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.
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.
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.
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.
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.
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.
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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kālikādivyadhādanyathā'pi vyāpadaṁ taccikitsāṁ ca nirdiśannāha- kliṣṭajihmāpraśastētyādi| kliṣṭā amanōjñā, jihmā vakratamā, apraśastā yathōktaguṇahīnā| dōṣasamudāyāditi dōṣaprakōpāt| apraśastavyadhādvēti adaivakr̥tacchidrē vyadhād garhitaśastrādivyadhādvā| saṁrambhaḥ śvayathuḥ| kēcit 'kliṣṭajihmāpraśastasūcīvyadhādgāḍhataravartitvāt' iti na paṭhanti, ‘dōṣasamudāyāt' ityādi ca paṭhanti, ‘surūḍhaṁ cainaṁ punarvidhyēt' iti ca na paṭhanti||6||
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 6 (7) · Śloka 7
tatra samyagviddhamāmatailēna pariṣēcayēt, tryahāttryahācca vartiṁ sthūlatarāṁ dadyāt, pariṣēkaṁ ca tamēva ||7||
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.
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.
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.
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.
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.
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.
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.
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 12 (13) · Śloka 13
ēkaiva tu bhavēt pāliḥ sthūlā pr̥thvī sthirā ca yā |
tāṁ dvidhā pāṭayitvā tu chittvā cōpari sandhayēt ||13||
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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.
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.
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.
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.
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.
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.
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.
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 16 (17) · Śloka 17
na cāśuddharaktamatipravr̥ttaraktaṁ kṣīṇaraktaṁ vā sandadhyāt |
sa hi vātaduṣṭē raktē rūḍhō'pi paripuṭanavān, pittaduṣṭē dāhapākarāgavēdanāvān, ślēṣmaduṣṭē stabdhaḥ kaṇḍūmān, atipravr̥ttaraktē śyāvaśōphavān, kṣīṇō'lpamāṁsō na vr̥ddhimupaiti ||17||
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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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parihāryasāmānyādanyadapi viruddhaṁ pratipādayannāha- na cētyādi| aśuddharaktamiti duṣṭaraktam| atipravr̥ttaraktamiti śuddharaktamapi yadā'tipravr̥ttaṁ syāttadā na sandhēyam| aśuddharaktasandhānē dōṣamāha- sa hi vātaduṣṭē ityādi| paripuṭanaṁ tvaca uccaṭanaṁ, miśrakādhyāyōktaḥ saśōphaḥ karṇalatikārōgō vā| atipravr̥ttaraktasya sandhānē dōṣamāha- atipravr̥ttaraktē iti; atisravadraktē ityarthaḥ| śyāvaśōphō'tra vātakr̥taḥ| kṣīṇakarṇasya sandhānē dōṣamāha- kṣīṇa ityādi| kṣīṇō'tra śuddharaktātipravr̥ttyā; na tu dōṣōpadravaiḥ, sadōṣōpadravavardhanē chidyata ēva||17||
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.
(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.
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.
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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asya tailasyāvacāraṇamāha- svēditōnmarditamityādi||20||
Meaning of the commentary
The commentary identifies this verse as the instruction for applying the oil described previously.
Adhikarana 19 (21) · Śloka 21
yavāśvagandhāyaṣṭyāhvaistilaiścōdvartanaṁ hitam |21|
Oil prepared with shatavari, ashvagandha, payasya, eranda and the jivaniya drugs, and cooked with milk, promotes growth of the earlobe when used for massage.
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 21 (22-23) · Śloka 23
yē tu karṇā na vardhantē svēdasnēhōpapāditāḥ ||22||
tēṣāmapāṅgadēśē tu kuryāt pracchānamēva tu |
bāhyacchēdaṁ na kurvīta vyāpadaḥ syustatōdhruvāḥ ||23||
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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.
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.
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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arūḍhakarṇasya vardhanē dōṣamāha- baddhamātramityādi| āmakōśīti asamyagrūḍhamadhyaḥ| kēcidamuṁ na paṭhanti||24||
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.
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.
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.
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.
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 25 (27-31) · Śloka 31
viślēṣitāyāstvatha nāsikāyā vakṣyāmi sandhānavidhiṁ yathāvat |
nāsāpramāṇaṁ pr̥thivīruhāṇāṁ patraṁ gr̥hītvā tvavalambi tasya ||27||
tēna pramāṇēna hi gaṇḍapārśvādutkr̥tya baddhaṁ tvatha nāsikāgram |
vilikhya cāśu pratisandadhīta tat sādhubandhairbhiṣagapramattaḥ ||28||
susaṁhitaṁ samyagatō yathāvannāḍīdvayēnābhisamīkṣya baddhvā |
prōnnamya caināmavacūrṇayēttu pataṅgayaṣṭīmadhukāñjanaiśca ||29||
sañchādya samyak picunā sitēna tailēna siñcēdasakr̥ttilānām |
ghr̥taṁ ca pāyyaḥ sa naraḥ sujīrṇē snigdhō virēcyaḥ sa yathōpadēśam ||30||
rūḍhaṁ ca sandhānamupāgataṁ syāttadardhaśēṣaṁ tu punarnikr̥ntēt |
hīnāṁ punarvardhayituṁ yatēta samāṁ ca kuryādativr̥ddhamāṁsām ||31||
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.
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 26 (32) · Śloka 32
nāḍīyōgaṁ vinauṣṭhasya nāsāsandhānavadvidhim |
ya ēvamēva jānīyāt sa rājñaḥ kartumarhati ||32||
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.
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.