The fifteenth chapter of Uttaratantra of Sushruta Samhita is called as Chedya Roga Pratisedha Adhyaya. This chapter offers with the therapy of Illnesses Requiring Excision.
अथातश्छेद्यरोगप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We are going to now expound Chedya roga pratisedha – therapy of illnesses that are to be excised (lower and eliminated); as revealed by the venerable Dhanvantari.
Arma chedana – excising the pterygium
स्निग्धं भुक्तवतो ह्यन्नमुपविष्टस्य यत्नतः |
संरोषयेत्तु नयनं भिषक् चूर्णैस्तु लावणैः ||३||
Firstly, oleation needs to be achieved to the one that is affected by Arma illness. The individual needs to be instructed to take his meals after which sit comfortably on a stool or chair. Now, by placing clean powder of rock salt into the attention, the doctor ought to enrage the attention.
ततः संरोषितं तूर्णं सुस्विन्नं परिघट्टितम् |
अर्म यत्र वलीजातं तत्रैतल्लगयेद्भिषक् ||४||
अपाङ्गं प्रेक्षमाणस्य बडिशेन समाहितः |
मुचुण्ड्याऽऽदाय मेधावी सूचीसूत्रेण वा पुनः ||५||
न चोत्थापयता क्षिप्रं कार्यमभ्युन्नतं तु तत् |
शस्त्राबाधभयाच्चास्य वर्त्मनी ग्राहयेद्दृढम् ||६||
ततः प्रशिथिलीभूतं त्रिभिरेव विलम्बितम् |
उल्लिखन्मण्डलाग्रेण तीक्ष्णेन परिशोधयेत् ||७||
विमुक्तं सर्वतश्चापि कृष्णाच्छुक्लाच्च मण्डलात् |
नीत्वा कनीनकोपान्तं छिन्द्यान्नातिकनीनकम् ||८||
चतुर्भागस्थिते मांसे नाक्षि व्यापत्तिमृच्छति |
कनीनकवधादस्रं नाडी वाऽप्युपजायते ||९||
हीनच्छेदात् पुनर्वृद्धिं शीघ्रमेवाधिगच्छति |
The attention ought to shortly be administered with fomentation and actions made instantly after the attention is correctly enraged.
The affected person is now instructed to have a look at the outer canthus / angle of his eye (apanga). When the affected person is positioned, the doctor ought to maintain the arma – muscular progress – on the place the place it has wrinkles. The doctor (surgeon) ought to catch the arma at this place with the assistance of Badisa – sharp hook or Mucundi – quick toothed forceps and regularly raise it (it shouldn’t be shortly lifted).
There are possibilities that the attention could get injured by sharp devices. Because of this concern of harm, the eyelids needs to be held firmly. As soon as the doctor has famous that the arma has change into unfastened, he ought to raise it up with the assistance of the identical three devices (talked about above). After lifting it, the arma needs to be lower nicely with the sharp fringe of a Mandalagra Sastra – curved lancet.
Now, the doctor has to launch the lower finish of the arma from its attachments on all its sides. It ought to then be introduced close to (pulled slowly in the direction of) the internal canthus / angle (kaninika) of the attention. Right here it needs to be lower however taking care that it isn’t lower very close to to the internal canthus. One fourth portion of the arma is allowed to stay. When achieved, the attention wouldn’t develop any issues. If the internal canthus is injured through the means of reducing arma, bleeding could happen or sinus could also be shaped.
However, if the arma is inadequately lower, the arma would as soon as once more develop in a short time.
अर्म यज्जालवद्व्यापि तदप्युन्मार्ज्य लम्बितम् ||१०||
छिन्द्याद्वक्रेण शस्त्रेण वर्त्मशुक्लान्तमाश्रितम् |११|
The muscular progress of Arma which has unfold like a internet and is located on the finish of the eyelid and sclera (white portion of the attention) needs to be gently lifted up. After lifting, it must be pulled (elongated / stretched) and lower with the assistance of a pointy curved instrument which has a curved edge.
