౧౫. ఛేద్యరోగప్రతిషేధాధ్యాయః

Meaning of the śloka

Now we shall explain the prevention and management of diseases treated by excision. Thus spoke the venerable Dhanvantari.

Key terms

chedyaroga (chedya-roga)

conditions described as requiring excision

pratiṣedha

prevention and therapeutic management

Dhanvantari

the authoritative teacher named in the passage

Meaning of the śloka

After the patient has been oleated, has eaten, and is seated, the physician should carefully irritate or stimulate the eye with saline powders.

Key terms

snigdha

oleated or supplied with unctuous nourishment

arma

an ocular tissue growth described in this chapter

saindhava

the salt identified by the commentary as the source of the saline powder

Meaning of the śloka

Once the arma has been stimulated, quickly well fomented, and moved so that a fold forms, the physician should engage it at that site. While the patient looks toward the outer canthus, the careful physician lifts it with a hook held by mucuṇḍī forceps or with a threaded needle. It should not be raised suddenly or excessively, because of the danger of injury from the instrument, and the eyelids should be held firmly. When loosened, it is suspended securely with three supports and carefully separated with the sharp rounded-tip instrument. After freeing it throughout from the dark and white regions of the eye, it is brought near the inner canthus and excised without cutting too close to that canthus. Leaving one quarter of the tissue there is said to avoid injury to the eye; destruction of the inner canthus may produce bleeding or a sinus, while insufficient excision leads rapidly to renewed growth.

Key terms

arma

the ocular growth being surgically separated and excised

mucuṇḍī

forceps described as being operated between the index finger and thumb

maṇḍalāgra

a sharp rounded-tip surgical instrument used here to separate the growth

kanīnaka

the inner angle of the eye near the nose

nāḍī-vraṇa

a sinus-like wound named as a complication

Meaning of the śloka

An arma that spreads like a net should likewise be wiped or loosened, suspended, and excised with a curved instrument when it extends near the eyelid and onto the white part of the eye.

Key terms

arma

a spreading ocular tissue growth

jālaka

a net-like or sinewy growth in the alternative reading

saindhava

the salt powder used in the described loosening step

vakra-śastra

curved surgical instrument

Meaning of the śloka

Immediately afterward, the eye is treated by pratisāraṇa with powders of yāvanāla, trikaṭu, and salt. After fomentation, the skilled physician applies a bandage. Knowing the doṣa, season, strength, and stage of the condition, the physician applies a suitable unctuous substance and thereafter manages it like a wound. After three days the bandage is released, warmth is applied by the hand, and cleansing treatment is undertaken.

Key terms

pratisāraṇa

a local rubbing or application procedure described after excision

yavakṣāra

the alkaline preparation identified with yāvanāla by the commentary

trikaṭu

the pungent three-ingredient group named in the application

doṣa

the functional pathological factors whose state is considered in treatment

vraṇavat

in the manner of wound care

Meaning of the śloka

For pain, milk prepared with karañja seed, āmalaka, and madhuka, combined with honey, is described as beneficial for āścyotana twice during the day. A cool paste of madhuka, blue-lotus filaments, and dūrvā, ground with milk and mixed with ghṛta, is commended for application to the head.

Key terms

āścyotana

an ocular instillation or irrigation procedure, glossed here as filling the eye

karañja-bīja

karañja seed named in the milk preparation

āmalaka

āmalaka fruit named in the preparation

madhuka

the medicinal substance named in both formulations

kiñjalka

lotus filament or stamen

Meaning of the śloka

If a remnant of the arma remains, it should be removed with scraping-type añjana preparations.

Key terms

arma-śeṣa

a remnant of the ocular growth left after the procedure

lekhyāñjana

a scraping-type collyrium described for removing residual tissue

dhātu

mineral or metallic substances mentioned as ingredients in the referenced preparations

Meaning of the śloka

A small arma resembling curd, one that is blue or red, or one that is greyish and thin, should be treated in the same way as śukra.

