The 15th chapter of Uttaratantra of Sushruta Samhita is named as Chedya Roga Pratisedha Adhyaya. This chapter deals with the treatment of Diseases Requiring Excision.
अथातश्छेद्यरोगप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Chedya roga pratisedha – treatment of diseases which are to be excised (cut and removed); as revealed by the venerable Dhanvantari.
Arma chedana – excising the pterygium
स्निग्धं भुक्तवतो ह्यन्नमुपविष्टस्य यत्नतः |
संरोषयेत्तु नयनं भिषक् चूर्णैस्तु लावणैः ||३||
Firstly, oleation should be done to the person who is suffering from Arma disease. The person should be instructed to take his food and then sit comfortably on a stool or chair. Now, by putting smooth powder of rock salt into the eye, the physician should enrage the eye.
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 eye should quickly be administered with fomentation and movements made immediately after the eye is properly enraged.
The patient is now instructed to look at the outer canthus / angle of his eye (apanga). When the patient is positioned, the physician should hold the arma – muscular growth – at the place where it has wrinkles. The physician (surgeon) should catch the arma at this place with the help of Badisa – sharp hook or Mucundi – short toothed forceps and gradually lift it (it should not be quickly lifted).
There are chances that the eye may get injured by sharp instruments. Due to this fear of injury, the eyelids should be held firmly. Once the physician has noted that the arma has become loose, he should lift it up with the help of the same three instruments (mentioned above). After lifting it, the arma should be cut well with the sharp edge of a Mandalagra Sastra – curved lancet.
Now, the physician has to release the cut end of the arma from its attachments on all its sides. It should then be brought near (pulled slowly towards) the inner canthus / angle (kaninika) of the eye. Here it should be cut but taking care that it is not cut very near to the inner canthus. One fourth portion of the arma is allowed to remain. When done, the eye would not develop any complications. If the inner canthus is injured during the process of cutting arma, bleeding may occur or sinus may be formed.
On the other hand, if the arma is inadequately cut, the arma would once again grow very quickly.
अर्म यज्जालवद्व्यापि तदप्युन्मार्ज्य लम्बितम् ||१०||
छिन्द्याद्वक्रेण शस्त्रेण वर्त्मशुक्लान्तमाश्रितम् |११|
The muscular growth of Arma which has spread like a net and is situated at the end of the eyelid and sclera (white portion of the eye) should be gently lifted up. After lifting, it needs to be pulled (elongated / stretched) and cut with the help of a sharp 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 eye should be smeared with powder of the below mentioned –
– Yavanala,
– Trikatu and
– Saindhava Lavana
After this, fomentation is given to the eye following which the skilled physician should anoint the eye and apply a bandage to it. He should do it after having considered the strength of the dosha, season and time.
Next, the treatments mentioned for wounds are adopted. The bandage shall be removed after three days. The eye should be fomented with the palms and the purificatory therapies should be adopted after that.
करञ्जबीजामलकमधुकैः साधितं पयः ||१४||
हितमाश्च्योतनं शूले द्विरह्नः क्षौद्रसंयुतम् |
मधुकोत्पलकिञ्जल्कदूर्वाकल्कैश्च मूर्धनि ||१५||
प्रलेपः सघृतः शीतः क्षीरपिष्टः प्रशस्यते |
Ideal Ascyotana of eye pain – Seeds of Karanja, Amalaka fruits and Mmadhuka are boiled with milk. To this, honey is added and used for Ascyotana. It is done twice daily.
Paste of Madhuka, stamens of Utpala (lily flower) and Durva is made with milk. To this, ghee is added. This is applied as a cold poultice on the head. It is said to be greatly beneficial.
लेख्याञ्जनैरपहरेदर्मशेषं भवेद्यदि ||१६||
Lekhyanjana i.e. collyrium used for scarifying purposes should be used to remove any part of Arma which is remaining.
