Sushruta Samhita Sutrasthana Chapter 16: Karna Vyadha Bandha Vidhi Adhyaya (Puncturing the Ear and Repair of Mutilated Ear)

अथातः कर्णव्यधबन्धविधिमध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भगवान धन्वन्तरिः ॥२॥

Now we shall propound the chapter by name Karnavyadha Bandha Vidhi- procedure of puncturing the ear and repairing the mutilated ear, as revealed by the venerable Dhanvantari.

 Karnavyadha: Puncturing the earlobe

रक्षाभूषणनिमित्तं बालस्य कर्णौ विध्येते। तौ षष्ठे मासि सप्तमे वा शुक्लपक्षे प्रशस्तेषु तिथिकरणमुहूर्तनक्षत्रेषु कृतमङ्गलस्ववाचनं धात्र्यङ्के कुमारधराङ्के वा कुमारमुपवेश्य बालक्रीडनकैः प्रलोभ्याभिसान्त्वयन् भिषग्वामहस्तेनाकृष्य कर्णं दैवकृते छिद्र आदित्यकरावभासिते शनैः शनैर्दक्षिणहस्तेनर्जु विध्येत्, प्रतनुकं, सूच्या, बहलमारया; पूर्वं दक्षिणं कुमारस्य, वामं कुमार्याः; ततः पिचुवर्ति प्रवेशयेत् ॥३॥

 Ears of the children are punctured with the purpose of

–        protection (from evil) and
–        decoration (wearing ornaments)

Scheduling proper time and day for doing karna vyadha – Auspiciousness of day and time is very important for carrying out any ritual. So, the date and time which is auspicious to the child should be selected and scheduled taking care that it should be –

–        during the sixth or seventh month of the year
–        on a day and time having auspicious stellar constellation,
–        during the bright fortnight of the month.

After selecting the date and time, religious rites, oblations and chanting of sacred hymns as related to the procedure should be performed as per the procedure.

Positioning the child – On the scheduled auspicious day and time, the child should be placed on the lap of Dhatri – wet nurse. Toys should be given to the child so as to keep him happy. For this, the toys of the child’s choice or his favorite toys should be given. If not toys, similar such things which would please the child and keep him distracted and also to draw the attention of the child should be given. This helps the wet nurse to take the child with confidence before conducting the procedure and keep the child on good terms, so that he cooperates through the ritual. The physician should also speak to the child in a pleasing voice and with pleasant words (in the language of the child or language which the child understands).

Then the physician should hold the ear of the child with his left hand and pull it down slightly. The ear should be exposed to the sunlight. Now, the physician with his right hand should puncture the earlobe, straight and below the daivakrta chidra – the God made orifice (natural orifice of the ear) slowly. The piercing should be made using a suci (needle) if the earlobe is thin and with an ara (thick needle) if it is thick. In the case of a male child, the right ear should be punctured first. On the other hand the left earlobe should be punctured first in case of a female child. Following this, a cotton thread / thin wick shall be introduced through the puncture.

According to Master Dalhana, the sixth or seventh month should be counted from the commencement of that particular year and should not be counted from the birth day of the child. According to Hindu Calander, the sixth month is Magha and the seventh month is Phalguna.

How to know that the earlobe puncture has been done in the right way?

शोणितबहुत्वेन  वेदनया चान्यदेशविद्धमिति जानियात्, निरुपद्रवतया तह्देशविद्धमिति ॥४॥

When there is too much bleeding and pain following the earlobe puncture it should be understood that the puncture has been made at another place, different from the exact specified spot (daivakrita chidra). If there are no complications (pain and bleeding are absent after the earlobe puncture) it should be understood that the puncture has been done at the right spot i.e. daivakrita chidra.

Complications caused by wrongly puncturing the earlobe

तत्राज्ञेन यदृच्छया विद्धासु सिरासु कालिकामर्मरिकालोहितिकासूपद्रवा भवन्ति ।

तत्र कालिकायां ज्वरो दाहः श्वयथुर्वेदना च भवति; मर्मरिकायां वेदना ज्वरोग्रन्थयश्च; लोहितिकायां मन्यास्तम्भापतानकशिरोग्रहकर्णशूलानि भवन्ति । तेषु यथास्वं प्रतिकुर्वीत ॥५॥

If an ignorant physician / surgeon, by his choice (or by chance) happens to puncture the Kalika, Marmika and Lohitika veins, without focusing on ‘daivakrita chidra’ (where the puncture needs to be done), then many complications will arise.

When Kalika Sira is punctured – fever, burning sensation, swelling and pain are manifested.

When Marmika Sira is punctured – pain, fever and small cysts / tumors are manifested.