Key terms

अर्म (arma)

The ocular lesion being classified here according to colour, extent, and thickness.

शुक्लार्म (śuklārma)

The curd-like or white form of arma identified by the commentary.

स्नाय्वर्म (snāyvarma)

The thin form of arma identified by the commentary.

लेख्याञ्जन (lekhyāñjana)

A scraping type of collyrium prescribed in the passage's historical treatment framework.

Meaning of the śloka

An arma that resembles skin, is thick, is densely covered by sinewy and fleshy tissue, or extends onto the dark circular region is regarded as requiring excision.

Key terms

चर्माभ (carmābha)

Having the appearance of skin or a piece of skin.

बहल (bahala)

Thick or bulky in this description of arma.

कृष्णमण्डल (kṛṣṇamaṇḍala)

The dark circular region of the eye referred to as being reached by the lesion.

छेद्य (chedya)

Classified as requiring excision in the historical surgical scheme.

Meaning of the śloka

When an arma has been properly excised, the eye has a clear, natural colour, performs its functions without distress or fatigue, and remains free from the complications associated with the procedure.

Key terms

विशुद्धवर्ण (viśuddhavarṇa)

Having regained a clear or natural colour after removal of the arma.

अक्लिष्ट (akliṣṭa)

Without distress during ocular functions; alternatively explained as free from defect.

गतक्लम (gataklama)

Free from fatigue, effort, or discomfort.

हीनातिच्छेद (hīnāticcheda)

Insufficient or excessive excision, each associated with its own complications.

Meaning of the śloka

In sirājāla, the skilled practitioner should lift the hard vessels with a hook and scrape or cut them upward with a maṇḍalāgra instrument.

Key terms

सिराजाल (sirājāla)

The ocular vascular condition for which the historical procedure is described.

कठिनसिरा (kaṭhinasirā)

Hard vessels selected for the described operative treatment.

मण्डलाग्र (maṇḍalāgra)

The instrument named for scraping or cutting the raised vessels.

बडिश (baḍiśa)

A hook used in the historical procedure to lift the vessels.

Meaning of the śloka

Pustules arising on the vessels that do not respond to medicinal treatment are considered suitable for excision with a maṇḍalāgra, in the same manner as arma.

Key terms

सिरापिडका (sirāpiḍakā)

Pustular lesions described as arising on the ocular vessels.

भेषज (bheṣaja)

Medicinal treatment stated to have been unsuccessful in this context.

मण्डलाग्र (maṇḍalāgra)

The instrument prescribed for the historical excision.

अर्मवत् (armavat)

In the same manner as arma, including the previously described preliminary measures.

Meaning of the śloka

For both of these disorders, the local application prescribed for arma should be used, together with the appropriate doṣa-based regimen employing scraping substances.

Key terms

सिराजाल (sirājāla)

One of the two ocular disorders referred to in the verse.

सिरापिडका (sirāpiḍakā)

The second ocular disorder referred to in the verse.

प्रतिसारण (pratisāraṇa)

A local application, here referring back to the one prescribed for arma.

यथादोष (yathādoṣa)

Treatment selected according to the doṣa framework stated in the source.

लेखनद्रव्य (lekhanadravya)

Substances classified as scraping and used in the historical regimen.

Meaning of the śloka

After properly fomenting the parvaṇikā at the junction, the skilled practitioner should hold it with a hook in its upper third and incise it at the middle, measured between its base and tip. Otherwise an aśrunāḍī may result. Here too, rubbing with saindhava and honey is prescribed, and scraping powders are the treatment for any remnant of the disorder.

Key terms

पर्वणिका (parvaṇikā)

The ocular swelling described here as requiring excision.

कृष्णशुक्लसन्धि (kṛṣṇa-śukla-sandhi)

The junction of the dark and white parts of the eye.

बडिश (baḍiśa)

A hook used in the described historical operative procedure.

अश्रुनाडी (aśrunāḍī)

A lacrimal-channel complication said to arise if the incision is improperly placed.

