१३. लेख्यरोगप्रतिषेधाध्यायः

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Adhikarana १ (१-२) · Śloka २

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

Meaning of the śloka

Now the chapter concerning the prevention and treatment of diseases indicated for lekhana is explained, as taught by the venerable Dhanvantari.

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रक्ताभिष्यन्दानन्तरमौषधसाध्यान् गदाञ्चतुर्ष्वभिष्यन्देष्वभिधाय शस्त्रसाध्यान् प्रतिपादयितुकामो लेख्याञ्जनप्रसङ्गेन प्रथमं लेख्यरोगप्रतिषेधमाह- अथात इत्यादि| यद्यपि चिकित्साप्रविभागीयोद्दिष्टात् ‘छेद्यास्तेषु दशैकश्च’ इत्यादिवचनात् पूर्वं छेद्यरोगाणामुपादानं प्रप्नोति, तथाऽपि लेख्याञ्जनप्रसङ्गाच्छेद्यादिष्वल्पावस्थायां लेखनोपयोगाच्च लिख्यानां प्रागुपादानम्||१-२||

Meaning of the commentary

After describing medicinal treatment for disorders among the four kinds of abhiṣyanda following raktābhiṣyanda, the text now begins to explain disorders treated by operative measures. Because lekhya-añjana has just been discussed, it first presents the treatment of diseases indicated for lekhana. Although the earlier classification, beginning with the statement that eleven conditions are chedya, could suggest that chedya disorders should be taken first, lekhya disorders are presented beforehand because of that immediate context and because lekhana may also be used in the mild stage of disorders otherwise treated by chedana and related procedures.

Key terms

लेख्यरोग (lekhyaroga): Disorders described as suitable for the historical procedure of lekhana.
लेखन (lekhana): A scraping procedure discussed in this chapter.
छेद्य (chedya): A category of disorders described as suitable for excision.
लेख्याञ्जन (lekhya-añjana): A scraping or cleansing type of historical ocular application mentioned in the commentary.

Adhikarana २ (३-८) · Śloka ९

नव येऽभिहिता लेख्याः सामान्यस्तेष्वयं विधिः | स्निग्धवान्तविरिक्तस्य निवातातपसद्मनि ||३|| (आप्तैर्दृढं गृहीतस्य वेश्मन्युत्तानशायिनः) | सुखोदकप्रतप्तेन वाससा सुसमाहितः | स्वेदयेद्वर्त्म निर्भुज्य वामाङ्गुष्ठाङ्गुलिस्थितम् ||४|| अङ्गुल्यङ्गुष्ठकाभ्यां तु नि र्भुग्नं वर्त्म यत्नतः | प्लोतान्तराभ्यां न यथा चलति स्रंसतेऽपि वा ||५|| ततः प्रमृज्य प्लोतेन वर्त्म शस्त्रपदाङ्कितम् | लिखेच्छस्त्रेण पत्रैर्वा, ततो रक्ते स्थिते पुनः ||६|| स्विन्नं मनोह्वाकासीसव्योषार्द्राञ्जनसैन्धवैः | श्लक्ष्णपिष्टैः समाक्षीकैः प्रतिसार्योष्णवारिणा ||७|| प्रक्षाल्य हविषा सिक्तं व्रणवत् समुपाचरेत् | स्वेदावपीडप्रभृतींस्त्र्यहादूर्ध्वं प्रयोजयेत् ||८|| व्यासतस्ते समुद्दिष्टं विधानं लेख्यकर्मणि |९|

Meaning of the śloka

A common procedure is stated for the nine disorders described as lekhya. After oleation, emesis, and purgation, the person is placed lying face upward in a sheltered, sun-warmed room and held securely by trusted attendants. The eyelid is everted and gently warmed with cloth heated in comfortably warm water. With the finger and thumb covered by cloth, the everted lid is held steadily so that it neither moves nor slips. After wiping it with cloth and marking the operative site, the lid is scraped with an instrument or with leaves. When bleeding has ceased, the warmed site is rubbed with finely powdered manohvā, kāsīsa, vyoṣa, ārdrāñjana, saindhava, and mākṣīka mixed with honey. It is then washed with warm water, covered with ghee, and cared for like a wound. After three days, measures beginning with fomentation and avapīḍa are prescribed. This outlines the procedure for lekhana; its details are stated elsewhere.

