधाद्गाढतरवर्तित्वाद्दोषसमुदायादप्रशस्तव्यधाद्वा यत्र संरम्भो वेदना वा भवति तत्र वर्तिमुपहृत्याशु मधुकैरण्डमूलमञ्जिष्ठायवतिलकल्कैर्मधुघृतप्रगाढैरालेपयेत्तावद्यावत् सुरूढ इति; सुरूढं चैनं पुनर्विध्येत्; विधानं तु पूर्वोक्तमेव ||६||

Meaning of the śloka

If inflammation or pain develops because the needle was unpleasant, crooked or unsuitable, because the wick was inserted too tightly, because the doshas became collectively aggravated, or because the piercing itself was unsuitable, remove the wick promptly. Apply a paste of madhuka, castor root, manjishtha, barley and sesame, made thick with honey and ghee, until the site has healed well. Once healed, pierce it again according to the procedure already stated.

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कालिकादिव्यधादन्यथाऽपि व्यापदं तच्चिकित्सां च निर्दिशन्नाह- क्लिष्टजिह्माप्रशस्तेत्यादि| क्लिष्टा अमनोज्ञा, जिह्मा वक्रतमा, अप्रशस्ता यथोक्तगुणहीना| दोषसमुदायादिति दोषप्रकोपात्| अप्रशस्तव्यधाद्वेति अदैवकृतच्छिद्रे व्यधाद् गर्हितशस्त्रादिव्यधाद्वा| संरम्भः श्वयथुः| केचित् 'क्लिष्टजिह्माप्रशस्तसूचीव्यधाद्गाढतरवर्तित्वात्' इति न पठन्ति, ‘दोषसमुदायात्' इत्यादि च पठन्ति, ‘सुरूढं चैनं पुनर्विध्येत्' इति च न पठन्ति||६||

Meaning of the commentary

This describes a complication and its treatment apart from injury to Kalika and the other named vessels. Klista means unpleasant, jihma very crooked, and aprashasta lacking the stated proper qualities. Doshasamudaya means aggravation of the doshas. Unsuitable piercing can mean piercing away from the naturally formed opening or piercing with a condemned instrument or by another improper method. Samrambha means swelling. Some recensions omit the words concerning an unpleasant, crooked or unsuitable needle and an excessively tight wick; they instead read from the statement about dosha aggravation. Those recensions also omit the instruction to pierce again after healing.

Key terms

saMrambha (samrambha)
Swelling or inflammatory enlargement at the pierced site.

Adhikarana ६ (७) · Śloka ७

तत्र सम्यग्विद्धमामतैलेन परिषेचयेत्, त्र्यहात्त्र्यहाच्च वर्तिं स्थूलतरां दद्यात्, परिषेकं च तमेव ||७||

Meaning of the śloka

When the ear has been pierced correctly, irrigate it with raw sesame oil. Every third day insert a somewhat thicker wick and repeat the same irrigation.

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दुर्विद्धे व्यापच्चिकित्सां प्रतिपाद्य सम्यग्विद्धे चिकित्सामाह- तत्रेत्यादि| आमतैलेनेति अपक्वतैलेन, तिलकल्कनिष्पीडनेन मुष्टितः परिस्रुतेनेत्यर्थः; तमेवेति आमतैलपरिषेकमेवेत्यर्थः||७||

Meaning of the commentary

After describing treatment for complications of faulty piercing, the text gives care for a correctly pierced ear. Ama oil means unprocessed oil obtained by pressing sesame paste and allowing it to strain through. The same irrigation means continued irrigation with this raw oil.

Key terms

Amataila (amataila)
Raw or unprocessed sesame oil, explained as oil pressed from sesame paste and strained.

Adhikarana ७ (८) · Śloka ८

अथ व्यपगतदोषोपद्रवे कर्णे वर्धनार्थं लघु वर्धनकं कुर्यात् ||८||

Meaning of the śloka

After dosha disturbance and complications have subsided in the ear, a light enlarging device should be made to expand the opening.

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गतोपद्रवे कर्णे वर्धनोपायमाह- अथेत्यादि| लघुवर्धनकमिति दोषविशेषादपामार्गनिम्बकार्पासादीनां काष्ठानामन्यतमस्य, अथवा सीसकादिघटितं धत्तूरपुष्पाकृतिं कुर्यात्||८||

Meaning of the commentary

This gives the means of enlarging an ear once its complications have resolved. The light enlarger may be made, according to the particular dosha, from the wood of apamarga, nimba, karpasa or another suitable plant. Alternatively it may be fashioned from lead or a similar material in the shape of a dhattura flower.

Key terms

vardhanaka
A light device placed in the pierced ear to enlarge the opening gradually.

Adhikarana ८ (९) · Śloka ९

एवं विवर्धितः कर्णश्छिद्यते तु द्विधा नृणाम् | दोषतो वाऽभिघाताद्वा सन्धानं तस्य मे शृणु ||९||

Meaning of the śloka

An ear enlarged in this way may become split into two in a person, either through dosha-related disorder or through trauma. Now hear from me how it is repaired.

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एवमित्यादि| दोषत इति दोषशब्दो व्याधिष्वपि वर्तते, तेन दोषैर्वातादिभिस्तज्जनितव्याधिभिर्वेत्यर्थः| अभिघाताद्वेति पतनपीडनादिभिः||९||

Meaning of the commentary

Dosha can denote vata and the other doshas or diseases produced by them. Trauma includes falling, compression and similar injuries.

Key terms

sandhAna (sandhana)
Joining or surgical repair of a split ear.

Adhikarana ९ (१०) · Śloka १०

तत्र समासेन पञ्चदशकर्णबन्धाकृतयः | तद्यथा- नेमिसन्धानक उत्पलभेद्यको वल्लूरक आसङ्गिमो गण्डकर्ण आहार्यो निर्वेधिमो व्यायोजिमः कपाटसन्धिकोऽर्धकपाटसन्धिकः सङ्क्षिप्तो हीनकर्णो वल्लीकर्णो यष्टिकर्णः काकौष्ठक इति | तेषु, पृथुलायतसमोभयपालिर्नेमिसन्धानकः, वृत्तायतसमोभयपालिरुत्पलभेद्यकः; ह्रस्ववृत्तसमोभयपालिर्वल्लूरकः; अभ्यन्तरदीर्घैकपालिरासङ्गिमः; बाह्यदीर्घैकपालिर्गण्डकर्णः; अपालिरुभयतोऽप्याहार्यः; पीठोपमपालिरुभयतः क्षीणपुत्रिकाश्रितो निर्वेधिमः, स्थूलाणुसमविषमपालिर्व्यायोजिमः; अभ्यन्तरदीर्घैकपालिरितराल्पपालिः कपाटसन्धिकः; बाह्यदीर्घैकपालिरितराल्पपालिरर्धकपाटसन्धिकः | तत्र दशैते कर्णबन्धविकल्पाः साध्याः ; तेषां स्वनामभिरेवाकृतयः प्रायेण व्याख्याताः सङ्क्षिप्तादयः पञ्चासाध्याः | तत्र शुष्कशष्कुलिरुत्सन्नपालिरितराल्पपालिः सङ्क्षिप्तः ; अनधिष्ठानपालिः पर्यन्तयोः क्षीणमांसो हीनकर्णः; तनुविषमाल्पपालिर्वल्लीकर्णः; ग्रथितमांसस्तब्धसिराततसूक्ष्मपालिर्यष्टिकर्णः; निर्मांससङ्क्षिप्ताग्राल्पशोणितपालिः काकौष्ठक इति | बद्धेष्वपि तु शोफदाहरागपाकपिडकास्रावयुक्ता न सिद्धिमुपयान्ति ||१०||

