अथातः लिङ्गनाशप्रतिषेधं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter-Linganasa pratisedha – treatment of blindness; thus said Atreya and other great sages.
विध्येत्सुजातं निःप्रेक्ष्यं लिङ्गनाशं कफोद्भवम् । आवर्तक्यादिभिः षद्भिर्विवर्जितमुपद्रवैः ॥ १ ॥
Linganasa (blindness due to opacity of the lens/cataract) which is of kapha origin, which has developed fully (ripened, become opaque) which has produced (complete) loss of vision, which is not having the six complications such as the avartaki, etc. should be punctured (couching done) .1
Notes : The six complications are avartaki, sarkara rajimati, chinnamsuka, candraki and chatraki — these are described further.
सोऽसञ्जातो हि विषमो दधिमस्तुनिभस्तनुः । शलाकयाऽवकृष्टोऽपि पुनरुर्ध्वं प्रपद्यते ॥ २ ॥
करोति वेदनां तीव्रां दृष्टिं च स्थगयेत्पुनः | श्लेष्मलैः पूर्यते चाशु सोऽन्यैः सोपद्रवश्चिरात् ॥ ३ ॥
It (linganasa) when not fully formed, is uneven, resemble the water of curds ( in colour ) , thin, even; when pressed hard by a metal rod it 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 persist long. 2-3.
श्लैष्मिको लिङ्गनाशोहि सितत्वाच्छ्लेष्मणः सितः । तस्यान्यदोषाभिभवाद्भवत्यानीलता गदः ॥
Linganasa born from slesma ( kapha ) is white because of the white colour of slesma, it (linganasa) dominated by other dosas attains bluishness. 4.
तत्रावर्तचला दृष्टिरावर्तक्यरुणाऽसिता । शर्कराऽर्कपयोलेशनिचितेव घनाति च॥५॥
राजीमती दृड्निचिता शालिशूकाभराजिभिः | विषमच्छिन्नदग्धाभा सरुक् छिन्नांशुका स्मृता ॥ ६ ॥
दृष्टिः कांस्यसमच्छाया चन्द्रकी चन्द्रकाकृतिः | छत्राभा नैकवर्णा च छत्रकी नाम नीलिका ॥ ७ ॥
Avartaki is that in which the vision (lens) is unsteady and slightly red or black in colour.
Sarkara is that in which the vision (lens) appears as though smeared with milky sap of arka and is thick/hard. In Rajimati, the vision (lens) appears as though studded by spikes of paddy grains.
Chinnamsuka is that in which the vision (lens) is uneven (irregular) torn ( dicontented) and burnt like and is painful.
In candriki, the vision (lens) resembles the bell-metal in colour and moon like (in appearance).
Chatraki is that in which the vision (lens) resembles an 5-7. umbrella, has many colours and is blue.
Notes The above six are the secondary diseases arising in the course of linganasa.
न विध्येदसिरार्हाणां न तृपीनसकासिनाम् । नाजीर्णिभीरुवमितशिरः कर्णाक्षिशूलिनाम् ॥८॥
Puncturing (couching of the lens) should not be done in persons who are unsuitable for venesection, who are suffering from thirst, chronic nasal catarrah, cough, indigestion, fear, vomiting and diseases of the head, ears and eyes. 8.
Vedhana — vidhi – (method of puncturing) cataract operation
अथ साधारणे काले शुद्धसम्भोजितात्मनः । देशे प्रकाशे पूर्वाहे भिषग्जानूच्चपीठगः ॥ ९॥
यन्त्रितस्योपविष्टस्य स्विन्नाक्षस्य मुखानिलैः | अङ्गुष्ठमृदिते नेत्रो दृष्टौ दष्ट्वोत्प्लुतं मलम् ॥ १० ॥
स्वां नासां प्रेक्षमाणस्य निष्कम्पं मूर्ध्नि धारिते । कृष्णादर्धाङ्गुलं मुक्त्वा तर्जनीमध्यमाङ्गुष्ठैः शलाकां निश्चलं धृताम् ।
देवच्छिद्रं तथाऽर्धार्धमपाङ्गतः ॥ ११ ॥
नयेत्पार्श्वादूर्ध्वमामन्थयन्निव ॥ १२ ॥
सव्यं दक्षिणहस्तेन नेत्रं सव्येन चेतरत् । विध्येत् सुविद्ध शब्दः स्यादरुक् चाम्बुलबस्स्रुतिः ॥ १३ ॥
Next, during the temporate season, the patient who has been comforted with good, 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 his thumb, remove the dirt arising from the eyes, 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 of space from the border of the black portion (cornea) and a quarter angula from the outer canthus, holding the salaka (metal rod) tight between the middle and index fingers and the thumb, draw the natural apperture ( pupil ) to the sides, twisting from above and then puncture (push the lens 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, no pain and slight flow of water. 9-13.
सान्त्वयन्नातुरं चानु नेत्रं स्तन्येन सेचयेत् । शलाकायास्ततोऽग्रेण निर्लिखेन्नेत्रमण्डलम् ॥ १४ ॥
अबाधमानः शनकैर्नासां प्रतिनुदंस्ततः । उच्छिङ्घनाच्चापहरेदृष्टिमण्डलगं कफम् ॥ १५ ॥
स्थिरे दोषे चले वाऽति स्वेदयेदक्षि बाह्यतः । अथ दृष्टेषु रूपेषु शलाकामाहरेच्छनैः ॥ १६ ॥
घृताप्लुतं पिचुं दत्त्वा बद्धाक्षं शाययेत्ततः । विद्धादन्येन पार्श्वेन तमुत्तानं द्वयोर्व्यधे ॥ १७ ॥ निवाते शयनेऽभ्यक्तशिरः पाद हिते रतम् ।
After that, the patient is made comfortable, the eyes filled with breast-milk, then the areas of the eye scraped 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 dosas 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 eyes and bandaged; the patient is asked to lie on the side opposite of the operated eye and with his face up when both eyes are operated, in a room deviod of breeze, with his head and feet anointed and with other suitable things. 14-18a.
