Ashtanga Hridayam Uttara Sthanam Chapter 14: Linganasha Pratishedham (Treatment of Blindness)

The 14^th chapter of Uttara Sthanam of Ashtanga Hridayam is named as Linganasha Pratishedha. This chapter deals with the explanation of ‘Treatment of blindness’.

The topics covered in this chapter include –

–   Vyadhana in Linganasha
–   Signs of improperly formed Linganasha
–   Linganasha formed from Kapha
–   Avartaki and other disorders of vision
–   Contraindications for puncturing
–   Vyadhana Vidhi (methods of puncturing), Cataract operation
–   Durvadi Mukhalepa
–   Sarshapadi Mukhalepa
–   Payasyadi Lepa
–   Lodhradi Kshira Aschyotana
–   Vataghna Lepa
–   Adhakyadi Varti
–   Pindanjana

Pledge by the author(s)

अथातो लिङ्गनाशप्रतिषेधं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
Athāto liṅganāśa pratiṣedhaṃ vyākhyāsyāma: – After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘treatment of blindness’.
iti ha smāhu: ātreyādayo maharṣaya: – Thus, say (pledge) Atreya and other sages.

Vyadhana in Linganasha

विध्येत्सुजातं निष्प्रेक्ष्यं लिङ्गनाशं कफोद्भवम् ।
आवर्तक्यादिभिः षड्भिर्विवर्जितमुपद्रवैः ॥ १ ॥
Linganasha (blindness due to opacity of the lens / cataract) which is of Kapha origin, which has developed fully (ripened), becomes opaque, which has caused complete loss of vision, which is not having six complications such as the Avartaki etc. should be punctured (couching done).

Signs of Improperly Formed Linganasha

सोऽसञ्जातो हि विषमो दधिमस्तुनिभस्तनुः ।
शलाकयाऽवकृष्टोऽपि पुनरूर्ध्वं प्रपद्यते ॥२॥
करोति वेदनां तीव्रां दृष्टिं च स्थगयेत्पुनः ।
श्लेष्मलैः पूर्यते चाशु सोऽन्यैः सोपद्रवश्चिरात्॥३॥
It (Linganasha), when not fully formed, is uneven, resemble the water of curds (in colour), thin; when pressed hard by a metal rod it again moves upwards, causes severe pain and hinders vision; again (even after puncturing) gets filled quickly by ingestion of foods which increase Kapha and even others (Vata and Pitta), becomes associated with complications which persists for long.

Linganasha formed from Kapha

श्लैष्मिको लिङ्गनाशो हि सितत्वाच्छ्लेष्मणः सितः ।
तस्यान्यदोषाभिभवाद्भवत्यानीलता गदः ॥ ४ ॥
Linganasha born from Kapha is white. Because of the white color, it is caused due to Kapha. When it is dominated by other doshas, it attains bluishness.

Avartaki and other disorders of vision

तत्रावर्तचला दृष्टिरावर्तक्यरुणासिता ।
शर्करार्कपयोलेशनिचितेव घनाति च ॥ ५ ॥
राजीमती दृङ्निचिता शालिशूकाभराजिभिः ।
विषमच्छिन्नदग्धाभा सरुक् छिन्नांशुका स्मृता॥६॥
दृष्टिः कांस्यसमच्छाया चन्द्रकी चन्द्रकाकृतिः ।
छत्राभा नैकवर्णा च छत्रकी नाम नीलिका ॥७॥
Avartaki is that, in which the vision (less) is unsteady like a whirl and slightly red or black in color. Sharkara is that in which, the vision (lens) appears as though smeared with milky sap of Calotropis gigantea and is thick / hard. In Rajimati, the vision (lens) appears as though studded by spikes of paddy grains. If the vision (less) is uneven (irregular), torn (discontented), burnt like, and is painful is known as Chinnamshuka. In Chandriki, the vision (less) resembles the bell-metal in color and moon-like (in appearance). Chatraki is that in which the lesion resembles an umbrella, has many colors and is blue.

