Unit 2 — Sāmānya Cikitsā & Kriyākalpa (Netra)

Unit 2 — Sāmānya Cikitsā & Kriyākalpa (Netra)

A) Sāmānya Cikitsā of Netraroga

1) Therapeutic framework

• Nidāna-parivarjana: absolute first step—avoid smoke/dust (dhūma/rajaḥ), late nights, excessive near-work (sūkṣma-darśana), glare/heat alternation, and irritant cosmetics.
• Doṣa-tantra: assess pradhāna doṣa and āma status.
  • Vātaja: rukṣa, śūla, sandhi-kṣobha → snigdha śamana, mr̥du svedana, ghṛta-yoga, gentle aścyotana with warm sneha; tarpana later.
  • Pittaja/Raktaja: dāha, raga, kṣata-śotha → śītala, raktaprasādana, lekhana where needed, seka/aścyotana with cool dravyas; nasya/śiro-śītala measures; tarpana/putapāka only after acute phase calms.
  • Kaphaja: guru-staimitya, kapha-srāva → rūkṣa dīpana-pācana, warm seka/aścyotana, lekhana-anjana; avoid heavy sneha early.
• Āma vs nirāma decision:
  • Sāma eyes: sticky discharge, heaviness, photophobia; start with dīpana-pācana, rūkṣa seka/aścyotana; delay tarpana.
  • Nirāma eyes: clean tear film, settled pain; proceed to snehana procedures (tarpana, ropana putapāka) as indicated.
• Śodhana when needed: mr̥du virecana in pittaja/raktaja states; śirovirecana (nasya) and raktamokṣaṇa in select raktaja conditions; basti in chronic vātānubandha.
• Rasāyana/poshana: cakṣuṣya ghṛta (e.g., triphalā-ghṛta) orally when suitable; tarpaka support through diet (snehayukta, madhura-rasa) and padābhyanga/netrabhyanga.
• Charyā (regimen): avoid day sleep in kapha states; use dark glasses outdoors (anukūla deśa-kāla), controlled reading time, frequent blinking (nimeṣa-unmeṣa saumyatā).

Exam mnemonic (SAFEST): Sūtra (nidāna-parivarjana) → Ama check → Focus doṣa → Early local kriyā → Shoḍhana (if needed) → Tarpana/putapāka (later).

B) Enumeration of Kriyākalpa

Kriyākalpa = localized ocular therapeutics (bāhya-parimarjana) applied on/around the eye for targeted action.

For university answers: write “Suśruta’s five” as the foundational list; add that later compendia include Pindī and Vidalaka → total seven widely taught today.

C) Seka (Pariseka) — Therapeutic irrigation

Paribhāṣā: Continuous stream of medicated liquid over closed eyes (palpebral surface), at controlled temperature and height.

Indications (typical):

• Acute pittaja/raktaja abhishyanda with dāha, raga, photophobia
• Foreign-body sensation without abrasion, environmental irritation
• As pūrva-karma before aścyotana/añjana

Contra-indications: open corneal ulcer, recent ocular surgery, severe vātānubandha pain (prefer warm aścyotana first), extreme photophobia where streaming worsens spasm.

Dravya selection (doṣa-wise examples):

• Pitta/Rakta: cool infusions—uśīra, candana, padma-patra, triphalā kwātha cooled, dudh-mixed rose-water style śītala anupāna (classically advised).
• Vāta/Kapha: warm dashamūla-kṣīra-pāka, yaṣṭimadhu-kṣīra, pañcamūla-kwātha lukewarm.

Technique (steps):

1. Pūrva-karma: assess doṣa/āma; wipe discharge; mild svedana in kapha/vāta.
2. Pradhāna-karma: patient supine; closed lids; irrigate from inner → outer canthus with a steady thin stream (height ~6–8 cm), 10–20 min or till symptomatic relief.
3. Paścāt-karma: dab dry; protect from wind/glare; if pittaja, follow with prasadana añjana later in the day.

Lakṣaṇa of proper Seka: cooling/comfort, reduction of burning/tearing, easy opening of eyes.
Improper: too cold→ spasm; too hot/strong→ increased dāha/raga.

D) Pindī — Medicated poultice over closed lids

Paribhāṣā: Sterile gauze/cloth poultice soaked in medicated swarasa/kwātha/sneha and placed over closed eyelids.

Indications: subacute blepharo-conjunctival inflammation, meibomian dysfunction, post-irritative fatigue; also for kapha-staimitya with sticky discharge.

Materials & dravyas:

• Lekhana/Rūkṣa: triphalā kwātha, daruharidrā, saindhava (for kapha-saṅga)
• Śītala-prasadana: uśīra-candana-padma-patra swarasa, chandana-taila (pitta/rakta)
• Snigdha: yaṣṭimadhu-kṣīra-pāka gāḍha for vātānubandha

Method: prepare warm/cool as per doṣa; soak folded pads; place 10–15 min; repeat 2–3 times/day.
Paścāt: light prasadana aścyotana or gentle añjana when nirāma.