क्षवथुं कासमुद्रारं ष्ठीवनं पानमम्भसः ॥ १८
अधोमुखस्थितिं स्नानं दन्तधावनभक्षणम् । सप्ताहं नाचारेत्स्नेहपीतवच्चात्र यन्त्रणा ॥ १९॥
For seven days, he should avoid sneezing, coughing, bel ching, expectoration water drinking, lieing with his face down, taking bath, chewing the tooth brush (hard sticks to make them brush like ) ; his control is by ( adopting ) the regimen prescribed for sneha pana (chapter 16 of sutrasthana). 18b-19.
शक्तितो लङ्घयेत्सेको रुजि कोष्णेन सव्योषामलकं सर्पिषा द्रवम् ॥ २० ॥
वाट्यम श्रीयात्सघृतं विलेपीं वात्र्यहाच्चास्य 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 barley) mixed with powder of vyosa, amalaka and ghee or drink vilepi ( thick gruel); after three days the bandage (of the eye) removed and eye bathed with the decoction of drugs mitigating vata. On the seventh day the bandage should be discontinued once for all. 20-21.
यन्त्रणामनुरुध्येत दृष्टेरास्थैर्यलाभतः ।
रूपाणि सूक्ष्मदीप्तानि सहसा नावलोकयेत् ॥ २२ ॥
Seeing should be restricted till steadiness is attained, things which are very minute and brilliant (shining) should not be seen suddenly. 22.
शोफरागरुजादीनामधिमन्थस्य चोद्भवः । अहितैर्वेधदोषाच्च यथास्वं तानुपाचरेत् ॥ २३ ॥
Swelling, redness, pain etc. and adhirmantha (another eye disease) arise from improper puncturing and by (increase of dosas) these should be treated appropriately. 23.
कल्किता: सघृता दूर्वायवगैरिकसारिवाः ।
मुखालेपे प्रयोक्तव्या रुजारागोपशान्तये ॥ २४ ॥
Durva, yava, gairika and sariva, made into paste and added with ghee should be used as mukhalepa (applied over the face and eyes also) to relieve pain and redness. 24
ससर्षपास्तिलास्तद्वन्मातुलुङ्गरसाप्लुताः ।
Similarly, sarsapa and tila macerated with the juice of matulunga (may be applied). 25a.
पयस्यासारिवापत्रमञ्जिष्ठामधुयष्टिभिः ॥ २५॥
अजाक्षीरयुतैर्लेपः सुखोष्ण: शर्मकृत्परम् ।
Payasya, sariva, patra, manjistha and madhuyasti made into a paste with goat’s milk and applied warm is best to give comfort. 25b-26a.
रोध्रसैन्धवमृद्वीकामधुकैश्छागलं पयः ॥ २६ ॥ शृतमाश्च्योतनं योज्यं रुजारागविनाशनम् ।
मधुकोत्पलकुष्ठैर्वा द्राक्षालाक्षासितान्वितैः ॥ २७ ॥
Goat’s milk boiled with rodhra, saindhava, mrdvika and madhuka used as ascyotana (bathing the eyes) cures pain and redness; similarly, with madhuka utpala, kustha, draksa, laksa and sita (sugar). 26b-27.
वातघ्नसिद्धे पयसि शृतं सर्पिश्चतुर्गुणे | पद्मकादिप्रतीवापं सर्वकर्मसु शस्यते ॥ २८ ॥
Medicated ghee prepared with decoction of drugs mitigating vata, ghee, four parts of milk and paste of drugs of padmakadi gana (chapter 15 of sutrasthana ) is best for all therapies (of the eye). 28.
सिरां तथाऽनुपाशमे स्निग्धस्विन्नस्य मोक्षयेत् । मन्थोक्तां च क्रियां कुर्याद्वयधे 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. 29.
आढकीमूलमरिचहरितालरसाञ्जनैः
विद्धेऽक्षिण सगुडा वर्तिर्योज्या दिव्याम्बुपेषिता ॥ ३० ॥
Roots of adhaki, marica, haritala and rasanjana 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. 30
जातीशिरीषधवमेषबिषाणिपुष्पवैंडूर्यमौक्तिकफलं पयसा सुपिष्टम् ।
आजेन ताम्रममुना प्रतनु प्रदिग्धं सप्ताहतः पुनरिदं पयसैव पिष्टम् ॥ ३१ ॥
पिण्डाञ्जनं हितमनातपशुष्कमक्षिण बिद्धे प्रसादजननं बलकृच्च दृष्टेः ।
स्त्रोतोजविद्रुमशिलाम्बुधिफेनतीक्ष्णैरस्यैव तुल्यमुदितं गुणकल्पनाभिः ॥ ३२ ॥
Flower of jati, sirisa, dhava and mesavisana, vaidurya (cat’s eye), mauktika phala (pearl) macerated with goat’s 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’s milk only and dried without explosing it to sunlight. This pindanjana, applied as collyrium is good for the eyes operated upon, bestows clarity and strength of the vision.
Collyrium of srotonjana, vidruma ( coral), sila (manassila), ambudhiphena (sea foam ) and tiksna ( marica ) is similar (with the above recipe) in actions and mode of preparation. 31-32.
इति श्रीवैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे
उत्तरस्थाने लिङ्गनाशप्रतिषेधो नाम चतुर्दशोऽध्यायः ॥ १४ ॥
Thus ends the chapter-Linganasa pratisedha-the fourteenth in Uttarasthana of Astanga hrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
