Ashtanga Hridayam UttaraSthanam Chapter 9: Vartmarogapratishedam (Treatment of diseases of the eyelids)

The 9th chapter of Uttara Sthanam of Ashtanga Hridayam is named as Vartma Roga Pratisedha adhyāyaṃ. This chapter deals with the explanation of ‘treatment of diseases of the eyelids.’

The topics covered in this chapter include –

• Treatment of Kricchronmila
• Treatment of Kumbhika Vartma
• Vartma Lekhana Vidhi – procedure of scraping the lids
• Signs of proper and excessive scraping of eyelids
• Lodhra Putapakva Rasa
• Bhedana
• Lekhana and Bhedana
• Treatment of Pittotklishta and Raktotklishta Vartma Roga
• Treatment of Paksmasadana
• Treatment of Paksmasata
• Treatment of Pothaki
• Saindhavadi Pratisarana in Kaphotklishta Vartma
• Treatment of Lagana
• Treatment of Anjananamika
• Treatment of Kukuna
• Recipes for emesis
• Vartis for Kukunaka and Pothaki
• Surgical process in Paksmarodha
• Dahakarma

Pledge by the author(s)

अथातो वर्त्मरोगप्रतिषेधं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
athāto vartmaroga pratiṣedhaṃ vyākhyāsyāma: – After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘treatment of the diseases of the eyelids.
iti ha smāhu: ātreyādayo maharṣaya: – Thus say (pledge) Atreya and other sages.

Treatment of Kricchronmila

कृच्छ्रोन्मीले पुराणाज्यं द्राक्षाकल्काम्बुसाधितम् ।
ससितं योजयेत्स्निग्धं नस्यधूमाञ्जनादि च ॥१॥
For Krchronmila, old ghee, paste of Vitis vinifera, boiled with decoction of the same added with sugar should be made use of for lubricating nasal drops, fumigation, eye-salve etc.

Treatment of Kumbhika Vartma

कुम्भीकावर्त्मलिखितं सैन्धवप्रतिसारितम् ।
यष्टीधात्रीपटोलीनां क्वाथेन परिषेचयेत् ॥ २ ॥
Kumbhika Vartma should be scraped, and rock salt should be sprinkled and decoction of yaṣṭī – Gylcyrrhiza glabra, dhātrī – Emblica officinalis, paṭolīnāṃ – Trichosanthes dioica poured over it.

Vartma Lekhana Vidhi: Procedure of scraping the lids

निवातेऽधिष्ठितस्याप्तैः शुद्धस्योत्तानशायिनः ।
बहिः कोष्णाम्बुतप्तेन स्वेदितं वर्त्म वाससा॥३॥
निर्भुज्य वस्त्रान्तरितं वामाङ्गुष्ठाङ्गुलीघृतम् ।
न स्रंसते चलति वा वर्त्मैवं सर्वतस्ततः ॥४॥
मण्डलाग्रेण तत्तिर्यक् कृत्वा शस्त्रपदाङ्कितम् ।
लिखेत्तेनैव पत्रैर्वा शाकशेफालिकादिजैः ॥५॥
फेनेन तोयराशेर्वा पिचुना प्रमृजन्नसृक् ।
स्थिते रक्ते सुलिखितं सक्षौद्रैः प्रतिसारयेत् ॥६॥
यथास्वमुक्तैरनु च प्रक्षाल्योष्णेन वारिणा ।
घृतेन सिक्तमभ्यक्तं बध्नीयान्मधुसर्पिषा ॥७॥
ऊर्ध्वाधः कर्णयोर्दत्त्वा पिण्डीं च यवसक्तुभिः ।
द्वितीयेऽहनि मुक्तस्य परिषेकं यथायथम् ॥८॥
कुर्याच्चतुर्थे नस्यादीन् मुञ्चेदेवाह्नि पञ्चमे ।
The patient who has been purified (by emesis, purgation etc.), is made to lie in a room devoid of breeze, with his face up and surrounded by his well-wishers. The outside of the lids is then given fomentation with a cloth dipped in warm water, lids held twisted by the left thumb and left fingers wrapped with cloth in such a way that the lid neither slips away nor makes any movement on all sides Then with the Mandalagra Sastra (Lancet), an incision should be made horizontally, and then scraping done by its own edge, or with leaves of Nyctanthes arbour-tristis etc. (which are very rough); the exuding blood being washed by either Phena (Samudra Phena / cuttlefish) water or wet cloth. After the bleeding stops, the scraped place should be smeared with the powder of rock salt mixed with honey as described earlier; after some time it (lid) should be washed with warm water, bathed with ghee and massaged; a bolus of flour of Hordeum vulgare mixed with honey and ghee, is inserted inside and the lids bandaged above and below the ears. On the second day, it should be removed and bathing the eye done as described earlier. On the fourth day, nasal medication etc. should be done and from the fifth day, the bandage removed.