प्रतिसारणमक्ष्णोस्तु ततः कार्यमनन्तरम् ||११||
यावनालस्य चूर्णेन त्रिकटोर्लवणस्य च |
स्वेदयित्वा ततः पश्चाद्बध्नीयात् कुशलो भिषक् ||१२||
दोषर्तुबलकालज्ञः स्नेहं दत्त्वा यथाहितम् |
व्रणवत् संविधानं तु तस्य कुर्यादतः परम् ||१३||
त्र्यहान्मुक्त्वा करस्वेदं दत्त्वा शोधनमाचरेत् |
Afterwards, the attention needs to be smeared with powder of the beneath talked about –
– Yavanala,
– Trikatu and
– Saindhava Lavana
After this, fomentation is given to the attention following which the expert doctor ought to anoint the attention and apply a bandage to it. He ought to do it after having thought of the power of the dosha, season and time.
Subsequent, the therapies talked about for wounds are adopted. The bandage shall be eliminated after three days. The attention needs to be fomented with the palms and the purificatory therapies needs to be adopted after that.
करञ्जबीजामलकमधुकैः साधितं पयः ||१४||
हितमाश्च्योतनं शूले द्विरह्नः क्षौद्रसंयुतम् |
मधुकोत्पलकिञ्जल्कदूर्वाकल्कैश्च मूर्धनि ||१५||
प्रलेपः सघृतः शीतः क्षीरपिष्टः प्रशस्यते |
Very best Ascyotana of eye ache – Seeds of Karanja, Amalaka fruits and Mmadhuka are boiled with milk. To this, honey is added and used for Ascyotana. It’s achieved twice day by day.
Paste of Madhuka, stamens of Utpala (lily flower) and Durva is made with milk. To this, ghee is added. That is utilized as a chilly poultice on the top. It’s mentioned to be enormously useful.
लेख्याञ्जनैरपहरेदर्मशेषं भवेद्यदि ||१६||
Lekhyanjana i.e. collyrium used for scarifying functions needs to be used to take away any a part of Arma which is remaining.
अर्म चाल्पं दधिनिभं नीलं रक्तमथापि वा |
धूसरं तनु यच्चापि शुक्रवत्तदुपाचरेत् ||१७||
Arma having the beneath talked about options needs to be handled just like Savrana Sukra –
– that which is small and never broad,
– resembles curd / yoghurt (white),
– is blue, crimson or ash like in color
चर्माभं बहलं यत्तु स्नायुमांसघनावृतम् |
छेद्यमेव तदर्म स्यात् कृष्णमण्डलगं च यत् ||१८||
Arma with beneath talked about options ought to solely be excised i.e. it needs to be lower and eliminated –
– that which resembles leather-based,
– is thick,
– is surrounded by thick ligaments and muscle tissues and
– is located on the Krsna Mandala i.e. cornea
Samyak Cheda laksana – Indicators of correct excision:-
विशुद्धवर्णमक्लिष्टं क्रियास्वक्षि गतक्लमम् |
छिन्नेऽर्मणि भवेत् सम्यग्यथास्वमनुपद्रवम् ||१९||
Indicators of correctly excised Arma –
– eye has clear color, like that which is pure to the attention,
– absence of troubles in its functioning,
– eye is relieved of its fatigue and
– absence of issues
Sirajala cikitsa
सिराजाले सिरा यास्तु कठिनास्ताश्च बुद्धिमान् |
उल्लिखेन्मण्डलाग्रेण बडिशेनावलम्बिताः ||२०||
The clever doctor ought to deal with Sirajala within the beneath talked about means –
– ought to raise the veins that are onerous
– utilizing badisa – sharp hook and
– lower it with the assistance of Mandalagra Sastra
Siraja Pidaka Cikitsa
सिरासु पिडका जाता या न सिध्यन्ति भेषजैः |
अर्मवन्मण्डलाग्रेण तासां छेदनमिष्यते ||२१||
Eruptions or swelling, cyst or tumour produced by veins which aren’t cured by medicines must also be excised similar to Arma.
रोगयोश्चैतयोः कार्यमर्मोक्तं प्रतिसारणम् |
विधिश्चापि यथादोषं लेखनद्रव्यसम्भृतः ||२२||
In each the above mentioned two illnesses i.e. Sirajala and Siraja Pidaka, pratisarana needs to be achieved i.e. medicinal powder is put into the attention. It needs to be achieved with powder of herbs indicated in Arma added with scarifying herbs in accordance with the aggravated dosha.
