౧౬. కర్ణవ్యధబంధవిధ్యధ్యాయః

Meaning of the śloka

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

Key terms

karNavyadhabandhavidhi (karnavyadhabandhavidhi)

The prescribed method of piercing the ear and repairing or joining it.

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.

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.

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.

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.

Key terms

kAlikA, marmarikA, lohitikA (kalika, marmarika, lohitika)

Three named vessels in the ear whose accidental piercing is said to produce distinct complications.

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.

Key terms

saMrambha (samrambha)

Swelling or inflammatory enlargement at the pierced site.

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.

Key terms

Amataila (amataila)

Raw or unprocessed sesame oil, explained as oil pressed from sesame paste and strained.

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.

Key terms

vardhanaka

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

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.

Key terms

sandhAna (sandhana)

Joining or surgical repair of a split ear.

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.

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.

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.

Key terms

karNapITham (karnapitham)

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

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.

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.

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.

Key terms

Asa~ggima (asangima)

The ear-repair type to which the main commentary assigns this joining procedure.

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.

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.

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.

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.

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.

Key terms

vighaTTanam (vighattanam)

Movement or disturbance of the repaired ear.

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.

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.

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.

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.

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.

Meaning of the śloka

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

Key terms

udvartanaM (udvartanam)

Rubbing or frictional application performed after anointing the ear.

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.

Key terms

pAlivardhanam (palivardhanam)

Promoting enlargement or development of the earlobe.

jIvanaiH (jivanaih)

With the jivaniya group, represented here by kakoli and related drugs.

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.

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.

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.

Key terms

AmakoshI (amakoshi)

Having an interior that has not yet healed properly.

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.

Key terms

shliShTasandhiH (shlishtasandhih)

Having the joined margins firmly united.

surUDhaH (surudhah)

Completely and soundly healed.

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.

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.

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.

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.

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.

Key terms

nADIyogaM vinA (nadiyogam vina)

Without the use of the two tubes employed in nasal repair.

Meaning of the śloka

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