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तान् सर्वान् सङ्ख्ययाऽभिधाय सङ्क्षेपार्थं तेष्वभिन्नविधिमुपदिशन्नाह- नवेत्यादि| तमेव सामान्यविधिमाह- स्निग्धेत्यादि|- स्निग्धवान्तविरिक्तस्येत्यत्रानुक्तोऽपि स्नेहानन्तरं स्वेदः कार्यः| सुसमाहित इत्यनेन यथा दृशोः पीडा न स्यात्तथा स्वेदयेदिती द्योत्यते| निर्भुज्य परिवर्त्य, उत्तानीकृत्येत्यर्थः| निर्भुग्नम् उत्तानीकृतम्| प्लोतान्तराभ्यां वस्त्रवेष्टिताभ्यामङ्गुल्यङ्गुष्ठाभ्यां यथा न चलति न कम्पते, न वा स्रंसते नाधः पतति, तथा वर्त्म निर्भुज्येत्यर्थः| शस्त्रपदाङ्कितमिति प्रच्छयितव्ये प्रच्छितं, भेदयितव्ये च भिन्नं, छेदनीये च छिन्नमित्यर्थः| वातकफव्याधिकठिनं दारुणं वर्त्म शस्त्रेण लिखेत्, पित्तरक्तगदक्रान्तं मृदुवर्त्म पुनः शेफालिकादीनां पत्रैर्लिखेत्| पश्चात्कर्माह- तत इत्यादि| स्विन्नं स्वेदितम्| मनोह्वा मनःशिला| आर्द्राञ्जनं रसाञ्जनम्| माक्षीकं सुवर्णमाक्षीकम्| प्रतिसार्य अवघृष्य| हविषा घृतेन| व्रणवत् सद्योव्रणवत् सप्ताहं यावत्, तदूर्ध्वं शारीरव्रणवत्; तच्च पर्णबन्धादिना क्रमेण| स्वेदावपीडेत्यादि| त्र्यहादूर्ध्वं पुनर्व्रणवदेव स्वेदापीडाप्रभृतीन् प्रयोजयेदिति तात्पर्यार्थः| स्वेदावपीडादिकं समासेनाभिधाय विस्तरेणातिदिशन्नाहा- व्यासत इत्यादि| विधानं स्वेदावपीडादिकम्| लेख्यकर्मणीति सकललेखनार्हगदकर्मणीत्यर्त्थः||३-८||-

Meaning of the commentary

The commentator explains that the verse first counts the disorders and then gives the procedure common to all nine. Fomentation, though not expressly stated, is understood after oleation. The warming should be controlled so that the eyes are not distressed. Nirbhujya and nirbhugna mean turning or everting the lid, and the cloth-covered finger and thumb keep it from trembling, moving, slipping, or falling downward. The phrase concerning the instrument-marked site includes a site that has been punctured where puncture is indicated, opened where opening is indicated, or excised where excision is indicated. A hard, severe eyelid disorder dominated by vāta and kapha is said to be scraped with an instrument, whereas a soft lid affected by pitta and rakta is scraped with leaves such as those of śephālikā. For aftercare, manohvā is identified as manaḥśilā, ārdrāñjana as rasāñjana, mākṣīka as suvarṇamākṣīka, pratisārya as rubbing, and havis as ghee. The site is treated like a fresh wound for seven days and thereafter like an ordinary bodily wound, including measures such as a leaf bandage. After the third day, fomentation, avapīḍa, and related measures are again used as wound care. The final statement refers these briefly named measures to their fuller descriptions and applies the regimen to all disorders considered suitable for lekhana.

Key terms

लेख्य (lekhya): A disorder classified as suitable for the historical scraping procedure.
निर्भुज्य (nirbhujya): Everting or turning the eyelid, as explained by the commentary.
मनोह्वा (manohvā): Identified by the commentary as manaḥśilā, a mineral substance in the historical application.
आर्द्राञ्जन (ārdrāñjana): Identified by the commentary as rasāñjana.
माक्षीक (mākṣīka): Identified here as suvarṇamākṣīka, a mineral substance.
अवपीड (avapīḍa): A measure included in the postoperative regimen, whose fuller procedure is referred to elsewhere.