Signs of proper and excessive scraping of eyelids

समं नखनिभं शोफकण्डूघर्षाद्यपीडितम् ॥९॥
विद्यात्सुलिखितं वर्त्म लिखेद्भूयो विपर्यये ।
रुक्पक्ष्मवर्त्मसदनस्रंसनान्यतिलेखनात् ॥१०॥
स्नेहस्वेदादिकस्तस्मिन्निष्टो वातहरः क्रमः ।
The lid becoming even, resembling the nail in shape, relieved of swelling, itching, friction and such other troubles should be considered as properly scared, and in case of opposite symptoms it should be scraped again. Pain, weakness of the hairs and lids and dropping, result from excess scraping for that, oleation, sudation etc. and methods of mitigating Vata are desired.

Lodhra Putapaka Rasa

अभ्यज्य नवनीतेन श्वेतलोध्रं प्रलेपयेत् ॥११॥
एरण्डमूलकल्केन पुटपाके पचेत्ततः ।
स्विन्नं प्रक्षालितं शुष्कं चूर्णितं पोटलीकृतम्॥१२॥
स्त्रियाः क्षीरे छगल्या वा मृदितं नेत्रसेचनम् ।
A piece of Symplocos racemosus smeared with butter is given a covering with the paste of roots of Ricinus communis, and cooked in the Putapaka method. After it gets cooked, it is washed, dried, powdered and macerated either with breast milk or goat’s milk, made into a ball (held inside cloth) and squeezed (so that droops of juice fall into the eye).

Lodhra Putapaka Rasa

शालितण्डुलकल्केन लिप्तं तद्वत्परिष्कृतम्॥१३॥
कुर्यान्नेत्रेऽतिलिखिते मृदितं दधिमस्तुना ।
केवलेनापि वा सेकं मस्तुना जाङ्गलाशिनः ॥१४॥
The same (svetarodhra) placed inside paste of flour of Sali and cooked in the same way, macerated with water of curds/ whey should be squeezed to the lid which has been over scraped; or eye may be bathed with whey or alone for the person who consumes meat of animals of desert-like lands.

Bhedana

पिटिका व्रीहिवक्त्रेण भित्त्वा तु कठिनोन्नताः ।
निष्पीडयेदनु विधिः परिशेषस्तु पूर्ववत् ॥१५॥
Hard and elevated eruptions should be pricked with Vrihimukha Shastra (Trocar) and their contents squeezed out, afterwards Parisheka (bathing the eye) is done as described earlier.

Lekhana and Bhedana

लेखने भेदने चायं क्रमः सर्वत्र वर्त्मनि ।
This is the procedure of scraping and pricking, Puncturing in all the diseases of the eyelids.

Treatment of Pittotklishta and Raktotklishta Vartma Roga

पित्तास्रोत्क्लिष्टयोः स्वादुस्कन्धसिद्धेन सर्पिषा ॥१६॥
सिराविमोक्षः स्निग्धस्य त्रिवृच्छ्रेष्ठं विरेचनम् ।
लिखिते स्रुतरक्ते च वर्त्मनि क्षालनं हितम् ॥१७॥यष्टीकषायः सेकस्तु क्षीरं चन्दनसाधितम् ।
In pittotklista and Raktotklista, venesection should be done after making the patient oleated with ghee prepared with herbs of sweet group (chapter 10 of Sutrasthana) followed by purgation with Operculina turpethum. The lid is then scraped and bleeding stopped; it is beneficial to wash the lid with the decoction of Glycyrrhiza glabra and bathe it by pouring milk boiled with
Santalum album.

