Chapter I - Diseases of the eye and its appendages

Now we shall discourse on the chapter which deals with the diseases, viz., of the eye, etc. (Aupadravika-adhyayam). 1.

Here commences that portion of the Sushruta Samhita which is known as the Uttara Tantra (the supplementary part) to which references have been often made in the preceding one hundred and twenty chapters, as the fit place wherein to revert in detail to the topics cursorily mentioned therein. This part comprises within it the specific descriptions of a large and a varied number of diseases, viz., those which form the subject matter of the Shalakya-Tantra (Diseases of the eye, ear, nose and throat) as narrated by the king of Videha; the etiology and symptomatology, etc. of diseases peculiar to infants and women (Kaumara-bhritya), the pathology, etc., of those diseases mentioned in the six books of the Practice of Medicine par excellence (Kaya-chikitsa) compiled by the holy sages of old and diseases known as Upasarga (e.g. Bhutopasarga—Demonology) as well as diseases of traumatic origin are also included in this supplementary text^[1]. Herein are also mentioned the sixty-three combinations of the six different Rasas (tasces) as well as the laws cf health and hygiene with their rationale (rules, interpretation and reasonings) and the classifications of different Doshas and organic principles of the body and various accessories and remedial agents required for their successful treatment and cure. 2.

I shall now begin with the description of the numbers, the pathology and the curability or incurability of those specific ailments of the body which are peculiar to the region of the head out of a myriad of other distempers reserved for treatment in this portion of the work (Uttara-tantra) which may be compared to the unfathomable deep in respect of the vastness of its depth and magnitude. 3.

Diseases of the eye and its appendages:—

The eye-ball (Nayana-Budbuda) is two fingers (about an inch) in transverse diameter, about the breadth of one’s own thumb in depth (Sagittal diameter), and two fingers and a half all round (in circumference). The eye-ball is almost round in shape and resembles the teat of a cow. It is made up of all the (five) elements of which the universe is built up. The element of the ‘solid’ earth (Bhu) contributes to the formation of its muscles, the element of ‘heat’ (Agni or Tejas) is in the blood (that courses in its veins and arteries), ‘the gaseous element’ (Vayu) contributes to the formation of the black part (Iris, etc.) in which the pupil is situated, the fluid element (Jala) preponderates in the lucid (white) part (Vitreous body) and the void (ethereal) Space (Akasha) is there to form lachrymal or the other ducts or sacs (Ashrumarga) through which the secretions are discharged. 4.

I shall now proceed to describe the Drishti (the central part of Retina—‘Macula Lutea’) as set forth by expert ophthalmic physicians. The black portion of the eye (Krishna-mandala—Choroid) forms one third part of its whole extent while the Drishti, according to them, occupies only one-seventh part of the Krishna-mandala. The Mandalas or sub-divisions or circles of the eye-ball, the Sandhis or Joints (parts where these sub-divisions meet with one another) and the Patalas (layers or coats) of the eye are respectively five, six and six in number. 5-6.

Mandala and Sandhi:—

The Mandalas of the eye are the following, viz.,

1. the Pakshma-mandala (the circle of the eye-lashes),
2. the Vartma-mandala (the eye-lid)
3. the Sveta-mandala (the Sclerotic and Cornea), the Krishna-mandala (the choroid)
4. and the Drishti-mandala (the pupil).

These circles are so arranged that the one preceding lies within the next in the list.^[2] The Sandhis (which serve as lines of demarcation of the circles) already pointed out are six in number, the first binding the eye-lashes (Paksha-mandala) with the eyelids (Vartma-mandala), the second the eye-lids and the Sclerotic coat (Sveta-mandala), the third binding the latter with the Krishna-mandala (choroid), the fourth situated between the latter and the Drishti-mandala, the fifth lying in the interior comer (Kaninakas) and the last (sixth) in the exterior (posterior) corner (Apangas) of the eye. 7-8.

The Patalas:—

Of the Patalas, two are in the eye-lid (Vartma-mandala) and four in the eye proper, wherein occurs the dreadful disease known as the Timira (loss of vision). Of these four the first or anterior coat (Patala) supports the humour Jala and light (Tejas),^[3] the second coat or Patala (choroid) is supported by muscles; the third coat or Patala (Sceroim and Cornea) consists of Medas (lit. fat) and there is the fourth which is a fifth part of the whole and is known as the Drishti. There are, however, divisions and subdivisions of these coats. 9.

The different parts of the eye-ball are held together by the blood-vessels, the muscles, the Vitreous body and the choroid^[4] Beyond the choroid, the eye-ball is held (in the orbit) by a mass of Sleshma (viscid substance—capsule of Tenon) supported by a number of vessels. The deranged Doshas which pass upward to the region of the eyes through the channels of the up-coursing veins and nerves give rise to a good many dreadful diseases in that region. 10.

Purva-rupa, etc.:—

Cloudiness of vision, slight inflammation, lachrymation, mucous accumulation, heaviness, burning sensation, sucking pain (D. R.—aching pain) and redness in the eyes are indistinctly manifest (in the incubatory stage) in such cases. In cases of an inflammation of the Vartmas (eye-lids) the eye seems as if studded with the bristles of worms (Shuka) and attended with pain (as if pricked into with thorns) and a sensible impairment of the faculty of the eyes in detecting colours and in closing and opening the eye-lids freely. An intelligent physician will conclude from these symptoms that the eyes have been affected by the (deranged) Doshas, with a due consideration whereof the remedies should be (carefully) administered, otherwise the eye-diseases might become too serious. The simple maxim or principle to be followed in the treatment of a disease is simply to forego the primary pathological causes of that disease. The special remedial measures that would pacify the different Doshas, Vayu, etc. have been described in detail. 12-13.