When Lohitika Sira is punctured – rigidity / stiffness of the (nape of the) neck, convulsions, catching pain in the head and pain in the ears are manifested.

These conditions shall be treated suitably.

क्लिष्टजिह्माशस्तसूचीव्यधाद्राढतरवर्तित्वाद्दोषसमुदायादप्रशस्तव्यधाद्वायत्रसंरम्भो वेदना वा भवति तत्र वर्तिमुपह्यत्याशु मधुकैरणडमूलमञ्जिष्ठायवतिलकल्कैर्मधुघृतप्रगाढैरालेपयेत्तावद्यावत् सुरूढं इति’ सुरूढं चैनंपुनर्विध्येत् ःविधानं तु पूर्वोक्तमेव॥६॥

When rough / ugly (not pointed), crooked and unsuitable needle is used to puncture the earlobe, or when a thick thread is inserted in the orifice made after earlobe has been punctured or when there is severe aggravation of the doshas or when the puncture of the earlobe has not been done properly (inauspicious puncturing) – swelling or pain develops in the ear (at the site of puncture). When this happens, the thread which had been inserted in the orifice following the puncture of the earlobe should be pulled out quickly. On the site, paste made from Madhuka, Erandamula, Manjishta, Yava and Tila made with more honey and ghee should be applied repeatedly, every day until the puncture site has been healed completely. Once the earlobe (at the site of puncture) has been healed properly, puncturing should be done again in the mentioned (proper) site. The method of puncturing the earlobe is as explained above.

Follow up of proper earlobe puncture  

तत्र सम्यग्विद्धमामतैलन परिषेचयेत्, त्र्यहात्र्यहाच्च वर्तिं स्थूलतरां दद्यात्, परिषेकं च तमेव ॥७॥

Parisecana – Showering / sprinkling / bathing of the earlobe should be done after properly puncturing it. For this, ama taila i.e. oil extracted from fresh / raw sesame. Ama taila is uncooked oil – the oil should not be prepared or extracted by heat process. Should be used. Following this, on every third day, thicker threads should be inserted into the orifice of the ear (created after vyadhana – puncturing). Every time, the thickness of the thread should increase i.e. it should be more than the thickness of the thread that was inserted three days ago. Following this, it shall be bathed with uncooked oil as already explained.

Use of Vardhanaka:  Dilator

अथ व्यपगतदोषोपद्रवे कर्णे वर्धनार्थं लघु वर्धनकंकुर्यात् ॥८॥

The orifice (created by karna vyadhana) should be dilated by an experienced surgeon, using a laghu vardhanaka – light dilator. This should be done only after the aggravation of doshas and complications have subsided.

एवं विवर्धितः कर्णश्छिद्यते तु द्विधा नृणाम् ।
दोषतो वाऽभिघाताद्वा सन्धानं तस्य मे श्रृणु ॥९॥

When the hole is dilated in this manner, the ear may get cut (severed) in two ways – either by aggravated doshas (diseases) or by injury. Now listen to me the method of rejoining them (repairing, sewing).

Karna Bandha-techniques and repairing the ear-Otoplasty

तत्र समासेन पञ्चदशकर्णबन्धाकृतयः । तद्यथानेमिसन्धानक उत्पलभेद्यको वल्लूरक आसङ्गिमो गण्डकर्ण आहार्यो निर्वेधिमो व्यायोजिमःकपाटसन्धिकोऽर्धकपाटसन्धिकःसंक्षिप्तो हीनकर्णो वल्लीकर्णो यष्टिकर्णः काकौष्टक इति।तेषु, पृथुलायतसमोभयपालिर्नेमिसन्धानक ः वृत्तायतसमोभयपालिरुत्पलभेद्यकः ; हस्ववृत्तसमोभयपालिर्वल्लूरकः ; अभ्यन्तरदीर्घैकपालिरासङ्गिमः बाह्यदीर्घैकपालिर्गण्डकर्णः ;अपालिरूभयतोऽप्याहार्यः ;पीठोपमपालिरूभयतः क्षीणपुत्रिकाश्रिकाश्रितो निर्वेधिमः ; स्थूलाणुसमविषमपालिर्व्यायोजिमः ; अभ्यन्तरदीर्घैकपालिरितराल्पपालिः साध्याः ; तेषां स्वनामभिरेवाकृतयः प्रायोण व्याख्याताः । संक्षिप्तादयःपञ्चासाध्याः । तत्र शुष्कशष्कुलिरूत्सन्नपालिरितराल्पपालिः संक्षिप्तः अनधिष्ठानपालिः पर्यन्तयोः क्षीणमांसो हीनकर्णः ; तनुविषमाल्पपालिर्वल्लीकर्णः ; ग्रथितमांसस्तब्धसिराततसूक्ष्मपालिर्यष्टिकर्णः ; निर्मांससंक्षिप्ताग्राल्पशोणितपालिः काकौष्टक इति। बद्धेष्वपि तु शोफदाहरागपाकपिडकास्त्रावयुक्ता न सिद्धिमुपयान्ति ॥१०॥