Meaning of the śloka

In brief there are fifteen forms of ear repair: Nemisandhanaka, Utpalabhedyaka, Valluraka, Asangima, Gandakarna, Aharya, Nirvedhima, Vyayojima, Kapatasandhika, Ardhakapatasandhika, Sankshipta, Hinakarna, Vallikarna, Yashtikarna and Kakaushthaka. Nemisandhanaka has two equally broad and long lobes. Utpalabhedyaka has two equally rounded and long lobes. Valluraka has two equally short and rounded lobes. Asangima has one long inner lobe. Gandakarna has one long outer lobe. Aharya has no adequate lobe on either side. Nirvedhima has a platform-like remnant supported by a diminished putrika on both sides. Vyayojima has lobes unequal in thickness or thinness. Kapatasandhika has one long inner lobe and a small opposite lobe. Ardhakapatasandhika has one long outer lobe and a small opposite lobe. These ten repair patterns are treatable, and their forms are mostly explained by their names. The remaining five, beginning with Sankshipta, are not treatable. Sankshipta has a dry auricular structure, a raised lobe and a small opposite lobe. Hinakarna lacks a supporting lobe and has diminished flesh at both margins. Vallikarna has a thin, irregular and small lobe. Yashtikarna has a small lobe with knotted flesh, stiffness and stretched vessels. Kakaushthaka has a fleshless, contracted tip and a lobe with little blood supply. Even repaired ears do not heal successfully when accompanied by swelling, burning, redness, suppuration, pustules or discharge.

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इदानीं सन्धेयस्य सन्धानायासन्धेयस्य परिहाराय चाह- तत्रेत्यादि| समासेन सङ्क्षेपेण, विस्तरेण तु कर्णबन्धा अमिताः, यद्यपि पञ्चदशसु कर्णेषु मध्ये दशैव बन्ध्याः, तथाऽपि बन्ध्यबाहुल्यादबन्ध्येष्वपि बन्धशब्दो वर्तते; यथा 'छत्रिणो यान्ति' इत्यत्र छत्रिबाहुल्यादच्छत्रिष्वपि छत्रिव्यपदेशः| 'तत्र समासेन पञ्चदश कर्णाकृतय' इत्यन्ये पठन्ति| तानेव बन्धान्नामभिर्निर्दिशन्नाह- तद्यथा- नेमिसन्धानक इत्यादि| तद्यथेति निदर्शने| तत्रामी बन्धविकल्पाः नित्यकर्मदर्शनादभ्यासाच्च जायन्ते| यद्यप्येषां नामभिरेवाकृतयः प्रायेण व्याख्यातास्तथाऽपि लक्षणसूत्रं निर्दिशन्नाह- तेषु पृथुलायतेत्यादि| पृथुले विस्तीर्णे, आयते दीर्घे, समे तुल्ये, इत्थम्भूते द्वे पाल्यौ यस्य स तथा; पालिः कर्णलतिका| नेमिः चक्रधारा, तद्वत् सन्धानं यस्य स नेमिसन्धानकः| वल्लूरक इति वल्लूरं शुष्कमांसं, शुष्कमांसवदनेकधा विपाट्य यः सन्धीयते स वल्लूरकः| `समुन्नतसमोभयपालिः' इत्येके पठन्ति| एतत् कर्णबन्धत्रयं समोभयपालिविषयतया ज्ञेयम्| अभ्यन्तरदीर्घैकेत्यादि यस्त्वभ्यन्तरदीर्घैकपालिः कथञ्चिच्छिन्नो भवति तस्येतरपाल्यभावाद्बाह्यपालिमूले व्यासङ्ग आसङ्गिमः| गण्डकर्ण इति सानुबन्धकपोलमांसमुत्कृत्य बाह्यदीर्घपाल्यग्रभागः सन्धीयते यस्मिन् स गण्डकर्णः| एतद्बन्धद्वयमेकपालिकम्| अपालिरिति ईषत्पालिः| उभयतो गण्डप्रदेशात् सानुबन्धमांसमाहृत्य पाल्याकारं कृत्वा सन्धानं यस्य क्रियते स आहार्यः| पीठोपमपालिरिति यस्य तु पालिद्वयं मूलत एव छिन्नं भवति स पीठोपमपालिः, निर्वेधिम इति वेधेन निष्पन्न इत्यर्थः, पालिद्वयहीनं कर्णं पुत्रिकाया उपरि विद्ध्वा निष्पादनीय इत्यर्थः; इदमपालिकं कर्णबन्धद्वयम्| स्थूलाणुसमेत्यादि स्थूलाणुत्वाभ्यामेका पालिः समा, अपरा विषमा, ते उल्लिख्य नानाप्रकारयोजनाद्व्यायोजिम इति| अभ्यन्तरदीर्घैकपालिरिति अभ्यन्तरदीर्घैकपालिरितराल्पपाल्या सह बहिः सन्धानात् कपाटवत्सन्धानं यत्र स कपाटसन्धिकः| अर्धकपाटसन्धिक इति बाह्यदीर्घैकपालिरितराल्पपाल्या सहाभ्यन्तरसन्धानेनार्धकपाटवद्यत्र सन्धीयते सोऽर्धकपाटसन्धिकः| इदं कर्णबन्धत्रयं विषमोभयपालिकम्| तत्रेत्यादि तत्र तेषु पञ्चदशसु कर्णबन्धविकल्पेषु मध्ये| तेषामाकारज्ञानमधिकृत्याह- तेषां नामभिरेवेत्यादि| शेषाणां परिहारार्थमाह- सङ्क्षिप्तादय इत्यादि| तेषां लक्षणमाह- तत्र शुष्केत्यादि| शुष्कशष्कुलिरिति शुष्कबाह्यपाल्यधिष्ठानः, इतराल्पपालिरिति इतरा गण्डदेशानुगता अल्पा पालिर्यस्य स तथा| अनधिष्ठानपालिरिति अल्पत्वेन अविद्यमाने अधिष्ठानपाली यस्य स तथा, पर्यन्तयोश्चेति गण्डबाह्यपार्श्वयोः| विषमा तनुत्वस्थूलत्वाभ्याम्| त एते पञ्च कर्णबन्धाः सपालयोऽप्यसाध्याः, असाध्या इति साधनायाशक्याः; केचिदमुं पाठं न पठन्ति| एतेषां पञ्चानामसाध्यत्वे हेतुमाह- बद्धेष्वपीत्यादि| अन्ये तु शोफाद्युपद्रवोपेतानां पूर्वेषां दशानां बन्धानां साध्यानामप्यसाध्यत्वमाहुः||१०||

