INDICATION OF KAPHAJA LINGANASHA SHASTRA KARMA
([Link].17.56)
सजु ािं – Fully ripened or matured cataract
ति: प्रेक्ष्यि ् - Complete loss of vision
कफोत्भवं – which is of kapha origin
Uncomplicated cataract - following Six complications of
Kaphaja linganasha are to be avoided before surgical
intervention:
[Link]: Pupillary circle appears like whirlpool, hyper-
reactive, of reddish white colour.
[Link]: Where linganasha-cataract appears like that of
coagulated milk. 2
c. Rajimati: When cataract’s anterior surface is seen with
linings.
d. Chhinanshuka: Pupil is irregular, with tears, charred
coloured and painful.
e. Chandraki: Pupillary area reflects off- white color and its
shape is like that of moon.
f. Chhatrki:The pupillary area (Cataract) is multicolored
that of mushroom.
like 5
CONTRAINDICATIONS
([Link].17.55)
A) Related to cataract (Kaphaja Linganasha)
Pupillary Appearance:
अर्धेन्दु - Half moon shaped pupil-posterior
subluxated lens
घिााम्भु - Drop of sweat-anterior dislocation of lens
ति न्दु ि क्
तु ाकृ ति - Pearl shaped-shrinked lens
स्स्थ रा – Hard cataract
विषम - Irregular shaped
राजीिाि - Having streaks-calcified
तिु मर् ध्ये- Thin from the centre.
ि हप्रु भ – Multicolored
ि रु
जो िलोदहत: - Painful or red eye
4
B) Related to patient:
Those patients who are contraindicated for
सि
राव्यध.
Suffering from:
Thrishna
Kasa
Peenasa
Ajeerna
Vamana
diseases of Karna, akshi,shira
who is bheeru.
5
Pre-operative
steps / measures;
⚫ Preparation of patient ;
- snehana (oleation)
- Swedana ( sudation)
- Virechana ( medicated purgation)
- Ghrita mixed food
- Tarpana of head-by abhyanga (massage)
- He should be given nasya of
mamsarasa on previous night.
- Pt should not take food on the day of
surgery.
- The operation theatre should be checked
for all the necessary equipments or
medicines.
⚫ The day should be normal one without
excessive heat or cold.
⚫ The place of surgery should be
devoid of excessive flow of wind.
⚫ There should be good illumination.
⚫ The room where surgery will be done
should be made clean and smooth by
watering.
Preparation and collection of
required materials ;
[Link]- vakra shalaka having following
qualities;
a. Length – 8 angula; i.e 6 inches.
b. Wrapped in center with thread for
proper grip.
c. Thickness equal to thumb.
d. Both ends shaped like flower- bud.
e. Made of copper, silver / gold.
2. Vetas patra shastra for scleral
incision. [Link] stanya /goat/ cow
milk.
[Link] patra.
[Link] for
heating.
6. Ghrita
[Link] from vatahara drugs e.g. eranda
patra and dashamoola kwatha.
[Link] medicated with yasti madhu
kashaya. [Link] patta ( bandage)
[Link] (cotton)
[Link] for poultice ( sudation)
[Link], brave, strong, devoted attendants
to hold and assist the patient during the
procedure.
Operative
procedure
⚫ Fix a particular date and time for the
operation and pray prayers to god.
⚫ Make the patient sit in O.T with extended
legs, hands resting on seat, hyper
extended neck- facing sun(light) in the
forenoon. the attendants should make
patient stable. The patient has to
constantly see his own nose.
⚫ The surgeon should sit in front of the
patient knee bent. The eye should be
given mild sudation by
the surgeon’s breath (bashpa swinnam).
⚫ Surgeon should hold the
shalaka(linganasha vedhani shalaka)
steadily in right hand(gripped with
thumb, index and middle finger) and enter
the left eye at daiva krita chidra i.e.
keyhole(2/3rd parts from krishna-shukla
sandhi and 1/3rd parts from the apanga
sandhi in interpalpebral space).
⚫ The shalaka should be introduced in the
eyeball by rotatory movements; a specific
sound of entry of shalaka inside the eye is
experienced which follows a drop of water
(aqueous humour) through the vedhana
⚫ Steadily pushing forward and
manipulating the shalaka until it reaches
the drishti mandala (pupillary aperture)
i.e on anterior surface of the cataractous
lens so that lekhana karma is completed
under direct vision.
