After the preceding discussion of Kriyākalpa and of eye disorders arising from bodily doṣas, this chapter appropriately begins the treatment of the remaining external cause: injury to the eye. Here abhighāta includes pain and other effects produced by injury, and pratiṣedha means their treatment. Such injury may arise from a tangible agent, such as a staff, or from an intangible cause, such as fear or grief.
Key terms
nayanābhighāta
injury or trauma affecting the eye
pratiṣedha
management or treatment in this chapter title
abhighāta
an injurious impact or cause, described as either tangible or intangible
When a person's eye has been injured in various ways and there is intense pain accompanied by swelling and redness, the discerning physician should promptly employ the previously described measures—including nasal treatment, applications to the face, irrigation, and tarpaṇa—that are considered suitable for pain arising from injury, rakta, and pitta. Measures that are unctuous, cooling, and sweet should likewise be used to restore clarity and comfort to vision.
The passage concerns physical injury, such as that caused by a staff, for which treatment varies with the condition. Its overall instruction is to use the nasal, facial, irrigation, and related measures previously recommended for pain associated with injury and for rakta- and pitta-related abhiṣyanda, together with unctuous, cooling, and sweet measures intended to soothe the eyeball. Bahudhā means in many ways. Videha gives a broad list of circumstances affecting weakened eyes, including excessive sharp añjana, wind, heat, smoke, dust, work, insects, water play, wakefulness, fasting, exertion, fear, and prolonged viewing, with symptoms such as redness, burning, piercing pain, swelling, suppuration, and irritation. One explanation takes tumula pain as pain complicated by swelling and redness; another treats saṃrambha, rāga, and severe pain as separate features, with saṃrambha meaning swelling. Another interpretation explains that trauma-aggravated vāyu disturbs śoṇita and pitta and, being obstructed by them, produces pain; treatment beneficial for those factors is therefore used.
Key terms
saṃrambha
swelling or inflammatory disturbance around the injured eye
rāga
redness of the eye
tarpaṇa
a classical nourishing or soothing ophthalmic procedure
kṣataja
arising from injury
dṛṣṭiprasādana
soothing or restoring clarity to the eye and vision
The treatment just prescribed for injury from tangible objects such as a staff is extended here to effects arising from non-tangible or environmental causes such as heat, fire, smoke, fear, and grief. 'In the same manner' means according to the method already stated, within the period before seven days. In the earlier statement, 'in many ways' refers to physical injuries; this passage supplies the treatment for the other class of causes.
Key terms
sveda
heat or heating exposure in this list of causes
dhūma
smoke exposure affecting the eye
bhaya
fear, classified by the commentary among non-tangible causes
For an eye injured recently, this procedure is used. After that period, the treatment described for abhiṣyanda should be applied after considering the involved doṣa.
The previously described procedure is intended only for the period before seven days have elapsed after injury. Beyond seven days, another approach is used: the method stated for vāta-related abhiṣyanda, selected with attention to the doṣa.
Key terms
sadyohata
recently injured; explained here as within seven days
syanda
abhiṣyanda, a classical ocular disorder category whose treatment is referenced
doṣa
the classical pathogenic factor to be assessed when choosing treatment
साध्यं क्षतं पटलमेकमुभे तु कृच्छ्रे त्रीणि क्षतानि पटलानि विवर्जयेत्तु |
स्यात् पिच्चितं च नयनं ह्यति चावसन्नं स्रस्तं च्युतं च हतदृक् च भवेत्तु याप्यम् ||६||
विस्तीर्णदृष्टितनुरागमसत्प्रदर्शि, साध्यं यथास्थितमनाविलदर्शनं च |७|
Meaning of the śloka
Injury confined to one paṭala is described as treatable; injury to two paṭalas is difficult to treat, while injury involving three paṭalas should be avoided as unsuitable for treatment. An eye that is crushed, deeply sunken, lax, displaced or hanging down, deprived of sight, or has a widely altered visual region with slight redness and false or distorted vision is described as yāpya, manageable rather than fully curable. An eye that remains in its normal position and retains clear vision is described as treatable.
