The 8th chapter of Uttara Sthanam of Ashtanga Hridayam is named as Vartma Roga Vijnaniyam adhyāyaṃ. This chapter deals with the explanation of ‘knowledge of diseases of the eyelids.’

The topics covered in this chapter include –

• Nirvacana – Samprapti – Definition and Pathogenesis
• Krchronmila
• Nimesa
• Vatahata Vartma
• Kumbhi
• Pittotklishta Vartma
• Paksmashata
• Pothaki
• Kaphotklista Vartma
• Lagana
• Utsanga Pitaka
• Utklishta Vartma and Vartmarsas
• Anjana Namika
• Dosotklista Vartma
• Syavavartma Vartma
• Shlishta Vartma
• Sikata Vartma
• Kardama Vartma
• Bahala Vartma
• Kukunaka
• Paksmoparodha
• Alaji
• Vartmarbuda
• Prognosis of disorders of eyelids
• Indications of chedana, bhedana and lekhana

Pledge by the author(s)

अथातो वर्त्मरोगविज्ञानीयमध्यायं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘knowledge about the diseases of the eyelids.
Thus say (pledge) Atreya and other sages.

Nirvachana: Samprapti: Definition and Pathogenesis

सर्वरोगनिदानोक्तैरहितैः कुपिता मलाः ।
अचक्षुष्यैर्विशेषेण प्रायः पित्तानुसारिणः ॥ १ ॥
सिराभिरूर्ध्वं प्रसृता नेत्रावयवमाश्रिताः ।
वर्त्मसन्धिं सितं कृष्णं दृष्टिं वा सर्वमक्षि वा ॥ २ ॥
Malas (Doshas); increased by indulgence in unsuitable (unhealthy foods and activities) described in the Sarvaroga Nidana (chapter 1 of Nidana sthana) especially by those which are not good to the eyes, generally following the Pitta (Pitta being the predominant Dosha); they (doshas) spread upwards (to the head) through the veins, get localized in different parts of the eye and produce diseases either in the eyelids, joints, fornices, white portion, sclera, black portion, cornea, vision, pupil or the whole eye.

Krichronmila

रोगान् कुर्युश्चलस्तत्र प्राप्य वर्त्माश्रयाः सिराः ।
सुप्तोत्थितस्य कुरुते वर्त्मस्तम्भं सवेदनम् ॥ ३ ॥
पांसुपूर्णाभनेत्रत्वं कृच्छ्रोन्मीलनमश्रु च ।
विमर्दनात्स्याच्च शमः कृच्छ्रोन्मूलं वदन्ति तत् ॥ ४ ॥
Vata spreading through the siras (veins) of the eyelids causes diseases in the eyelids, produce rigidity of the eyelid (inability to open) accompanied by pain after waking from sleep; feeling as if sand is filled in his eye, difficulty to open the lid up, increased lacrimation; obtains relief by rubbing the eyes. This disease is known as Krchronmila.

Nimesha

चालयन् वर्त्मनी वायुर्निमेषोन्मेषणं मुहुः ।
करोत्यरुङ्निमेषोऽसौ
Vata moves the lids up and down again and again (very quickly) without any pain. This is Nimesa.

Vatahata Vartma

वर्त्म यत्तु निमील्यते ॥ ५ ॥
विमुक्तसन्धि निश्चेष्टं हीनं वातहतं हि तत् ।
The lid is dropping down, detached from its joint, without movement and is weak. This is Vatahata Vartma.

Kumbhi

कृष्णाः पित्तेन बह्व्योऽन्तर्वर्त्म कुम्भीकबीजवत् ॥ ६ ॥
आध्मायन्ते पुनर्भिन्नाः पिटिकाः कुम्भिसञ्ज्ञिताः ।
Black, multiple eruptions resembling the seeds of Kumbhika, found in the interior surface of the lid,
Bursting and again getting filled up (with blood, us etc.) and is caused by Pitta. This is called Kumbhi.

Pittotklishta Vartma

सदाहक्लेदनिस्तोदं रक्ताभं स्पर्शनाक्षमम् ॥ ७ ॥
पित्तेन जायते वर्त्म पित्तोत्क्लिष्टमुशन्ति तत् ।
The lid becomes red, associated with burning sensation,
moistness, pain and inability to bear the touch; is caused by pitta. It is known as Pittotklista (Vartma).