Meaning of the commentary

The classification enables repair of suitable ears and avoidance of unsuitable ones. The number fifteen is a summary, since detailed variations are unlimited. Although only ten are repairable, the term ear repairs is applied to all fifteen because the repairable forms predominate; some instead read fifteen forms of the ear. The named patterns arise through observation of standard operative methods and repeated practice. Pali means the ear lobe. In Nemisandhanaka, nemi is a wheel rim, indicating a rim-like union. Valluraka takes its name from dried meat and is joined after being divided in several places like dried meat; some read that both lobes are equally elevated. These first three concern two equal lobes. In Asangima, a somehow severed long inner lobe is attached at the root of the missing outer lobe. In Gandakarna, cheek flesh with its attachment is cut and joined to the tip of a long outer lobe. These two use one existing lobe. In Aharya, where only a slight lobe remains, attached flesh is brought from both cheek regions and shaped into a lobe. In Nirvedhima, where both lobes have been severed at the root and the remainder resembles a seat, an ear lacking both lobes is fashioned by piercing above the putrika; nirvedhima means produced by piercing. These two concern ears without usable lobes. In Vyayojima, one lobe is even and the other uneven in thickness, and repair uses trimming and varied joining. Kapatasandhika joins a long inner lobe outward to the small other lobe like a door panel. Ardhakapatasandhika joins a long outer lobe inward to the small other lobe like half a door panel. These three concern two unequal lobes. The next five are stated so that they may be avoided. The commentary further explains Sankshipta's dry portion as the dry base of the outer lobe and its small other lobe as the one extending toward the cheek. Hinakarna has so little lobe that there is no base, with deficient flesh at the cheek-side and outer margins. Vallikarna is irregular through being alternately thin and thick. All five are impossible to repair even when some lobe remains. Some do not read this statement. One interpretation takes the final complications as explaining why these five remain unsuccessful even after repair; another applies them to the first ten, saying that otherwise treatable repairs also become unsuccessful when those complications occur.

Key terms

pAli (pali)
The ear lobe or hanging fleshy part used in the classification of repair patterns.
nemisandhAnaka (nemisandhanaka)
A repair using two equal broad, long lobes, producing a union likened to the rim of a wheel.
kAkauShThaka (kakaushthaka)
One of the five stated unrepairable ear forms, marked by a fleshless contracted tip and scant blood supply in the lobe.

Adhikarana १० (११) · Śloka ११

भवन्ति चात्र- यस्य पालिद्वयमपि कर्णस्य न भवेदिह | कर्णपीठं समे मध्ये तस्य विद्ध्वा विवर्धयेत् ||११||

Meaning of the śloka

If both ear lobes are absent, the ear-seat should be pierced at its even central part and then gradually enlarged.

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गद्योक्तानां कर्णबन्धानां मध्ये निर्वेधिमस्य सन्धानसूत्रमाह- यस्येत्यादि| इहेति कर्णबन्धमध्ये| कर्णपीठं पुत्रिकोपरिप्रदेशम्||११||

Meaning of the commentary

Among the ear-repair methods described in prose, this verse gives the joining procedure for the nirvedhima type. Here, 'among these' means among the ear-repair methods. Karnapitha is the region above the putrika.

Key terms

karNapITham (karnapitham)
The ear-seat, explained here as the region above the putrika, where the opening is to be made.

Adhikarana ११ (१२) · Śloka १२

बाह्यायामिह दीर्घायां सन्धिराभ्यन्तरो भवेत् | आभ्यन्तरायां दीर्घायां बाह्यसन्घिरुदाहृतः ||१२||

Meaning of the śloka

When the outer ear lobe is long, the junction should be made on the inner side. When the inner lobe is long, an outer junction is prescribed.

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व्यायोजिमकपाटसन्धिकार्धकपाटसन्धिकानां सन्धानसूत्रमाह- बाह्यायामित्यादि| यदा बाह्या पालिर्दीर्घा भवेत्तदा आभ्यन्तरः सन्धिः कर्तव्य इत्यर्थः, आभ्यन्तरा च पालिर्यदा दीर्घा स्यात्तदा बाह्यसन्धिर्विधेय इति; बाह्यायां गण्डाद्दूरवर्तिन्यां पाल्यां दीर्घायाम्, आभ्यन्तरो गण्डसन्निकृष्टो गण्डसंश्रयी वेत्यर्थः| "कपाटसन्धिकार्धकपाटसन्धिकयोरेवेदं सन्धानसूत्रं, न तु व्यायोजिमस्य" इत्यन्ये||१२||

Meaning of the commentary

The commentary presents this as the joining rule for the vyayojima, kapatasandhika and ardhakapatasandhika methods. If the outer lobe, the part farther from the cheek, is long, the junction is made internally, close to or supported by the cheek. If the inner lobe is long, the junction is made externally. Others hold that this rule applies only to kapatasandhika and ardhakapatasandhika, not to vyayojima.

Key terms

bAhyasandhiH (bahyasandhih)
An externally placed junction used when the inner lobe is the longer part.
AbhyantaraH sandhiH (abhyantarah sandhih)
An inner junction, explained as close to or supported by the cheek.

Adhikarana १२ (१३) · Śloka १३

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

Meaning of the śloka

If only one lobe remains and it is thick, broad and firm, it should be split into two; after making an incision above, the parts should be joined.

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इदानीमासङ्गिमस्य सन्धानसूत्रमाह- एकैवेत्यादि| "वल्लूरकस्येदं सन्धानसूत्रं सम्भाव्यते" इत्यन्ये वदन्ति||१३||

Meaning of the commentary

The commentary introduces this as the joining procedure for the asangima method. Other authorities say that it may instead be the joining procedure for valluraka.

Key terms

Asa~ggima (asangima)
The ear-repair type to which the main commentary assigns this joining procedure.

Adhikarana १३ (१४) · Śloka १४

गण्डादुत्पाट्य मांसेन सानुबन्धेन जीवता | कर्णपालीमपालेस्तु कुर्यान्निर्लिख्य शास्त्रवित् ||१४||

Meaning of the śloka

For a person without an ear lobe, a surgeon versed in the science should raise living flesh from the cheek while keeping it attached, freshen the receiving surface, and fashion an ear lobe from it.

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आहार्यस्य सन्धिसूत्रं निर्देष्टुमाह- गण्डादुत्पाठ्येत्यादि| सानुबन्धेनेति गण्डप्रदेशलग्नेनेत्यर्थः| जीवतेति शोणितसहितेनेत्यर्थः| अन्ये तु "गण्डकर्णस्याप्येतत् सन्धानसूत्रम्" इति वदन्ति||१४||

Meaning of the commentary

This verse gives the joining rule for the aharya method. Keeping the tissue attached means that it remains connected to the cheek region, and living means accompanied by blood. Others say that the same joining rule also applies to gandakarna.

Key terms

sAnubandhena jIvatA mAMsena (sanubandhena jivata mamsena)
Living cheek tissue kept attached to its original region and retaining a blood supply.
nirlikhya
After scraping or freshening the surface intended for joining.