Repairing the severed ear is of fifteen kinds in brief. They are –

1. Nemisandhanaka

2. Utpala bhedyaka

3. Valluraka,

4. Asangima.

5. Gandakarana,

6. Aharya,

7. Nirvedhima,

8. Vyayojima,

9. Kapatasandhika,

10. Ardhakapata Sandhika,

11. Sanksipta,

12. Hinakarna,

13. Vallikarna,

14. Yastikarana and

15. Kakaustaka

Conditions wherein these earlobe repairs are done –

Among these,

In this way these ten types of repairing (joining by suturing) are going to be successful. Their shapes are explained generally by their names.

Sanksitpa and other (totally five) types of ear lobe repairs are going to be unsuccessful.

The physician / surgeon will not find success in these cases because in spite of doing these properly, the patient would suffer from symptoms including swelling, burning sensation, reddish discoloration, suppuration, eruptions and discharge of pus etc.

Notes: In this context bandhana means ‘joining together by suturing / sewing’ and not ‘bandaging / binding’ as it actually means. Sandhana means joining the mutilated parts together. After doing sandhana, bandhana (bandaging) is also needed. Therefore, the term ‘karna bandha’ means both suturing and bandaging.

From the description of the above said surgical methods (operations) it is not possible to understand them (i.e. know their exact nature). According to Master Dalhana the exact nature of these patterns or procedures can be known and understood by regularly observing (seeing) these procedures being done by any expert followed by regular practice of the same.

He has also tried to throw some light on some of these methods. Examples include –

–        Nemi means impression of the wheel, so nemisandhanaka is sewing in a round or circular way.

–        Vallura means dried meat. It should be understood that just like dried meat is torn to many pieces, the ear is cut into many pieces. A procedure of joining these pieces is called valluraka.

–        Asangima = sewing a big portion when a small portion is not available at the same place.

–        Gandakarna = cutting a muscle piece from the neck while maintaining its attachment and turning it over the damaged pinna (as in modern day otoplasty)

–        Aharya = fabricating the pinna from the muscle flaps of both cheeks

–        Nirvedhima = making the pinna by cutting a muscle piece from the back of the ear.

–        Vyayojima = fabricating the pinna by different kinds of cuttings.

–        Kapadasandhika = joining by different kinds of suturing just like a hinge at the back.

–        Ardhakapata Sandhi = joining the pinna by suturing in its front.

How to suture in different conditions?

यस्यपालिद्वयमपि कर्णस्यनभवेदिह ॥

कर्णपीठं समे मध्ये तस्य विद्धवा विवर्धयेत् ॥११॥

बाह्यायामिह दीर्घायां सन्धिराभ्यन्तरो भवेत् ॥

आभ्यान्तरायां  दीर्घायां बाह्यसन्धिरुदाह्तः ॥१२॥

एकैव तु भवेत् पालिः स्थूला पृथ्वी स्थिरा च या ॥

तां द्विधा पाटयित्वा तु छित्वा चोपरि सन्धयेत्॥१३॥

गण्डादुत्पाट्च मांसेन  सानुबन्धेन जीवता ॥

कर्णपालीमपालेस्तु कुर्यान्निर्लिख्य शास्त्र्वित् ॥१४॥

Some verses here –

When the Pinna (including the lobe) of both ears are not present, then the same should be repaired by cutting the skin at the back of the ears.

When the external ear (Pinna) is long (damaged greatly), joining (suturing) should be done internally (medially), whereas when it is long (damaged greatly) internally (medially), then joining (suturing) should be done externally (posteriorly).

When the external ear (Pinna) only is present (without the lobe) and is big, thick, and static, then it should be cut into two and joined (sutured) above.

(If anyone does not have an earlobe) the physician well learned in science should cut out a flap of the living muscles from the cheek while retaining its connection intact, turn it over to the site of the lobe after scraping the area and thus make up the lobe.