Causes of Eye-disease:—

The local Doshas deranged and aggravated by such causes as diving in water immediately after an exposure to the heat and the glare of the sun, (constant) gazing at distant objects, sleep in the day time and keeping up late hours in the night, fixed and steady gaze, excessive weeping or over-indulgence in grief, worry and fatigue, a blow or a hurt, sexual excesses, the partaking (in inordinate quantities) of Shukta, Aranala (fermented rice-water), acid gruel, Masha pulse, and Kulattha pulse, voluntary repression of any call of nature, exposure (of the eyes) to smoke or dust, trickling down of the drops of sweat (into the eyes), excessive or impeded vomiting, repression of tears, constant contraction of the eyes to adjust the sight to extremely small objects, etc., beget disorders of the organs of vision. 14.

Classification of the Eye-diseases:—

Seventy-six different kinds of eye-diseases have been come across in practice; of these ten are originated by the deranged Vayu, ten by Pitta and thirteen by Kapha. Sixteen are produced by vitiated blood, and twenty-five by the concerted action of the deranged Doshas (Tri-Doshaja), and lastly, two are produced by external causes i.e., they are traumatic in their origin. 15.

Prognosis of the Vataja Type:—

Of the diseases of the eyes which are due to the action of the deranged Vayu, those known as Hatadhimantha, Nimisha, Gambhirika affecting the vision, and Vata-hata-vartma (Vayu-affficted Sclerotic coat) is said to be incurable. A temporary cure (Yapya) is all that can be effected in a case of Kacha (cataract) due to the action of the deranged bodily Vayu; while the affection of the eyes known as the Anyato-Vata, Adhi-mantha (ophthalmia), Shushkakshi-paka, Abhishyanda and Maruta-Paryaya are curable. 16.

Prognosis of the Pittaja Type:—

Of the diseases due to the deranged action of the Pitta known as Hrasva-jadya and Jala-srava should be deemed incurable; and palliative measures are the only remedies in cases of Kacha, Parimlayi and Nila, while Abhishynda, Adhi-mantha Amladhyushita, Sùktika, Pitta-Vidagdha-Drishti, Pothaki and Lagana are curable. 17.

Prognosis of Kaphaja Type:—

Of the diseases due to the aggravation of Kapha, the one known as the Srava-roga is incurable and (Kaphaja) Kacha (cataract) admits of only palliative treatment, while a cure may be be effected in the following cases, viz., Abhishyanda (conjunctivitis), Adhi-mantha, Balasa-Grathita, Shleshma-Vidagdha-Drishti, Pothaki, Lagana, Krimi-granthi, Pariklinna-Vartma, Shuklarma, Pishtaka, Shleshmo-panaha. 18.

Prognosis of the Raktaja Type:—

Of the diseases of the eyes due to the vitiated condition of the blood, those known as Raktasrava, Ajakajata, Avalambita (pendent), Shonitarshas and Shukra-roga should be regarded as incurable, and the type of Kacha (cataract) due to the same cause admits of only palliative measures, while the diseases known as Adhi-mantha, Abhishyanda, Klishta-vartma, Sira-harsha and Sirotpata, Anjana, Sira-jala, Parvani, Avrana (non-ulcerated), Shukra-roga, Sonitarma and Arjuna may be included within the group of curables. 19.

Prognosis of the Tridoshaja Type, etc.:—

Of the eye-diseases due to the concerted action of the three aggravated Doshas, those known as Puya-srava, Nakulandhya, Akshipakatyaya and Alaji are incurable and palliative measures are only possible in cases of Kacha (cataract) or Pakshma-kopa; while those known as Vartmavabandha, Siraja-pidaka, Prastaryarma, Adhi-mansarma, Snayvarma, Utsangini, Puyalasa, Arvuda, Shyava-vartma, Kardama-vartma, Arsho-vartma, Shukrarshas, Sharkara-vartma, the two forms of inflammation with or without local swelling known as) Sashopha-paka and Ashopha-paka, Bahala-vartma, Kumbhika and Visa-vartma yeild to the curative efficacy of appropriate remedial agents. Both the forms of eye-disease due to the external causes^[5] should be considered as incurable. 20—21.

Their Localities:—

Thus we have finished enumerating the seventy-six types of eye-diseases, of which nine are confined to the Sandhis (binding unions), twenty-one to the Vartma (eye-lids), eleven to the Shukla-bhaga (the Vitreous body), four to the Krishna-bhaga (the region of the Choroid), seventeen to the entire region (eye-ball) and twelve to the region of the Drishti (pupil or the crystalline lens, etc.). The two cases due to the extraneous cause (are chiefly located in the Drishti though affecting the whole of the eye-ball and) are very painful and incurable. The characteristic symptoms of all these will be hereafter described in detail. 22—23.

 

Thus ends the first chapter of the Uttra-tantra in the Sushruta Samhita which deals with the diseases, viz. of the eye, etc.

Footnotes and references:

[1]:

The text has Āgantuka (traumatic diseases). Gayadasa explains it to mean Apasmāra, Unmāda, etc. (Hysteria, insanity, etc.).

[2]:

Evidently some line or lines are missing here as the line cannot give a complete sense by itself. Ed.

[3]:

By “Jala” is meant here the serum (Rasa) in the skin, and by “Tejas” the blood in the veins (Sirā) carrying the (Tejas) known as the Ālocaka.

[4]:

D. R. vessels, muscles and aqueous humour (Medas) are most important for the maintenance of Krishna-mandala.

[5]:

The one due to any external blow or hurt (Sanimitta) and the other originating from the sudden sight of any celestial being of extreme brilliancy (Animitta).