१४. भेद्यरोगप्रतिषेधाध्यायः

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Adhikarana १ (१-२) · Śloka २

अथातो भेद्यरोगप्रतिषेधं व्याख्यास्यामः ||१|| यथोवाच भगवान् धन्वन्तरिः ||२||

Meaning of the śloka

Now the chapter on the management of disorders requiring bhedana (opening or incision) will be explained, as taught by Bhagavan Dhanvantari.

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लेख्यप्रतिषेधानन्तरं भित्त्वा लिखेदिति वचनाद्भेद्यरोगप्रतिषेधारम्भः- अथात इत्यादि||१-२||

Meaning of the commentary

Following the chapter on lekhya disorders, this chapter begins the management of bhedya disorders because the preceding instruction states that an affected structure should first be opened and then scraped.

Key terms

भेद्यरोग (bhedya-roga): Disorders for which opening or incision is prescribed in the source.
लेख्य (lekhya): A condition or procedure involving scraping, referenced as the topic of the preceding chapter.
धन्वन्तरि (Dhanvantari): The authoritative teacher to whom the instruction is attributed.

Adhikarana २ (३-४) · Śloka ४

स्वेदयित्वा बिसग्रन्थिं छिद्राण्यस्य निराशयम् | पक्वं भित्त्वा तु शस्त्रेण सैन्धवेनावचूर्णयेत् ||३|| कासीसमागधीपुष्पनेपाल्येलायुतेन तु | ततः क्षौद्रघृतं दत्त्वा सम्यग्बन्धमथाचरेत् ||४||

Meaning of the śloka

After fomenting a mature bisagranthi, its openings are to be incised with an instrument so that no residual cavity or pocket remains. The source then prescribes dusting it with saindhava combined with kasisa, Magadhi, pushpanjana, Nepali and ela. Thereafter, honey and ghee are applied and an appropriate bandage is placed.

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स्वेदयित्वेत्यादि| बिसग्रन्थिं पक्वं स्वेदयित्वा, अनन्तरमस्य पक्वस्य बिसग्रन्थेः स्विन्नस्य छिद्राणि निराशयं भित्त्वा, सैन्धवेन कासीसादियुक्तेनावचूर्णयेत्| निराशयमिति आशयस्य उत्सङ्गस्याभावो यथा स्यात्तथा भित्त्वेत्यर्थः| पुष्पं पुष्पाञ्जनं, नेपाली मनःशिला| ततः प्रतिसारणादनन्तरं सन्धानार्थं क्षौद्रघृतदानम्| केचित् ‘सम्यग्बन्धमथाचरेत्’ इत्यत्र ‘बन्धेनोक्तेन योजयेत्’ इति पठन्ति| सम्यक्शब्देन शिथिलता बन्धस्य ख्याप्यते||३-४||

Meaning of the commentary

The commentary explains that a mature bisagranthi is first fomented. Once softened, its openings are incised in a manner that leaves no asaya, understood here as a residual recess or pocket. Saindhava mixed with the listed substances is then used for pratisarana. It identifies pushpa as pushpanjana and Nepali as manahshila. Honey and ghee are subsequently applied for sandhana, or bringing the tissues together. An alternative reading has 'it should be treated with the prescribed bandage' in place of 'an appropriate bandage should then be applied.' The word samyak is explained as indicating that the bandage should be loose rather than tight.

Key terms

बिसग्रन्थि (bisagranthi): The lesion being treated by fomentation and opening in this passage.
निराशयम् (nirasayam): So that no residual recess or pocket remains after opening.
प्रतिसारण (pratisarana): Local application or rubbing of the prescribed substances onto the opened lesion.
नेपालि (Nepali): Identified by the commentary as manahshila, a hazardous mineral substance.
सन्धान (sandhana): Bringing the treated tissues or wound surfaces together.

Adhikarana ३ (५) · Śloka ६

रोचनाक्षारतुत्थानि पिप्पल्यः क्षौद्रमेव च | प्रतिसारणमेकैकं भिन्ने लगण इष्यते ||५|| महत्यपि च युञ्जीत क्षाराग्नी विधिकोविदः |६|

Meaning of the śloka

For a lagaṇa that has been opened, the source recommends each of the following separately as a pratisarana: rochana, kshara, tuttha, pippali or honey. In a large lagaṇa, a practitioner knowledgeable in the prescribed method is also directed to employ kshara and agni.

