The 1st chapter of Uttaratantra of Sushruta Samhita is named as Aupadravika Adhyaya. This chapter deals with Secondary Diseases.
अथात औपद्रविकमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound the chapter by name aupadravya – concerning secondary diseases; as revealed by the venerable dhañvañtari.
Uttarasthāna aucitya- relevance of this section-
अध्यायानां शते विंशे यदुक्तमसकृन्मया |
वक्ष्यामि बहुधा सम्यगुत्तरेऽर्थानिमानिति ||३||
इदानीं तत् प्रवक्ष्यामि तन्त्रमुत्तरमुत्तमम् |
निखिलेनोपदिश्यन्ते यत्र रोगाः पृथग्विधाः ||४||
While expounding one hundred and twenty chapters (described so far) I have stated many times that more details about many of those topics shall further be furnished in the Uttara Sthana section. Therefore, I will now describe the last section called Uttara Sthana, which is the most important one.
Uttarasthāna vişaya- subjects dealt with
शालाक्यतन्त्राभिहिता विदेहाधिपकीर्तिताः |
ये च विस्तरतो दृष्टाः कुमाराबाधहेतवः ||५||
षट्सु कायचिकित्सासु ये चोक्ताः परमर्षिभिः |
उपसर्गादयो रोगा ये चाप्यागन्तवः स्मृताः ||६||
त्रिषष्टी रससंसर्गाः स्वस्थवृत्तं तथैव च |
युक्तार्था युक्तयश्चैव दोषभेदास्तथैव च ||७||
यत्रोक्ता विविधा अर्था रोगसाधनहेतवः |
In this Uttara Tantra section, I will describe in detail –
– Urdhwanga Chikitsa – All the diseases separately described in Salakya Tantra will be explained here. Salakya Tantra is a science (part of Ayurveda healing system) concerned with urdhwanga chikitsa i.e. treatment of organs of the head expounded by Nimi, the king of Videha (according to Dalhana).
– Bala Chikitsa – All those diseases described in detail as causing troubles to the children.
– Kaya Chikitsa – All those secondary and exogenous diseases of Kaya Chikitsa which have been mentioned in the texts written by Agnivesha etc. six great sages.
– Sixty-three combinations of tastes
– Svastha Vrtta – regimens of health
– Tantrayukti – codes of interpretation of the text and
– Description of different combinations of doshas helpful in treatment of diseases
Śālākya tantra prāthamya – priority of diseases of the head and the organs located therein
महतस्तस्य तन्त्रस्य दुर्गाधस्याम्बुधेरिव ||८||
आदावेवोत्तमाङ्गस्थान् रोगानभिदधाम्यहम् |
सङ्ख्यया लक्षणैश्चापि साध्यासाध्यक्रमेण च ||९||
This science is a great one. It is like an ocean, vast and difficult to cross. In this science, at the beginning, I will describe the diseases of the head along with their number, features, prognosis etc. in proper order.