Pakshmashata

करोति कण्डूं दाहं च पित्तं पक्ष्मान्तमास्थितम् ॥ ८ ॥
पक्ष्मणां शातनं चानु पक्ष्मशातं वदन्ति तम् ।
Pitta getting localized inside the region of the eye lashes produces itching, burning sensation, followed by falling of the eyelashes, this is called Pakshmashata.

Pothaki

पोथक्यः पिटिकाः श्वेताः सर्षपाभा घनाः कफात् ॥ ९ ॥
शोफोपदेहरुक्कण्डूपिच्छिलाश्रुसमन्विताः ।
Pathoki are white colored eruptions resembling mustard,
hard, associated with swelling, coating, pain, itching associated with slimy tears; this is caused by Kapha.

Kaphotklista Vartma

कफोत्क्लिष्टं भवेद्वर्त्म स्तम्भक्लेदोपदेहवत् ॥ १० ॥
The lids having no movement, but found coated with thick fluid is Kaphotklista Vartma.

Lagana

ग्रन्थिः पाण्डुररुक्पाकः कण्डूमान् कठिनः कफात् ।
कोलमात्रः स लगणः किञ्चिदल्पस्ततोऽथवा ॥ ११ ॥
Tumor, which is pale, painless, not suppurating, having itching, hard (generally). of the size of Ziziphus jujuba fruit
and (sometimes) either slightly less or more of it, caused by Kapha. This is known as Lagana.

Utsanga Pitaka

रक्ता रक्तेन पिटिका तत्तुल्यपिटिकाचिता ।
उत्सङ्गाख्या
Rakta (blood) produce red colored Pitaka (eruptions) more than one in number, known as Utsanga.

Utklishta Vartma and Vartmarshas

तथोत्क्लिष्टं राजीमत्स्पर्शनाक्षमम् ॥ १२ ॥
अर्शोऽधिमांसं वर्त्मान्तः स्तब्धं स्निग्धं सदाहरुक् ।
रक्तं रक्तेन तत्स्रावि छिन्नं छिन्नं च वर्धते ॥ १३ ॥
The lids have linear marks and do not tolerate touch
in Utklistavartma. Arsas is excess growth of muscles
inside the lids, immovable, unctuous, associated with burning sensation and pain, red in colour, grows again
Even often cutting (exercising) and bleeding, this is caused by Rakta (blood).

Anjana Namika

मध्ये वा वर्त्मनोऽन्ते वा कण्डूषारुग्वती स्थिरा ।
मुद्गमात्रासृजा ताम्रा पिटिकाऽञ्जननामिका ॥ १४ ॥
Eruptions either in the middle or at the ends
of the lids associated with itching, warmth, pain, immovable, of the size of a green gram, coppery red in colour, produced by blood is Anjana Namika.

Bisavartma

दोषैर्वर्त्म बहिः शूनं यदन्तः सूक्ष्मखाचितम् ।
सस्रावमन्तरुदकं बिसाभं बिसवर्त्म तत् ॥ १५ ॥
Lid swollen externally, having small holes in its interior,
Discharging watery fluid like the bisa (Stalk of the flowers of Nelumbo nucifera) is Bisa vartma, caused by all the Doshas.

Doshotklista Vartma

यद्वर्त्मोत्क्लिष्टमुत्क्लिष्टमकस्मान्म्लानतामियात् ।
रक्तदोषत्रयोत्क्लेशाद्भवत्युत्क्लिष्टवर्त्म तत् ॥ १६ ॥
The lid which is coated the coated lid becomes dry without any apparent reason caused by the drying of
Blood and the tridoshas is dosaotklistavartma.

Shyavavartma Vartma

श्याववर्त्म मलैः सास्रैः श्यावं रुक्क्लेदशोफवत् ।
Syava Vartma is caused by the Malas (Doshas) along with Asra (blood), the lid is blue black, Painful, moist and swollen.

Shlishta Vartma

श्लिष्टाख्यं वर्त्मनी श्लिष्टे कण्डूश्वयथुरागिणी ॥ १७ ॥
Slista Vartma is that in which the lids adhere together associated with itching, swelling and redness.

Sikata Vartma

वर्त्मनोऽन्तः खरा रूक्षाः पिटिकाः सिकतोपमाः ।
सिकतावर्त्म
Pitaka (eruptions) which are hard / rough, dry, resembling sand appearing inside the lids, is Sikatavartma.

Kardama Vartma

कृष्णं तु कर्दमं कर्दमोपमम् ॥ १८ ॥
The lid is black inside and has the features of slush, known as Kardamavartma.