Adhikarana ३ (९) · Śloka १०

असृगास्रावरहितं कण्डूशोफविवर्जितम् ||९|| समं नखनिभं वर्त्म लिखितं सम्यगिष्यते |१०|

Meaning of the śloka

An eyelid is considered properly scraped when it is free from bleeding and watery discharge, itching and swelling, is even, and has an appearance resembling a fingernail.

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इदानीं सम्यग्लिखितस्य वर्त्मनो लक्षणमाह- असृगास्रावरहितमित्यादि| समं निम्नोन्नतत्वरहितम्| नखनिभं नखस्येव निभा यस्य तत्तथा| तदेव व्रणवदुपचरणीयम्||९||-

Meaning of the commentary

The commentator states that these are the signs of an eyelid on which lekhana has been properly performed. Sama means that the surface is free from depressions and elevations, and nakhanibha means that it has a lustre or appearance like that of a nail. Such a site is to be cared for like a wound.

Key terms

असृक् (asṛk): Blood, whose continued flow should be absent in the stated sign of proper lekhana.
आस्राव (āsrāva): Watery or fluid discharge.
सम (sama): Even, explained as having neither depressions nor elevations.
नखनिभ (nakhanibha): Having an appearance or lustre resembling a fingernail.

Adhikarana ४ (१०-१२) · Śloka १२

रक्तमक्षि स्रवेत् स्कन्नं क्षताच्छस्त्रकृताद्ध्रुवम् ||१०|| रागशोफपरिस्रावास्तिमिरं व्याध्यनिर्जयः | वर्त्म श्यावं गुरु स्तब्धं कण्डूहर्षोपदेहवत् ||११|| नेत्रपाकमुदीर्णं वा कुर्वीताप्रतिकारिणः | एतद्दुर्लिखितं ज्ञेयं स्नेहयित्वा पुनार्लिखेत् ||१२||

Meaning of the śloka

Improper scraping is indicated when thickened blood certainly flows from the wound made by the instrument, or when redness, swelling, discharge, dimness of vision, and persistence of the disorder occur. The eyelid may become dark, heavy, rigid, itchy, tingling, or coated; without corrective care, severe inflammation of the eye may develop. This is to be recognized as faulty lekhana. The text then states that, after oleation, lekhana should be performed again.

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दुर्लिखितस्य वर्त्मनो लक्षणमाह- रक्तमित्यादि| स्कन्नं स्त्यानम्| व्याध्यनिर्जय इति लेखनसाध्यस्य व्याधेरनुपशमः| अप्रतिकारिण इति तस्य प्रतिक्रियामकुर्वत इत्यर्थः| तत्र चिकित्सामाह- स्नेहत्वेत्यादि| केचित् ‘स्वेदयित्वा’ इति पठन्ति||१०-१२||

Meaning of the commentary

The commentator presents the signs of an eyelid that has been improperly scraped. Skanna means thickened or congealed. Vyādhyanirjaya means that the disorder intended to be treated by lekhana has not subsided. Apratikārin refers to a person for whom no countermeasure is undertaken. As treatment, the text reads that the site is to be oleated and scraped again; however, some authorities read ‘after fomenting’ instead of ‘after oleating.’

Key terms

दुर्लिखित (durlikhita): Improperly or inadequately scraped in the historical procedure.
स्कन्न रक्त (skanna rakta): Thickened or congealed blood, as explained by the commentary.
व्याध्यनिर्जय (vyādhy-anirjaya): Failure of the disorder indicated for lekhana to subside.
नेत्रपाक (netrapāka): Severe inflammatory or suppurative affection of the eye described as a possible consequence.
स्नेहयित्वा / स्वेदयित्वा (snehayitvā / svedayitvā): Alternative readings meaning ‘after oleating’ or ‘after fomenting,’ respectively.

Adhikarana ५ (१३) · Śloka १४

व्यावर्तते यदा वर्त्म पक्ष्म चापि विमुह्यति | स्यात् सरुक् स्रावबहुलं तदतिस्रावितं विदुः ||१३|| स्नेहस्वेदादिरिष्टः स्यात् क्रमस्तत्रानिलापहः |१४|

Meaning of the śloka

When the eyelid turns outward, the eyelashes become disordered, and there is pain with profuse discharge, this is understood as excessive scraping. In that condition, a course beginning with snehana and svedana, and intended to pacify anila (Vata), is prescribed.