Contraindications for puncturing

न विध्येदसिरार्हाणां न तृट्पीनसकासिनाम् ।
नाजीर्णिभीरुवमितशिरःकर्णाक्षिशूलिनाम् ॥ ८ ॥ Puncturing (couching of the less) should not be done in persons who are unsuitable for venesection, who are suffering from thirst, chronic nasal catarrh, cough, not in indigestion, fear, vomiting and diseases (pain) of the head, ears and eyes.

Vyadhana Vidhi (Methods of puncturing), Cataract operation

अथ साधारणे काले शुद्धसम्भोजितात्मनः ।
देशे प्रकाशे पूर्वाह्णे भिषग्जानूच्चपीठगः ॥९॥
यन्त्रितस्योपविष्टस्य स्विन्नाक्षस्य मुखानिलैः ।
अङ्गुष्ठमृदिते नेत्रे दृष्टौ दृष्ट्वोत्प्लुतं मलम्॥१० ॥
स्वां नासां प्रेक्षमाणस्य निष्कम्पं मूर्ध्नि धारिते ।
कृष्णादर्धाङ्गुलं मुक्त्वा तथार्धार्धमपाङ्गतः ॥११॥
तर्जनीमध्यमाङ्गुष्ठैः शलाकां निश्चलं धृताम् ।
दैवच्छिद्रं नयेत्पार्श्वादूर्ध्वमामन्थयन् इव ॥१२॥
सव्यं दक्षिणहस्तेन नेत्रं सव्येन चेतरत् ।
विध्येत्सुविद्धे शब्दः स्यादरुक् चाम्बुलवस्रुतिः॥१३॥
Next, during the temperate season, the patient who has been cleansed, comforted with good food and who has controlled his senses, should be made to sit in a place having good light, in the morning and restrained (held tight by attendants). Then the physician sitting on a seat of the height of the knee, should first give fomentation to the eyes by blowing air (into the eyes) from his mouth, then rub the eyes with the thumb. After seeing that, the eye wastes have been removed, the head of the patient should be held tight, not allowing its shaking; he should be asked to fix his gaze on (the tip of) his own nose. Then leaving half angula (1 cm) of space from the border of the black portion (cornea) and a quarter angula (0.5 cm) from the outer canthus, holding the metal rod tight between the middle finger, index finger and the thumb, draw the natural aperture (pupil) to the sides, twisting from above and then puncture (push the less outside) using the right hand for the left eye and the left hand for the other eye. When properly punctured (driven outside), there will be a sound produced, there will be no pain and slight flow of water. 

Vyadhana Vidhi (methods of puncturing), Cataract operation

सान्त्वयन्नातुरं चानु नेत्रं स्तन्येन सेचयेत् ।
शलाकायास्ततोऽग्रेण निर्लिखेन्नेत्रमण्डलम् ॥१४॥
अबाधमानः शनकैर्नासां प्रति नुदंस्ततः ।
उच्छिङ्घनाच्चापहरेद्दृष्टिमण्डलगं कफम् ॥१५॥
स्थिरे दोषे चले वाति स्वेदयेदक्षि बाह्यतः ।
अथ दृष्टेषु रूपेषु शलाकामाहरेच्छनैः ॥१६॥
घृताप्लुतं पिचुं दत्त्वा बद्धाक्षं शाययेत्ततः ।
विद्धादन्येन पार्श्वेन तमुत्तानं द्वयोर्व्यधे ॥१७॥
निवाते शयनेऽभ्यक्तशिरःपादं हिते रतम् ।
After that the patient is made comfortable, the eyes filled with breast milk, then the areas of the eye scratched with the tip / edge of the metal rod, without causing pain, slowly pushing the dirt (mucous) in the direction of the nose (downward) and then remove the Kapha (dirty mucus) collected on the area of vision (surrounding the pupil). When the doshas are either very static (adhering fast), or very unsteady (moving quickly), the eyes should be given fomentation from outside. Next, when the patient begins to see the objects, the metal rod should be withdrawn slowly, a swab soaked in ghee put into the eye and the eye is bandaged. Then, he is made to sleep on the opposite side of the operated eye and with his face up, when both eyes are operated, should sleep in a room devoid of breeze, with his heads and feet anointed and with other suitable things.