Bahala Vartma

बहलं बहलैर्मांसैः सवर्णैश्चीयते समैः ।
The lid develops thick muscle tissue of the same colour spread evenly as Bahalavartma.

Kukunaka

कुकूणकः शिशोरेव दन्तोत्पत्तिनिमित्तजः ॥ १९ ॥
स्यात्तेन शिशुरुच्छूनताम्राक्षो वीक्षणाक्षमः ।
सवर्त्मशूलपैच्छिल्यः कर्णनासाक्षिमर्दनः ॥ २० ॥
Kukunaka occurs only in children, due to eruption of teeth, the child has pain, swelling, coppery red colour of eyes, inability to see, lids having pain and sliminess, the child rubbing its ears, nose and eye (often).

Paksmoparodha

पक्ष्मोपरोधे सङ्कोचो वर्त्मनां जायते तथा ।
खरताऽन्तर्मुखत्वं च रोम्णामन्यानि वा पुनः ॥ २१ ॥
कण्टकैरिव तीक्ष्णाग्रैर्घृष्टं तैरक्षि शूयते ।
उष्यते चानिलादिद्विडल्पाहः शान्तिरुद्धृतैः ॥ २२ ॥
In Paksmoparodha, there occurs contractions of the eyelids, roughness, the hair (eyelashes) are bent inwards or outwards, the eye is rubbed by the sharp edges of the hair as if by thorns, by which eye gets swollen; associated with serve burning sensation, inability to bear breeze etc.; removing the hair (by which eye got swollen), gives relief
for a short duration.

Alaji

कनीनके बहिर्वर्त्म कठिनो ग्रन्थिरुन्नतः ।
ताम्रः पक्वोऽस्रपूयस्रुदलज्याध्मायते मुहुः ॥ २३ ॥
A hard, elevated granthi (tumor) developing at the kaninaka (inner canthus), on the outer part of the lid, coppery red, suppurating and discharging blood and pus and getting filled up again and again is known as Alaji.

Vartmarbuda

वर्त्मान्तर्मांसपिण्डाभः श्वयथुर्ग्रथितोऽरुजः ।
सास्रैः स्यादर्बुदो दोषैर्विषमो बाह्यतश्चलः ॥ २४ ॥
A hard Granthi (tumour) resembling a ball of muscle developing inside the lid, accompanied with swelling of the lid; painless, uneven and movable from outside (over the lid), this is Arbuda produced by the tridoshas together with blood.

Prognosis of disorders of eyelids

चतुर्विंशतिरित्येते व्याधयो वर्त्मसंश्रयाः ।
आद्योऽत्र भेषजैः साध्यो द्वौ ततोऽर्शश्च वर्यजेत् ॥ २५ ॥
पक्ष्मोपरोधो याप्यः स्याच्छेषाञ्छस्त्रेण साधयेत् ।
These are the twenty-four diseases developing in the eyelids; the first of these (Krchronmila) is curable by medicines, the next two, (nimesa and Vatahata) and Arsas are rejectable; paksmoparodha is controllable but persist long; and the remaining should be cured by surgical treatment.

Indications of chedana, bhedana and lekhana

कुट्टयेत्पक्ष्मसदनं छिन्द्यात्तेष्वपि चार्बुदम् ॥ २६ ॥
भिन्द्याल्लगणकुम्भीकाबिसोत्सङ्गाञ्जनालजीः ।
पोथकीश्यावसिकताश्लिष्टोत्क्लिष्टचतुष्टयम् ॥ २७ ॥
सकर्दमं सबहलं विलिखेत्सकुकूणकम् ॥ २७ऊअब् ॥
Among these, Paksma Sadana (Sata) should be pricked (by needles), Arbuda should be excised, Lagana, Kumbhika, Bisa Vartma, Utsanga, Anjananamika and Alaji should be punctured; pothaki, Syava Vartma, Sikatavartma, Slistavartma, the four Utklista (Pittoklista, Kaphotklista, Raktotklista and Dosotklista), Kardamavartma,
Bahala Vartma and Kukunaka should be scrapped.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने वर्त्मरोगविज्ञानीयो नाम अष्टमोऽध्याय: ॥ ८ ॥
Thus, ends the chapter –Vartmoroga Vijnaniya the eight in Uttara Sthana of Astanga Hrdaya Samhita composed by Srimad Vagbhata, son of Vaidyapati Simhagupta.