Adhikarana १४ (१५) · Śloka १५

अतोऽन्यतमं बन्धं चिकीर्षुरग्रोपहरणीयोक्तोपसम्भृतसम्भारं विशेषतश्चात्रोपहरेत् सुरामण्डं क्षीरमुदकं धान्याम्लं कपालचूर्णं चेति | ततोऽङ्गनां पुरुषं वा ग्रथितकेशान्तं लघु भुक्तवन्तमाप्तैः सुपरिगृहीतं च कृत्वा, बन्धमुपधार्य, छेद्यभेद्यलेख्यव्यधनैरुपपन्नैरुपपाद्य, कर्णशोणितमवेक्ष्य दुष्टमदुष्टं वेति; तत्र वातदुष्टे धान्याम्लोष्णोदकाभ्यां पित्तदुष्टे शीतोदकपयोभ्यां श्लेष्मदुष्टे सुरामण्डोष्णोदकाभ्यां प्रक्षाल्य कर्णौ, पुनरवलिख्यानुन्नतमहीनमविषमं च कर्णसन्धिं सन्निवेश्य, स्थितरक्तं सन्दध्यात् | ततो मधुघृतेनाभ्यज्य पिचुप्रोतयोरन्यतरेणावगुण्ठ्य सूत्रेणानवगाढमनतिशिथिलं च बद्ध्वा कपालचूर्णेनावकीर्याचारिकमुपदिशेत्, द्विव्रणीयोक्तेन च विधानेनोपचरेत् ||१५||

Meaning of the śloka

A surgeon intending to perform any one of these ear-repair operations should assemble nearby all the instruments and materials prescribed in the Agropaharaniya chapter. For this operation in particular, clear sura fluid, milk, water, sour fermented grain liquid and powdered earthenware should be provided. The woman or man should have the ends of the hair tied, should have eaten a light meal, and should be held securely by trusted attendants. After deciding which repair is suitable, the surgeon should prepare and unite the parts with the appropriate cutting, splitting, scraping or puncturing procedures. The blood of the ear should be examined for doshic impurity. If affected by vata, the ears are washed with warm sour grain liquid and water; if by pitta, with cool water and milk; and if by kapha, with clear sura fluid and warm water. The junction is then scraped again and positioned without elevation, deficiency or unevenness. Once bleeding has stopped, the parts are joined. The site is anointed with honey and ghee, covered with either a cotton pad or cloth, and bound with thread neither too tightly nor too loosely. It is dusted with powdered earthenware, appropriate rules of food and conduct are prescribed, and care follows the method taught for a wound with two openings.

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अतः परं बन्धविधिः| अग्रोपहरणीयोक्तोपसम्भृतसम्भारमिति अग्रोपहरणीयोक्तो यन्त्रशस्त्रादिरुप समीपे सम्भृतः सम्यक्कृत्वा धृतः सम्भारः समूहो यत्र| सुरामण्डं मद्यस्योपर्यच्छभागं, कपालचूर्णं नवमृन्मयभाण्डखण्डचूर्णम्| ततोऽङ्गनां पुरुषं वेति अङ्गनाया भूषणप्राधान्यात् प्राङ्निर्देशः| ग्रथितकेशान्तमिति ग्रथितकेशावयवम्, अन्यथा केशव्याकुलतया कर्माभिघातः स्याद्बन्धविश्लेषो वा| लघुभुक्तवन्तमिति भुक्तवान् शस्त्रकर्मपीडां सहते, आहारलघुत्वाद्वेदनया रात्रिजागरितवतोऽपि नाजीर्णबाधा स्यात्| आप्तैः सुपरिगृहीतं च कृत्वेति आप्तैर्हितैः| बन्धमुपधार्येति अयं बन्धोऽत्र कर्तव्य इति निश्चित्य| छेद्याद्यैरुपपन्नैरिति युक्तैः| उपपाद्येति संयोज्य, सन्निवेश्य आरोप्य, सन्दध्यात् सन्धानं कुर्यात्| पिचुप्रोतयोरिति तूलकर्पटयोरित्यर्थः| अवगुण्ठ्येति आवेष्ठ्य| आचारिकमिति आहारविहाराख्यम्| द्विव्रणीयोक्तेन विधानेनेति आलेपनादिना||१५||

Meaning of the commentary

The commentary explains that this begins the operative method. The Agropaharaniya materials are the collection of instruments and other requisites properly assembled close at hand. Suramanda is the clear upper portion of liquor, and kapalacurna is powder from a fragment of a new earthen vessel. The woman is mentioned first because ornamentation is especially important for her. Tying the hair prevents loose hair from being struck during the operation or disturbing the repair. A light meal helps the patient endure operative pain without creating indigestion even if pain causes wakefulness at night. Trusted attendants are well-wishers. The surgeon first determines the applicable repair; the cutting and related procedures must be appropriate. Upapadya is explained as joining, sanniveshya as placing, and sandadhyat as performing the union. Picu and prota mean cotton and cloth respectively, while avagunthya means wrapping. Acharika refers to dietary and behavioral instructions, and the method for a wound with two openings includes measures such as applications.

Key terms

surAmaNDam (suramandam)
The clear upper portion of sura, used here as a wash in a kapha-affected condition.
kapAlacUrNam (kapalacurnam)
Powder made from a fragment of a new earthen vessel, applied after bandaging.
AcArikam (acarikam)
Instructions concerning the patient's food and conduct after the repair.

Adhikarana १५ (१६) · Śloka १६

भवति चात्र- विघट्टनं दिवास्वप्नं व्यायाममतिभोजनम् | व्यवायमग्निसन्तापं वाक्श्रमं च विवर्जयेत् ||१६||

Meaning of the śloka

The patient should avoid disturbing or moving the repaired part, daytime sleep, exercise, excessive eating, sexual intercourse, exposure to the heat of fire and excessive speaking.

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परिहार्याण्युपदिशन्नाह- विघट्टनमित्यादि| विघट्टनं चालनम्||१६||

Meaning of the commentary

The commentary introduces the practices to be avoided and specifically glosses vighattana as moving or shaking the repaired part.

Key terms

vighaTTanam (vighattanam)
Movement or disturbance of the repaired ear.

Adhikarana १६ (१७) · Śloka १७

न चाशुद्धरक्तमतिप्रवृत्तरक्तं क्षीणरक्तं वा सन्दध्यात् | स हि वातदुष्टे रक्ते रूढोऽपि परिपुटनवान्, पित्तदुष्टे दाहपाकरागवेदनावान्, श्लेष्मदुष्टे स्तब्धः कण्डूमान्, अतिप्रवृत्तरक्ते श्यावशोफवान्, क्षीणोऽल्पमांसो न वृद्धिमुपैति ||१७||

Meaning of the śloka

An ear should not be joined while its blood is impure, flowing excessively or depleted. Even if a repair made when the blood is affected by vata initially heals, it develops pariputana. With pitta-affected blood it develops burning, suppuration, redness and pain; with kapha-affected blood it becomes rigid and itchy. With excessive bleeding it becomes dusky and swollen, while with depletion of blood it has little flesh and does not grow.

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परिहार्यसामान्यादन्यदपि विरुद्धं प्रतिपादयन्नाह- न चेत्यादि| अशुद्धरक्तमिति दुष्टरक्तम्| अतिप्रवृत्तरक्तमिति शुद्धरक्तमपि यदाऽतिप्रवृत्तं स्यात्तदा न सन्धेयम्| अशुद्धरक्तसन्धाने दोषमाह- स हि वातदुष्टे इत्यादि| परिपुटनं त्वच उच्चटनं, मिश्रकाध्यायोक्तः सशोफः कर्णलतिकारोगो वा| अतिप्रवृत्तरक्तस्य सन्धाने दोषमाह- अतिप्रवृत्तरक्ते इति; अतिस्रवद्रक्ते इत्यर्थः| श्यावशोफोऽत्र वातकृतः| क्षीणकर्णस्य सन्धाने दोषमाह- क्षीण इत्यादि| क्षीणोऽत्र शुद्धरक्तातिप्रवृत्त्या; न तु दोषोपद्रवैः, सदोषोपद्रववर्धने छिद्यत एव||१७||

Meaning of the commentary

The commentary adds these contraindications to the previously stated avoidances. Impure blood means dosha-affected blood. Even otherwise pure blood is unsuitable when it flows excessively. Pariputana means lifting or separation of the skin, or alternatively the swollen disease of the ear lobe described in the Mishraka chapter. The dusky swelling following excessive bleeding is attributed here to vata. In this context a depleted ear results from excessive loss of pure blood, not from complications caused by doshas; when growth is attempted in the presence of doshic complications, the repair separates.