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अतिलिखितवर्त्मनो लक्षणमाह- व्यावर्तत इत्यादि| तच्चिकित्सितमाह- स्नेहस्वेदादिरित्यादि| अनिलापहः क्रमोऽन्योऽपि परिषेकादिर्बाह्य आभ्यन्तरो वाऽऽहारादिकः| अनिलापहेन वायुं जित्वा पश्चाद्व्रणवदुपचरणीयम्||१३||-

Meaning of the commentary

The commentary identifies the first portion as the signs of an eyelid that has been scraped excessively and the next portion as its treatment. It explains that the anila-pacifying course may also include other external measures such as sprinkling or internal measures involving diet. After Vayu has been brought under control by such measures, the affected area is to be managed in the manner of a wound.

Key terms

atisrAvita (atisrāvita): The condition resulting from excessive scraping, marked here by eyelid eversion, disturbed eyelashes, pain, and profuse discharge.
sneha: Oleation, named as the beginning of the prescribed historical management sequence.
sveda: Sudation or fomentation, included in the historical management sequence.
anilApaha (anilāpaha): Pacifying anila or Vata.

Adhikarana ६ (१४) · Śloka १५

वर्त्मावबन्धं क्लिष्टं च बहलं यच्च कीर्तितम् ||१४|| पोथकीश्चाप्यवलिखेत् प्रच्छयित्वाऽग्रतः शनैः |१५|

Meaning of the śloka

The conditions described as vartmavabandha, kliṣṭa-vartman, bahala-vartman, and pothakī should first be gently punctured or incised anteriorly and then scraped gradually.

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इदानीं रोगविशेषे क्वचिदेव प्रच्छन्नेन रक्तहरणमृदुकरणपूर्वकं लेखनमतिदिशन्नाह- वर्त्मेत्यादि| अवलिखेत् शस्त्रेण, न तु पत्रादिभिः||१४||-

Meaning of the commentary

The commentary says that, in these particular disorders, scraping is prescribed after the area has first been softened by blood removal through pracchanna. It specifies that the scraping is to be performed with a surgical instrument, rather than with leaves or similar materials.

Key terms

vartmAvabandha (vartmāvabandha): A named eyelid disorder for which the passage prescribes historical operative treatment.
pothakI (pothakī): A named eyelid disorder included among the conditions to be treated by the described procedure.
pracchayitvA (pracchayitvā): After puncturing or making small incisions; the commentary associates this with blood removal and softening.
avalikhet: Should scrape, here explicitly with a surgical instrument.

Adhikarana ७ (१५) · Śloka १५

समं लिखेत्तु मेधावी श्यावकर्दमवर्त्मनी ||१५||

Meaning of the śloka

A knowledgeable practitioner should scrape śyāva-vartman and kardama-vartman evenly.

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क्वचित् पुनर्लेखनमात्रमेव कर्तव्यं न पुनश्छेदभेदप्रच्छन्नानीति दर्शयन्नाह- सममित्यादि| समम् एककालमित्यर्थः; अन्ये तु नात्यवगाढं नात्युत्तानमिति सममाहुः||१५||

Meaning of the commentary

The commentary explains that, in these conditions, scraping alone is to be performed, without cutting, splitting, or puncturing. It gives two interpretations of samam: one understands it as treating both at the same time, while others understand it as scraping to a balanced depth, neither too deep nor too superficial.

Key terms

shyAvavartman (śyāva-vartman): A named eyelid disorder for which scraping alone is prescribed here.
kardamavartman (kardama-vartman): A named eyelid disorder paired with śyāva-vartman in this prescription.
samam: Evenly; interpreted either as at the same time or at a depth that is neither excessive nor superficial.
likhet: Should scrape, referring to the historical operative treatment discussed in the chapter.

Adhikarana ८ (१६) · Śloka १६

कुम्भीकिनीं शर्करां च तथैवोत्सङ्गिनीमपि | कल्पयित्वा तु शस्त्रेण लिखेत् पश्चादतन्द्रितः ||१६||

Meaning of the śloka

For kumbhīkinī, śarkarā, and utsaṅginī, the practitioner should first prepare the lesion with a surgical instrument and afterward scrape it attentively.