Netra vivarana – description of the eye
विद्याद्द्वयङ्गुलबाहुल्यं स्वाङ्गुष्ठोदरसम्मितम् |
द्व्यङ्गुलं सर्वतः सार्धं भिषङ्नयनबुद्बुदम् ||१०||
सुवृत्तं गोस्तनाकारं सर्वभूतगुणोद्भवम् |
Nayana Budbuda means eyeball. The physician should understand the dimensions of the eyeball as below described –
– depth – 2 angula (4cm),
– width – of one’s own thumb in thickness,
– circumference – two and half angula (5cm),
– shape – is round and resembles the nipple of a cow
– origin – it arises from (comprises of) all the bhutas i.e. five elements of nature (earth, water, fire, air and ether) and their qualities
Involvement of five elements in the formation of different parts of the eye
पलं भुवोऽग्नितो रक्तं वातात् कृष्णं सितं जलात् ||११||
आकाशादश्रुमार्गाश्च जायन्ते नेत्रबुद्बुदे |
| Part of Netra Budbuda – eyeball | Mahabhuta involved in its makeover |
| Pala – muscles of the eye | Bhuvi – Prithvi – Earth |
| Rakta – blood | Tejas – Agni – Fire |
| Krsna – black portion of the eye – cornea | Vata – Vayu – Air |
| Sita – white portion of the eye – sclera | Jala – Ap – Water |
| Asru Marga – channels of tears / lacrimal ducts | Akasa – Ether |
दृष्टिं चात्र तथा वक्ष्ये यथा ब्रूयाद्विशारदः ||१२||
नेत्रायामत्रिभागं तु कृष्णमण्डलमुच्यते |
कृष्णात् सप्तममिच्छन्ति दृष्टिं दृष्टिविशारदाः ||१३||
Now, I shall explain about Drsti (vision, pupil) as described by the experts of the eye –
– Krsna Mandala (black part of the eye / cornea) is one-third of the length of the eye
– Drsti (part of vision, pupil) is one seventh part of Krsna Mandala
Netra bhāga- parts of the eye
मण्डलानि च सन्धींश्च पटलानि च लोचने |
यथाक्रमं विजानीयात् पञ्च षट् च षडेव च ||१४||
पक्ष्मवर्त्मश्वेतकृष्णदृष्टीनां मण्डलानि तु |
अनुपूर्वं तु ते मध्याश्चत्वारोऽन्त्या यथोत्तरम् ||१५||
In the eye,
– Mandala i.e. spheres or areas are five in number,
– Sandhi i.e. joints / fornices are six in number and
– Patala i.e. layers or sheaths are six in number
The five mandalas or areas of the eye are –
– Paksma Mandala – areas of eye lashes – the outermost area of the eye
– Vartma Mandala – areas of eyelids – located next to Paksma Mandala inwards
– Sveta Mandala – area comprising of white portion of the eye / sclera – is the next one inner to the area of the eyelids
– Krsna Mandala – area of black portion of the eye / cornea and
– Drsti Mandala – area of sight / pupil – both Krsna and Drshti Mandala are next inner layers and are present in the middle of Krsna Mandala
Netra sandhi- joints / fornices of the eye
पक्ष्मवर्त्मगतः सन्धिर्वर्त्मशुक्लगतोऽपरः |
शुक्लकृष्णगतस्त्वन्यः कृष्णदृष्टिगतोऽपरः |
ततः कनीनकगतः षष्ठश्चापाङ्गगः स्मृतः ||१६||
Sandhi (joints / fornices) present in the eyes are –
– one between pakşma (eyelashes) and vartma (eyelids);
– another between vartma (lids) and sukla (sclera);
– another between sukla (selera) and krsna (cornea);
– another between krsna (cornea) and drsţi (pupil);
– one at kanīnaka (inner canthus) and
– the sixth at apānga (outer canthus) – thus six in total
Netra patala- layers / sheaths of the eye
द्वे वर्त्मपटले विद्याच्चत्वार्यन्यानि चाक्षिणि |
जायते तिमिरं येषु व्याधिः परमदारुणः ||१७||
तेजोजलाश्रितं बाह्यं तेष्वन्यत् पिशिताश्रितम् |
मेदस्तृतीयं पटलमाश्रितं त्वस्थि चापरम् ||१८||
पञ्चमांशसमं दृष्टेस्तेषां बाहुल्यमिष्यते |
Two patalas are present in two eyelids – one in each eyelid. Other four patalas are present the eye. Timira – the most dreadful disease (blindness) occurs in these Patalas.
– The external patala which is the outermost layer of the eye is the seat of Tejas (fire, heat, pitta) and jala (water / kapha).
– The second patala is the seat of Pisita i.e. muscles.
– The third patala is the seat of medas i.e. fat.
– The fourth patala is the seat of asthi i.e. bone.
The thickness of these patalas is equal to one fifth of the drshti.
Netra Bandana – Binders of the eye (eyeball)
सिराणां कण्डराणां च मेदसः कालकस्य च ||१९||
गुणाः कालात् परः श्लेष्मा बन्धनेऽक्ष्णोः सिरायुतः |
The qualities of the below mentioned structures are the best in that order –
– sira – veins and arteries,
– kandara – ligaments,
– medas – fat and
– kalaka – bones of the sockets of the eye
These structures take part in binding the eyeball to its structures. The kapha located near the bony socket of the eyes along with the siras will take part in binding both the eyes.
