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Prakaara Paribhashaa:

• Tarpan`a: Triptijanakam(Nourishing / Rehydrating); Akshi / Netra: Eye
• The procedure which imparts Tripti(Nourishment) to eye is called Akshitarpan`a.

D`alhan`a

• This is a procedure in which medicated or plain unctuous substances like Ghritaare retained over the eyeball for a prescribed period of time as either preventive or curative treatment modality. It is aimed at providing nourishment and improving the efficiency of the eyes.

Description: Kaala/Vaya/Ahoraatra/Ritu/Bhukta

• Akshitarpan`ais normally administered at the time of Poorvaahn`a (pre noon).
• Aparaanhn`a(afternoon) of the day
• Akshitarpan`ais given both at the morning and evening.
• Akshitarpan`ais given at Sadhaaran`a Kaala (moderate, temperate season) of the year.

Poorvakarma: (Prerequisites):

• The patient should under go S`hodhana(Vamana Virechana Raktamokshan`a, Nirooha Basti) and S`hiro Virechana Nasya (Errhines) this leads to elimination of the vitiated three Dosha. A cleaner internal environment and improved sensorimotor apparatus function which is called as Mastishka S`hodhana should be achieved.
• The patient should be examined by the Vaidyawith respect to digestion status of previous day. This gives information about the Agni status of the person.
• The room where NetraTarpan`a is to be administered should be closed, devoid of direct breeze, sunlight, smoke, and should be furnished with curtains of colours except blue and yellow..
• Selection of auspicious and suitable timefor the patient.

Instrument Checklist:

• Flour of Maasha(Phaseolus mungo) / Yava (Hordeum vulgare), Water, Utensil for mixing the flour, eyelid cover, sunglasses, hot water bath, cotton, cloth.

Patient Preparation:

• Pre procedural counselling should be done to maintain good psychological health and to explain the procedure, its effects.
• The patient should lie down in supine and face upward position without a pillow or head rest on a levelled bed.

Medicine Preparation:

• The flour of the Maasha / Yavashould be thoroughly mixed and made into thick paste,
• Unctuous material Sneha(Ghritaman`d`a supernatant part of ghee that does not set or congeal/ Ghrita / medicated milk, Vasaa it is the unctuous part of meat that separates on cooking).

Pradhaanakarma:

• The thick homogenous paste of black gram or barley flour should be rolled into a cylinder(tube like) of about one inch thickness and should be gently placed around the eye, the joint between the skin and the paste should be sealed using wet finger and pressing it to the skin, the height should be about two finger breadth. Precaution should be taken that it should not leak and should be tolerable to the patient. As a precaution a packing of cotton can be packed on the outside to prevent possible leakage of the ghee.
• The unctuous material should be made lukewarm in a hot water bath. The temperature should be tested by dipping little finger in it; ghee should be of just body temperature as eyes are generally contraindicated for sudation.
• The eyes of patient should be closed.
• The lukewarm unctuous (Ghritaman`d`a/ medicated ghee/ milk) material should be poured inside the flour wall made around the eyelid slowly. The physician should keep his left index finger just above the eye lashes and then pour the warm ghee on the closed eyes till the lashes are immersed.
• The quantity of Snehashould be just above the level the tip of eyelashes.
• After pouring the ghee the finger should be removed and the patient should be asked to blink eye slowly and repeatedly, he should be asked to perform eye movements slowly through out the session up to adequate Tripti Lakshan`a.

Tarpan`a :

Pas`hchaatkarma:

• The Gheeshould be retained for prescribed length of time or till the symptoms of adequacy become apparent, it should be then drained by puncturing the flour wall laterally and the flowing ghee should be collected in a vessel. The flour should be gently removed from the skin, using the residual Ghee to moisten it.
• The eye should be cleaned with a soft moist warm cloth. He should be asked to get up and relax for a while.
• The patient should be given the medicated smoking Dhoomapaana.
• The patient should not be allowed to face direct bright light immediately after Tarpan`a.
• The patient should not be allowed to see bright objects and sky immediately after Tarpan`a.
• The patient should follow the dietary and lifestyle regime double the period with respect to Tarpan`aKaala.
• The patient should keep the flowers of jasmine over the eyes for cooling effect.
• After Tarpan`athe eyesight gets Klaanta therefore Put`apaka is advised .Due to prolonged retention e.g. volume of ghee and continuous movements of eyes with the volume of ghee in them they are exhausted hence to relieve their fatigue and to restore them to normality Put`apaka.