Key terms

paripuTana (pariputana)
Lifting or separation of the skin; alternatively, a swollen disorder of the ear lobe described elsewhere.
ashuddharaktam
A condition in which the blood is affected by doshas and is unsuitable for joining.

Adhikarana १७ (१८-१९) · Śloka १९

(आमतैलेन त्रिरात्रं परिषेचयेत्, त्रिरात्राच्च पिचुं परिवर्तयेत्) | स यदा सुरूढो निरुपद्रवः सवर्णो भवति तदैनं शनैः शनैरभिवर्धयेत् | अतोऽन्यथा संरम्भदाहपाकरागवेदनावान्, पुनश्छिद्यते वा ||१८|| अथास्याप्रदुष्टस्याभिवर्धनार्थमभ्यङ्गः | तद्यथा- गोधाप्रतुदविष्किरानूपौदकवसामज्जानौ पयः सर्पिस्तैलं गौरसर्षपजं च यथालाभं सम्भृत्यार्कालर्कबलातिबलानन्तापामार्गाश्वगन्धाविदारिगन्धाक्षीरशुक्लाजलशूकमधुरवर्गपयस्याप्रतिवापं तैलं वा पाचयित्वा स्वनुगुप्तं निदध्यात् ||१९||

Meaning of the śloka

The site should be irrigated with unprocessed sesame oil for three nights, and the cotton dressing should be changed after three nights. When it is firmly healed, free from complications and of normal color, it should be enlarged very gradually. If enlarged otherwise, it develops swelling, burning, suppuration, redness and pain, or it may split again. To promote growth in a site that is not impaired, an oil for massage should be prepared. As available, fat and marrow from godha and from pratuda, vishkira, marsh-dwelling and aquatic animals are collected with milk, ghee and oil of gaura mustard. An oil is cooked with pastes of arka, alarka, bala, atibala, ananta, apamarga, ashvagandha, vidarigandha, kshirashukla, jalashuka, drugs of the sweet group and payasya. It should be stored in a well-protected place.

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द्विव्रणीयोक्तसामान्यविधिमुद्दिश्य विशेषविधिं निर्दिशन्नाह- आमतैलेनेत्यादि| प्रतुदाः लट्वादयः श्रेष्ठत्वात्, विष्किरा लावादयः, आनूपा वराहमहिषादयः, औदका रोहितमत्स्यादयः, एषां वसामज्जानौ, वसा मांसस्नेहः| गौरसर्षपजस्थाने ‘राजसर्षपजं’ इति केचित् पठन्ति, राजसर्षपाः श्वेतसर्षपाः| वसामज्जासर्पिर्गौरसर्षपतैलमेतत्स्नेहचतुष्टयमर्कादिकल्कमावाप्य चतुर्गुणेन दुग्धेनैव पचनीयमिति| अन्ये त्वत्र सर्पिर्न पठन्ति| अपरे वसादिस्नेहचतुष्टयं परं पठन्ति नतु पयः, द्रवानुक्तौ च जलं चतुर्गुणं वदन्ति स्नेहपाके; ‘यदाऽन्यत्रापि केवलं दुग्धं स्यात्तदा स्नेहाच्चतुर्गुणं दुग्धं, यदा पुनरन्योऽपि द्रवो भवेत्तदा स्नेहसममेव दुग्धं कार्यम्’ इत्याचार्या भाषन्ते| यथालाभं सम्भृत्येति यस्य यस्य लाभस्तं तमेकत्र कृत्वेत्यर्थः; एतेन द्वित्राणामपि ग्रहणमुक्तम् | अलर्को मन्दारः, अनन्ता उत्पलसारिवा, विदारिगन्धा शालपर्णी, क्षीरशुक्ला क्षीरविदारी; जलशूको जलनीलिका, जलान्तर्वर्ती रोमयुक्तः सविषप्राणी वा, जलशूको जलसंस्थस्तृणसक्तो जन्तुविरचितः शूकसङ्घातवान् निवासोऽन्दुक इत्यन्ये, `जलचारी कृष्णकीट’ इति लक्ष्मणटीप्पणकेनोक्तं; मधुरवर्गः काकोल्यादिः, पयस्या विदारीभेदः, केचिदर्कपुष्पीत्याहुः; अन्ये मधुरवर्गं पयस्यां च न पठन्ति| तैलं वेति तिलतैलं वा पचेत्, एकैकं वा| स्वनुगुप्तमिति निरुपद्रवस्थान इत्यर्थः||१८-१९||

Meaning of the commentary

After referring to the general wound care taught for wounds with two openings, the passage gives special measures. Pratuda includes birds such as latva and is mentioned first as preferable; vishkira includes birds such as lava, marsh-dwelling animals include boar and buffalo, and aquatic animals include fish such as rohita. Their vasa is the fat of their flesh. Some read raja mustard, meaning white mustard, instead of gaura mustard. One explanation uses four unctuous substances—fat, marrow, ghee and gaura-mustard oil—with the arka and other pastes, cooked using four times as much milk. Others omit ghee. Still others read only the four unctuous substances beginning with fat and omit milk; because no liquid is then named, they prescribe four times as much water for cooking. Teachers further state that when milk is the only liquid it should be four times the unctuous substance, but when another liquid is also present the milk should equal the unctuous substance. 'As available' permits combining whichever ingredients can be obtained, even only two or three. Alarka is mandara, ananta is utpalasariva, vidarigandha is shalaparni, kshirashukla is kshiravidari, and the sweet group is the kakolyadi group. Jalashuka has several explanations: jalanilika; a hairy poisonous creature living in water; a creature-made, bristle-clustered dwelling attached to aquatic grass, called anduka; or, according to the Lakshmana note, a black aquatic insect. Payasya is a kind of vidari, though some call it arkapushpi. Some omit the sweet group and payasya. Tailam va may mean cooking sesame oil, or preparing each oil separately. Svanugupta means keeping it in a place free from harmful conditions.

Key terms

Amatailena (amatailena)
With unprocessed oil; in context, sesame oil used for irrigation during early healing.
jalashUka (jalashuka)
An uncertain aquatic ingredient for which the commentary preserves several distinct identifications.
yathAlAbham (yathalabham)
According to availability, allowing the obtainable ingredients, even two or three, to be combined.

Adhikarana १८ (२०) · Śloka २०

स्वेदितोन्मर्दितं कर्णं स्नेहेनैतेन योजयेत् | अथानुपद्रवः सम्यग्बलवांश्च विवर्धते ||२०||

Meaning of the śloka

After fomenting and gently massaging the ear, the physician should apply this oil to it. The ear will then develop properly, without complications and with good strength.