E) Vidalaka (Bidālaka) — Pastous lepa on lids

Paribhāṣā: Thick paste of indicated drugs applied externally over eyelids (not entering the fornix), typically 1–2 mm layer.

Indications: superficial pittaja inflammations with burning, mild swelling; eyestrain/cephalalgia linked to ocular surface irritation.

Dravya choices:

• Pitta/Rakta: chandana, uśīra, lodhra, maṇḍūkaparṇī, padma-patra; binders—ghṛta/kṣīra-paṣṭa for prasadana
• Kapha: saindhava, trikatu + lodhra in minimal medium (rūkṣa)
• Vāta: add a touch of ghṛta/tila-taila to avoid over-drying

Application: avoid ciliary margins; keep 15–30 min; wash gently.
Cautions: do not use on eczema/dermatitis, infected chalazion, or when discharge is profuse (prefer Pindī/Seka).

F) Aścyotana — Instillation of eye-drops

Paribhāṣā: Controlled dropwise instillation of medicated liquid into the open eye, typically 2–6 drops per sitting.

Indications:

• First-line for sarvābhiśyanda, foreign-body sensation, early timira discomforts
• After Seka/Pindī to deliver active drug to cul-de-sac

Types (vehicles):

• Swarasa (fresh juice), kwātha (decoction), sneha (taila/ghṛta), kṣīra-pāka (milk-processed), madhu-yukta (for lekhana/prasadana).
• Doṣa logic: pitta/rakta → cool swarasa/kwātha; kapha → lekhana/madhu-yukta; vāta → warm sneha/kṣīra-pāka.

Technique pearls:

• Patient supine; look up; pull lower lid; instill without touching lashes; ask patient to blink gently; collect overflow.
• Frequency: 3–6×/day depending on acuity.
• Avoid very strong/tīkṣṇa drops in acute raktāvasthā (risk of flare).

Proper effect: clarity, reduced pain/watering; Improper: increased burning, chemosis, spasm.

G) Tarpana — Retention of medicated sneha over eyes

Paribhāṣā: Retaining lukewarm sneha (classically clarified butter/ghṛta) over the open palpebral aperture within a māṣa-piṣṭi ring built around the orbit.

Classical indications:

• Dry, fatigued eyes; lack of tears; eyelash depilation/shrivelling; chronic vātānubandha pain; early optic fatigue syndromes.
• Per Suśruta, seat-/doṣa-based retention times are modulated (shorter for sandhi-gata, longer for dṛṣṭi/sarvagata).
• Not to be done during acute upadrava, cloudy/very hot or very cold days, or in anxious/fearful patients.

Method outline:

1. Pūrva-karma: bowel-head lightness, āma clearance; ambient still air; protect from dust/sun.
2. Ring: māṣa (black gram) paste made into an even, firm circular wall around the eye; ensure leak-proofing.
3. Sneha: transparent layer of ghṛta, made lukewarm; pour till lash level; retain as per indication (gradations traditionally expressed in akṣara-kāla counts).
4. Paschāt-karma: drain via inner canthus; gentle barley paste pads; kapha-śamana dhūma if needed; protect from wind/glare; diet-regimen for 1–3 days.

Satisfactory tarpana: easy sleep, lightness, clarity, less secretion.
Excess: heaviness, sliminess, tearing, itching.
Deficient: dryness, photophobia, continuing cloudiness.

Viva tip: “Tarpana = snigdha-br̥ṃhaṇa kriyā; Putapāka = targeted extract (snehana/lekhana/ropana) after doṣa subsides.”

H) Putapāka — Cooked extract for the eye

Paribhāṣā: A bolus of flesh/herbs is wrapped in leaves, clay-coated, roasted (puṭa), then its expressed extract is applied/retained like tarpana.

Three classical types & indications:

1. Snehana Putapāka: for extreme rukṣatā/parchedness (vātaja); uses sneha-rich materials (māṃsa of ānūpa animals, vāsa/majjā/medas, madhura-varga, ghṛta/kṣīra).
2. Lekhana Putapāka: for kapha-sañcaya or over-snehanatā; includes lekhana dravyas—lodhra/triphala + śaṅkha-bhasma/saindhava etc.
3. Ropaṇa Putapāka: for healing ulcers/defects after doṣa subsides—jangala māṃsa cooked with stanya, madhu, ghṛta, tikta-varga; enhances vāta–pitta–rakta normalization and ropana.

Timing: usually after tarpana and after acute doṣa subsidence; apply 1–3 consecutive days per need.
Doṣ & antidotes: too hot/too tīkṣṇa → burning/redness; too cold/mild → ineffective; correct with nasya/dhūma/anjana per doṣa.

