Sushruta Samhita, Volume 6: Uttara-tantra
Chapter XV - Treatment of eye-diseases which require Excision
Treatment of Armas:—
The patient should be first treated with a Sneha-predominating food before being surgically operated upon in a case of Arman marked by the manifest vegetation or polypus (on the affected eye). The patient should then be made carefully to sit at ease and the affected eye should then be irritated by casting powdered Saindhava -salt into its cavity after which the eye-ball, without any loss of time, should be duly fomented and rubbed with the hand. The intelligent physician will then ask the patient to look at his Apanga (the interior corner of his own affected eye) and the cyst or the polypus (thus turned up), should be carefully secured with a hook (Vadisha) and held with a Muchundi instrument or with a thread-needle. It is dangerous to suddenly uplift the eye-lid under the circumstances. The two eye-lids should be firmly drawn asunder so as to guard against their being anywise hurt during the operation. The polypus, thus made flabby and pendent with the means of the three aforesaid accessories, should be fully got rid of by scraping it with a sharp Mandalagra instrument. The root of the polypus should be pushed asunder from the Krishna-mandala (Sclerotic region) and the Shukla-mandala (region of the cornea), to the extremity of the Kaninaka (pupil) and then removed. The Kaninaka (pupil) should be duly guarded so as not to be hurt. A quarter layer of the flesh (of the polypus) should be left back and then the operation would not in any way hurt or injure the eye. An operation at a point beyond the aforesaid limit of the Kaninaka (might hurt the pupil and) would set up a hemorrhage and beget a sinus (as well as pain) in the locality. The vegetation or polypus is sure to grow up again to its former size if it is cut off insufficiently. 2.
A shreddy or netted Arman in the form of a membranous growth (Jala) in the eye should be made pendent by rubbing it (with Saindhava- salt) and then cut with a bent Vadisha instrument at the junction of the Shukla-mandala (cornea) and the Vartma-mandala (conjunctiva or eye-lid). The affected part should then be rubbed with a compound consisting of Yava-kshara, Trikatu and Saindhava- salt (pounded together) and then (duly) fomented and bandaged up by the skilful physician. Lardaceous or oily (Sneha) application should thereafter be prescribed with due regard to the nature of the place, the season, the time (day or night) and the strength of the patient, and the incidental wound should be treated as an ulcer. The bandage should be removed after three days and the affected part should be (mildly) fomented with the application of heated palms of the hands and treated with corrective or purifying remedies. 3.
Milk duly cooked with Karanja seed, Amalaka and Yashti-madhu and mixed with honey (when cold), should be dropped twice a day (morning and evening) into the affected eye in the event of there being any pain in it. A cold plaster composed of Yashti-madhu, polens of lotus (Utpala) and Durva- grass pasted together with milk and mixed with clarified butter is recommended in such cases to be applied to the scalp. 4.
Any residue of the Arman, left after the excision, should be removed with the application of Lekhya (scraping) Anjana or eye-salve. An Arman (Cyst-like papilla or protruberance) which is as white as curdled milk (Dadhi), or which looks blood-red or blue or grey, should be treated like a case of Shukrarman (Opacity of the cornea or a flimy and fleshy growth in the eye). An Arman which is very thick and looks like a piece of skin and covered over with fibres of flesh and nerves, as well as one occurring on the Krishna-mandala (region of the iris) should be excisioned. The eye assumes its former and natural colour and function, and becomes free from pain and other complications by the proper excision of an Arman. 5–8.
Treatment of Sira-Jala and Sira-pidaka:—
In a case of Sira-Jala, the hardened veins (Sira) should be hung down with a hook (Vadisha) and scraped with a Mandalagra (round-topped) instrument. Cysts or pimples (Pidakas) appearing on the diseased veins in a case of the aforesaid Sira-Jala and not proving amenable to the application of medicines, should be excisioned as in a case of Arma with a Mandalagra instrument. Pratisarana (rubbing) as in a case of Arma and Lekhana (scraping) with due regard to the nature of the deranged Doshas involved in each case, are also recommendad in both the diseases (Sira-Jala and Sira-Pidaka) under discussion. 9.
Treatment of Parvanika:—
In a case of Parvanika the place of junction (of the lachrymal sac and the cornea) should be duly fomented. A quarter part only of the protuberance or growth should be kept apart, while the remaining upper three quarters should be secured with a hook and cut with a knife. Half of the aforesaid quarter part should then be cut away (very carefully), as lachrymal sinus (and consequent lachrymation) would otherwise set in. The seat of operation should be subsequently rubbed (Prati-sarana) with a compound of honey and Saindhava- salt. Scarifying (Lekhana) powders should then be applied to the affected part for the complete recovery of the disease (any complaint still remaining), io.
Powders of Shamkha (conch-shell), Samudra-phena, marine oyster-shell, crystal, ruby, coral, Ashmantaka, Vaidurya (Lapis lazuli), pearl, iron, copper and Srotonjana (antimony) taken in equal parts and mixed together, should be stuffed in a ram’s horn and then let the intelligent one apply this Churna-anjana (powder) to the affected locality, morning and evening everyday, as such applications are extremely efficacious in all types of Armans, Pidakas, Sira-jala, Arsas, Shushkarshas and Arvuda, etc., in the eye. 11.
Treatment of inner part of the eyelids:—
The mode of treatment in a case of any affection in the inner lining of the Vartma (eye-lid) is given below. The affected part should be first fomented and then the eye-lid should be over-turned (held at an angle), and the diseased growth or swelling should be carefully lifted up with a needle, when an experienced physician should cut it at its root or base with the help of a sharp Mandalagra instrument. After that the affected part should be rubbed with a pulverised compound consisting of Saindhava, Kasisa (Sulphate of iron) and Pippali. The affected eyedid should then be carefully cauterised with a (red-hot) rod after a (complete) cessation of the bleeding. The residue of its root or base, if any, should be scarified with a scarifying alkaline (caustic) preparation. Decoctions of strong emetic and purgative drugs should be (internally) administered for the elimination of the Doshas (from the Vrana—ulcer). The measures and remedies mentioned in connection with Abhi-shyanda (Ophthalmia) should also be prescribed with regard to the nature of the bodily Doshas involved in the case. The patient shall observe strict regimen ot diet and conduct for a month after the surgical operation. 12.
Thus ends the fifteenth chapter in the Uttara-Tantra of the Sushruta Samhita which treats of the remedies of eye-diseases requiring excisions or surgical operation.
Footnotes and references:
In place of ‘deśa’—the particular part and nature of the country, some read ‘deṣa’—the particular Dosha involved in each case.
For Lekhya Anjana see Chapter XII, para 16 of this Uttara Tantra.
Some here read ‘sirā’ (veins) in place of ‘ghana’ |
The ‘junction’ is the junction of the Krishna-mandala and the Śukla-mandala of the eye.—Dallana.
Dallana explains ‘Mesha-śringa’ as a kind of Ingudi tree.
Some commentators say that emetics and purgatives should be internally administered, but Dallana and the Panjikā-kāra oppose this view.