Sushruta Samhita Uttaratantra Chapter 2 Sandhigata Roga Vijnaniya (Diseases of the Fornices)

पक्वः शोफः सन्धिजः संस्रवेद्यः सान्द्रं पूयं पूति पूयालसः सः |४|

Puyalasa is a condition which manifests with swelling in the sandhi i.e. fornices of the eye. When this swelling gets ripe, it discharges thick and foul-smelling pus and hence is called puyalasa.  

2. Upanaha

ग्रन्थिर्नाल्पो दृष्टिसन्धावपाकः कण्डूप्रायो नीरुजस्तूपनाहः ||४||

Upanaha is yet another disease of the sandhi of the eye wherein a big granthi i.e. tumor or cyst like mass is formed in the drshti sandhi i.e. joint of the drshti mandala. This granthi does not suppurate. It presents with itching but is not associated with pain.

3. Srava

गत्वा सन्धीनश्रुमार्गेण दोषाः कुर्युः स्रावान् रुग्विहीनान् कनीनात् |
तान् वै स्रावान् नेत्रनाडीमथैके तस्या लिङ्गं कीर्तयिष्ये चतुर्धा ||५||
पाकः सन्धौ संस्रवेद्यश्च पूयं पूयास्रावो नैकरूपः प्रदिष्टः |
श्वेतं सान्द्रं पिच्छिलं संस्रवेद्यः श्लेष्मास्रावो नीरुजः स प्रदिष्टः ||६||
रक्तास्रावः शोणितोत्थः सरक्तमुष्णं नाल्पं संस्रवेन्नातिसान्द्रम् |
पीताभासं नीलमुष्णं जलाभं पित्तास्रावः संस्रवेत् सन्धिमध्यात् ||७||

Srava means discharges or exudates. It is caused when the morbid doshas reach the netra sandhi i.e. fornices of the eye. When the morbid doshas travelling through the ashrumarga i.e. channels of the tears reach the sandhis, they give rise to srava. This srava occurs from the kaninika sandhi i.e. inner canthus or angle of the eye, the nose end of the eye. This condition has exudates but does not have pain. This condition is called Netra Srava. It is also called Netranadi by some scholars. The features of different kinds of netra srava shall be described now.

There are four types of srava. They are –

Puyasrava – In this condition, there is discharge of puya i.e. pus. This occurs when paka i.e. suppuration occurs at the sandhis. Due to this there is discharge of pus of different nature from the eye. Since there is discharge of puya, it is called puyasrava. 

Slesmasrava – In this condition there is discharge of fluids which resemble slesma i.e. kapha in appearance. It presents with exudation of fluid which is white, thick and slimy. It is not associated with pain. Since the exudes resemble sleshma, it is called slesmasrava.

Raktasrava – In this condition there is exudation of fluids which resemble rakta – blood in colour. This condition is produced by blood wherein the discharges are red in colour or mixed with blood, warm, copious and not very thick. Since the discharges resemble rakta, this condition is called as raktasrava.

Pittasrava – In this condition there is discharge of fluids which resemble the colour of pitta. The discharges are slightly yellow or blue in colour, hot, and resemble water. Since the discharges resemble pitta, it is called as pittasrava.

4. Parvani

ताम्रा तन्वी दाहशूलोपपन्ना रक्ताज्ज्ञेया पर्वणी वृत्तशोफा |

Parvani is yet another disease which occurs in the netra sandhi. It presents with a round swelling. The swelling is coppery in colour and produced by morbid blood. It is accompanied by pain and burning sensation.

5. Alaji

जाता सन्धौ कृष्णशुक्लेऽलजी स्यात्तस्मिन्नेव ख्यापिता पूर्वलिङ्गैः ||८||

Alaji is another disease of netra sandhi which presents with swelling which has similar features as those of Parvani. It develops in krshna-shuklagata sandhi i.e. fornices between black of the eye (cornea) and white of the eye (sclera).  

6. Krimi Granthi

क्रिमिग्रन्थिर्वर्त्मनः पक्ष्मणश्च कण्डूं कुर्युः क्रिमयः सन्धिजाताः |
नानारूपा वर्त्मशुक्लस्य सन्धौ चरन्तोऽन्तर्नयनं दूषयन्ति ||९||

Krimi Granthi is a condition which manifests in the joints / fornices of the eyes and are caused due to the affliction of these fornices by krimi (worms, bacteria, virus etc. microorganisms). The krimis present in the vartma-paksmagata sandhi i.e. joint between (meeting place of) eyelids and eyelashes and vartma-suklagata sandhi i.e. joint between eyelids and white of the eyes (sclera) causes this condition. These krimis are of different shapes. They vitiate the eyes (fornices) and produce itching and small granthis – small tumours or cyst like growths. This condition is called krimi granthi.

Symptoms – In this condition, the krimis will move around and eat away the joints of the eyelids and sclera. In later periods, they will also vitiate the deeper layers of the eye.

इति सुश्रुतसंहितायामुत्तरतन्त्रे सन्धिगतरोगविज्ञानीयो नाम द्वितीयोऽध्ययः ||२||

Thus ends the second chapter by name Sandhigata roga Vijnaniya in Uttara Sthana Of Susruta Samhita.