I) Añjana — Collyrium applications

Kinds (therapeutic intent):

1. Lekhana Añjana — scraping/decongesting (kapha-saṅga, mala-sañcaya)
2. Prasādana Añjana — soothing/tonic (pitta/rakta pradhāna, fatigue)
3. Ropaṇa Añjana — healing (after ulcers/erosions begin to settle)
4. Rasakriyā Añjana — concentrated decoction reduced to thick extract (often counted under above intents)

Indications: kapha-mala on lids, chronic mucus strands, post-putapāka/tarpana cleanup, prasadana at night.

Method (śālākā-prayoga):

• Use appropriate añjana-varti (size ≈ kalāya pulse).
• Draw lower lid diagonally; apply from kanīnika → apāṅga and back on inner lid margin (not thickly in corners).
• Time: generally morning/evening/night depending on doṣa and intended effect (lekhana often morning; prasādana at night).

Contra-indications & cautions: fever, intoxication, severe head disease, angry/grieving state, windy day, just after nasya or bath; in insomnia, strong añjana may worsen vision—prefer prasadana only.

Proper effect: lightness, whiteness, clarity, improved vision and no discharge; Over-use: deep discoloration, dryness, lid hardness—treat with santarpaṇa measures.

Putting it together: site–doṣa–state → procedure

Assessment

Long Essays (10 marks; answer 1)

1. Define Kriyākalpa and describe Suśruta’s five with indications, contraindications, steps, and signs of proper/improper application.
2. Write Sāmānya Cikitsā of netraroga. Emphasize āma–nirāma assessment, doṣa-wise plan, and sequencing of Seka → Aścyotana → Añjana → Tarpana/Putapāka.

Short Essays (5 marks; answer 3)

1. Tarpana: indications, method, and complication management.
2. Putapāka: classify into Snehana–Lekhana–Ropaṇa with examples.
3. Añjana: lekhana vs prasādana vs ropaṇa—times, techniques, and precautions.
4. Pindī vs Vidalaka: definitions, differences, and suitable clinical snapshots.

Short Notes (3 marks; answer 4)

• Pariseka (Seka): temperature & stream dynamics
• Rasakriyā añjana (preparation & use)
• Doṣa-wise aścyotana vehicles
• Paścāt-karma after tarpana/putapāka
• When not to do Kriyākalpa

MCQs (1 mark × 5)

1. Foundational kriyākalpas in Suśruta are:
   a) 3 b) 5 c) 6 d) 7
2. Closed-eye irrigation refers to:
   a) Aścyotana b) Seka c) Añjana d) Tarpana
3. Māṣa-piṣṭi ring is essential for:
   a) Pindī b) Vidalaka c) Tarpana d) Aścyotana
4. Lekhana putapāka is best in:
   a) Raktaja dāha b) Vātaja śūla c) Kapha-sañcaya d) Tear deficiency
5. Prasādana añjana is usually preferred at:
   a) Morning b) Mid-day c) Night d) Any time

Answer key: 1-b, 2-b, 3-c, 4-c, 5-c.

References (cite these in your answers)

Classical

• Suśruta Saṃhitā, Uttara-tantra, Kriyākalpa Adhyāya (Chapter on “Preparations and medicinal measures for ocular affections in general”): Tarpana, Putapāka (types, indications, retention logic, proper vs improper signs), Aścyotana/Añjana guidelines.
• Aṣṭāṅga Hṛdaya, Sūtrasthāna: Aścyotana–Añjana-vidhi Adhyāya and Tarpana–Putapāka-vidhi Adhyāya—vehicle selection, timing, and procedural precautions.
• Śārṅgadhara Saṃhitā (Madhyama-khaṇḍa) and Cakradatta (Netraroga prakaraṇa): inclusion and details of Pindī and Vidalaka.
• Yogaratnākara, Netraroga Cikitsā: seven kriyākalpas and dravya choices.

Modern/Standard Texts

• Sreedhar Śālākya Tantra (Part-1); K.S. Dhiman Śālākya Kriyākalpa Vijñāna; Shiv Nath Khanna Śālākya Tantra—procedural standardization, doṣa-wise drug choices, safety.

Quick 60-second Review

• Suśruta’s five: Tarpana, Putapāka, Seka, Aścyotana, Añjana.
• Later seven: + Pindī, Vidalaka.
• Sequence rule: sāma → Seka/Aścyotana; nirāma → Sneha-based (Tarpana, Ropaṇa Putapāka, Prasādana Añjana).
• Tarpana hallmarks: māṣa-piṣṭi ring, lukewarm ghṛta, akṣara-kāla-based retention; clear signs of proper/excessive/deficient application.
• Putapāka triad: Snehana / Lekhana / Ropaṇa—choose by dryness-kapha-ulcer status.
• Añjana safety: avoid in fever, windy day, just after nasya/bath; choose lekhana vs prasādana judiciously.