The 16th chapter of Uttaratantra of Sushruta Samhita is named as Paksma Roga Pratisedha Adhyaya. This chapter deals with the treatment of Inflammation of the Area of Eyelashes.
अथातः पक्ष्मकोपप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Paksmakopa pratisedha – treatment of diseases of the area of the eyelashes; as revealed by the venerable Dhanvantari.
Paksmakopa Cikitsa- treatment of inflammation of area of eyelashes
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||
The fact that Paksmakopa which develops on the eyelid is Yapya i.e. persistent, cannot be totally cured yet manageable was stated earlier in this treatise (Chapter 3, verses 29-30).
Coming to the management of Paksmakopa –
The patient of Pakshmakopa should be given with snehana – oleation therapy, beforehand.
The patient who has been subjected to snehana should now be made to sit on a comfortable chair or stool. The physician should ask the patient to close his eyes.
Now, the physician should cut the skin of the eyelid without any delusion.
Where to make the cut? – The physician should mark the place / point on the eyelid firstly, to make the cut precisely. He should leave two third portion of the eyelid below the eyebrow and cut the skin near the area of eyelashes. The shape of the cut should be yava akara – shape of barley grain and should be made with a sterile, sharp instrument. It should be made at a place equidistant from Kaninika – inner canthus and Apanga – outer canthus.
After cutting the skin at the mentioned place on the eyelid, the physician should remove the skin and discard it.
Then the physician should carefully suture the skin using the hairs (of horse). Then a mixture of ghee and honey shall be applied to that area and the treatments (bandaging etc) indicated for wounds should be adopted in general.
Bands of stitched cloth should be tied round on the forehead (including the eye) and sutured. This suture should be sutured together with the suture and bandage tied around the eye.
Removal of suture – The skilled physician should wait for the wound to become stable and for signs of complete healing. When this is achieved, he should remove the suture by pulling out the hair or thread used for the purpose, from the site of operation.
Indication for Ksara Karma or Agni Karma
एवं न चेच्छाम्यति तस्य वर्त्म निर्भुज्य दोषोपहतां वलिं च |
ततोऽग्निना वा प्रतिसारयेत्तां क्षारेण वा सम्यगवेक्ष्य धीरः ||७||
छित्वा समं वाऽप्युपपक्ष्ममालां सम्यग्गृहीत्वा बडिशैस्त्रिभिस्तु |
पथ्याफलेन प्रतिसारयेत्तु घृष्टेन वा तौवरकेण सम्यक् ||८||
Ksara Karma – application of caustic alkali or Agni Karma – branding with fire should be done only if the disease does not subside after doing the above said treatment.
The region of the eyelid should be cauterised by fire, by touching the selected area of the eyelid with a hot iron rod. Alternatively caustic alkali should be applied over the same area. Both these procedures should be done cautiously and according to proper procedure.
Chedana – The physician should hold the upapaksma mala – row of eyelashes with badisa – sharp hook and cut / split it evenly, at once. Following this, he should apply the paste of Pathya or Tuvaraka Phala on this area.
Summing up
चत्वार एते विधयो विहन्तुं पक्ष्मोपरोधं पृथगेव शस्ताः |
विरेचनाश्च्योतनधूमनस्यलेपाञ्जनस्नेहरसक्रियाश्च ||९||
All the four methods of intervention mentioned above are individually best suited for curing paksmoparodha – inflammation of the region around eyelashes. Virecana, Ascyotana, Dhuma, Nasya, Lepa, Snehana, Rasakriya and Anjana are also likewise beneficial.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे पक्ष्मगतरोगप्रतिषेधो नाम षोडशोऽध्यायः ||१६||
Thus ends the sixteenth chapter by name Paksmaroga Pratisedha in Uttara Sthana of Susruta Samhita.