Dosas are causes of disease
सिरानुसारिभिर्दोषैर्विगुणैरूर्ध्वमागतैः ||२०||
जायन्ते नेत्रभागेषु रोगाः परमदारुणाः |
The aggravated doshas move upwards through the siras. They now get localized in the eye. This would give rise to dreadful diseases in different parts of the eye.
Netra dusti sämanya laksana- general signs of eye diseases
तत्राविलं ससंरम्भमश्रुकण्डूपदेहवत् ||२१||
गुरूषातोदरागाद्यैर्जुष्टं चाव्यक्तलक्षणैः |
सशूलं वर्त्मकोषेषु शूकपूर्णाभमेव च ||२२||
विहन्यमानं रूपे वा क्रियास्वक्षि यथा पुरा |
दृष्ट्वैव धीमान् बुध्येत दोषेणाधिष्ठितं तु तत् ||२३||
Below mentioned symptoms are unclearly manifested in the eyes –
– eyes become turbid / dirty along with
– swelling and
– filled with tears with
– itching and
– increase of exudates / waste products (in the eye),
– heaviness,
– burning sensation,
– pricking pain,
– redness etc.
Below mentioned symptoms are also seen –
– pain in the cells of the eyelids,
– feeling of husk of grains or full of thorns
– changes in vision and
– eyes will not be able to see things or function / perceive objects or tolerate light like before i.e. the functioning of eye has changed
The intelligent physician on noticing these symptoms only should understand and infer the presence of aggravated doshas in the eyes.
Samāñya chikitsa – general line of treatment
तत्र सम्भवमासाद्य यथादोषं भिषग्जितम् |
विदध्यान्नेत्रजा रोगा बलवन्तः स्युरन्यथा ||२४||
सङ्क्षेपतः क्रियायोगो निदानपरिवर्जनम् |
वातादीनां प्रतीघातः प्रोक्तो विस्तरतः पुनः ||२५||
Appropriate treatments should be quickly adopted after analysing and realizing the possibility of development of diseases according to the involved aggravated dosha. If the treatments are not promptly done, the eye diseases will become severe and incurable. Treatments in brief of these conditions would involve avoiding the causative factors and mitigation of vata and other doshas. More details of the same will be furnished later.
Netra roga nidāna – causes of eye diseases
उष्णाभितप्तस्य जलप्रवेशाद्दूरेक्षणात् स्वप्नविपर्ययाच्च |
प्रसक्तसंरोदनकोपशोकक्लेशाभिघातादतिमैथुनाच्च ||२६||
शुक्तारनालाम्लकुलत्थमाषनिषेवणाद्वेगविनिग्रहाच्च |
स्वेदादथो धूमनिषेवणाच्च छर्देर्विघाताद्वमनातियोगात् |
बाष्पग्रहात् सूक्ष्मनिरीक्षणाच्च नेत्रे विकारान् जनयन्ति दोषाः ||२७||
Below mentioned are the etiological factors (causative factors) of eye disorders –
– entering into the water (ponds, rivers, water reservoirs, showers) immediately after getting exposed to sunlight or fire etc. sources of heat
– trying to see the distant objects (the objects present or placed very far away)
– avoiding sleep,
– excessive indulgence in bouts of weeping, anger, sorrow and exertion for long periods,
– occurrence of injury to the eye,
– indulgence in excessive sex (copulation),
– excessive consumption of sukta (vinegar), aranala (rice-wash or soul and fermented liquids), and many such other sour and fermented drinks,
– excessively consuming foods prepared from kulattha – horse gram or masa – black gram
– frequently (habitually) suppressing the urges of the body, of those of urine, faeces etc.
– sweating in excess,
– inhaling smoke in excess,
– forcibly withholding / controlling the bouts of vomiting or vomiting in excess
– controlling of tears,
– observing minute things for long periods of time
The doshas would get aggravated by these causative factors and produce many diseases.
