The 13th chapter of Uttaratantra of Sushruta Samhita is named as Lekhya Roga Pratisedha Adhyaya. This chapter deals with the treatment of Diseases Requiring Scarping.

अथातो रक्ताभिष्यन्दप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound the treatment of Lekhya roga – diseases requiring scraping – scarification; as revealed by the venerable Dhanvantari.

Lekhana Vidhi – Procedure of scraping

नव येऽभिहिता लेख्याः सामान्यस्तेष्वयं विधिः |
स्निग्धवान्तविरिक्तस्य निवातातपसद्मनि ||३||
(आप्तैर्दृढं गृहीतस्य वेश्मन्युत्तानशायिनः) |
सुखोदकप्रतप्तेन वाससा सुसमाहितः |
स्वेदयेद्वर्त्म निर्भुज्य वामाङ्गुष्ठाङ्गुलिस्थितम् ||४||
अङ्गुल्यङ्गुष्ठकाभ्यां तु नि र्भुग्नं वर्त्म यत्नतः |
प्लोतान्तराभ्यां न यथा चलति स्रंसतेऽपि वा ||५||
ततः प्रमृज्य प्लोतेन वर्त्म शस्त्रपदाङ्कितम् |
लिखेच्छस्त्रेण पत्रैर्वा, ततो रक्ते स्थिते पुनः ||६||
स्विन्नं मनोह्वाकासीसव्योषार्द्राञ्जनसैन्धवैः |
श्लक्ष्णपिष्टैः समाक्षीकैः प्रतिसार्योष्णवारिणा ||७||
प्रक्षाल्य हविषा सिक्तं व्रणवत् समुपाचरेत् |
स्वेदावपीडप्रभृतींस्त्र्यहादूर्ध्वं प्रयोजयेत् ||८||
व्यासतस्ते समुद्दिष्टं विधानं लेख्यकर्मणि |

There are in total nine diseases in which Lekhana – scraping has been indicated as a predominant treatment approach. Below explained is the common procedure of Lekhana which should be followed in treating all these 9 conditions.

Preparatory purification – Firstly the patient should have undergone purification therapies, including snehana, swedana, vamana and virecana.

Preparatory measures

The person who has been thus purified is brought into a room which is well protected from heavy breeze and sunlight.

He should then be asked to lie on a cot after having passed on the instructions to be followed during the procedure of Lekhana. The patient should be well informed about what he or she is undergoing. The patient should lie in supine position, keeping his face upwards.

Strong and faithful attendants should now hold the patient tightly.

The eye in which Lekhana Karma is to be done should be thoroughly washed. Later, the eye is given fomentation with a sterile cloth dipped in comfortably warm water.

Positioning the patient and conducting the procedure

Now the physician should hold the eyelid with the help of folds of sterile cloth, held firmly by the thumb and fingers of his left-hand, taking care that the lid is in position and it neither moves nor slips away from the hold.

The physician should now raise and evert the eyelid and gently massage it with a sterile cotton swab.

Next, he should mark the area of the eyelid to be scraped by a sharp instrument.

Later, the physician should conduct the Lekhana Karma and scrap the eyelid and the region chosen for scraping with either a sharp instrument or a rough leaf in such a way that there will be no bleeding.

The lid shall be once again subjected to swedana – fomentation, after the bleeding has stopped. Later, the lid should be smeared with medicinal paste.

Paste for smearing – Below mentioned ingredients shall be macerated nicely, mixed with honey and gently applied on the eyelid –

–        Manohva

–        Kasisa

–        Vyosa

–        Ardra

–        Anjana (Rasanjana) and

–        Saindhava Lavana

Follow up measures

The lids should be washed with warm water. Ghee should be applied and the eyelid should be treated on the lines of treating a wound.

Swedana – fomentation, Avapida – nasal drops etc should only be done after three days of Lekhana.

Thus, the detailed procedure of lekhana karma which is common for all lekhana sadhya vyadhis has been explained.

