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AYANAACADEMYby Dr Vijaya Dwarampudi
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16. pakṣmakōpapratiṣēdhādhyāyaḥ

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Adhikarana 1 (1-2) · Śloka 2

athātaḥ pakṣmakōpapratiṣēdhaṁ vyākhyāsyāmaḥ ||1|| yathōvāca bhagavān dhanvantariḥ ||2||

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अथातः पक्ष्मकोपप्रतिषेधं व्याख्यास्यामः ||१|| यथोवाच भगवान् धन्वन्तरिः ||२||

Meaning of the śloka

Now we shall explain the prevention and treatment of pakṣmakopa. Thus spoke the venerable Dhanvantari.

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chēdyarōgapratiṣēdhānantaraṁ pakṣmakōpē cchēdyakarmasamavāyāt pakṣmagatarōgapratiṣēdhārambhō yuktō'ta āha- athāta ityādi| pakṣma vartmagatarōmamālikā; kēcit pakṣmaśabdēna pakṣmāśrayaṁ vartma kathayanti||1-2||

Meaning of the commentary

The commentary explains that this chapter appropriately begins the treatment of diseases involving the eyelashes after the chapter on disorders requiring excision, because excisional treatment is also involved in pakṣmakopa. Pakṣma means the row of hairs situated on the eyelid. Some authorities, however, use the word pakṣma to denote the eyelid that serves as the support of those hairs.

Key terms

पक्ष्मकोप (pakṣmakopa)
The eyelash-related disorder whose prevention and treatment form the subject of this chapter.
पक्ष्म (pakṣma)
Explained primarily as the row of eyelid hairs, though some authorities understand it as the supporting eyelid.
प्रतिषेध (pratiṣedha)
The prevention and treatment being explained in the chapter.
धन्वन्तरि (Dhanvantari)
The revered teacher to whom the teaching is attributed.

Adhikarana 2 (3-6) · Śloka 6

yāpyastu yō vartmabhavō vikāraḥ pakṣmaprakōpō'bhihitaḥ purastāt | tatrōpaviṣṭasya narasya carma vartmōpariṣṭādanutiryagēva ||3|| bhruvōradhastāt parimucya bhāgau pakṣmāśritaṁ caikamatō'vakr̥ntēt | kanīnakāpāṅgasamaṁ samantādyavākr̥ti snigdhatanōrnarasya ||4|| utkr̥tya śastrēṇa yavapramāṇaṁ bālēna sīvyēdbhiṣagapramattaḥ | dattvā ca sarpirmadhunā'vaśēṣaṁ kuryādvidhānaṁ vihitaṁ vraṇē yat ||5|| lalāṭadēśē ca nibaddhapaṭṭaṁ prāksyūtamatrāpyaparaṁ ca baddhvā | sthairyaṁ gatē cāpyatha śastramārgē bālān vimuñcēt kuśalō'bhivīkṣya ||6||

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याप्यस्तु यो वर्त्मभवो विकारः पक्ष्मप्रकोपोऽभिहितः पुरस्तात् | तत्रोपविष्टस्य नरस्य चर्म वर्त्मोपरिष्टादनुतिर्यगेव ||३|| भ्रुवोरधस्तात् परिमुच्य भागौ पक्ष्माश्रितं चैकमतोऽवकृन्तेत् | कनीनकापाङ्गसमं समन्ताद्यवाकृति स्निग्धतनोर्नरस्य ||४|| उत्कृत्य शस्त्रेण यवप्रमाणं बालेन सीव्येद्भिषगप्रमत्तः | दत्त्वा च सर्पिर्मधुनाऽवशेषं कुर्याद्विधानं विहितं व्रणे यत् ||५|| ललाटदेशे च निबद्धपट्टं प्राक्स्यूतमत्राप्यपरं च बद्ध्वा | स्थैर्यं गते चाप्यथ शस्त्रमार्गे बालान् विमुञ्चेत् कुशलोऽभिवीक्ष्य ||६||

Meaning of the śloka

For the eyelid disorder previously described as pakṣmaprakopa and regarded as manageable rather than completely curable, the seated patient—whose body has been duly prepared with oleation—is treated by making a transverse, barley-shaped excision in the skin above the eyelid. It is made evenly from the region corresponding to the inner canthus to the outer canthus, below the eyebrow, while leaving the eyelash-bearing portion intact. After excising a barley-sized strip with an instrument, the careful practitioner sutures it with a hair, applies ghee and honey, and follows the regimen prescribed for a wound. The ends of the suture are secured by a bandage at the forehead. Once the operative wound has become firm, the skilled practitioner examines it and removes the suture hairs.