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कुत्रचिच्छेदपूर्वकं लेखनमाह- कुम्भीकिनीमित्यादि| कल्पयित्वा छित्त्वेत्यर्थः| अतन्द्रितः अनलसः||१६||

Meaning of the commentary

The commentary states that this passage prescribes scraping after cutting in certain conditions. It glosses kalpayitvā as ‘having cut’ and atandrita as ‘not being negligent or sluggish.’

Key terms

kumbhIkinI (kumbhīkinī): A named eyelid disorder included in the historical cut-then-scrape treatment group.
sharkarA (śarkarā): A named eyelid disorder included in the same treatment group.
utsa~gginI (utsaṅginī): A named eyelid disorder for which cutting followed by scraping is described.
kalpayitvA (kalpayitvā): Having prepared; specifically glossed by the commentary here as having cut.

Adhikarana ९ (१७) · Śloka १७

भवेयुर्वर्त्मसु च याः पिडकाः कठिना भृशम् | ह्रस्वास्ताम्राश्च ताः पक्वा भिन्द्याद्भिन्ना लिखेदपि ||१७||

Meaning of the śloka

Very hard, small, copper-coloured piḍakās occurring on the eyelids should be opened when they have matured; after they are opened, they may also be scraped.

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कस्मिंश्चिद्भेदपूर्वकं लेखनमाह- भवेयुरित्यादि||१७||

Meaning of the commentary

The commentator states that, in a certain condition, scraping is prescribed only after the lesion has first been opened.

Key terms

वर्त्मस् (vartmas): The eyelid, where the lesions described here occur.
पिडका (piḍakā): A small raised lesion or pustule described on the eyelid.
पक्व (pakva): Matured or ready to be opened, in the source's procedural sequence.
भेदन (bhedana): Opening or puncturing the matured lesion.
लेखन (lekhana): Scraping, prescribed here after the lesion has been opened.

Adhikarana १० (१८) · Śloka १८

तरुणीश्चाल्पसंरम्भा पिडका बाह्यवर्त्मजाः | विदित्वैताः प्रशमयेत् स्वेदालेपनशोधनैः ||१८||

Meaning of the śloka

Recognizing that the piḍakās arising on the outer eyelid are recent and only mildly inflamed, one should calm them with fomentation, topical applications, and cleansing measures.

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कुत्रापि वर्त्मरोगे न पूर्वं छेदभेदप्रच्छन्नानि, न चोत्तरकालं लेखनमिति दर्शयन्नाह- तरुणीश्चाल्पेत्यादि||१८||

Meaning of the commentary

The commentator explains that this verse shows an eyelid condition in which cutting, opening, or scarification is not to be performed at the earlier stage, and scraping is not to be performed later; the condition is instead managed by the measures stated in the verse.

Key terms

तरुणी पिडका (taruṇī piḍakā): A recent or immature eyelid lesion.
अल्पसंरम्भ (alpasaṃrambha): Having only slight inflammation or agitation.
बाह्यवर्त्मज (bāhyavartmaja): Arising on the outer eyelid.
स्वेद (sveda): Fomentation, named as a calming measure.
आलेपन (ālepana): A topical application or paste.
शोधन (śodhana): Cleansing or purificatory measures, whose exact form is not specified in this passage.

Adhikarana पुष्पिका · Śloka १३

इति सुशुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे लेख्यरोगप्रतिषेधो नाम त्रयोदशोऽध्यायः ||१३||

Meaning of the śloka

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

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इति श्रीडल्ह(ह्ल)णविरचितायां निबन्धसङ्ग्रहख्यायां सुश्रुतव्याख्यायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे त्रयोदशोऽध्यायः||१३||

Meaning of the commentary

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

Key terms

लेख्यरोगप्रतिषेध (lekhyaroga-pratiṣedha): The chapter title, concerning the prevention and treatment of disorders designated for lekhana.
लेखन (lekhana): Scraping, 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.
उत्तरतन्त्र (uttaratantra): The division of the Suśruta Saṃhitā containing this chapter.
निबन्धसङ्ग्रह (Nibandhasaṅgraha): The title of Dalhaṇa’s commentary.

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