Bandhana vidhi: Procedure of joining (suturing)

अतोऽन्यतमं बन्धं चिकीर्षुरग्रोपहरणीयोक्तोपसंभृतसंभारं विशेषतश्चात्रोपहरेत् सुरामण्डं क्षीरमुदकं धान्याम्लं कपालचूर्णं चेति। ततोऽङ्गनां पुरुषं वाग्रथितकेशान्तं लघु भुक्तवन्तमाप्तैः सुपरिगृहीतं च कृत्वा, बन्धमुपधार्य,छेद्यभेद्यलेख्यधनैरुपपाद्य,कर्णशोणितमवेक्ष्य दुष्टमदुष्टंवेति, ; तत्र वातदुष्टे धान्याम्लोष्णोदकाभ्यां पित्तदुष्टे शीतोदकपयोभ्यं स्लेष्मष्टे सुरामण्डोष्णोदकाभ्यां प्रक्षाल्य कर्णौ, पुनर्विलिख्यानुन्नतमहीनमविषमं च कर्णसधिं सन्निवेश्य, स्थितरक्तं संदध्यात् । ततो मधुघृतेनाभ्यज्य, पिचुप्रोतयोरन्यतरेणावगुण्ट्च, सूत्रेणानवगाढमातिशिथिलं च बद्ध् वा, कपालचूर्णेनावकीर्याचारिकमुपदिशोत्, द्विव्रणीयोक्तेन च विधानेनोपचरेत् ॥१५॥

Materials to be collected beforehand – Firstly the surgeon should decide which method of suturing he is going to adopt from amongst the types of sutures which have already been enumerated in this chapter earlier. According to the choice of the type of suture, he should collect all materials needed beforehand, as explained in Chapter 5 i.e. Agropaharaniya Adhyaya. Among these he should collect and keep the suramanda – scum of sura, milk, water, Dhanyamla and powder of Kapala curna i.e. piece of saucer or earthen pot (potsherd) at a hands distance.

Following this, the hairs of the head of the person selected for operation, be it man or woman, should be tied firmly into a knot, at the back of the head in such a way that it does not open up and spread out.

Next, light food should be given to the patient. Later, the kith or any close relative of the patient should be advised to hold the patient tightly so as to position him for the procedure.

Then the physician / surgeon should decide the type of bandhana (joining, suturing) to be done. Accordingly, he should conduct excision, separation, scraping or puncturing or any appropriate method or technique as needed. Following this, the physician should examine the blood which is being discharged from the ear so as to decide if the blood is vitiated on not.

If the blood is found vitiated, the vitiation should be addressed in accordance to the dosha vitiating the blood –

–        If the blood is vitiated by vata – the ear shall be bathed with Dhanyamla and hot water.

–        If the blood is vitiated by pitta – cold water and milk should be considered for washing the ear.

–        In case of the blood being vitiated by kapha – sura manda – scum of beer and water should be chosen to wash the ear.

Sandhana and sivana – The physician should now conduct sandhana – joining the parts, by placing the parts together only after scraping the area of the ear selected properly. It should be in such a way that the joining should neither be too high nor too low and also not irregular. The ear should be sutured after the bleeding stops.

Post-procedure – Now, the area should be anointed with a mixture of ghee and honey. It should be covered with sterile cotton swab or any other suitable pad and tied in place with threads. The fastening should not be too loose or too tight. Over this, smooth powder of potsherd (piece of earthen pot) should be sprinkled. Suitable regimen of food and activities should be advised to the patient and the patient has to follow them strictly. The patient should be taken care of as explained in Dwivraniya Adhyaya of Chikitsa Sthana section.

Contraindications during post-operative care

भवति चात्र:-

विधट्टनं दिवास्वप्रं व्यायाममतिभोजाम् ।

व्यावायमग्रिसंतापं वाकश्रमं च विवर्जयेत् ॥१६॥

 Another verse here:-

The person (who has been operated) should avoid –

–        movement (of the ear),

–        day sleep,

–        exercise,

–        overeating,

–        exposure to fire and

–        exertion by talking too much

Sandhana Anarhata: Contra Indications for operation

न चासुद्धरक्तमतोप्रवृत्तरक्तं क्षीणरक्तं वा संदध्यात् । स हि वातदुष्टे रक्ते सूढोऽपि परिपुटावान्,पित्तदॄष्टे दाहपाकरागवेदानावान, श्लेष्मदुश्ष्टे स्तब्धः कण्डूमान्, अतिप्रवृत्तरक्तेश्यावशोफवान्, क्षीणॊऽल्पमांसो न वृद्धिमुपैति ॥१७॥

Karna Sandhana i.e. joining (sewing) the damaged ear should not be done in the below mentioned conditions –

–        ashuddha rakta – presence of impure / vitiated blood in the ear

–        pravrutta rakta – when there is excessive bleeding or

–        kshina raktam – when there is loss of blood

In such conditions, if sandhana is done, it can cause many complications. They are –

Upadrava Chikitsa: Treatment of complication

आमतैलने त्रिरात्रं परिषेचयेत्, त्रिरात्राच्च पिचुं परिवर्तयेत् । स यदा सूरूढो निरूपद्रवः सवर्णो भवति तदैनं शनैः शनैरभिवर्धयेत् । अतोऽन्याथा संरम्भदाहपाकरागवेदानावान्,पुनशिछद्यते वा ॥१८॥

Parisecana – For three days, the area should be bathed with amataila – uncooked oil. The swab kept on the wound should be changed after three days.