Treatment of Pakshmasadana

पक्ष्मणां सदने सूच्या रोमकूपान् विकुट्टयेत्॥१८॥ग्राहयेद्वा जलौकोभिः पयसेक्षुरसेन वा ।
वमनं नावनं सर्पिः शृतं मधुरशीतलैः ॥ १९ ॥
In Paksmasadana, the hair follicles should be pricked well with the needle or seized by leeches, emesis therapy using milk and sugarcane juice and nasal medication with ghee processed with herbs which are sweet and cold in potency should be done.

Treatment of Pakshmasata

सञ्चूर्ण्य पुष्पकासीसं भावयेत्सुरसारसैः ।
ताम्रे दशाहं परमं पक्ष्मशाते तदञ्जनम् ॥२०॥
Puspakasisa well powdered is soaked in the juice of Ocimum sanctum kept in a copper vessel, after ten days this if used as a colyrium is best in Paksmasata.

Treatment of Pothaki

पोथकीर्लिखिताः शुण्ठीसैन्धवप्रतिसारिताः ।
उष्णाम्बुक्षालिताः सिञ्चेत्खदिराढकिशिग्रुभिः ॥२१॥अप्सिद्धैर्द्विनिशाश्रेष्ठामधुकैर्वा समाक्षिकैः ।
Pothaki should be scared, smeared with Zingiber officinale and rock salt, washed with warm water, and sprinkled with water boiled with either khadira – Acacia catechu, āḍhaki – Cajanas cajana, śigrubhiḥ – Moringa oliefera or with the two Nisa (Haridra – Curcuma longa & Daruharidra – Berberis aristata), śreṣṭhā – Cynodon dactylon, madhukai – Glycyrrhiza glabra both mixed with honey.

Saindhavadi Pratisarana in Kaphotklishta Vartma

कफोत्क्लिष्टे विलिखिते सक्षौद्रैः प्रतिसारणम्॥२२॥
सूक्ष्मैः सैन्धवकासीसमनोह्वाकणतार्क्ष्यजैः ।
वमनाञ्जननस्यादि सर्वं च कफजिद्धितम् ॥२३॥
In Kaphotklista after doing the scraping, nice powder of rock salt, kāsīsa – ferrous sulphate, manohvā – realgar, kaṇa – Piper longum, tārkṣyajaiḥ – Emerald mixed with honey should be applied; emesis, applying colyrium, nasal medication etc. and all therapies mitigating Kapha are beneficial

Treatment of Lagana

कर्तव्यं लगणेऽप्येतदशान्तावग्निना दहेत् ।
Even for Lagana the same treatment should be done; if it does not subside then it should be burnt with fire (cauterised).

Treatment of Anjananamika

स्विन्नां भित्त्वा विनिष्पीड्य भिषगञ्जननामिकाम् ।
शिलैलासैन्धवनतैः सक्षौद्रैः प्रतिसारयेत् ॥ २४१+(१) ॥
The physician should apply fomentation to Utsanga and Anjanamika, prick it, remove its contents and then apply the powder of Asphaltum, Elettaria cardamomum, rock salt Valeriana wallicii added with honey