The prognosis is differentiated according to how deeply the injury penetrates the paṭalas. The commentator notes that some authorities do not read this passage. The verse then describes a yāpya condition: the eye may be crushed, driven inward, lax, displaced or hanging, without sight, or have an enlarged visual region, slight redness, and faulty perception. A treatable case is one in which the eye remains normally positioned and vision is not clouded.
Key terms
paṭala
a classical layer or structural level used here to grade depth of ocular injury
An eye that has sunk too deeply inward is said to be raised promptly by breath restraint, inducing vomiting or sneezing, or constricting the throat.
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অতিপ্রবিষ্টনেত্রে চিকিত্সিতমাহ- প্রাণোপরোধেত্যাদি| প্রাণাযামেন বমনেন ছিক্কাপ্রবর্তনেন তথা কণ্ঠনিরোধনেন বা উন্নম্যমুন্নমনীযম্||৭||
Meaning of the commentary
For a markedly sunken eye, the text prescribes an attempt to raise it by prāṇāyāma or breath restraint, vomiting, provoking a sneeze, or constricting the throat.
नेत्रे विलम्बिनि विधिर्विहितः पुरस्तादुच्छिङ्घनं शिरसि वार्यवसेचनं च |८|
Meaning of the śloka
For an eye that hangs or protrudes excessively, the procedure stated earlier is prescribed, together with drawing air inward through the nose and pouring cool water over the head.
Vilambin is explained as an eye displaced excessively outward. The earlier procedure referenced is the one beginning with the description of an injured eye that remains attached but hangs down. Ucchiṅghana means drawing air inward through the nose, and vāryavasecana means pouring cool water over the head.
The seventy-six disorders described as arising in the eye occur in both children and adults. Apart from these, Kukūṇaka is a disorder specifically affecting a child's eyelids and is associated with disturbance of breast milk together with kapha, vāta, pitta, and rakta.
The commentator addresses the possible objection that adding Kukūṇaka would raise the stated total beyond seventy-six. The seventy-six eye diseases occur in children as well as adults, whereas Kukūṇaka is distinct in being confined to children's eyelids and not those of adults. Because it is included under kaphābhiṣyanda, it does not create an additional item in the count. Alternative readings are recorded: some read that it arises from disturbed breast milk or from the appearance of fleshy tissue, while others read 'from elevation of fleshy tissue'; Jejjaṭa rejects both readings.
Key terms
षट्सप्तति (ṣaṭsaptati)
the stated total of seventy-six eye disorders
कुकूणक (kukūṇaka)
a disorder described here as occurring specifically in a child's eyelids
स्तन्यप्रकोप (stanyaprakopa)
disturbance of breast milk implicated in the condition
कफाभिष्यन्द (kaphābhiṣyanda)
the kapha-related category under which Kukūṇaka is counted
मृद्गाति नेत्रमतिकण्डुमथाक्षिकूटं नासाललाटमपि तेन शिशुः स नित्यम् ||९||
सूर्यप्रभां न सहते स्रवति प्रबद्धं, तस्याहरेद्रुधिरमाशु विनिर्लिखेच्च |
क्षौद्रायुतैश्च कटुभिः प्रतिसारयेत्तु मातुः शिशोरभिहितं च विधिं विदध्यात् ||१०||
Meaning of the śloka
Because of this condition, the infant repeatedly rubs the eye, which is intensely itchy, as well as the orbital region, nose, and forehead. The child cannot tolerate sunlight and has continuous discharge. The text then directs prompt removal of blood, scraping, and rubbing with pungent substances combined with honey, and says that the prescribed regimen should be applied to the child's mother.