Parvanika cikitsa
सन्धौ संस्वेद्य शस्त्रेण पर्वणीकां विचक्षणः |
उत्तरे च त्रिभागे च बडिशेनावलम्बिताम् ||२३||
छिन्द्यात्ततोऽर्धमग्रे, स्यादश्रुनाडी ह्यतोऽन्यथा |
प्रतिसारणमत्रापि सैन्धवक्षौद्रमिष्यते ||२४||
लेखनीयानि चूर्णानि व्याधिशेषस्य भेषजम् |
Fomentation needs to be given to Parvanika located within the sclero-corneal junction (joint or assembly place between sclera and cornea). The expert doctor ought to now raise parvanika in its higher one third utilizing Badisa (sharp hook) and lower it. Whereas doing so, half of it within the entrance and half on the again needs to be left with out reducing. In any other case, the lacrimal duct will get injured. Even on this situation, saindhava lavana added with honey is fascinating for use as pratisarana. For residue of the illness, powder of scarifying herbs needs to be used for therapy.
Curnanajana – powdery collyrium
शङ्खं समुद्रफेनं च मण्डूकीं च समुद्रजाम् ||२५||
स्फटिकं कुरुविन्दं च प्रवालाश्मन्तकं तथा |
वैदूर्यं पुलकं मुक्तामयस्ताम्ररजांसि च ||२६||
समभागानि सम्पिष्य सार्धं स्रोतोञ्जनेन तु |
चूर्णाञ्जनं कारयित्वा भाजने मेषशृङ्गजे ||२७||
संस्थाप्योभयतः कालमञ्जयेत् सततं बुधः |
अर्माणि पिडकां हन्यात् सिराजालानि तेन वै ||२८||
Equal components of the beneath talked about are taken –
– Sankha,
– Samudraphena,
– Sammudra Manduki,
– Sphatika,
– Kuruvinda,
– Pravala,
– Asmantaka,
– Vaidurya,
– Pulaka,
– Mukta,
– Powder of Ayas and
– Powder of Tamra
Srotonjana needs to be taken in amount equal to that of all of the above mentioned components.
All these are macerated collectively and made into good powder.
This Curnanjana is crammed in a container made out of horn of ram and preserved. This powder needs to be put into the eyes, twice day by day, repeatedly for a lot of days.
Advantages – This drugs cures Arma, Siraja Pidaka and Sirajala.
Suskarasas and Vartmarbuda Cikitsa
अर्शस्तथा यच्च नाम्ना शुष्कार्शोऽर्बुदमेव च |
अभ्यन्तरं वर्त्मशया विधानं तेषु वक्ष्यते ||२९||
वर्त्मोपस्वेद्य निर्भुज्य सूच्योत्क्षिप्य प्रयत्नतः |
मण्डलाग्रेण तीक्ष्णेन मूले भिन्द्याद्भिषग्वरः ||३०||
ततः सैन्धवकासीसकृष्णाभिः प्रतिसारयेत् |
स्थिते च रुधिरे वर्त्म दहेत् सम्यक् शलाकया ||३१||
क्षारेणावलिखेच्चापि व्याधिशेषो भवेद्यदि |
तीक्ष्णैरुभयतोभागैस्ततो दोषमधिक्षिपेत् ||३२||
वितरेच्च यथादोषमभिष्यन्दक्रियाविधिम् |
Now, the therapy of Suska Arsas and Vartma Arbuda located within the inside the eyelids shall be described.
Firstly, the eyelids needs to be fomented. Then, the eyelids needs to be averted (rolled again). The arsas – polyp or Arbuda – tumour located contained in the eyelids needs to be lifted up with the assistance of a needle. After lifting, they need to be lower (excised) at their root with a pointy Mandalagra Sastra.
Then, powder of the beneath talked about components needs to be crammed into the eyes –
– Saindhava,
– Kasisa and
– Krsna
As soon as the bleeding stops, the location on the attention lid needs to be burnt with the assistance of a heated iron rod. The remnants if any needs to be scraped by making use of caustic alkalies on it.
After this, purificatory therapies i.e. emesis and purgation needs to be administered in accordance with the aggravated dosha.
Equally, therapies indicated for Abhisyanda must also be adopted after having thought of the doshas.
The affected person ought to observe restraints associated to meals and actions for a interval of 1 month after present process surgical therapy.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे छेद्यरोगप्रतिषेधो नाम पञ्चदशोऽध्यायः ||१५||
Thus ends the fifteenth chapter by identify Chedya roga pratisedha in Uttara sthana of Susruta Samhita.