⚫ Shalaka is to be gripped in left hand for
operation on right eye.
⚫ Hold the entered shalaka in situ and
irrigate the eye with human milk and
apply mild sudation on the closed eye with
vata pacifying leaves e.g. Eranda patra.
this will prevent redness, discharge and
pain.
⚫ There after assuring the patient, push the
⚫ With the tip of the shalaka in pupillary
aperture, kaphaja linganasha (cataract)
should be scraped properly to disintegrate
the organized material. To remove this
disintegrated cortical/nuclear matter, close
the nasal cavity opposite to the operated
eye and ask the patient to forcefully sneeze
out through the open nare (ipsilateral to
the eye being operated)while keeping the
shalaka inside the eye.
⚫ Acharya vagbhata varies in its technique
at this step of surgical procedure.
⚫ He is of the opinion that ask the patient to
see towards ground and gently push the
cataract downside without any delay,
then ask the patient to sneez (as above)
so that cataract goes down enough
leaving the pupillary aperture ( Dristi
mandala) clear.
⚫ If the cataract is not completely scraped
and extracted out or if it reoccurs ( after-
cataract) then irrigate the eye again with
human milk, apply sudation (as earlier)
and rescrap the cataract (in pupillary
⚫ When by doing this procedure the pupil
become clear of all kapha/ white
material- cataract ( like sky clear of
clouds) and patient starts seeing finger,
threads like objects then shalaka should
be slowly removed by rolling out
movemrnts.
⚫ Apply pure ghee in the eye and
apply the bandage.
SAMYAK LIKHITA
LAKSHANA
When the drsti becomes as bright as the sun in a cloudless
sky.
When there is no pain, it should be regarded as properly
scraped
In a case of failure to expel the doshas or in case the
doshas reappear therein, the whole process from oleation
to puncturing should be repeated.
16
PASCHAT KARMA
([Link].17.69)
When the patient is able to visualise objects shalaka
should be withdrawn. eye should be lubricated with ghrita
and bandaged with cloth.
Patient should lie down in supine position, in room free
from disturbing agencies like dust, smoke , blasts of wind,
sun etc
Avoid Udgara, kasa, kshavathu, Shteevana, utkampana.
Should follow the regimen prescribed for snehapana. 17
Every 3rd day the eye should be washed with
the Vata-alleviating decoctions.
The eye should be fomented from 3rd day onwards to
avoid the danger of vata vitiation and this is followed
for
10 days.
Bandage should removed on 7th day.
Measures to improve the vision along with light
diet.
18
COMPLICATIONS OF SHASTRA KARMA
राग: शोफो अबुदा ं चोषो बुद्बुदं शकू
रक्
षित || अधधमा
न्
थादय
श्चा
न्ये रोगा:
अदहताचरतो िा अवप यथास्िम ् ([Link].17.85)
स्
युव्धा
य दोषजा: ||
तािुपाचरेत ् ||
Redness
Inflammation
New growths
Sucking pain
Bubble like projections
Squint
Glaucoma
19
MANAGEMENT OF COMPLICATIONS
1. Lepa on eye :
[Link], yava, gairika and sariva paste with ghee.
[Link] and tila macerated with the juice of matulunga.
[Link], sariva, tejapatra, manjishta,madhuyasti
with goats milk. ([Link].14.24 & 25)
2. Seka
[Link] milk boiled with rodhra, saindhava, mrudvika and
madhuka
2. Madhuka, utpala, kushta, draksha, laksha, and sita
([Link].14.26 & 27)
20
Complications due to defect in shalaka;
( Improper surgical instruments )
Sl. Defect Features
in
N Shalak
o a
01. Brittle Ocular pain
02. Rough Intra ocular pain
03. Blunt tipped Big ocular wound
04. Very sharp Multiple wounds, intra ocular
wound
05. Irregular/une Lacrimation
ven
06. Malleable Lacrimation
07. Very thin Anterior chamber dislocation
vedhana & (surgical intervention) their management;
Sl Site of Features Management
. puncture
N
o
01. Any site other -Injury to blood -Seka of eye by
than daivkrit vessels human milk &
chidra -Haemorrhage ghrita medicated
-Pain with Yasti
kalka/kwatha.
-Agnikarma in
temporal region.