The passage first gives the signs of Kukūṇaka: the child rubs the nose and forehead as well as the eye, and the discharge is continuous. For treatment, the commentary interprets blood removal as being performed with leeches, scraping with leaves of Śephālikā, and the pungent substances as including Trikaṭuka. Because a young child cannot tolerate medicines, it understands the regimen previously taught for disorders of breast milk as being administered to the mother. Other authorities, however, interpret the prescribed regimen as applying to both mother and child.
Key terms
कुकूणक (kukūṇaka)
the childhood eye and eyelid disorder being described
प्रबद्ध (prabaddha)
continuous or uninterrupted, referring to the discharge
जलौका (jalaukā)
leech, specified by the commentary for blood removal
The text says that the child should be made to vomit after drinking milk combined with honey, rock salt, and the fruits of Kharamañjarī. It then begins to state an alternative involving pippalī, salt, and honey, but the supplied passage is incomplete.
Since milk is habitual nourishment for a milk-fed child, the commentary explains that emesis is prescribed through a milk-based preparation. The child is said to vomit after drinking breast milk with honey, rock salt, and powdered fruits of Kharamañjarī, identified as Apāmārga fruit. The incomplete next phrase is understood as offering an alternative in which the Kharamañjarī fruit powder is combined with breast milk, pippalī, rock salt, and related substances to induce vomiting.
Key terms
वमन (vamana)
therapeutic emesis described in the historical regimen
खरमञ्जरी (kharamañjarī)
a plant whose fruit the commentary identifies with Apāmārga fruit
सैन्धव (saindhava)
rock salt used in the described preparation
पिप्पली (pippalī)
a pungent ingredient in the alternative formulation
Adhikarana ১২ (১২) · Śloka ১২
... নৈনং বমন্তমপি বামযিতুং যতেত |১২|
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... नैनं वमन्तमपि वामयितुं यतेत |१२|
Meaning of the śloka
Even when the child is already vomiting, one should not attempt to induce further vomiting.
The commentary explains that when aggravated doṣas have already caused the child to vomit spontaneously, no additional method should be used to provoke vomiting, because excessive emesis is feared.
Key terms
वमन्त (vamanta)
one who is already vomiting
वामयितुम् (vāmayitum)
to cause or induce vomiting
वमनातियोग (vamanātiyoga)
excessive administration or effect of emesis
उत्क्लिष्टदोष (utkliṣṭadoṣa)
doṣas described as sufficiently aggravated to produce spontaneous vomiting
For a child who consumes both food and milk, the knowledgeable practitioner is directed to administer vacā and then the previously described emetic. At the later stage when the child eats solid food, the emetic is described with madanaphala.
The commentary distinguishes the milk-and-food stage from the food-eating stage. For a child taking both milk and solid food, it says to give vacā and use the emetic already described. After that developmental stage, for a child eating solid food, the same emetic is to be combined with madanaphala and may be given with or without milk.
Key terms
क्षीरान्नाद (kṣīrānnāda)
a child who consumes both milk and solid food
अन्नाद (annāda)
a child at the stage of eating solid food
वचा (vacā)
the medicinal substance named before the emetic regimen
मदनफल (madanaphala)
the fruit prescribed as part of the later-stage emetic
For Kukūṇaka, the commentary states that this decoction is intended for washing and pouring over the eyelids. It identifies dhātrī as āmalakī and aṇu as aśmantaka, and explains paridhāvana as washing and pariṣecana as irrigation or pouring.
Key terms
जम्बू (jambū)
one of the plants whose leaves are included in the decoction
After describing washing and irrigation, the commentary gives two ghee preparations without herbal paste for filling or instilling into the eye in Kukūṇaka. One is ghee processed with guḍūcī juice, which the commentary describes in relation to four parts of ghee; the other is ghee processed with a decoction of triphalā. These are presented as two separate eye preparations.