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pakṣmakōpē śastramagniḥ kṣārō bhēṣajamiti caturvidhaṁ karma; tatrādau śastrakarma nirdiśannāha- yāpya ityādi| purastāt vartmarōgavijñānīyē| tatra pakṣmaprakōpē| snigdhadēhasyōpaviṣṭasya narasya, bhruvōradhastāddvau bhāgau, tatra pakṣmāśritamēkaṁ bhāgaṁ vimucya kanīnakāpāṅgayōḥ samaṁ pradēśamanulakṣīkr̥tya, samantāt sarvataḥ na tu kvacidēva, ētēnōpapakṣmamālāpramāṇēna vartmōpariṣṭādyavākr̥ti carma tiryak śastrēṇa nikr̥ntēt, carma nikr̥tya tadaśvādīnāṁ bālēna sīvyēt| tataḥ sandhānārthaṁ madhu ghr̥taṁ ca dattvā, prāksyūtaṁ yattat aparaṁ yat syūtvōddhr̥taṁ tat ētadbālāñcaladvayēna lalāṭē paṭṭaṁ baddhvā vraṇōktaṁ vidhiṁ kuryāditi piṇḍārthaḥ| sthairyaṁ gatē kaṭhinībhūtē saṁrūḍhē ityarthaḥ| śastramārgē vraṇē, bālān sēvanabālān, vimuñcēt syūtarandhrāt kramēṇāpakarṣēdityarthaḥ| kēcit ‘vimuñcēt’ ityatra ‘prakalpayēt’ iti paṭhanti, prakalpayēt kartaryā cchindyāditi ca vyākhyānayanti||3-6||

Meaning of the commentary

The commentary states that pakṣmakopa has four modes of treatment: an operative instrument, fire cautery, an alkaline agent, and medicine; this passage first describes the operative procedure. The disorder was discussed earlier in the chapter on the recognition of eyelid diseases. In a seated patient prepared by oleation, the area below the eyebrows is considered in two portions. The eyelash-bearing portion is spared, and a transverse, barley-shaped strip of skin above the eyelid is cut evenly along the full extent corresponding to the inner and outer canthi, rather than at only one point; its extent is related to the adjacent row of eyelashes. The cut skin is then sutured with animal hair. Honey and ghee are applied to promote union, and the two free ends of the hair suture are secured with a forehead bandage, after which the prescribed wound regimen is followed. When the wound has become firm, hardened, and united, the suture hairs are gradually withdrawn from the stitch holes. Some authorities read prakalpayet instead of vimuñcet and explain it as cutting with scissors; the commentary preserves this alternative reading.

Key terms

पक्ष्मप्रकोप (pakṣmaprakopa)
The eyelash-related eyelid disorder for which the historical procedure is described.
याप्य (yāpya)
A condition described as manageable or controllable rather than completely curable.
यवाकृति (yavākṛti)
Barley-shaped, describing the form of the historical excision.
कनीनकापाङ्ग (kanīnakāpāṅga)
The inner and outer canthal regions used to describe the extent of the procedure.
शस्त्रमार्ग (śastramārga)
The wound or track produced by the operative instrument.
विमुञ्चेत् (vimuñcet)
To release or remove the suture hairs; an alternative reading, prakalpayet, is interpreted as cutting them with scissors.