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अस्य तैलस्यावचारणमाह- स्वेदितोन्मर्दितमित्यादि||२०||

Meaning of the commentary

The commentary identifies this verse as the instruction for applying the oil described previously.

Adhikarana १९ (२१) · Śloka २१

यवाश्वगन्धायष्ट्याह्वैस्तिलैश्चोद्वर्तनं हितम् |२१|

Meaning of the śloka

Rubbing the anointed ear with a powder or paste of barley, ashvagandha, yashtyahva and sesame is beneficial.

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अभ्यक्तस्योद्वर्तनमाह- यवेत्यादि|२१|-

Meaning of the commentary

The commentary states that this verse prescribes udvartana after the ear has been anointed.

Key terms

udvartanaM (udvartanam)
Rubbing or frictional application performed after anointing the ear.

Adhikarana २० (२१) · Śloka २२

शतावर्यश्वगन्धाभ्यां पयस्यैरण्डजीवनैः ||२१|| तैलं विपक्वं सक्षीरमभ्यङ्गात् पालिवर्धनम् |२२|

Meaning of the śloka

Oil prepared with shatavari, ashvagandha, payasya, eranda and the jivaniya drugs, and cooked with milk, promotes growth of the earlobe when used for massage.

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कर्णपालिविवृद्ध्यर्थमपरं तैलमाह- शतावर्यश्वगन्धाभ्यामित्यादि| शतावर्यादिकल्केन स्नेहचतुर्थांशेन केवलक्षीरेण चतुर्गुणेन तैलमत्र पचनीयम्| पयस्या अर्कपुष्पी| जीवनैः काकोल्यादिद्रव्यैः||२१||

Meaning of the commentary

This is another oil for enlarging the earlobe. The oil is to be cooked with a paste of shatavari and the other named drugs equal to one quarter of the oil, using four times the quantity of milk as the sole liquid. Payasya is identified as arkapushpi, and the jivaniya substances include kakoli and the other drugs of that group.

Key terms

pAlivardhanam (palivardhanam)
Promoting enlargement or development of the earlobe.
jIvanaiH (jivanaih)
With the jivaniya group, represented here by kakoli and related drugs.

Adhikarana २१ (२२-२३) · Śloka २३

ये तु कर्णा न वर्धन्ते स्वेदस्नेहोपपादिताः ||२२|| तेषामपाङ्गदेशे तु कुर्यात् प्रच्छानमेव तु | बाह्यच्छेदं न कुर्वीत व्यापदः स्युस्ततोध्रुवाः ||२३||

Meaning of the śloka

If ears prepared with fomentation and oleation still do not enlarge, slight scarification should be made in the apanga region. An external incision must not be made, because complications will certainly follow from it.

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एवमप्यवर्धमानानां कर्णानां वर्धनोपायं दर्शयन्नाह- ये त्वित्यादि| उपपादिताः संयोजिताः| अपाङ्गदेशे त्विति कर्णपुत्रिकाया अधः| तुशब्द एवार्थः| प्रच्छानमेव त्विति एवशब्द ईषदर्थे, ईषच्छेदनं; तुशब्दोऽयमप्यर्थः, तेन कर्णपुत्रिकाया अध एव छेदनं, तदपीषदेव कार्यमित्युक्तं भवति| तेषामपाङ्गच्छेद्यं हि कार्यमाभ्यन्तरं भवेत्’ इति केचित् पठन्ति, अपाङ्गपुत्रिकाया अधः कर्णानुकूलमाभ्यन्तरं छेद्यं प्रच्छयेद्वा| बाह्यच्छेदं कर्णबाह्यलतिकाच्छेदम्| व्यापदः कर्णलतिकात्रुटनादयः; ‘व्याधयः स्युः’ इत्यन्ये पठन्ति||२२-२३||

Meaning of the commentary

The passage gives a further method for ears that have not enlarged through the preceding measures. Upapadita means prepared or treated. Apanga is explained here as the area below the small earlobe. The expression pracchanam eva indicates only a slight incision or scarification below that part. One variant reads that an internal incision suited to the ear should be made below the apanga-putrika, or that the area should be scarified. An external incision means cutting the outer strip of the ear; its complications include tearing of the ear strip. Another reading has 'diseases will arise' instead of 'complications will arise.'

Key terms

pracchAnam (pracchanam)
A slight incision or scarification, restricted here to the region below the small earlobe.
bAhyacchedam (bahyacchedam)
An external cut through the outer strip of the ear, which the text prohibits.

Adhikarana २२ (२४) · Śloka २४

बद्धमात्रं तु यः कर्णं सहसैवाभिवर्धयेत् | आमकोशी समाध्मातः क्षिप्रमेव विमुच्यते ||२४||

Meaning of the śloka

If someone suddenly begins enlarging an ear as soon as it has been joined, its incompletely healed interior becomes swollen and the union soon comes apart.

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अरूढकर्णस्य वर्धने दोषमाह- बद्धमात्रमित्यादि| आमकोशीति असम्यग्रूढमध्यः| केचिदमुं न पठन्ति||२४||

Meaning of the commentary

The verse describes the fault in attempting enlargement before the repaired ear has healed. Amakoshi means that the middle or interior has not healed properly. Some authorities do not read this verse.

Key terms

AmakoshI (amakoshi)
Having an interior that has not yet healed properly.

Adhikarana २३ (२५) · Śloka २५

जातरोमा सुवर्त्मा च श्लिष्टसन्धिः समः स्थिरः | सुरूढोऽवेदनो यश्च तं कर्णं वर्धयेच्छनैः ||२५||

Meaning of the śloka

An ear should be enlarged gradually only after hair has appeared, its opening is well formed, the joined edges have united, its surface is even, it is firm, fully healed and free from pain.

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कीदृशः पुनर्वर्धनीयस्तमाह- जातरोमेत्यादि| सुवर्त्मेति शोभनच्छिद्रः, श्लिष्टसन्धिः; संलग्नसन्धिः; समो निम्नोन्नतत्वरहितः, स्थिरो दृढः||२५||

Meaning of the commentary

The commentary explains the qualities required before enlargement. Suvartma means having a well-formed opening; shlishtasandhi means that the joined edges are adherent; sama means free from depressions and elevations; and sthira means firm.

Key terms

shliShTasandhiH (shlishtasandhih)
Having the joined margins firmly united.
surUDhaH (surudhah)
Completely and soundly healed.