02. Puncture - Pain -Swedana above
towards - Inflammation eyebrows
temporal side - Redness -Agnikarma
-Lacrimation above eyebrows
-Pricking -Intake of usna
sensatio ghrita
n -Fasting
-Get torn from -Intake of Ghrita
03. Puncture -Redness -
very near -Inflammation Medicate
to shukla- -Improper d
krishna healing purgatio
sandhi -Pupil gets n
covered -Netra seka
with by luke
blood warm
ghrita
-Blood
letting
04. Puncture above Increase in -Netra seka by
the indicated site ocular pain and luke warm
discomfort ghrita
- vata hara rx
05. Puncture -Pain -Netra seka
much
below the - Lacrimation by luke
warm
indicated - Redness ghrita
site
- slimy, - medicated
mucilaginou purgation
s
discharge -Blood
letting
after - a/c
drawing
out shalaka vagbhata
the
-Inflamation condition is
in
eyeball incurable
but
steps should
be taken to
prevent
eyeball from
Latrogenic complication and management
Sl . N Improper Features Managemen
o movement t
of
shalaka
01. Unstable -Constriction -Blood letting
movement / relaxation by jalauka.
of pupil - Seka-
-piercing / Ghritha
pricking pain medicated
with leaves of
Yasti and
patola.
02. Excessive upward -Redness -Fasting
movement -Excessive pain - Seka with
luke
warm
ghrita.
03. Excessive -Pain -blood letting
downward - Seka-
Ghritha
movement Haemorrha medicated
g with
e leaves of
Yasti
and patola.
04. Pupil damage Haemorrhag -Seka with –
e ghrita manda
-Anuvasana
basti with
ghrita manda.
05. Piercing - -Seka with
opposite to Haemorrhag ghrita
site of e -fasting
puncture. - - Blood letting
(damage of Chromatopsi
ciliary body) a
Certain intraoperative complications of linganasha (catar
surgery & their management;
Sl Complication Features Managemen
. t
N
o
01. Sputan ( breaking of Cataract - Sudation by
the linganasha) breaks in poultice of
multiple paste eranda
fragments on patra &
being touched extraction of
by shalaka. broken pieces
one by one.
02. Avagalana ( falling Dislocation -Seka by
down) into posterior human milk.
segment -Avapidana
nasya – sunti
& honey
-Blood
03. Vistirna Spreading/ -Sudation on face
(spreading ) dispersion by cloth dipped in
of liquefied luke warm water.
cataract - Pratimarsha nasya
with ghrita manda
04. Utplavana Dislocation -Sudation on face by
(leaping –up) into cloth dipped in luke
anterior warm water.
chamber -frighten the patient
-Sprinkle cold water
-If linganasha is
stationary or mobile do
sudation by vata
pacifying group of
leaves.
-If problem persists;
snehapana ,sneha
nasya & blood letting,
agnikarma .
05. Linata On being -Sudation –
(Disappear) scrapped by nadi sweda
shalaka, by milk.
linganasha -Pratimarsha
disappears in nasya by
pupillary mixture of
area. ghrita, Yasti
choorna &
satapushpa
choorna .
Manage
ment
⚫ ; line of treatment is followed in
Following
all these complications:
1. Lepa on eye : for pacifying pain &
redness.
a. Luke warm paste of gairika, sariva,
durva are grinded finely in ghrita & milk
& heated on fire.
b. Luke warm paste of mild roasted tila &
white sarshapa grinde with
matulunga swarasa.
c. Luke warm paste of sariva, tejapatra,
yasti & manjista in equal quantity
ground with goats milk.
2. seka :
- For alleviating pain and redness:
a. Goats milk boiled with kalka/ kashaya of
Yasti, saindhava, Lodhra & Draksha.
b. Goats milk boiled with kalka/ kashaya of
kusta, saindhava, Laksha, yasti,
sarkara, utpala & Draksha.
- For alleviating pain and burning sensation:
Goats ghrita cooked with goats milk
along with paste / kashaya of
shatavari, prithakparni, mustaka,
amalaka & padmaka.
[Link] , anjana & seka :
Goat’s ghrita processed with goats milk
along with paste of vata pacifying
devadaru etc. drugs & four times paste of
kaakolyadigana herbs should be used for
lepa & seka.
4. Blood letting :
If ocular pain persists, then snehana,
swedana & rakta mokshana from veins of
temporal or frontal region.
5. Agnikarma on temporal or frontal area.