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लगणस्य चिकित्सामाह- रोचनेत्यादि| रोचना गोरोचना, क्षारो यवक्षारः| एतानि प्रतिसारणान्यल्पे लगणे भिन्ने सति योज्यानि| एकैकमिति वचनेन गोरोचनादिभिरेकैकशः प्रतिसारणं विधेयमित्यर्थः| अल्पलगणचिकित्सामभिधाय महालगणचिकित्सामाह- महत्यपि च युञ्जीतेत्यादि| महति गुरुतरे इति| युञ्जीतेति भिन्ने सति लगणे क्षाराग्नी प्रयुञ्जीत; तदनन्तरं तत्कालमेव क्षाराग्निदग्धव्रणवच्चिकित्सा, पश्चात् सामान्यव्रणवत्| कोविदः पण्डितः||५||-

Meaning of the commentary

The commentary presents this as treatment for lagaṇa. It identifies rochana as gorochana and kshara as yavakshara. In a small lagaṇa that has been opened, the listed substances are to be used one at a time for pratisarana. It then distinguishes the treatment of a larger or more severe lagaṇa: after opening it, the knowledgeable practitioner is said to employ kshara and agni. Immediately afterward it is managed like a wound produced by kshara or agni, and subsequently like an ordinary wound. Kovida means one who is learned or skilled in the method.

Key terms

लगण (lagana): The eye-region lesion discussed here, classified as small or large in the commentary.
प्रतिसारण (pratisarana): Separate local application of one prescribed substance after the lesion has been opened.
क्षार (kshara): An alkaline or caustic agent, identified here as yavakshara in the list and also prescribed procedurally for a large lesion.
अग्नि (agni): Thermal cautery in the procedural context of treating a large lagaṇa.
तुत्थ (tuttha): A mineral substance listed for local application in the historical formulation.

Adhikarana ४ (६) · Śloka ७

स्विन्नां भिन्नां विनिष्पीड्य भिषगञ्जननामिकाम् ||६|| शिलैलानतसिन्धूत्थैः सक्षौद्रैः प्रतिसारयेत् |७|

Meaning of the śloka

After the añjananāmikā has been fomented and has opened, the physician should express it and then rub it with a preparation of manaḥśilā, elā, nata, and saindhava mixed with honey.

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स्वयं भिन्नाया अञ्जननामिकायाश्चिकित्सामाह- स्विन्नामित्यादि| भिन्नां स्वयम्भिन्नाम्| विनिष्पीड्येति स्नेहस्वेदपूर्वकं निष्पीडनं कृत्वा, शिला मनःशिला, एला सूक्ष्मैला, नतं तगरं, सिन्धूत्थं सैन्धवम्| प्रतिसारयेत् घर्षयेत्||६||-

Meaning of the commentary

The commentator presents the treatment of an añjananāmikā that has opened by itself. The lesion is to be expressed after prior oleation and fomentation. He identifies śilā as manaḥśilā, elā as the small variety of cardamom, nata as tagara, and sindhūttha as saindhava, and explains pratisārayet as rubbing the preparation over the site.

Key terms

अञ्जननामिका (añjananāmikā): The eye or eyelid disorder being treated; the passage does not establish a modern diagnostic equivalent.
विनिष्पीड्य (viniṣpīḍya): Having expressed or pressed out the contents after the preparatory measures described by the commentator.
मनःशिला (manaḥśilā): The mineral substance identified by the commentary for śilā in the historical preparation.
नत (nata): An ingredient identified by the commentator as tagara.
प्रतिसारण (pratisāraṇa): Rubbing or applying a medicinal preparation over the treated site.

Adhikarana ५ (७) · Śloka ८

रसाञ्जनमधुभ्यां तु भित्त्वा वा शस्त्रकर्मवित् ||७|| प्रतिसार्याञ्जनैर्युञ्ज्यादुष्णैर्दीपशिखोद्भवैः |८|

Meaning of the śloka

Alternatively, a practitioner skilled in surgical procedures should open it, rub the site with rasāñjana and honey, and then apply the warm añjanas produced from a lamp flame.