Regimen after Vyadhana Vidhi (puncturing), Cataract operation

क्षवथुं कासमुद्गारं ष्ठीवनं पानमम्भसः ॥१८॥ अधोमुखस्थितिं स्नानं दन्तधावनभक्षणम् ।
सप्ताहं नाचरेत्स्नेहपीतवच्चात्र यन्त्रणा ॥ १९ ॥
For seven days, he should avoid sneezing, coughing, belching, expectoration, drinking water, lying with his face down, taking bath, cleaning (brushing) the teeth, eating food; his control is by (adopting) the regimen prescribed for sneha paana (chapter 16 of Sutrasthana).

Regimen after Vyadhana Vidhi (puncturing) / Cataract operation

शक्तितो लङ्घयेत्सेको रुजि कोष्णेन सर्पिषा ।
सव्योषामलकं वाट्यमश्नीयात्सघृतं द्रवम् ॥२०॥
विलेपीं वा त्र्यहाच्चास्य क्वाथैर्मुक्त्वाऽक्षि सेचयेत् ।
वातघ्नैः सप्तमे त्वह्नि सर्वथैवाक्षि मोचयेत्॥२१॥
He should be made to fast depending on his strength. In case of pain, the eye should be bathed with warm ghee, drink vatya (gruel prepared from prepared from barley) mixed with powder of Trikatu (Pippali – Piper longum, Maricha – Piper nigrum & Shunti – Zingiber officinale) āmalakaṃ – Emblica officinalis and ghee or drink thin gruel.  After three days, the bandage (of the eye) is removed and the eye bathed with the decoction of herbs mitigating Vata. On the seventh day, the bandage should be discontinued once for all.

Regimen after Vyadhana Vidhi (puncturing)/Cataract operation

यन्त्रणामनुरुध्येत दृष्टेरास्थैर्यलाभतः ।
रूपाणि सूक्ष्मदीप्तानि सहसा नावलोकयेत् ॥२२॥|
Seeing should be restricted. This should be practiced till steadiness is attained. Things which are very minute and bright should not be seen suddenly.

Complications of improper Vyadhana (Puncturing)/ Cataract operation

शोफरागरुजादीनामधिमन्थस्य चोद्भवः ।
अहितैर्वेधदोषाच्च यथास्वं तान् उपाचरेत् ॥२३॥
Swelling, redness, pain etc. of Adhimantha (another eye disease) arise from improper puncturing and by increase of doshas, those should be treated appropriately.

Durvadi Mukhalepa

कल्किताः सघृता दूर्वायवगैरिकशारिवाः ।
मुखालेपे प्रयोक्तव्या रुजारागोपशान्तये ॥ २४ ॥
Dūrvā – Cynodon dactylon, yava – Hordeum vulgare, gairika – red ochre, śārivāḥ – ­Hemidesmus indicus, made into paste and added with ghee should be used as mukhalepa (applied over the face and eyes also) to relieve pain and redness.

Sarshapadi Mukhalepa

ससर्षपास्तिलास्तद्वन्मातुलुङ्गरसाप्लुताः ।
Similarly, sasarṣapā – Brassica juncea and tilā: – Sesamum indicum macerated with the juice of mātuluṅga – Citrus medica (may be applied).

Payasyadi Lepa

पयस्याशारिवापत्रमञ्जिष्ठामधुयष्टिभिः ॥२५॥
अजाक्षीरयुतैर्लेपः सुखोष्णः शर्मकृत्परम् ।
Payasyā – Ipomoea paniculata, śārivā – Hemidesmus indicus, patra – Cinnamomum tamala, mañjiṣṭhā – Rubia cordifolia, madhuyaṣṭibhiḥ – Glycyrrhiza glabra are made into a paste and applied with goat milk and applied warm is best to give comfort.

