The 10th chapter of Uttara Sthanam of Ashtanga Hridayam is named as Sandhi Sita Asita Roga Vijnaniya. This chapter deals with the explanation of ‘Knowledge of diseases of the fornixes, Sclera and Cornea’.

The topics covered in this chapter include –

• Sandhigata Roga – diseases of the fornixes
• Jalasrava
• Kaphasrava
• Upanaha
• Raktasrava
• Parvani
• Puyasrava
• Puyalasa
• Alaji
• Krmi Granthi
• Indication of surgical methods in Upanaha and other conditions
• Sita / Shuklagata Roga – Diseases of the Sclera
• Suklarma and Balasa Grthita
• Pistaka
• Sirotpata
• Siraharsa
• Sirajala
• Sonitarma
• Arjuna
• Prastaryarma
• Adhimamsarma
• Siraja Pitaka
• Methods of intervention and prognosis
• Asita – Krsnagata Roga – Diseases of the Cornea
• Ksata Sukra
• Suddha Sukra
• Ajaka
• Sirasukra
• Pakatyaya

Pledge by the author(s)

अथात: सन्धिसितासितरोगविज्ञानीयं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
अथात: सन्धि सित असित रोग विज्ञानीयं व्याख्यास्याम: – athāta: sandhi sita asita roga vijñānīyaṃ vyākhyāsyāma: – After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘Knowledge of diseases of the fornices, Sclera and Cornea’.
इति ह स्माहु: आत्रेयादयो महर्षय: – iti ha smāhu: ātreyādayo maharṣaya: – Thus say (pledge) Atreya and other sages.

Sandhigata Roga: Diseases of the fornices

Jalasrava

वायुः क्रुद्धः सिराः प्राप्य जलाभं जलवाहिनीः ।
अश्रु स्रावयते वर्त्मशुक्लसन्धेः कनीनकात् ॥ १ ॥
तेन नेत्रं सरुग्रागशोफं स्यात्स जलास्रवः ।
Vata undergoing increase, getting localized in the channels of water (tears) causes excess flow of tears, resembling water from the joints of the lids and the white portion (sclera), through the Kaninaka (inner canthus). By this the eye develops pain, redness, and swelling. This disease is called Jalasrava.

Kaphasrava

कफात्कफास्रवे श्वेतं पिच्छिलं बहलं स्रवेत् ॥ २ ॥
From (increase of) Kapha arises Kaphasrava. The exuding fluid will be white, slimy and thick.

Upanaha

कफेन शोफस्तीक्ष्णाग्रः क्षारबुद्बुदकोपमः ।
पृथुमूलबलः स्निग्धः सवर्णो मृदुपिच्छिलः ॥ ३ ॥
महानपाकः कण्डूमानुपनाहः स नीरुजः ।
From Kapha, arises a big swelling with a pointed tip, resembling the bubbles of kshara (Alkali) with thick base, strong, unctuous, of the color (as of the base), soft and slimy, big in size, non-suppurating and having itching but no pain. This is Upanaha.

Raktasrava

रक्ताद्रक्तास्रावे ताम्रं बहूष्णं चाश्रु संस्रवेत् ॥ ४ ॥
From the blood arises Raktasrava, in which the exudation is coppery red, bahu – copious, along with warm tears.

Parvani

वर्त्मसन्ध्याश्रया शुक्ले पिटिका दाहशूलिनी ।
ताम्रा मुद्गोपमा भिन्ना रक्तं स्रवति पर्वणी ॥ ५ ॥
Pitaka (eruptions) appear in the joints between the eyelid and sclera having burning sensation and pain, coppery red, of the size of a green gram, exuding blood when burst. This disease is known as Parvani.

Puyasrava

पूयास्रवे मलाः सास्रा वर्त्मसन्धेः कनीनकात् ।
स्रावयन्ति मुहुः पूयं सास्रं त्वङ्मांसपाकतः ॥ ६ ॥
In Puyasrava, the malas (doshas) associated with blood, discharge pus mixed with blood, often from the joints of the lids, though the inner canthus, as a result of suppuration/ulceration of the skin and muscles.

Puyalasa

पूयालसो व्रणः सूक्ष्मः शोफसंरम्भपूर्वकः ।
कनीनसन्धावाध्मायी पूयास्रावी सवेदनः ॥ ७ ॥
Puyalasa is a small ulcer, preceded with swelling and pain, redness etc. causing swelling of the inner canthus, discharge of pus and pain.

Alaji

कनीनस्यान्तरलजी शोफो रुक्तोददाहवान् ।
Alaji is a swelling inside the inner canthus, having pain, pricking sensation and burning sensation.

Krimi Granthi

अपाङ्गे वा कनीने वा कण्डूषापक्ष्मपोटवान् ॥ ८ ॥
पूयास्रावी कृमिग्रन्थिर्ग्रन्थिः कृमियुतोऽर्तिमान् ।
A tumor developing either at the outer canthus or inner canthus, accompanied with itching, local burning sensation, falling of eyelashes, discharge of pus, having worms (bacteria etc.) inside and painful. This disease is called Krmigranthi.