Other Description:

• Tarpan`ashould not be advised when climate is too cloudy, hot, and cold and when the patient is suffering from redness and excessive pain in the eye.
• Tarpan`aof Vasaa (muscular fat / lard) is indicated in Timira, Naktaandhya (night blindness), (Krichhrabodha)Krichhronmeelana (difficulty in opening the eyes), ptosis
• Tarpan`ais effective on the Netra Budbud.
• Tarpan`a should be administered using Vaata alleviating drugs in Dvi Tvaggata Savran`a S`hukra associated withS`hoola.
• Various formulations used can be got through Anveshaksearch facility.

Prakaara Paribhaashaa:

Removal of hair from the site of wound or from the site of surgical procedure.

Pradhaanakarma:

This Chikitsaa Prakaara is explained in context to Vran`a.

This procedure is important because if the hairs are not removed they hinder and prevent its healing.

This is one of the important procedures in surgery, particularly in plastic surgery.

This prevents the infection or Vran`a Dusht`ee.

Indications and various formulations (Lepa etc.)

Prakaara Paribhaashaa:

The procedure in which Netra Tarpan`a is done with the help of juice extracted by Put`apaaka method.

Types:

1. Lekhana Put`apaaka
2. Snehana Put`apaaka
3. Prasaadana Put`apaaka

Poorvakarma (Prerequisites):

Patient preparation:

The patient should under go S`hodhana (Vamana, Virechana, Raktamokshan`a, Nirooha Basti) and S`hiro Virechana Nasya (Errhines) this leads to elimination of the vitiated three Dosha. A cleaner internal environment and improved sensorimotor apparatus function called as Mastishka S`hodhana should be achieved. S.U. 18 /5-11

The patient should be examined by the Vaidya with respect to digestion status of the previous day. This gives information about the Agni status of the person.

The room where Netra Tarpan`a is to be administered should be closed, devoid of direct breeze, sunlight, smoke, and should be furnished with curtains of colours except blue and yellow.. A.S. Su. 33/3

Selection of auspicious and suitable time for the patient. S.U.18/5

Pradhaanakarma:

The Lekhana, Snehana and Prasaadana Put`apaaka should be retained around eye for 100, 200 and 300 Maatraa consecutively.

For Lekhana and Snehana Put`apaaka the medicine should be lukewarm and for Prasaadana Put`apaaka it should be cold.

Put`apaaka should be done only for one day for Kapha dominance.

Put`apaaka should be done consecutively for two days for Pitta dominance.

Put`apaaka should be done consecutively for three days for Vaata dominance.

Pas`hchatkarma:

Dhoomapaana should be done after Lekhana and Snehana Put`apaaka.

The patient should not be allowed to face direct bright light immediately after Tarpan`a

The patient should not be allowed to see bright objects and sky immediately after Tarpan`a

The patient should follow the dietary and lifestyle regime for double the period of Put`apaaka treatment.

The patient should keep pack of petals of jasmine flowers over the eyes for cooling effect at night during the period of treatment.

Samyak Yoga (Benefits):

Prasanna Varn`a (improves glow of eyes)

Vis`hada Netra (cleanses eye)

Vaata Aatapasaha (improves tolerance of the eye for sun and wind)

Sukha Svapna (good sleep)

Sukha Svapna Avabodha (easy awakening)

Atiyoga:

Rujaa (pain in eye)

S`hotha (oedema of eye)

Pid`akaa (blisters)

Timira (vision problem)

Heenayoga:

Paaka (inflammation of eye)

As`hru (increased lacrimation)

Netra Harsha

Doshodgama

Other Description:

Snehana Put`apaaka should be administered in Vaataja Abhishyanda, Raktaja Abhishyanda, Raktaja Adhimantha, Siraaharsha, Sirotpaata and Vaataja Adhimantha Netra Roga.