The orifice of the earlobe should be made to grow slowly when –

–        the wound has healed properly

–        there are no complications

–        the color of the skin of that region becomes similar to that of the surrounding skin i.e. color of the skin of the body

If these rules are not followed, it will lead to development of swelling, burning sensation, suppuration and pain or once again the parts may get separated.

Abhyanga: Massage of the pinna and earlobe with medicated oil

अथास्याप्रदुष्टस्याभिवर्धामभ्यङ्ग। तद्यथा- गोधाप्रतुदविष्करानूपौदकवसामज्जानौ पयः सर्पिस्तैलं गौरसर्षपजं च यथालाभं संभृत्यार्कालर्कबलातिबलानन्तापामार्गश्वगन्धाविदारिगन्धाक्षीराशुकमधुरवर्गपयस्याप्रतिवापं तैलं वापाचयित्वा स्वनुगुप्तं निदध्यात् ॥१९॥

स्वेदितोमर्दितं कर्णं स्नेहेनैतेन योजयेत् ।

अथानुपद्रवः सम्यग्बलवांश्च विवर्धते ॥२०॥

Abhyanga and purpose – Massage or anointing with oil should be done to the ear only after the complications have subsided and no vitiation is found. The purpose of massage is to promote proper growth of the earlobe.

Preparation of oil for ear massage –

Ingredients –

The below mentioned ingredients should be collected as many as available –

–        muscle fat and bone marrow of godha – iguana lizard

–        muscle fat and bone marrow of animals and birds belonging to pratuda, viskira, anupa and audaka groups

–        milk

–        ghee

–        oil of gaura sarsapa – white mustard

These ingredients should be boiled with the paste of the below mentioned herbs –

–        arka

–        alarka

–        bala

–        atibala

–        Ananta

–        Apamarga

–        Asvagandha

–        Vidagigandha

–        Kshirasukla

–        Jalasuka

–        Ksirakakoli

–        Madhura gana herbs – herbs having sweet taste

–        Payasya

Alternatively, medicated oil prepared with Arka etc herbs mentioned above should be prepared and stored at a concealed place.

Procedure – Firstly, fomentation should be given to the ear. Later, the ear / lobe should be given massage with this prepared medicated oil.

Benefits – There will be proper growth of ear / earlobe without any complications. The ear would become strong.

Use of Yavadi Kalka and Shatavaryadi Taila

यवाश्वगधायष्ट् याह्वैस्तिलैश्चोद्वर्तानं हितम् ।

शतावर्यश्वगन्धाभ्यां पयस्यैण्डजीवानैः॥२१॥

तैलं विपक्वं सक्षीरमभ्यङ्गात् पालिवर्धाम् ।

ये तु कर्णा न वर्धते स्वेदस्नेहोपपादिता ः॥२२॥

तेषामपाङ्गदेशे तु कुर्यात् प्रच्छानमेव  तु।

बाह्यच्छ्र्दं अ किर्वीत व्यापदःस्युस्ततो ध्रुवाः॥२२॥

Yavadi Kalka – Paste of Yava, Ashwagandha, Yastyahva and Tila should be used to massage the ear in upward direction.  

Satavaryadi Taila – Massage to the earlobe done by using the oil prepared with the below mentioned ingredients along with milk will help in growth of earlobe –

–        Satavari

–        Ashwagandha

–        Payasya

–        Eranda

–        Jivaniya gana group of herbs

Prachana – Scraping should be considered if the earlobe does not grow even after conducting swedana and abhyanga. It should be done at the outer canthus of the eye. Scraping / incision should not be done on the outer side of the ear. If done, it would lead to complications (due to the presence of sira etc marmas – vital spots in this region).

Effect of making the earlobe grow immediately after sandhana

बद्धमात्रं तु यः कर्णं सहसैवाभिवर्धयेत् ।

आमकोशी समाध्मातः क्षिप्रमेव विमुच्यते॥२४॥

 If the earlobe is suddenly made to grow after doing the sandhana (sewing, joining, suturing), there occurs swelling of the earlobe. The earlobe may also break and fall off quickly. This is because the earlobe is in an unripe state.