Key terms
आश्च्योतन (āścyotana)
instillation into the eye, explained here as filling the eye
गुडूची (guḍūcī)
the plant juice used in one ghee preparation
त्रिफला (triphalā)
the three-fruit group used as a decoction in the second preparation
अकल्कघृत (akalkaghṛta)
ghee preparation made without an herbal paste, as characterized by the commentary
An eye application is described using nepālajā, black pepper, conch-derived material, rasāñjana, rock salt, jaggery, and honey. Alternatively, an eye application may be made with madhurasā, madhuka, and āmraka. The supplied verse is incomplete.
The commentary introduces this as an eye application for kukūṇaka. It identifies nepālajā as manaḥśilā and sindhuprasūta as saindhava. It then explains the alternative formulation: madhurasā means mūrvā, and these three substances beginning with mūrvā are to form the eye application.
Key terms
nepAlajA (nepālajā)
Identified by the commentary as manaḥśilā.
sindhuprasUta (sindhuprasūta)
Identified by the commentary as saindhava, rock salt.
madhurasA (madhurasā)
Identified by the commentary as mūrvā.
a~jjana (añjana)
A substance intended for application to the eye.
Adhikarana ১৭ (১৪) · Śloka ১৪
... কৃষ্ণাযসং ঘৃতপযো মধু বাঽপি দগ্ধম্ ||১৪||
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... कृष्णायसं घृतपयो मधु वाऽपि दग्धम् ||१४||
Meaning of the śloka
The surviving fragment refers to black iron together with ghee, milk, or honey, subjected to burning. The supplied verse begins with an ellipsis, so its complete construction is unavailable.
The commentary presents this as a powdered eye application. Kṛṣṇāyasa is explained as powder of black iron. The materials beginning with black iron are said to be burned in a closed or smoke-contained manner to produce the powder. It also cites Videha: iron powder, ghee, honey, and milk are heated, and the ground powder is described as an eye application for children in kukūṇaka.
Key terms
kRuShNAyasa (kṛṣṇāyasa)
Black iron, explained here as powdered black iron.
cUrNA~jjana (cūrṇāñjana)
A powdered preparation intended for application to the eye.
kukUNaka (kukūṇaka)
The pediatric eye disorder named in the cited formulation.
व्योषं पलाण्डु मधुकं लवणोत्तमं च लाक्षां च गौरिकयुतां गुटिकाञ्जनं वा |
निम्बच्छदं मधुकदार्वि सताम्रलोध्रमिच्छन्ति चात्र भिषजोऽञ्जनमंशतुल्यम् ||१५||
Meaning of the śloka
One pill-form eye application is described with vyoṣa, palāṇḍu, madhuka, the best salt, lākṣā, and gairika. Physicians also recommend another eye application made in equal parts from neem leaves, madhuka, dārvī, copper, and lodhra.
The commentary identifies this as a guṭikāñjana, an eye preparation made in a pill or wick form. It explains palāṇḍu as a variety of garlic, madhuka as yaṣṭīmadhu, and lavaṇottama as saindhava. It then introduces another such preparation from neem leaf and the other listed substances. Dārvī is understood as the two kinds of haridrā on the authority of Videha. The word guṭikā is considered omitted in the second statement, and aṃśatulya means that the ingredients beginning with neem leaf are taken in equal proportions.
Key terms
vyoSha (vyoṣa)
The pungent compound named as an ingredient.
palANDu (palāṇḍu)
Explained here as a variety of garlic.
guTikA~jjana (guṭikāñjana)
A pill- or wick-form preparation intended for eye application.
aMshatulya (aṃśatulya)
Having the listed ingredients in equal proportions.
Rasāñjana prepared for half a fortnight with conch, curd, and saindhava is said to remove śukra in a child when used as an eye application. For syanda, a physician skilled in disease should follow in the child the regimen previously stated for the condition arising from kapha, with the aim of overcoming the eye disorder.