Samyak lekhana – features of proper scraping

असृगास्रावरहितं कण्डूशोफविवर्जितम् ||९||
समं नखनिभं वर्त्म लिखितं सम्यगिष्यते |

Below mentioned are the signs of lekhana karma properly done –

–        stoppage of bleeding after lekhana has been completed

–        absence of itching

–        absence of swelling

–        even – absence of depressions or elevations after the procedure

–        eyelid resembling the colour of nail

Durlekhana – improper / inadequate scraping

रक्तमक्षि स्रवेत् स्कन्नं क्षताच्छस्त्रकृताद्ध्रुवम् ||१०||
रागशोफपरिस्रावास्तिमिरं व्याध्यनिर्जयः |
वर्त्म श्यावं गुरु स्तब्धं कण्डूहर्षोपदेहवत् ||११||
नेत्रपाकमुदीर्णं वा कुर्वीताप्रतिकारिणः |
एतद्दुर्लिखितं ज्ञेयं स्नेहयित्वा पुनार्लिखेत् ||१२||

Below mentioned are the features / signs of improperly or inadequately done lekhana karma – scraping, –

–        discharge of clotted blood from the site of scraping, for prolonged time

–        redness of the lid

–        swelling of the lid

–        exudation from the eye

–        blindness

–        disease persisting (not subsided even after scraping)

–        bluish discolouration of eyelid

–        lids are heavy and static

–        itching

–        tingling sensation

–        thickness of the lid

–        inflammation of the eye increases, if it is not treated quickly

Remedy – In such conditions, the eyelid should be anointed and the lekhana karma done once again.

व्यावर्तते यदा वर्त्म पक्ष्म चापि विमुह्यति |
स्यात् सरुक् स्रावबहुलं तदतिस्रावितं विदुः ||१३||
स्नेहस्वेदादिरिष्टः स्यात् क्रमस्तत्रानिलापहः |

Below mentioned are the features / signs of excessively done lekhana karma / scraping –

–        eversion of eyelid for prolonged time

–        bending of eyelashes

–        more of pain in eyelids

–        more of exudation / bleeding

Remedy – In such a condition, snehana, swedana and all other treatments and measures useful for mitigating vata should be implemented.

Lekhya roga – diseases requiring scraping

वर्त्मावबन्धं क्लिष्टं च बहलं यच्च कीर्तितम् ||१४||
पोथकीश्चाप्यवलिखेत् प्रच्छयित्वाऽग्रतः शनैः |
समं लिखेत्तु मेधावी श्यावकर्दमवर्त्मनी ||१५||
कुम्भीकिनीं शर्करां च तथैवोत्सङ्गिनीमपि |
कल्पयित्वा तु शस्त्रेण लिखेत् पश्चादतन्द्रितः ||१६||
भवेयुर्वर्त्मसु च याः पिडकाः कठिना भृशम् |
ह्रस्वास्ताम्राश्च ताः पक्वा भिन्द्याद्भिन्ना लिखेदपि ||१७||

In the below mentioned conditions, mild and gentle lekhana karma should be done using a sharp instrument or a rough leaf –

–        Vartmavabandha

–        Klista Vartma

–        Bahala Vartma and

–        Pothaki

Proper and adequate lekhana – scraping should be done by a wise physician in the below mentioned conditions –

–        Syava Vartma

–        Kardama Vartma

The eyelid should be first incised with a sharp instrument and then scraped properly without any lethargy in the below mentioned conditions –

–        Kumbhika Vartma

–        Vartma Sarkara

–        Utsanga Vartma

The pidakas i.e. eruptions or cystic swelling should first be cut open by puncturing them and then subjected to lekhana, when they are very hard, small, coppery in colour and ripened.

तरुणीश्चाल्पसंरम्भा पिडका बाह्यवर्त्मजाः |
विदित्वैताः प्रशमयेत् स्वेदालेपनशोधनैः ||१८||

Swedana – fomentation, Lepana – application of medicinal pastes and Shodana – purificatory therapies shall be done for treating the pidakas – eruptions, in the below mentioned conditions –

–        when they are nascent / newly appearing

–        present with less swelling

–        located externally on the eyelid

इति सुशुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे लेख्यरोगप्रतिषेधो नाम त्रयोदशोऽध्यायः ||१३||

Thus ends the thirteenth chapter by the name Lekhyaroga Pratisedha  in Uttara Sthana of Susruta samhita.