Roga sankhyas number of diseases
वाताद्दश तथा पित्तात् कफाच्चैव त्रयोदश |
रक्तात् षोडश विज्ञेयाः सर्वजाः पञ्चविंशतिः ||२८||
तथा बाह्यौ पुनर्द्वौ च रोगाः षट्सप्ततिः स्मृताः |
The diseases which affect the eyes are seventy-six in number. They include –
– Ten diseases from vata and ten diseases from pitta,
– Thirteen diseases from kapha,
– Sixteen diseases from rakta,
– Twenty-five diseases from all the three doshas together and
– Two diseases from extraneous causes
Vātaja roga – diseases of vāta origin
हताधिमन्थो निमिषो दृष्टिर्गम्भीरिका च या ||२९||
यच्च वातहतं वर्त्म न ते सिध्यन्ति वातजाः |
याप्योऽथ तन्मयः काचः साध्याः स्युःसान्यमारुताः ||३०||
शुष्काक्षिपाकाधीमन्थस्यन्दमारुतपर्ययाः |
Below mentioned diseases produced by Vata are incurable –
– Hatadhimantha,
– Nimesa,
– Gambhira Drsti and
– Vatahata Vartma
Vataja Kaca cannot be completely cured, it can be controllable but it would persist,
Below mentioned diseases produced by Vata are curable –
– Anyamaruta (Anyatovata),
– Suskaksipaka,
– Adhimantha,
– Abhisyanda and
– Marutaparyaya (Vataparyaya)
– Vātaja kāca is controllable but persisting.
Pittaja roga – diseases of the pitta origin
असाध्यो ह्रस्वजाड्यो यो जलस्रावश्च पैत्तिकः ||३१||
परिम्लायी च नीलश्च याप्यः काचोऽथ तन्मयः |
अभिष्यन्दोऽधिमन्थोऽम्लाध्युषितं शुक्तिका च या ||३२||
दृष्टिः पित्तविदग्धा च धूमदर्शी च सिध्यति |३३
Below mentioned diseases caused by pitta are incurable –
– Pittaja Hrasvajadya and
– Pittaja Jala Srāva
Below mentioned diseases caused by pitta are controllable / maintainable (but persisting) –
– Parimlayi
– Nila and
– Pittaja Kaca
Below mentioned diseases caused by pitta are curable –
– Abhisyanda,
– Adhimantha,
– Amladhysita,
– Suktika,
– Pitta Vidagdha Drshti and
– Dhumadarsi
Kaphaja roga – diseases of kapha origin
असाध्यः कफजः स्रावो याप्यः काचश्च तन्मयः ||३३||
अभिष्यन्दोऽधिमन्थश्च बलासग्रथितं च यत् |
दृष्टिः श्लेष्मविदग्धा च पोथक्यो लगण्श्च यः ||३४||
क्रिमिग्रन्थिपरिक्लिन्नवर्त्मशुक्लार्मपिष्टकाः |
श्लेष्मोपनाहः साध्यास्तु कथिताः श्लेष्मजेषु तु ||३५||
Among the diseases caused by Kapha,
– Kaphasrāva is incurable.
– Kaphaja kāca is controllable
Below mentioned diseases produced by Kapha are curable –
– Abhisyanda,
– Adhimantha,
– Balasagrathita,
– Slesmavidagdha Drsti,
– Pothaki,
– Lagana,
– Krimigranthi,
– Praklinna Vartma,
– Suklarma,
– Pistika and
– Slesmopanaha
Raktaja Roga – diseases produced by rakta (blood)
रक्तस्रावोऽजकाजातं शोणितार्शोव्रणान्वितम् |
शुक्रं न साध्यं काचश्च याप्यस्तज्जः प्रकीर्तितः ||३६||
मन्थस्यन्दौ क्लिष्टवर्त्म हर्षोत्पातौ तथैव च |
सिराजाताऽञ्जनाख्या च सिराजालं च यत् स्मृतम् ||३७||
पर्वण्यथाव्रणं शुक्रं शोणितार्मार्जुनश्च यः |
एते साध्या विकारेषु रक्तजेषु भवन्ति हि ||३८||
Below mentioned four diseases caused by Rakta – aggravated blood are incurable –
– Rakta Srava,
– Ajakajata,
– Sonitarsa,
– Ksata Sukra – Sukra with an ulcer
Raktaja Kaca is controllable (but persisting).