अर्म चाल्पं दधिनिभं नीलं रक्तमथापि वा |
धूसरं तनु यच्चापि शुक्रवत्तदुपाचरेत् ||१७||
Arma having the below mentioned features should be treated similar to Savrana Sukra –
– that which is small and not broad,
– resembles curd / yoghurt (white),
– is blue, red or ash like in colour
चर्माभं बहलं यत्तु स्नायुमांसघनावृतम् |
छेद्यमेव तदर्म स्यात् कृष्णमण्डलगं च यत् ||१८||
Arma with below mentioned features should only be excised i.e. it should be cut and removed –
– that which resembles leather,
– is thick,
– is surrounded by thick ligaments and muscles and
– is situated on the Krsna Mandala i.e. cornea
Samyak Cheda laksana – Signs of proper excision:-
विशुद्धवर्णमक्लिष्टं क्रियास्वक्षि गतक्लमम् |
छिन्नेऽर्मणि भवेत् सम्यग्यथास्वमनुपद्रवम् ||१९||
Signs of properly excised Arma –
– eye has clean colour, like that which is natural to the eye,
– absence of troubles in its functioning,
– eye is relieved of its fatigue and
– absence of complications
Sirajala cikitsa
सिराजाले सिरा यास्तु कठिनास्ताश्च बुद्धिमान् |
उल्लिखेन्मण्डलाग्रेण बडिशेनावलम्बिताः ||२०||
The intelligent physician should treat Sirajala in the below mentioned way –
– should lift the veins which are hard
– using badisa – sharp hook and
– cut it with the help 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 are not cured by medicines should also be excised just like Arma.
रोगयोश्चैतयोः कार्यमर्मोक्तं प्रतिसारणम् |
विधिश्चापि यथादोषं लेखनद्रव्यसम्भृतः ||२२||
In both the above said two diseases i.e. Sirajala and Siraja Pidaka, pratisarana should be done i.e. medicinal powder is put into the eye. It should be done 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 should be given to Parvanika situated in the sclero-corneal junction (joint or meeting place between sclera and cornea). The skilled physician should now lift parvanika in its upper one third using Badisa (sharp hook) and cut it. While doing so, half of it in the front and half at the back should be left without cutting. Otherwise, the lacrimal duct gets injured. Even in this condition, saindhava lavana added with honey is desirable to be used as pratisarana. For residue of the disease, powder of scarifying herbs should be used for treatment.
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 parts of the below mentioned are taken –
– Sankha,
– Samudraphena,
– Sammudra Manduki,
– Sphatika,
– Kuruvinda,
– Pravala,
– Asmantaka,
– Vaidurya,
– Pulaka,
– Mukta,
– Powder of Ayas and
– Powder of Tamra
Srotonjana should be taken in quantity equal to that of all the above said ingredients.
All these are macerated together and made into nice powder.
This Curnanjana is filled in a container made from horn of ram and preserved. This powder should be put into the eyes, twice daily, continuously for many days.
Benefits – This medicine 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 treatment of Suska Arsas and Vartma Arbuda situated in the inside of the eyelids shall be described.
Firstly, the eyelids should be fomented. Then, the eyelids should be averted (rolled back). The arsas – polyp or Arbuda – tumour situated inside the eyelids should be lifted up with the help of a needle. After lifting, they should be cut (excised) at their root with a sharp Mandalagra Sastra.
Then, powder of the below mentioned ingredients should be filled into the eyes –
– Saindhava,
– Kasisa and
– Krsna
Once the bleeding stops, the site on the eye lid should be burnt with the help of a heated iron rod. The remnants if any should be scraped by applying caustic alkalies on it.
After this, purificatory therapies i.e. emesis and purgation should be administered in accordance with the aggravated dosha.
Similarly, treatments indicated for Abhisyanda should also be adopted after having considered the doshas.
The patient should observe restraints related to foods and activities for a period of one month after undergoing surgical treatment.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे छेद्यरोगप्रतिषेधो नाम पञ्चदशोऽध्यायः ||१५||
Thus ends the fifteenth chapter by name Chedya roga pratisedha in Uttara sthana of Susruta Samhita.