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अभिन्नाञ्जननामिकाचिकित्सामाह- रसाञ्जनेत्यादि| स्वयमभिन्नामञ्जननामिकां पूर्वं स्विन्नां शस्त्रकर्मविद्भित्त्वा रसाञ्जनमधुभ्यां प्रतिसार्य तदुत्तरकालं दीपशिखोद्भवैः कज्जलाख्यैरञ्जनैर्योजयेदिति पिण्डार्थः||७||-

Meaning of the commentary

The commentator explains the treatment of an añjananāmikā that has not opened by itself. After it has first been fomented, a practitioner skilled in surgery opens it, applies rasāñjana with honey by rubbing, and afterward uses the lamp-flame products called kajjala as añjana. This is given as the overall sense of the passage.

Key terms

अभिन्नाञ्जननामिका (abhinnāñjananāmikā): An añjananāmikā that has not opened spontaneously.
शस्त्रकर्मवित् (śastrakarmavit): A practitioner knowledgeable in operative procedures.
रसाञ्जन (rasāñjana): A substance named for the historical topical preparation; its exact material identification should be professionally verified.
दीपशिखोद्भव (dīpaśikhodbhava): Produced from a lamp flame, explained by the commentator as kajjala.
अञ्जन (añjana): A preparation intended for application to the eye in the source's historical treatment context.

Adhikarana ६ (८) · Śloka ९

सम्यक्स्विन्ने कृमिग्रन्थौ भिन्ने स्यात् प्रतिसारणम् ||८|| त्रिफलातुत्थकासीससैन्धवैश्च रसक्रिया |९|

Meaning of the śloka

When the kṛmigranthi has been properly fomented and opened, pratisāraṇa is to be performed. A concentrated preparation is then made with triphalā, tuttha, kāsīsa, and saindhava.

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क्रिमिग्रन्थिचिकित्सामाह- सम्यगित्यादि| सम्यक्स्विन्ने इति लोचनोचितस्वेदस्विन्ने, अनन्तरं भेदिते प्रतिसारणमिति; अनुक्तमप्यञ्जननामिकोद्दिष्टमञ्जनमधुभ्यां प्रतिसारणं, तदनन्तरं त्रिफलाक्वाथेन तुत्थकासीससैन्धवावापेन रसक्रिया||८||-

Meaning of the commentary

The commentator introduces the treatment of kṛmigranthi. Proper fomentation means fomentation suited to the eye, followed by opening and then pratisāraṇa. Although the verse does not state its ingredients here, he carries forward the rasāñjana-and-honey pratisāraṇa prescribed for añjananāmikā. After that, a rasakriyā is prepared from a decoction of triphalā with tuttha, kāsīsa, and saindhava added.

Key terms

कृमिग्रन्थि (kṛmigranthi): The named eye or eyelid disorder addressed in this passage; no modern diagnostic equivalence is established here.
सम्यक्स्विन्न (samyaksvinna): Properly fomented, which the commentary specifies as fomentation appropriate for the eye.
प्रतिसारण (pratisāraṇa): Rubbing or topical application after the lesion has been opened.
त्रिफला (triphalā): The three-fruit formulation used here as a decoction base.
रसक्रिया (rasakriyā): A concentrated medicinal preparation made here from the stated decoction and added substances.

Adhikarana ७ (९) · Śloka १०

भित्त्वोपनाहं कफजं पिप्पलीमधुसैन्धवैः ||९|| लेखयेन्मण्डलाग्रेण समन्तात् प्रच्छयेदपि |१०|

Meaning of the śloka

After opening a kaphaja upanāha, it should be treated with pippalī, honey, and saindhava. It may be scraped all around with a maṇḍalāgra instrument and may also be scarified.

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श्लेष्मोपनाहचिकित्सामाह- भित्त्वेत्यादि| श्लेष्मोपनाहो भेद्यः, महान्नीरुजश्च लेख्यः, रक्तानुबन्धश्च प्रच्छनीयः; श्लेष्मोपनाहे भिन्ने लिखिते प्रच्छितेऽपि च पिप्पल्यादिभिरेकमेव प्रतिसारणम्||९||-

Meaning of the commentary

The commentator explains the treatment of śleṣmopanāha. It is to be opened; when it is large and painless, scraping is indicated; and when blood is involved, scarification is indicated. Whether it has been opened, scraped, or scarified, the same local application made with pippalī and the other stated substances is used.