Indication of surgical methods in Upanaha and other conditions

उपनाहकृमिग्रन्थिपूयालसकपर्वणीः ॥ ९ ॥
शस्त्रेण साधयेत्पञ्च सालजीनास्रवांस्त्यजेत् ।
Upanaha, Krmigranthi, Puyalasaka, Parvani and Alaji, these five are to be treated surgically, the (four) Asrava should be refused treatment.

Sita / Shuklagata Roga: Diseases of the Sclera

पित्तं कुर्यात्सिते बिन्दूनसितश्यावपीतकान् ॥ १० ॥
मलाक्तादर्शतुल्यं वा सर्वं शुक्लं सदाहरुक् ।
रोगोऽयं शुक्तिकासञ्ज्ञः सशकृद्भेदतृड्ज्वरः ॥ ११ ॥
Pitta increased, produces in the sclera, small dots (spots) of black, blue or yellow color; the entire sclera
appearing like a mirror covered by dirt and has burning sensation and pain. These diseases known as Shuktika, are accompanied with diarrhoea, thirst and fever.

Shuklarma and Balasa Grathita

कफाच्छुक्ले समं श्वेतं चिरवृद्ध्यधिमांसकम् ।
शुक्लार्म शोफस्त्वरुजः सवर्णो बहलोऽमृदुः ॥ १२ ॥ गुरुः स्निग्धोऽम्बुबिन्द्वाभो बलासग्रथितं स्मृतं ।
From Kapha, there develops on the sclera, an extra growth of muscle which is even, white and growing very slowly, this is Suklarma. A swelling which is painless, of the same color (of the sclera), thick, not soft, heavy, greasy, resembling a water bubble is known as Balasa Grathita.

Pistaka

बिन्दुभिः पिष्टधवलैरुत्सन्नैः पिष्टकं वदेत् ॥ १३ ॥
Presence of pasty white, raised dots on the sclera is called as Pisthaka.

Sirotpata

रक्तराजीततं शुक्लमुष्यते यत्सवेदनम् ।
अशोफाश्रूपदेहं च सिरोत्पातः स शोणितात् ॥ १४ ॥
The sclera is full of red lines, has burning sensation, pain, with slight or no swelling, tears and thickening, this disease is Sirotpata and caused by blood (vitiated).

Siraharsha

उपेक्षित: सिरोत्पातो राजीस्ता एव वर्धयन् ।
कुर्यात्सास्रं सिराहर्षं तेनाक्ष्युद्वीक्षणाक्षमम् ॥ १५ ॥
Sirotapata when neglected leads to Siraharsa with increase of red line and discharge of blood (from them); by that the eye becomes unable to see.

Sirajala

सिराजाले सिराजालं बृहद्रक्तं घनोन्नतम् ।
Sirajala is the appearance of a big, blood red, hard and elevated network of veins.

Shonitarma

शोणितार्म समं श्लक्ष्णं पद्माभमधिमांसकम् ॥ १६ ॥
Sonitarma is an extra growth of muscle which is even, smooth and resembling a lotus flower (in color).

Arjuna

नीरुक् श्लक्ष्णोऽर्जुनं बिन्दुः शशलोहितलोहितः ।
Arjuna is a dot which is painless, smooth and red in color similar to that of blood of the rabbit.

Prastaryarma

मृद्वाशुवृद्ध्यरुङ्मांसं प्रस्तारि श्यावलोहितम् ॥ १७ ॥ प्रस्तार्यर्म मलैः सास्रैः स्नावार्म स्नावसन्निभम् ।
A soft, quick developing, painless, growth of muscle spread side-wards, bluish red in color is known as Prastharyarma and is caused by all the Doshas together with blood. Snayvarma resembles a tendon.

Adhimamsarma

शुष्कासृक्पिण्डवच्छ्यावं यन्मांसं बहलं पृथु ॥ १८ ॥
अधिमांसार्म
The muscle (of the sclera) becomes thick and hard, blue in color like the clump of dried blood; this is known as Adhimamsarma.

Siraja Pitaka

दाहहघर्षवत्यः सिरावृताः ।
कृष्णासन्नाः सिरासञ्ज्ञाः पिटिकाः सर्षपोपमाः ॥ १९ ॥
Eruptions resembling mustard, surrounded by veins, having burning sensation and causing friction appearing near the cornea is known as Siraja Pitaka.