Adhikarana २४ (२६) · Śloka २६

अमिताः कर्णबन्धास्तु विज्ञेयाः कुशलैरिह | यो यथा सुविशिष्टः स्यात्तं तथा विनियोजयेत् | (कर्णपाल्यामयान्नॄणां पुनर्वक्ष्यामि सुश्रुत! | कर्णपाल्यां प्रकुपिता वातपित्तकफास्त्रयः(१) ||२६|| द्विधा वाऽप्यथ संसृष्टाः कुर्वन्ति विविधा रुजः | विस्फोटः स्तब्धता शोफः पाल्यां दोषे तु वातिके(२) ||२६|| दाहविस्फोटजननं शोफः पाकश्च पैत्तिके | कण्डूः सश्वयथुः स्तम्भो गुरुत्वं च कफात्मके(३) ||२६|| यथादोषं च संशोध्य कुर्यात्तेषां चिकित्सितम् | स्वेदाभ्यङ्गपरीषेकैः प्रलेपासृग्विमोक्षणैः(४) ||२६|| मृद्वीं क्रियां बृंहणीयैर्यथास्वं भोजनैस्तथा | य एवं वेत्ति दोषाणां चिकित्सां कर्तुमर्हति(५) ||२६|| अत ऊर्ध्वं नामलिङ्गैर्वक्ष्ये पाल्यामुपद्रवान् | उत्पाटकश्चोत्पुटकः श्यावः कण्डूयुतो भृशम्(६) ||२६|| अवमन्थः सकण्डूको ग्रन्थिको जम्बुलस्तथा | स्रावी च दाहवांश्चैव शृण्वेषां क्रमशः क्रियाम्(७) ||२६|| अपामार्गः सर्जरसः पाटलालकुचत्वचौ | उत्पाटके प्रलेपः स्यात्तैलमेभिश्च पाचयेत्(८) ||२६|| शम्पाकशिग्रुपूतीकान् गोधामेदोऽथ तद्वसाम् | वाराहं गव्यमैणेयं पित्तं सर्पिश्च संसृजेत्(९) ||२६|| लेपमुत्पुटके दद्यात्तैलमेभिश्च साधितम् | गौरीं सुगन्धां सश्यामामनन्तां तण्डुलीयकम्(१०) ||२६|| श्यावे प्रलेपनं दद्यात्तैलमेभिश्च साधितम् | पाठां रसाञ्जनं क्षौद्रं तथा स्यादुष्णकाञ्जिकम्(११) ||२६|| दद्याल्लेपं सकण्डूके तैलमेभिश्च साधितम् | व्रणीभूतस्य देयं स्यादिदं तैलं विजानता(१२) ||२६|| मधुकक्षीरकाकोलीजीवकाद्यैर्विपाचितम् | गोधावराहसर्पाणां वसाः स्युः कृतबृंहणे(१३) ||२६|| प्रलेपनमिदं दद्यादवसिच्यावमन्थके | प्रपौण्डरीकं मधुकं समङ्गां धवमेव च(१४) ||२६|| तैलमेभिश्च सम्पक्वं शृणु कण्डूमतः क्रियाम् | सहदेवा विश्वदेवा अजाक्षीरं ससैन्धवम् | एतैरालेपनं दद्यात्तैलमेभिश्च साधितम्(१५) ||२६|| ग्रन्थिके गुटिकां पूर्वं स्रावयेदवपाट्य तु | ततः सैन्धवचूर्णं तु घृष्ट्वा लेपं प्रदापयेत्(१६) ||२६|| लिखित्वा तत्स्रुतं घृष्ट्वा चूर्णैर्लोध्रस्य जम्बुले | क्षीरेण प्रतिसार्यैनं शुद्धं संरोपयेत्ततः(१७) ||२६|| मधुपर्णी मधूकं च मधुकं मधुना सह | लेपः स्राविणि दातव्यस्तैलमेभिश्च साधितम्(१८) ||२६|| पञ्चवल्कैः समधुकैः पिष्टैस्तैश्च घृतान्वितैः | जीवकाद्यैः ससर्पिष्कैर्दह्यमानं प्रलेपयेत्)(१९) ||२६||

Meaning of the śloka

Skilled practitioners should understand that methods of joining the ear are innumerable. Whichever method is particularly suitable in a given case should be applied accordingly. The parenthetical continuation says that disorders of the earlobe will be described. Vata, pitta and kapha, singly or combined in pairs, produce various pains there. A vata disorder causes blisters, rigidity and swelling; a pitta disorder causes burning, blisters, swelling and suppuration; and a kapha disorder causes itching with swelling, stiffness and heaviness. After purification according to the dosha, treatment is performed with fomentation, massage, irrigation, pastes, bloodletting, gentle nourishing measures and suitable foods. One who understands treatment according to the doshas is fit to undertake it. The named complications are utpataka, utputaka, shyava, a severely itching condition, avamantha with itching, granthika, jambula, a discharging condition and a burning condition. For utpataka, a paste and oil are prepared from apamarga, sarjarasa, patala bark and lakuca bark. For utputaka, a paste and oil are prepared using shampaka, shigru, putika, monitor-lizard fat and its vasa, and the fat or bile substances named from boar, cow, ena and sarpa, with ghee. For shyava, a paste and oil are prepared from gauri, sugandha, shyama, ananta and tanduliyaka. For the itching condition, a warm sour-gruel paste with patha, rasanjana and honey is prescribed, with oil prepared from them; when ulceration has occurred, knowledgeable use of oil cooked with madhuka, kshirakakoli, jivaka and related drugs is stated. Fats of monitor lizard, boar and sarpa are used after nourishing preparation. For avamantha, after irrigation, a paste of prapaundarika, madhuka, samanga and dhava is applied, and oil is cooked with them. For the subsequent itching treatment, a paste and oil are prepared from sahadeva, vishvadeva, goat milk and saindhava. In granthika, the nodule is first incised and drained; saindhava powder is rubbed in and a paste applied. In jambula, the discharged lesion is scraped and rubbed with lodhra powder, treated with milk, purified and then healed. For a discharging lesion, a paste and oil of madhuparni, madhuka and another madhuka with honey are prescribed. For burning, a paste of the five barks and madhuka, ground and mixed with ghee, or jivaka and related drugs with ghee, is applied.

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कर्णपालिच्छेदविशेषेण कर्णसन्धिबन्धानामपरिमितत्वादनुक्तमपि प्रकारं दर्शयन्नाह- अमिता इत्यादि| `सुविशिष्ट’ इत्यत्र केचित् ‘सुनिविष्टः’ इति पठन्ति| केचिदत्रैवाध्याये कर्णपाल्यामयान् परिपोटादीन् पठन्ति, अन्ये तु सलिङ्गचिकित्सितान् मिश्रकचिकित्सिते पठन्ति; तांश्च तत्रैव व्याख्यास्यामः| अन्ये तु सुश्रुताध्यायिनोऽत्र `कर्णपाल्यामयानन्यान् वक्ष्यामि चतुरः पृथक्’ इत्यादिकं ग्रन्थं सचिकित्सितं पठन्ति, स त्वाचार्यैरनार्षीकृतः; तस्मान्न पठनीयः| अपरे पुनरत्रैवोत्पाटकादीन् सचिकित्सितान् पठन्ति, अमुमपि पाठमनार्षमाचार्या वर्णयन्ति, अतोऽयमपि न पठितव्यः||२६||

Meaning of the commentary

Because the varieties of ear repair vary without limit according to the particular cut of the earlobe, the verse permits an unenumerated but suitable method to be selected. Some read sunivishtah, 'well positioned,' in place of suvishishtah, 'particularly suitable.' The commentary then records competing textual traditions for the long parenthetical material. Some read earlobe disorders such as paripota in this chapter; others place their signs and treatment in Mishraka Chikitsita, where the commentator says they will be explained. Other students of Sushruta read here a separate passage beginning with four other earlobe disorders and their treatment, but the teachers judged it non-authoritative and therefore not to be read. Still others include here the supplied utpataka group with treatment; the teachers likewise call this reading non-authoritative and say it should not be read.

Key terms

amitAH karNabandhAH (amitah karnabandhah)
The possible methods of joining or repairing an ear are innumerable.
anArSha (anarsha)
Judged by the teachers not to belong to the authoritative rishi-derived text.