Adhikarana 3 (7) · Śloka 7

ēvaṁ na cēcchāmyati tasya vartma nirbhujya dōṣōpahatāṁ valiṁ ca | tatō'gninā vā pratisārayēttāṁ kṣārēṇa vā samyagavēkṣya dhīraḥ ||7||

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एवं न चेच्छाम्यति तस्य वर्त्म निर्भुज्य दोषोपहतां वलिं च | ततोऽग्निना वा प्रतिसारयेत्तां क्षारेण वा सम्यगवेक्ष्य धीरः ||७||

Meaning of the śloka

If the condition still does not subside in this way, the practitioner should evert the eyelid and address the fold affected by doṣa. After carefully considering the matter, the knowledgeable practitioner should cauterize that fold either with fire or with an alkaline agent.

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ēvamapyaśāmyati pakṣmakōpē upapakṣmamālāparaparyāyē karmāntaramāha- ēvamityādi| nirbhujya uttānīkr̥tvētyarthaḥ| avēkṣya ‘śāstram’ iti śēṣaḥ||7||

Meaning of the commentary

The commentary states that when pakṣmakopa, also called upapakṣmamālā, does not settle even with the preceding treatment, this verse prescribes another procedure. Nirbhujya means turning the eyelid upward. In the expression 'after considering,' the commentary supplies the understood word śāstra, indicating consideration of the authoritative surgical teaching.

Key terms

पक्ष्मकोप (pakṣmakopa)
The eyelash-related disorder being treated in this chapter.
उपपक्ष्ममाला (upapakṣmamālā)
The alternative name given by the commentary for pakṣmakopa.
निर्भुज्य (nirbhujya)
Explained by the commentary as everting the eyelid and turning it upward.
दोषोपहता वलि (doṣopahatā vali)
The eyelid fold described as affected by doṣa.
प्रतिसारण (pratisāraṇa)
Here, cauterizing or treating the affected fold with the stated fire or alkaline agent.

Adhikarana 4 (8) · Śloka 8

chitvā samaṁ vā'pyupapakṣmamālāṁ samyaggr̥hītvā baḍiśaistribhistu | pathyāphalēna pratisārayēttu ghr̥ṣṭēna vā tauvarakēṇa samyak ||8||

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छित्वा समं वाऽप्युपपक्ष्ममालां सम्यग्गृहीत्वा बडिशैस्त्रिभिस्तु | पथ्याफलेन प्रतिसारयेत्तु घृष्टेन वा तौवरकेण सम्यक् ||८||

Meaning of the śloka

Alternatively, after properly grasping the upapakṣmamālā with three hooks, the practitioner should divide or remove it evenly. The treated site is then to be rubbed properly with the fruit of pathyā ground in water, or with tauvaraka prepared by grinding.

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kṣārāgnibhyāmapyapraśāmyantyāmupapakṣmamālāyāṁ vidhyantaramāha- chittvā samamityādi| chittvā dvidhā bhāvaṁ nītvā, utpāṭyētyarthaḥ| samam ēkakālam| upapakṣmamālāṁ ‘dōṣāḥ pakṣmāśayagatāstīkṣṇāgrāṇi kharāṇi ca’ ityādyuktalakṣaṇām| pathyāphalēna jalaghr̥ṣṭēna pratisārayēt| kēcit ‘piṣṭēna’ iti paṭhanti||8||

Meaning of the commentary

The commentary presents this as another procedure when upapakṣmamālā has not subsided even after the use of alkaline cautery and fire cautery. It explains chittvā as bringing the structure into two parts, that is, uprooting or removing it, and sama as doing so at one time. Upapakṣmamālā is the condition previously characterized by doṣas lodged at the eyelash base, producing eyelashes with sharp and rough tips. The site is to be rubbed with the fruit of pathyā ground in water. Some authorities read piṣṭena, 'made into a paste,' in place of the transmitted wording.

Key terms

उपपक्ष्ममाला (upapakṣmamālā)
The eyelash disorder described as involving sharp, rough eyelash tips.
बडिश (baḍiśa)
A hook used to grasp the affected structure in the historical procedure.
पथ्याफल (pathyāphala)
The fruit called pathyā, prescribed here after grinding it in water.
तौवरक (tauvaraka)
A substance named as an alternative historical application in the verse.
प्रतिसारण (pratisāraṇa)
Rubbing or applying the stated preparation to the treated site.