Conditions in which the ear should be made to grow slowly

जातरोमा सुवर्त्मा च श्लिष्टसधिः समः स्थिरः ।

सुरूढोऽवेदानो यश्च  तं कर्णं वर्धयेच्छानैः ॥२५॥

Below mentioned are the conditions in which the ear should be allowed to grow slowly following suitable measures –

–        Jataroma – Ear on which the hairs have developed

–        Suvartma – Ears, whose passages are clear

–        Shlishta Sandhi – The joint made after sandhana i.e. place of union is well adhering

–        Sama – the lobe is even and stable

–        Surudha – wound has been well healed

–        Avedana – there is absence of pain

Use of suitable method of joining the mutilated ear

अमिताः कर्णबन्धास्तु विज्ञेयाः कुशलैरिह ।

यो यथा सुविशिष्टः स्यात्तं तथा विनियोजयेत् ॥२६॥

There are numerous methods of joining the mutilated ear. These methods should be learnt from expert surgeons. The appropriate method of joining the lobe at the very moment of conducting the procedure should be wisely decided and undertaken.

Karnapali roga: Other diseases of the earlobe

कर्णपाल्यामयान्नृणां पुनर्वक्ष्यामि सुश्रुत ! ।

कर्णपाल्यां प्रकुपिता वातपित्तकफास्त्रयः ॥२७॥

द्विधा वाऽप्यथ संसृष्टाः कुर्वन्ति विविधा रुजः ।

विस्फोटः स्तब्धता शोफः पाल्यां दोषेतु बातिके ॥२८॥

दाहविस्फोटजननं शोफः पाकश्च पैत्तिके ।

कण्डूः सश्र्वयथुः स्तम्भो गुरूत्वं च कत्फात्मके॥२९॥

यथादोषं च संशोध्य कुर्यात्तेषां चिकित्सितम् ।

स्वेदाभ्यङ्गपरीषेकैः प्रलेपासृग्विमोक्षणैः ॥३०॥

मृद्वीं क्रियां बृहणीयैर्यथास्वं  भोजाइस्तथा ।

य  एवं वेत्ति दोषाणां चिकित्सां कर्तुमर्हति ॥३१॥

Master Divodasa says ‘Dear Sushruta, now I will describe the diseases of the earlobe. Please listen to the same’

Pathogenesis – The Tridosas i.e. as in all diseases, are responsible for producing various types of disorders of the earlobe. Vata, pitta and kapha getting aggravated either individually or in combinations of two or three, reach the earlobe and get localized there. After getting lodged in the earlobe, these aggravated doshas produce different kinds of earlobe disorders. Each dosha would produce a different set of symptoms. They are as below mentioned.

Treatment –

Below mentioned are the most beneficial treatments for doshas aggravated in the earlobe –

–        Shodhana – purificatory therapies as suitable to the dosha involved

–        Swedana – sudation

–        Abhyanga – massage

–        Parisecana – showering or bathing the area with medicated liquids

–        Pralepa – application of medicinal pastes as anointments or in the form of poultice

–        Raktamokshana – bloodletting etc.

Apart from this, all mild therapies / measures shall be administered. The patient is encouraged to consume nourishing (bulk promoting) foods.

The physician who understands different conditions caused by the doshas will be able to plan and execute suitable modes of treatments.

Complications occurring in the earlobe

अत ऊर्ध्व नामलिङ्गैर्वक्ष्ये  पाल्यामुपद्रवान्।

उत्पाटकश्चोत्पुटकः श्यावः कण्डूयुतो भृशम् ॥३२॥

अवमन्थःसक्ण्डूको ग्रथिकोजन्बुलस्तथा ।

स्रावी च दाहवांश्चैव श्रृण्तेषां क्रमशः क्रियाम् ॥३३॥

The Master says – ‘Next, I would describe the diseases of the earlobe which manifest as complications. I will also mention their names, symptoms caused by them and suitable treatments for the same. These diseases are ten in number. They are –

–        Utpataka

–        Utputaka

–        Syava

–        Avamantha

–        Kanduka

–        Granthika

–        Jambula

–        Sravi

–        Dahava

Now I will enumerate the treatments for the same, listen.’