In connection with kukūṇaka, the commentary explains an eye application for lekhana of śukra in children. Citing the tradition of Videha, older physicians describe rasāñjana as repeatedly coated for seven and a half nights with conch and saindhava ground in cow's curd, then ground and formed into a wick; when applied, it is said to dislodge or break up the child's śukra. Some interpret srotoñjana as sauvīrāñjana. Variant readings are preserved: one reads a phrase about an eye application that removes a child's disease; another refers to preparation with brāhmī juice, a reading rejected by Gayī. For the following half, the commentary directs the regimen taught for kaphaja syanda, because kapha is considered predominant in children. It also records another reading meaning that the syanda regimen destroys kapha. Some interpreters add that accompanying vāta, pitta, or rakta should be assessed according to the condition and the corresponding regimens selected according to doṣa.
Key terms
srotoja rasA~jjana (srotoja rasāñjana)
The medicinal eye substance used in the described historical preparation; some read it as sauvīrāñjana.
shukra (śukra)
A named ocular lesion or opacity in this passage, not the reproductive substance.
lekhana
A scraping or reducing action attributed to the eye application.
syanda
The eye disorder for which a doṣa-specific regimen is referenced.
yathAdoSha (yathādoṣa)
Selection according to the doṣa judged to be involved.
Treatment is as deep as the ocean and cannot be stated without remainder even through tens of thousands of verses. Moreover, a person of limited understanding, lacking learning and the reasoning needed to grasp the meaning of the treatise, does not comprehend what has been taught even in thousands of verses.
The commentary answers why the teacher did not record every regimen for every particular stage of a condition. Treatment is ocean-like in depth and cannot be expressed exhaustively even through thousands or tens of thousands of verses—indeed, even through an immense number. This is not presented as inability on the author's part. Rather, a person of limited understanding who lacks the inferential reasoning by which the meaning of a treatise is understood will fail to grasp even an extensively stated teaching.
Key terms
cikitsita
The body of therapeutic knowledge described as profound and inexhaustible.
tarka
Reasoned inference used to understand the intended meaning of the treatise.
This teaching, rich in concealed meaning, has been expressed as a seed of treatment. When fully understood by a skilled physician, that seed develops in many ways. Therefore, an intelligent person who knows the meanings of various disciplines and whose understanding is grounded in authoritative teaching should continually reason through the entire treatise, whose meaning is profound.
Because the limitless stages of disease make it impossible to state treatment exhaustively—and an exhaustive statement would in any case be impractical—the teaching has been given as a deeply meaningful 'seed of treatment.' When a skilled physician who understands differing clinical states comprehends this seed, it develops into many applications, like a single seed placed in good soil growing into roots, stem, branches, and leaves. The commentary therefore says that an intelligent physician acquainted with the various Śālākya disciplines should continually reason through the profound text with an understanding grounded in āgama. Āgama is explained as the teaching of trustworthy authorities who perceive reality, supported by established means of knowledge and directed toward benefit here and hereafter.
Key terms
cikitsAbIja (cikitsābīja)
A foundational therapeutic principle likened to a seed that yields many applications when properly understood.
avasthAvid (avasthāvid)
One who understands the differing states or stages of a condition.
Uha (ūha)
Contextual reasoning used to work out the profound meaning of the teaching.
Agama (āgama)
Authoritative teaching transmitted by trustworthy knowers.
shAlAkya (śālākya)
The group of disciplines referred to by the commentary as the relevant various śāstras.
Thus ends the nineteenth chapter in the Śālākya-tantra portion of the Uttara-tantra in Dalhaṇa's Suśruta commentary entitled Nibandhasaṅgraha. The supplied commentary contains the variant form Dalhaṇa/Dalhaṇa in its authorial name.
Key terms
nayanAbhighAtacikitsita (nayanābhighātacikitsita)
Treatment of injury to the eye, the chapter title given in the colophon.
shAlAkyatantra (śālākyatantra)
The textual division in which this chapter is placed.
nibandhasa~ggraha (Nibandhasaṅgraha)
The title of Dalhaṇa's commentary on the Suśruta-saṃhitā.