Below mentioned diseases produced by Rakta are curable –
– Adhimantha,
– Abisyanda,
– Klistavartma,
– Siraharsa,
– Utpata,
– Sirajala,
– Anjanakhya,
– Parvani,
– Vranasukra and
– Raktaja Arjuna
Sannipātaja roga – diseases produced by all the doşās
पूयास्रावो नाकुलान्ध्यमक्षिपाकात्ययोऽलजी |
असाध्याः सर्वजा याप्यः काचः कोपश्च पक्ष्मणः ||३९||
वर्त्मावबन्धो यो व्याधिः सिरासु पिडका च या |
प्रस्तार्यर्माधिमांसार्म स्नाय्वर्मोत्सङ्गिनी च या ||४०||
पूयालसश्चार्बुदं च श्यावकर्दमवर्त्मनी |
तथाऽर्शोवर्त्म शुष्कार्शः शर्करावर्त्म यच्च वै ||४१||
सशोफश्चाप्यशोफश्च पाको बहलवर्त्म च |
अक्लिन्नवर्त्म कुम्भीका बिसवर्त्म च सिध्यति ||४२||
Incurable diseases produced by all the three doshas together –
– Puyasrava,
– Nakulandhya,
– Aksipakatyaya and
– Alaji
Below mentioned sannipataja conditions are controllable (but persisting) –
– Sannipataja Kaca and
– Paksmakopa
Below mentioned conditions produced by all three doshas together are curable –
– Vartmavabandha,
– Sirajapidaka,
– Prastari Arma,
– Adhimamsa Arma,
– Snayu Arma,
– Utsangini,
– Puyalasa,
– Vartma Arbuda,
– Syava Vartma,
– Kardama Vartma,
– Arsovartma,
– Suskarsa,
– Sarkara Vartma,
– Sasopha Paka,
– Asopha Paka,
– Bahala Vartma,
– Aklinna Vartma,
– Kumbhika and
– Bisa Vartma
Āgañtu roga-exogeneous diseases
सनिमित्तोऽनिमित्तश्च द्वावसाध्यौ तु बाह्यजौ |४३|
षट्सप्ततिर्विकाराणामेषा सङ्ग्रहकीर्तिता ||४३||
Below mentioned two diseases caused by extraneous agencies / causes are incurable –
– Sa-nimitta – those caused by injury etc. causes,
– Animitta – those produced without any apparent cause or according to Acharya Dalhana – those produced by the power of wrath of divinities, sages, saints etc.)
Thus, the seventy six diseases were enumerated in brief.
नव सन्ध्याश्रयास्तेषु वर्त्मजास्त्वेकविंशतिः |
शुक्लभागे दशैकश्च चत्वारः कृष्णभागजाः ||४४||
सर्वाश्रयाः सप्तदश दृष्टिजा द्वादशैव तु |
बाह्यजौ द्वौ समाख्यातौ रोगौ परमदारुणौ |
भूय एतान् प्रवक्ष्यामि सङ्ख्यारूपचिकित्सितैः ||४५||
Out of these,
– Nine diseases occur in sandhi – joints or fornices of the eye,
– Twenty-one diseases arise in vartma – eyelids,
– Ten diseases arise in sukla – sclera,
– Four diseases occur in krsna – cornea,
– Seventeen diseases arise in all parts of the eyes,
– Twelve diseases arise in drsti – pupil,
– Two diseases arise from external causes – these are very dreadful
Further, these diseases will be described in detail along with their number, signs and treatment.
इति श्रीसुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे औपद्रविको नाम प्रथमोऽध्यायः ।।१।।
Thus ends the first chapter by name Apadravya Adhyāya in Uttaratantra of suśruta samhita.