Treatment of complications of earlobe

अपामार्गः सर्जरसः पाटलालकुचत्वचौ ।

उत्पाटकेप्रलेप; स्यात्तैलमोभिश्च पाचयेत् ॥३४॥

शम्पाकशिग्रुपूतीकान् गोधामेदोऽथ तद्वसाम् ।

वाराहं गव्यमैणेयं पित्तं सर्पिश्च संसृजेत ॥३५॥

लेपमुत्पुटके दद्यात्तैलमेभिश्च साधितम् ।

गौरीं सुगन्धां सश्यामामान्तां तण्डुलीयकम्॥३६॥

श्यावे प्रलेपनं दद्यात्तैलमेभिश्च साधितम् ।

पाठां रसाञ्जनं क्षौद्रं तथा स्यादुष्णकाञ्जिकम् ॥३७॥

दद्याल्लेपं सकण्डूके तैलमेभिश्च साधितम् ।

व्रणीभूतस्य देयं स्यादिदं तैलं विजानता ॥३८॥

मधुकक्षीरकाकोलीजीवकाद्यैर्विपाचितम् ।

गोधावराहसर्पाणां वसाः स्यु कृतबृंहणे ॥३९॥

प्रलेपनमिदं दद्यादवसिच्यावमन्थके।

प्रपौण्डरीकं मधुकं समङ्गा धवमेव च॥४०॥

तैलमेभिश्च संपक्वं श्रृणु कण्डूमतः क्रियाम् ।

सहदेवा विश्वदेवा अजाक्षीरं ससैन्धवम् ।

एतैरालेपनं दद्यात्तैलमेभिश्च साधितम् ॥४१॥

ग्रन्थिके गुटिकां पूर्वं स्त्रावयेदवपाटय तु।

ततः सैन्धवचूर्णं तु घृष्ट्वा लेपं प्रदापयेत् ॥४२॥

लिखित्वा तत्स्त्रुतं घृष्टवा  चूर्णैर्लोध्रस्य जम्बुले ।

क्षीरेण प्रतिसार्यैनं शुद्धं संरोपयेत्ततः ॥४३॥

मधुपर्णी मधूकं च मधुकं मधुना सह ।

लेपः स्त्राविणि दातव्यस्तैलमेभिश्च साधितम् ॥४४॥

पञ्चवल्कैः पिष्टैस्तैश्च घृतान्वितैः ।

जीवकाद्यैः ससर्पिष्कैर्दह्यमानं प्रलेपयेत् ॥४५॥

1. Treatment for Utpataka –

a. Pralepa – Application of paste of the below mentioned herbs –

–        Apamarga

–        Sarjarasa

–        Bark of Patala

–        Bark of Lakuca

b. Abhyanga / Parisecana – The area should be massaged with the oil prepared from the above-mentioned Apamarga etc herbs.

2. Treatment for Utputaka –

a. Pralepa – Application of the paste of the below mentioned ingredients mixed with ghee –

–        Sampaka

–        Sigru

–        Putika

–        Fat, muscle fat and pitta (bile) of iguana, boar, cow and antelope

b. Taila – The oil prepared with the above said Sampaka etc ingredients should be used for anointing / bathing.

3. Treatment for Syava –

a. Pralepa – The paste of the below mentioned herbs should be applied –

–        Gauri

–        Sugandha

–        Syama

–        Ananta

–        Tanduliyaka

b. Taila – Oil prepared with the above-mentioned Gauri etc herbs should be applied or showered.

4. Treatment for Sakanduka –

a. Pralepa – Paste of the below mentioned ingredients should be applied –

–        Patha

–        Rasanjana

–        Honey

–        Warm Kanjika

b. Oil – Oil prepared with Patha etc herbs should be used for anointing or bathing the area.

Along with other complications, if the earlobe has become ulcerated, oil cooked with below mentioned ingredients should be used for application –

–        Madhuka

–        Ksirakakoli

–        Jivakadi Gana group of herbs

In case of emaciation of the lobe, muscle fat of iguana, boar and snake should be applied. This would cause stoutening of the earlobe.

5. Treatment for Avamanthaka –

a. Pralepa – The affected area should first be showered and cleansed. Later, the paste of the below mentioned should be applied –

–        Prapaundarika

–        Madhuka

–        Samanga

–        Dhava

b. Taila – Oil cooked with the same ingredients i.e., Prapaundarika etc. should be used for anointment or showering.

6. Treatment for Kanduka –

a. Pralepa – The paste of the below mentioned should be used for application –

–        Sahadeva

–        Visvadeva

–        Aja Kshira

–        Saindhava

b. Taila – Oil cooked with these Sahadeva etc ingredients mentioned above should be used for anointment / bathing.

7. Treatment for Granthika –

a. Vedhana – the tumor / cystic swelling should first be punctured and cut open. The contents of the tumor should be thoroughly drained.

b. Gharshana – Later, the region should be rubbed with powder of Saindhava lavana – rock salt.

c. Pralepa – Paste of Saindhava made with water should be applied.