Key terms

कफज उपनाह (kaphaja upanāha): An upanāha condition attributed here to kapha.
पिप्पलीमधुसैन्धव (pippalī-madhu-saindhava): Pippalī, honey, and saindhava, named for the local application.
मण्डलाग्र (maṇḍalāgra): The instrument specified for scraping around the lesion.
लेखन (lekhana): Scraping, associated by the commentary with a large, painless lesion.
प्रच्छन (pracchana): Scarification, associated by the commentary with involvement of blood.

Adhikarana ८ (१०-११) · Śloka ११

संस्नेह्य पत्रभङ्गैश्च स्वेदयित्वा यथासुखम् ||१०|| आपाकाद्विधिनोक्तेन पञ्चमेद्यानुपाचरेत् | सर्वेष्वेतेषु विहितं विधानं स्नेहपूर्वकम् | सम्पक्वे प्रयतो भूत्वा कुर्वीत व्रणरोपणम् ||११||

Meaning of the śloka

The five conditions designated for opening should, before suppuration, be managed by first applying unctuous treatment and then giving comfortable fomentation with pieces of leaves, according to the prescribed method. In all these conditions, the prescribed regimen begins with unctuous treatment. Once the lesion is fully matured, the practitioner should act carefully and undertake healing of the wound.

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एषां पञ्चानामपि मेद्यानां बिसग्रन्थ्यादीनामामानामादौ संशमनं निर्दिशन्नाह- संस्नेह्येत्यादि| पत्रभङ्गैः पत्रखण्डैः; अन्ये पत्रभङ्गशब्देन पल्लवमाहुः| विधिना अपतर्पणादिना सामान्यशोथप्रतीकारेण| स्नेहपूर्वकं विधानमिति स्नेहस्वेदरक्तास्रावविरेचनादि, नयनबुद्बुदजान्यत्र वमनं च||१०-११||

Meaning of the commentary

The commentator says that this passage first prescribes pacifying treatment for the five conditions designated for opening, beginning with bisagranthi, while they are still immature. Patrabhaṅga is explained by some as pieces of leaves, while others understand it as tender shoots. The prescribed method refers to general measures for swelling, beginning with apatarpaṇa. The regimen preceded by sneha includes oleation, fomentation, bloodletting, purgation, and related measures; vomiting is also mentioned, with an exception connected to nayanabudbuda. The precise syntax and scope of that exception require textual review.

Key terms

पञ्च मेद्य (pañca medya): The five conditions identified as requiring opening or incision.
पत्रभङ्ग (patrabhaṅga): Explained alternatively as pieces of leaves or as tender shoots used with fomentation.
आपाक (āpāka): The stage before suppuration or full maturation of the lesion.
अपतर्पण (apatarpaṇa): A reducing or non-nourishing measure cited as the beginning of general treatment for swelling.
व्रणरोपण (vraṇaropaṇa): Measures intended to promote healing of the wound after the lesion has matured.

Adhikarana पुष्पिका · Śloka १४

इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे भेद्यरोगप्रतिषेधो नाम चतुर्दशोऽध्यायः ||१४||

Meaning of the śloka

Thus ends the fourteenth chapter, named ‘Prevention and Treatment of Diseases Requiring Opening,’ in the Śālākya section of the Uttaratantra of the Suśruta Saṃhitā.

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इति श्रीडल्ह(ह्ल)णविरचितायां निबन्धसङ्ग्रहाख्यायां सुश्रुतव्याख्यायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे चतुर्दशोऽध्यायः||१४||

Meaning of the commentary

Thus ends the fourteenth chapter of the Śālākya section within the Uttaratantra in Śrī Dalhaṇa’s commentary on the Suśruta Saṃhitā entitled Nibandhasaṅgraha. The supplied source preserves the commentator’s name in the variant-looking form Dalha(hla)ṇa.

Key terms

भेद्यरोगप्रतिषेध (bhedyaroga-pratiṣedha): The chapter title, concerning the prevention and treatment of disorders designated for opening.
भेदन (bhedana): Opening or incision, the procedure defining the class of disorders named in the chapter title.
शालाक्यतन्त्र (śālākyatantra): The textual or clinical section under which the chapter is placed.
उत्तरतन्ट्र (uttaratantra): The division of the Suśruta Saṃhitā containing this chapter.
निबन्धसङ्ग्रह (Nibandhasaṅgraha): The title of Dalhaṇa’s commentary.

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