Methods of intervention and prognosis

शुक्तिहर्षसिरोत्पातपिष्टकग्रथितार्जुनम् ।
साधयेदौषधैः षट्कं शेषं शस्त्रेण सप्तकम् ॥ २० ॥ नवोत्थं तदपि द्रव्यैरर्मोक्तं यच्च पञ्चधा ।
तच्छेद्यमसितप्राप्तं मांसस्नावसिरावृतम् ॥ २१ ॥
चर्मोद्दालवदुच्छ्रायि दृष्टिप्राप्तं च वर्जयेत् ।
Suktika, Harsa (Siraharsa), Sirotpata, Pistaka, Balasagrahita, and Arjuna; these six should be treated with medicines. The remaining seven by surgery; among these, those which are of recent origin may be treated with herbs. The five kinds of arma should be excised but not those which have reached the Cornea, which are surrounded by Muscles, tendons and veins, that which is elevated as if rearing the skin, and has reached the Dristi (vision-pupil and hindering it) should be rejected.

Asita: Krishnagata Roga: Diseases of the Cornea

Kshata Shukra

पित्तं कृष्णेऽथवा दृष्टौ शुक्रं तोदाश्रुरागवत् ॥ २२ ॥
छित्त्वा त्वचं जनयति तेन स्यात्कृष्णमण्डलम् ।
पक्वजम्बूनिभं किञ्चिन्निम्नं च क्षतशुक्रकम् ॥ २३ ॥
तत्कृच्छ्रसाध्यं याप्यं तु द्वितीयपटलव्यधात् ।
तत्र तोदादिबाहुल्यं सूचीविद्धाभकृष्णता ॥ २४ ॥
तृतीयपटलच्छेदादसाध्यं निचितं व्रणैः ।
Pitta invading the Krsna (cornea) or the Drsti (pupil) causes shukra having pricking pain, discharge of tears and redness, by producing a tear by breaking the skin (conjunctiva), by this the cornea appears like a ripe Jambu fruit (bluish black) in color and slightly depressed, called Ksata shukra. This is difficult to cure; when it breaks the second layer, it causes a great increase of pricking pain etc. resembles the black hole made by the needle and the disease becomes controllable but persisting for a long time. When the third layer is broken it gives rise to many wounds/ ulcers and becomes incurable.

Suddha Sukra

शङ्खशुक्लं कफात्साध्यं नातिरुक् शुद्धशुक्रकम् ॥ २५ ॥
From Kapha Sudha Sukra is produced, in which the cornea has white color like that of a conch shell and without much pain; this is curable.

Ajaka

आताम्रपिच्छिलास्रस्रुदाताम्रपिटिकाऽतिरुक् ।
अजाविट्सदृशोच्छ्रायकार्ष्ण्या वर्ज्याऽसृजाऽजका ॥ २६ ॥
Eruptions which are coppery red in color, slimy, exuding blood, which is coppery red, very painful, resembling the excreta of the goat in size and black color. This disease ajaka caused by (vitiated) blood is to be rejected.

Sirashukra

सिराशुक्रं मलैः सास्रैस्तज्जुष्टं कृष्णमण्डलम् ।
सतोददाहताम्राभिः सिराभिरवतन्यते ॥ २७ ॥
अनिमित्तोष्णशीताच्छघनास्रस्रुच्च तत्त्यजेत् ।
Sirasukra is caused by all the Mala (Dosha) associated with blood; vitiated by these, the Cornea becomes filled with veins, which produce pricking pain, burning sensation and coppery color, blood which is sometimes hot and sometimes cold, clear and thick exuded out without any cause. This should be rejected.

Pakatyaya

दोषैः सास्रैः सकृत्कृष्णं नीयते शुक्लरूपताम् ॥ २८ ॥ धवलाभ्रोपलिप्ताभं निष्पावार्धदलाकृति ।
अतितीव्ररुजारागदाहश्वयथुपीडितम् ॥ २९ ॥
पाकात्ययेन तच्छुक्रं वर्जयेत्तीव्रवेदनम् ।
All the Doshas together with blood, all of sudden; make the cornea to assume the features of the Sclera. It appears as though covered with white clouds, has the shape of cotyledon of a Dolicos lablab, associated with severe pain, redness, burning sensation and swelling, troubling the patient due to over ripening. This Sukra, having very severe pain, should be rejected.

Pakatyaya

यस्य वा लिङ्गनाशोऽन्तः श्यावं यद्वा सलोहितम् ॥ ३० ॥
अत्युत्सेधावगाढं वा साश्रु नाडीव्रणावृतम् ।
पुराणं विषमं मध्ये विच्छिन्नं यच्च शुक्रकम् ॥ ३१ ॥
That (cornea) which has caused loss of vision, that which is blue inside, that which is slightly red, that which is greatly elevated or greatly depressed with copious tears flowing out, surrounded by sinus ulcers, which is chronic, uneven, torn in the center and that having dots / sports should be rejected.

Pakatyaya

पञ्चेत्युक्ता गदाः कृष्णे साध्यासाध्यविभागतः ॥ ३१ऊअब् ॥  
Thus, were described the five diseases of the Krsna (black portion/ cornea), classified into curable incurable diseases.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने सन्धिसितासितरोग विज्ञानीयो नाम दशमोऽध्याय: ॥ १० ॥
Thus, ends the chapter-Sandhisitasita Roga Vijnaniya, the tenth in Uttarasthana of Asthaga Hrdaya Samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.