Adhikarana 5 (9) · Śloka 9

catvāra ētē vidhayō vihantuṁ pakṣmōparōdhaṁ pr̥thagēva śastāḥ | virēcanāścyōtanadhūmanasyalēpāñjanasnēharasakriyāśca ||9||

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चत्वार एते विधयो विहन्तुं पक्ष्मोपरोधं पृथगेव शस्ताः | विरेचनाश्च्योतनधूमनस्यलेपाञ्जनस्नेहरसक्रियाश्च ||९||

Meaning of the śloka

These four methods are each recommended for counteracting pakṣmoparodha: purgation, eye drops, medicated smoke, nasal treatment, topical applications, collyrium, oleation, and concentrated preparations.

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uktamēvōpasaṁharannāha- catvāra ityādi| catvāra ēta iti śastrāgnikṣārabhēṣajāni| pakṣmōparōdhaṁ pakṣmaprakōpam| vihantuṁ vighaṭṭayituṁ na punaḥ sarvathā śamayituṁ, tasya yāpyatvāt| tathā'bhiṣyandōktā virēcanādayō yathāvasthamupayuktāḥ pr̥thagēva pakṣmōparōdhaṁ vihantuṁ samarthāḥ| rasakriyāścētyatra cakārādupapakṣmōtpāṭanam||9||

Meaning of the commentary

In summarizing the treatment already stated, the commentary explains that the four methods are the use of instruments, heat, alkaline substances, and medicines. Pakṣmoparodha is identified with pakṣmaprakopa. Here vihantuṃ means to check or disrupt the disorder, rather than to cure it completely, because it is considered manageable but persistent. Purgation and the other measures taught for abhiṣyanda may each, when selected according to the condition, help control pakṣmoparodha. The conjunction after rasakriyā also includes removal of subsidiary eyelashes.

Key terms

पक्ष्मोपरोध (pakṣmoparodha)
The eyelash-related disorder discussed here, equated by the commentary with pakṣmaprakopa.
शस्त्राग्निक्षारभेषज (śastra-agni-kṣāra-bheṣaja)
The four therapeutic categories identified by the commentary: instruments, heat, alkaline substances, and medicines.
विरेचन (virecana)
Purgation, listed among measures adapted from the treatment of abhiṣyanda.
रसक्रिया (rasakriyā)
A concentrated medicinal preparation included among the stated treatments.
उपपक्ष्मोत्पाटन (upapakṣmotpāṭana)
Removal of subsidiary or abnormal eyelashes, included by implication in the commentary.

Adhikarana puṣpikā · Śloka 16

iti suśrutasaṁhitāyāmuttaratantrāntargatē śālākyatantrē pakṣmagatarōgapratiṣēdhō nāma ṣōḍaśō'dhyāyaḥ ||16||

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इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे पक्ष्मगतरोगप्रतिषेधो नाम षोडशोऽध्यायः ||१६||

Meaning of the śloka

Thus ends the sixteenth chapter, entitled ‘Prevention and Treatment of Diseases Affecting the Eyelashes,’ in the Śālākya section of the Uttaratantra of the Suśruta Saṃhitā.

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iti śrīḍalha(hla)ṇaviracitāyāṁ nibandhasaṅgrahākhyāyāṁ suśrutavyākhyāyāmuttaratantrāntargatē śālākyatantrē ṣōḍaśō'dhyāyaḥ||16||

Meaning of the commentary

Thus ends the sixteenth chapter of the Śālākya section within the Uttaratantra in the Suśruta commentary called Nibandhasaṅgraha, composed by Śrī Dalhaṇa. The supplied source preserves the commentator's name in the variant-looking form Dalha(hla)ṇa.

Key terms

पक्ष्मगतरोगप्रतिषेध (pakṣmagata-roga-pratiṣedha)
The chapter title, concerning prevention and treatment of diseases situated in or affecting the eyelashes.
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.
← 15. chēdyarōgapratiṣēdhādhyāyaḥ17. dr̥ṣṭigatarōgapratiṣēdhādhyāyaḥ →