Adhikarana २५ (२७-३१) · Śloka ३१

विश्लेषितायास्त्वथ नासिकाया वक्ष्यामि सन्धानविधिं यथावत् | नासाप्रमाणं पृथिवीरुहाणां पत्रं गृहीत्वा त्ववलम्बि तस्य ||२७|| तेन प्रमाणेन हि गण्डपार्श्वादुत्कृत्य बद्धं त्वथ नासिकाग्रम् | विलिख्य चाशु प्रतिसन्दधीत तत् साधुबन्धैर्भिषगप्रमत्तः ||२८|| सुसंहितं सम्यगतो यथावन्नाडीद्वयेनाभिसमीक्ष्य बद्ध्वा | प्रोन्नम्य चैनामवचूर्णयेत्तु पतङ्गयष्टीमधुकाञ्जनैश्च ||२९|| सञ्छाद्य सम्यक् पिचुना सितेन तैलेन सिञ्चेदसकृत्तिलानाम् | घृतं च पाय्यः स नरः सुजीर्णे स्निग्धो विरेच्यः स यथोपदेशम् ||३०|| रूढं च सन्धानमुपागतं स्यात्तदर्धशेषं तु पुनर्निकृन्तेत् | हीनां पुनर्वर्धयितुं यतेत समां च कुर्यादतिवृद्धमांसाम् ||३१||

Meaning of the śloka

The proper method for repairing a severed nose is as follows. Take a hanging leaf from a tree and measure it against the nose. Using that measure, raise and cut a flap from the side of the cheek, leaving it attached, and join it promptly to the freshened nasal tip with careful, secure bandaging. After confirming that it is properly united, place and secure two tubes correctly, elevate the nose and dust it with patanga, yashtimadhuka and anjana. Cover it properly with clean cotton and repeatedly sprinkle it with sesame oil. Give the patient ghee to drink; when the meal is well digested, oleate and purge him as directed. When the repair has healed and united, cut away the remaining half of the attachment. If tissue is deficient, make efforts to increase it; if excessive flesh has grown, make it even.

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विश्लेषिताया इत्यादि| विश्लेषिताया इति छिन्नायाः| पृथिवीरुहाणां वृक्षाणाम्| तस्येति छिन्ननासिकस्य पुरुषस्य| तेन प्रमाणेनेति वृक्षपत्रप्रमाणेन| उत्कृत्येति ऊर्ध्वं छेदयित्वा| बद्धमिति संलग्नं यथा स्यात्, ‘मांसं’ इति शेषः| तदिति नासिकाग्रम्| साधुबन्धैरिति शोभनबन्धैः कृत्वा| अप्रमत्तः सावधानः| सुसंहितमित्यादि| सुसंहितं सम्यगभिसमीक्ष्य, नाडीद्वयेन यथावद्बद्ध्वा, प्रोन्नम्य च प्रकृष्टं यथा स्यादेवमुत्थाप्य, एनां नासिकामवचूर्णयेदिति सम्बन्धः| नाडीद्वयमत्र नलकृतमेरण्डपत्रनालकृतं वा, न तु सीसकादिबी(वी)टिका; कुतः? सा हि गुरुत्वादधो गच्छति| पतङ्गं रक्तचन्दनम्, अञ्जनं रसाञ्जनम्| सितेन शुक्लेन| तैलेनेत्युक्ते तिलतैलं लब्धं, तिलानामिति यत् कृतं तत् प्रतिनिधितैलनिषेधार्थम्| पाय्यः पाययितव्यः| सुजीर्णे भोजने| अन्ये त्वेवं पठन्ति-"छिन्नां तु नासिकां दृष्ट्वा वयःस्थस्य शरीरिणः| नासानुरूपं सञ्च्छिद्य पत्रं गण्डे निवेशयेत्"- इत्यादि||२७-३१||

Meaning of the commentary

Vishleshitaya means severed, and prithiviruh means a tree. The leaf measures the missing nose of that patient. Utkritya means cutting upward while leaving the flesh attached. The nasal tip is freshened and joined using good bandages by an attentive physician. After inspecting the union, two tubes are secured and the nose is elevated. The tubes should be made from reed or from the stalk of an eranda leaf, rather than heavy lead or similar tubes that would move downward. Patanga is red sandalwood, anjana is rasanjana, and sita means white or clean. Mention of sesame after 'oil' excludes substitute oils. Payyah means that the patient should be made to drink, and sujirna refers to the meal being well digested. The commentary also records an alternative version beginning, 'Having seen the severed nose of a person of suitable age, cut a leaf according to the nose and place it on the cheek,' followed by related instructions.

Key terms

sandhAnavidhiM (sandhanavidhim)
The operative method for restoring and joining a severed part.
nADIdvayena (nadidvayena)
With two light tubular splints, here made from reed or an eranda leaf stalk.

Adhikarana २६ (३२) · Śloka ३२

नाडीयोगं विनौष्ठस्य नासासन्धानवद्विधिम् | य एवमेव जानीयात् स राज्ञः कर्तुमर्हति ||३२||

Meaning of the śloka

The method of repairing a severed lip should be understood as the same as the method for repairing the nose, except that tubes are not used. One who knows this method correctly is fit to treat a king.

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अतश्छिन्नस्यौष्ठस्य सन्धानमाह- नाडीयोगमित्यादि| ओष्ठस्य सन्धानविधिर्नासासन्धानवत् कर्तव्यः; परं नाडीयोगं विना| अर्हति योग्यो भवति| इदं नासासन्धानौष्ठसन्धानसूत्रं पूर्वाचार्यैरनार्षीकृतमपि जेज्जटगयदासादिभिरङ्गीकृतं सुबोधत्वाच्च न व्याख्यातं, तैरङ्गीकृतत्वादस्माभिरपि सङ्गृहीतं, सुबोधमपि च वैद्यपुत्रबोधार्थं व्याख्यातम्| दाक्षिणात्यास्तु भिषजः कर्णस्योपरि कोटिव्यधमत्र पठन्ति| सोऽप्यत्राप्रसिद्धेरनार्षः||३२||

Meaning of the commentary

Repair of the lip follows the nasal repair procedure, with the sole exception of using tubes. Arhati means being qualified or fit. The commentary says earlier teachers judged the nose- and lip-repair passage non-authoritative, yet Jejjata, Gayadasa and others accepted it without explanation because it was easy to understand. The commentator therefore also includes it and explains it for students of medicine. Southern physicians read a passage on puncturing the tip above the ear at this location, but the commentary calls that reading non-authoritative because it is not established here.

Key terms

nADIyogaM vinA (nadiyogam vina)
Without the use of the two tubes employed in nasal repair.

Adhikarana पुष्पिका · Śloka १६

इति सुश्रुतसंहितायां सूत्रस्थाने कर्णव्यधबन्धविधिर्नाम षोडशोऽध्यायः ||१६||

Meaning of the śloka

Thus ends the sixteenth chapter, called Karnavyadhabandhavidhi, in the Sutrasthana of the Sushruta Samhita.

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इति श्रीडल्ह(ह्ल)णविरचितायां निबन्धसङ्ग्रहाख्यायां सुश्रुतव्याख्यायां सूत्रस्थाने षोडशोऽध्यायः||१६||

Meaning of the commentary

Thus ends the sixteenth chapter in the Sutrasthana of the commentary on Sushruta called Nibandhasangraha, composed by Shri Dalhana.

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