Treatment of Kukuna

कुकूणे खदिरश्रेष्ठानिम्बपत्रशृतं घृतम् ॥२४॥
पीत्वा धात्री वमेत्कृष्णायष्टीसर्षपसैन्धवैः ।
अभयापिप्पलीद्राक्षाक्वाथेनैनां विरेचयेत् ॥२५॥
मुस्ताद्विरजनीकृष्णाकल्केनालेपयेत्स्तनौ ।
धूपयेत्सर्षपैः साज्यैः शुद्धां क्वाथं च पाययेत् ॥२६॥
पटोलमुस्तमृद्वीकागुडूचीत्रिफलोद्भवम् ।
शिशोस्तु लिखितं वर्त्म स्रुतासृग्वाऽम्बुजन्मभिः ॥२७॥
धात्र्यश्मन्तकजम्बूत्थपत्रक्वाथेन सेचयेत् ।
In Kukunaka, the nursing mother should be made to consume medicated ghee prepared with:
khadira – Acacia catechu,
śreṣṭhā – Cynodon dactylon
nimbapatra – Leaves of Azadirachta indica,
then emesis therapy administered using Piper nigrum, yaṣṭī – Glycyrrhiza glabra, sarṣapa – Brassica juncea and rock salt and purgation therapy with the decoction of:
abhayā – Terminalia chebula,
pippalī – Piper longum
drākṣā – Vitis vinifera.
Her breasts should be smeared with the paste of mustā – Cyperus rotundus, the two rajani (Haridra – Curcuma longa & Daruharidra – Berberis aristata) kṛṣṇā – and Piper nigrum and exposed to the fumes of sarṣapaiḥ – Brassica juncea mixed with ghee, after purification she should be made to drink the decoction of prepared from paṭola – Trichosanthes dioica, musta – Cyperus rotundus, mṛdvīkā – Vitis vinifera, guḍūcī – Tinospora cordifolia, triphala – and
Triphala (Haritaki – Terminalia chebula, Vibhitaki – Terminalia bellerica & Amalaki – Emblica officinalis) The eye lid of the child should be scrapped or blood taken out by applying the leech; after it should be bathed with the decoction of dhātri – Emblica officinalis, aśmantaka – Ficus rumphii, jambūttha patra – leaves of Syzygium cumini.

Recipes for emesis

प्रायः क्षीरघृताशित्वाद्बालानां श्लेष्मजा गदाः॥२८ ॥
तस्माद्वमनमेवाग्रे सर्वव्याधिषु पूजितम् ।
सिन्धूत्थकृष्णापामार्गबीजाज्यस्तन्यमाक्षिकम्॥२९ ॥
चूर्णो वचायाः सक्षौद्रो मदनं मधुकान्वितम् ।
क्षीरं क्षीरान्नमन्नं च भजतः क्रमतः शिशोः॥३०॥
वमनं सर्वरोगेषु विशेषेण कुकूणके ।
सप्तलारससिद्धाज्यं योज्यं चोभयशोधनम् ॥३१॥
Because children are consuming milk and Ghee (as food) they genetically get affected by diseases caused by Kapha, hence in all diseases emesis therapy itself should be administered first. (powder of) rock salt, kṛṣṇā – Piper nigrum, apāmārga bīja – seeds of Achyranthes aspera mixed with ghee, breast milk and honey, powder of vacāyāḥ – Acorus calamus mixed with honey and Randia dumetorum with honey are best emetic recipe for children who consume breast-milk, those consume both milk and solid food and those consuming only solid food respectively for emesis in all the diseases, especially in Kukunaka. Medicated ghee prepared from the decoction of Euphorbia neriifolia should be made use of to produce both the purifications (emesis and purgation).

Vartis for Kukunaka and Pothaki

द्विनिशालोध्रयष्ट्याह्वरोहिणीनिम्बपल्लवैः ।
कुकूणके हिता वर्तिः पिष्टैस्ताम्ररजोऽन्वितैः॥३२॥
क्षीरक्षौद्रघृतोपेतं दग्धं वा लोहजं रजः ।
एलालशुनकतकशङ्खोषणफणिज्जकैः ॥३३॥
वर्तिः कुकूणपोथक्योः सुरापिष्टैः सकट्फलैः ।
Wick prepared with macerating in water the two Nisa (Haridra – Curcuma longa & Daruharidra – Berberis aristata), lodhra – Symplocos racemosa, yaṣṭyāhva – Glycyrrhiza glabra, rohiṇī – Picrorhiza kurroa, nimba pallavaiḥ – tender leaves of Azadirachta indica and fine powder of copper or the powder of burnt iron (iron slag) mixed with milk, honey and ghee is beneficial in Kukunaka (when applied as a collyrium to the eyes). Wick prepared with elā – Elettaria cardamomum, laśuna – Allium sativum, kataka – Strychnos potatorum, śaṅkha – Convolvulus pluricaulis, ūṣaṇa – Piper nigrum, phaṇijjakaiḥ – Origanum majorana, sakaṭphalaiḥ – Myrica nagi, macerated with Sura (beer) is beneficial in both Kukunaka and Pothaki.