8. Treatment of Jambula –

a. Lekhana – firstly it should be scraped and squeezed and drained.

b. Gharsana – Then, it should be rubbed with powder of Lodhra.

c. Kshira seka – Later, milk should be showered on it. When the wound becomes cleansed, healing measures should be adopted.

9. Treatment of Sravi –

a. Pralepa – Paste of the below mentioned ingredients added with honey should be applied –

–        Madhuparni

–        Madhuka

–        Madhuka

b. Taila – Oil cooked with the above said ingredients i.e. Madhuparni etc should be used for anointment or showering.

10. Treatment of Dahavan –

a. Pralepa – Paste of Panchavalkala and Maduka added with ghee should be applied. Alternatively, herbs of Jivakadi Gana should be made into paste, mixed with ghee and applied.

Nasa  Sandhana: Joining the mutilated nose: Rhinoplasty

विश्लेषितायास्त्वथ  नासिकाया वक्ष्यामि सन्धानविधिं यथावत् ।

नासाप्रमाणं पृथिवीरुहाणं पत्रं गृहीत्वा त्ववलम्बि तस्य ॥४६॥

तेन प्रमाणेन हि गण्डपार्श्वादुत्कृत्य बद्धं त्वथ नासिकाग्रम् ।

विलिख्य चाशु प्रतिसंदधीत तत् साधुबन्धौर्भिषगप्रमत्त : ॥४७॥

सुसंहितं सम्यगतो यथावन्नाडीद्वयेनाभिसमीक्ष्य बद्धवा ।

प्रोन्नम्य चैनामवचूर्णयेत्तु पतङ्गयष्टीमधुकाञ्जनैश्च ॥४८॥

संछाद्य सम्यक् पिचुना सितेन तैलेन सिञ्चेदसकृत्तिलानाम् ।

घृतं च पाय्यः स नरः सुजीर्णे स्निग्धो विरेच्यः स यथोपदेशम् ॥४९॥

रूढ्ं  च सन्धानमुपागतं स्यात्तदर्धशेषंतु पुनर्निकृन्तेत् ॥

हीनां पुनर्धयितुं यतेत समां च कुर्यादतिवृद्धमांसाम् ॥५०॥

Acharya further says – ‘Now, I will describe nasa sandhana i.e. the method of joining the mutilated nose’

Firstly, a clean leaf of a tree should be taken. Now, it should be cut into the shape and size of the nose of the person to whom nasa sandhana is planned to be done. The surgeon should place this leaf on the cheek of the patient and the shape of the leaf marked on the cheek. Next, the surgeon should cut the cheek muscle to the same size of the leaf mark i.e. the cut muscle should have the measurement of the leaf which was cut to the measurement of the nose. The cut is made by raising a flap of it and maintaining the connection with the live muscles.

Now the mutilated nose (damaged portion) is scraped (causing bleeding) and the flap of the cheek skin with the muscle attachment is placed quickly on the mutilated nose, sutured with a needle and a suitable bandage tied.

Following this, two tubes of Eranda are inserted into the nose (one in each nostril) and the nostrils elevated and observed if both are joined together in a proper way just as a normal nose and after confirming that it shall be bandaged.

Later, powder of the below mentioned herbs should be sprinkled on the site –

–        Patanga,

–        Yastimadhuka and

–        Anjana (Rasanjana according to Dalhana)

Now, keeping a white sterile cotton pad on it, tila taila – sesamem oil is frequently sprinkled on it.

Ghee should be given for the patient to drink, after the previously taken food has been properly digested.

Virechana – purgation should be administered as stipulated, after proper snehana – oleation is conducted.

The flap of the muscles should be cut at its half-length after making sure that the union has healed properly, allowing the remainder intact.

Attempts and interventions to augment the growth of the nose should be done if the repaired nose is short.

On the other hand, if there is excessive growth of the muscle, it should be made even and brought back to the normal size by cutting or scraping it.

Osthasandhaa-joining the mutilated lip: Oroplasty

नाडीयोगं विनौष्टस्य नासासन्धानवद्विधिम् ।

य एवमेव जानीयात्स राज्ञः कर्तुमहंति ॥५१॥

For Oshta Sandhana i.e. joining the mutilated lips, the same procedure explained for nasa sandhana i.e. joining the mutilated nose should be adopted and has to be done without inserting the tubes as done in repair of nose.

Any physician or surgeon who is an expert in performing these operations would become fit and eligible to become the royal physician / surgeon i.e. to treat the king.

इति श्रीसुश्रुतसंहितायां सूत्रस्थाने कर्णव्यधबन्ध विधिर्नाम षोडशोऽध्यायः ॥१६॥

Thus ends the sixteenth chapter by name Karnavyadha Bandha Vidhi In Sutra Sthana of Susruta Samhita.