प्रतिसारण (pratisāraṇa)

Rubbing or applying the stated substances to the treated site.

Meaning of the śloka

Conch shell, samudraphena, the marine maṇḍūkī, crystal, kuruvinda, coral, aśmantaka, vaidūrya, pulaka, pearl, and filings of iron and copper are to be ground together in equal parts with srotoñjana and made into a powdered eye preparation. It is stored in a vessel associated with meṣaśṛṅga. The learned practitioner is directed to apply it regularly at both prescribed times; it is said to remove arma growths, a swelling, and networks of vessels.

Key terms

लेखनीयचूर्ण (lekhanīya-cūrṇa)

A powdered preparation described as having a scraping action.

मण्डूकी समुद्रजा (maṇḍūkī samudrajā)

Explained by the commentary as the marine shell containing pearls.

स्रोतोञ्जन (srotoñjana)

A mineral eye-preparation ingredient combined with the other listed substances.

वैदूर्योपलक (vaidūryopalaka)

An alternative reading preserved by some authorities and glossed as veruḍikā.

मेषशृङ्ग (meṣaśṛṅga)

Interpreted either as a variety of iṅgudī or as a vessel made from ram's horn.

Meaning of the śloka

The treatment procedure will now be stated for the condition called arśas, for śuṣkārśas, and for arbuda when these are situated on the inner aspect of the eyelid.

Key terms

अर्शस् (arśas)

A named eyelid disorder included here among conditions requiring treatment.

शुष्कार्शस् (śuṣkārśas)

The dry form of the condition called arśas.

अर्बुद (arbuda)

A growth or swelling named in this eyelid context.

वर्त्माभ्यन्तराश्रय (vartmābhyantarāśraya)

Situated on the inner aspect of the eyelid.

Meaning of the śloka

After fomenting and everting the eyelid, the practitioner should carefully lift the lesion with a needle and divide it at its base with a sharp maṇḍalāgra instrument. It is then to be rubbed with saindhava, kāsīsa, and kṛṣṇā. When bleeding has stopped, the eyelid is to be cauterized appropriately with a probe; if any disease remains, it may also be scraped with an alkaline substance. Thereafter the affected doṣa is to be addressed with sharp agents having both actions, and the treatment regimen for abhiṣyanda is to be prescribed according to the doṣa.

Key terms

निर्भुज्य (nirbhujya)

Explained here as everting the eyelid and turning its inner surface upward.

मण्डलाग्र (maṇḍalāgra)

The sharp instrument specified for dividing the lesion at its base.

कासीस (kāsīsa)

A mineral substance named in the historical rubbing application.

शलाका (śalākā)

A probe described here as being heated for cauterization.

उभयतोभाग (ubhayatobhāga)

Interpreted as substances associated with both emetic and purgative actions.

Meaning of the śloka

After completion of the surgical procedure, the patient should remain carefully regulated for one month.

Key terms

शस्त्रकर्म (śastrakarma)

The operative procedure referred to in this chapter.

सुयन्त्रित (suyantrita)

Carefully regulated or kept under the prescribed restrictions.

परिहार (parihāra)

Post-procedure restrictions whose duration is specified here.

Meaning of the śloka

Thus ends the fifteenth chapter, entitled 'Prevention and Treatment of Diseases Requiring Excision,' in the Śālākya section of the Uttaratantra of the Suśruta Saṃhitā.

Key terms

छेद्यरोगप्रतिषेध (chedyaroga-pratiṣedha)

The chapter title, concerning prevention and treatment of disorders designated for excision.

छेदन (chedana)

Excision or cutting, the procedure defining the disorders treated in the chapter.

शालाक्यतन्त्र (śālākyatantra)

The textual and clinical section in which this chapter is placed.

उत्तरतन्त्र (uttaratantra)

The division of the Suśruta Saṃhitā containing this chapter.

निबन्धसङ्ग्रह (Nibandhasaṅgraha)

The title of Dalhaṇa's commentary.