Surgical process in Pakshmarodha

पक्ष्मरोधे प्रवृद्धेषु शुद्धदेहस्य रोमसु ॥ ३४ ॥
उत्सृज्य द्वौ भ्रुवोऽधस्ताद्भागौ भागं च पक्ष्मतः ।
यवमात्रं यवाकारं तिर्यक् छित्त्वाऽऽर्द्रवाससा ॥३५॥
अपनेयमसृक् तस्मिन्नल्पीभवति शोणिते ।
सीव्येत्कुटिलया सूच्या मुद्गमात्रान्तरैः पदैः ॥३६॥बद्ध्वा ललाटे पट्टं च तत्र सीवनसूत्रकम् ।
नातिगाढश्लथं सूच्या निक्षिपेदथ योजयेत् ॥३७॥
मधुसर्पिःकवलिकां न चास्मिन् बन्धमाचरेत् ।
न्यग्रोधादिकषायैश्च सक्षीरैः सेचयेद्रुजि ॥३८॥
पञ्चमे दिवसे सूत्रमपनीयावचूर्णयेत् ।
गैरिकेण व्रणं युञ्ज्यात्तीक्ष्णं नस्याञ्जनादि च॥३९ ॥
In Paksmarodha where the hair (eyelashes) have grown too much, the patient who has been purified (by emesis and purgation) (is subjected to a surgical operation as follows) a horizontal incision is made underneath the eyebrows of the size of a Hordeum vulgare( barley) and resembling a Hordeum vulgare(barley) in shape, at the place on the eyelid, leaving off two thirds part from above and one third part from the border line of the eyelashes; the exuding blood removed with the help of wet cloth; after the bleeding stops, the wound sutured with a curved needle making stitches, at the distance of the size of a green gram between them a band of cloth should be tied on the suture either thread of cotton, silk or flax, fixed to the band on the forehead; the band should be fastened with the help of a needle neither tightly or loosely a cotton wick soaked in honey and ghee is then placed over (the site of Operations), banding not be done in this condition. In case there is pain, decoction of herbs of Nyagrodhadi Gana (Chapter 15 of Sutrsthana) mixed with milk should be poured on the place. On the fifth day the suture should be removed and powdered along with Gairika should be applied on the wound Strong nasal medication and collyrium should be made use of

Dahakarma

दहेदशान्तौ निर्भुज्य वर्त्मदोषाश्रयां वलीम् ।
सन्दंशेनाधिकं पक्ष्म हृत्वा तस्याश्रयं दहेत् ॥४०॥
सूच्यग्रेणाग्निवर्णेन दाहो बाह्यालजेः पुनः ।
भिन्नस्य क्षारवह्निभ्यां सुच्छिन्नस्यार्बुदस्य च ॥४१॥
If the diseases do not subside (by the above treatment) the folds of the lid where in the Dosas are localised should be bent outwards and burnt, with the help of a forceps, the extra hairs are cut off and their place of dwelling (growth) burnt (cauterised) with the tip of the needle heated red hot, In Bahyalaji, cauterising should be done after Puncturing in Arbuda cauterising should be done with both alkalies and fire after exercising it completely.
इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने वर्त्मरोगप्रतिषेधो नाम नवमोऽध्याय: ॥९॥
Thus ends the chapter Vartmaroga Pratisedha- the ninth in Uttaraasthana of Asthanga Hrdaya samhita composed by Srimad Vagbhata , son of sri vaidyapati Simhagupta .