Lodhradi Kshira Aschyotana

लोध्रसैन्धवमृद्वीकामधुकैश्छागलं पयः ॥२६॥
शृतमाश्च्योतनं योज्यं रुजारागविनाशनम् ।
मधुकोत्पलकुष्ठैर्वा द्राक्षालाक्षासितान्वितैः ॥२७॥
Goat milk boiled with lodhra – Symplocos racemosa, saindhava – rock salt, mṛdvīkā – Vitis ­vinifera and madhukai – Glycyrrhiza glabra used as aschyotana (bathing the eyes) cures pain and redness; similarly, madhuka – Glycyrrhiza glabra, utpala –­ Nymphaea alba, kuṣṭhai – Sausurrea lappa, drākṣā – Vitis vinfera, lākṣā – Laccifer lacca and sugar.

Vataghna Lepa

वातघ्नसिद्धे पयसि शृतं सर्पिश्चतुर्गुणे ।
पद्मकादिप्रतीवापं सर्वकर्मसु शस्यते ॥२८॥
Medicated ghee prepared with decoction of herbs mitigating Vata, four parts of milk and paste of herbs of Padmakadi Gana (chapter 15 of Sutrasthana) is best for all therapies (of the eye).

Vataghna Lepa

सिरां तथानुपशमे स्निग्धस्विन्नस्य मोक्षयेत् ।
मन्थोक्तां च क्रियां कुर्याद्वेधे रूढेऽञ्जनं मृदु॥२९॥
If the troubles do not subside, the veins should be cut (and blood let out) after giving oleation and sudation therapies to the patient; the treatment advocated for Adhimantha should also be done. After the puncture heals, mild collyrium should be applied.

Adhakyadi Varti

आढकीमूलमरिचहरितालरसाञ्जनैः ।
विद्धेऽक्ष्णि सगुडा वर्तिर्योज्या दिव्याम्बुपेषिता ॥३०॥
Roots of Cajanas cajana, marica – Piper nigrum, haritāla – arsenic trisulphide and aqueous extract of Berberis aristata mixed with guda (jaggery) macerated in rain water and made into wicks. This (applied to the eyes as collyrium) is beneficial to the operated eye.

Pindanjana

जातीशिरीषधवमेषविषाणिपुष्पवैडूर्यमौक्तिकफलं पयसा सुपिष्टम् ।
आजेन ताम्रममुना प्रतनु प्रदिग्धं सप्ताहतः पुनरिदं पयसैव पिष्टम् ॥३१॥
पिण्डाञ्जनं हितमनातपशुष्कमक्ष्णि विद्धे प्रसादजननं बलकृच्च दृष्टेः ।
स्रोतोजविद्रुमशिलाम्बुधिफेनतीक्ष्णैरस्यैव तुल्यमुदितं गुणकल्पनाभिः ॥३२॥
Puṣpa jātī – Flower of Jasminum grandiflorum, śirīṣa – Albizia lebbeck­, dhava – Anogeissus latifolia, meṣa viṣāṇi – Meshavishana, vaidurya (cat’s eye) and pearl macerated with goat milk to form a nice paste which is applied over thin sheet of copper and kept for seven days. Next, it is taken out, macerated with goat milk only and dried without exposing it to sunlight. This Pindanjana, is good when applied as collyrium for the eyes operated upon, bestows clarity and strength of the vision. Collyrium of lead sulphide, coral, (Manassila) – realgar, seafoam and (Maricha) Piper nigrum similar (with the above recipe) in actions and mode of preparation.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने लिङ्गनाशप्रतिषेधं नाम चतुर्दशोऽध्याय: ॥१४॥
Thus, ends the chapter – Linganasha Pratishedha – the fourteenth in Uttarasthana of Astanga Hridaya Samhita composed by Srimad Vagbhata, Son of Sri Vaidyapati Simhagupta.