Snehana and Prasaadana Put`apaaka should be administered in Vaataja Timira Netra Roga.

Other indications and various formulations used can be got through Anveshak search facility.

Prakaara Paribhaashaa:

• The procedure by which Vilayana or Dravikaran`a (liquefaction) of Dusht`a Tvak and Maamsa and also removal of the same is achieved with the help of Kshaara is called as Kshaarakarma.
• It becomes imperative in certain conditions to physically remove the sloughs, Dusht`a Tvak (contaminated) skin or hypertrophic muscles from a wound or a lump, at such places Kshaarakarma should be done.

Types:

• Prtisaaran`eeya Kshaara is again divided into three types viz.

o Mridu,

o Madhyama and

o Teekshn`a.

Poorvakarma (Prerequisites):

Medicine preparation:

• Madhu, Kaanjee, Dadhi, Dadhi Mastu, Lepa of S`heetaveerya Dravya, Tila Kalka, Yasht`i, Ghrita, Amla Varga, Sauveeraka, Tushodaka, Dhaanyaamla

Pradhaanakarma:

• The procedure should be conducted inside a room free from excessive wind flow and sunlight.
• The person should be given a position according to the disease.
• The area around the site of Kshaarakarma should be covered by a cloth.
• For Pittaja diseases Gharshan`a (rubbing), for Vaataja diseases, Kathin`a and Supta Tvak Lekhana (scrapping) for Kaphaja diseases and when excessive Kan`d`ooand S`hotha is present then Prachchhaana Karma should be done before application of Kshaara.
• Then Kshaara should be applied with the help of S`halaakaa.
• Kshaara should be washed off after a time required calculating 100 numbers. (For Kshaara karma at Mridu organs the time should be that equal to calculate 50 numbers.)
• The site should be covered by a Plota / palm.

Pas`hchaatkarma:

• The site of Kshaarakarma should be flushed with drugs from Amlavarga.
• Then Lepa of solid part from Sauveeraka, Tushodaka etc. or Tila, Yasht`i should be applied at the site of Kshaarakarma.
• The patient should be given Abhishyandi Aahaara e.g. Dadhi, Maasha. Due to this there is formation of Kleda at the site of Kshaarakarma and Vilayana ofMaamsaadi Dhaatu resulting in Ksharan`a (destruction) of Dhaatu.

Other Description:

• Pratisaaran`eeya Kshaara should not be used at the region of Marma, Siraa, Snaayu, Sandhi, Tarun`aasthi, Sevanee, Dhamanee, Gala, Naabhee, Nakhaanta,Med`hra, Srotasaagra, Netra, Kan`t`ha and the region where small amount of Maamsa is present.
• This procedure has effect on Kleda.
• This procedure should not be done when the patient is having multiple wounds.
• After S`hastrakarma, Kshaarakarma should be done over Vartmaars`ha, S`hushkaars`ha (Netra Roga) and Arbuda Netra Roga.

Following is the procedure performed particularly in the treatment of Ars`ha:

Poorvakarma (Prerequisites):

Instrument checklist:

• Ars`hoyantra
• Darvi
• Koorchaa
• S`halaakaa Yantra

Patient preparation:

• The patient should eat light diet having Anulomana effect in small amount on the previous night.
• The patient is not allowed to eat anything on the day of procedure till the end of the procedure.
• He should be asked to evacuate bowel and pass urine prior to the procedure.
• The patient should have bath. (The area should be cleaned thoroughly before Kshaarakarma.)
• Svastivaachana to stabilize the patient psychologically.

Medicine preparation:

• Pratisaaran`eeya Kshaara Mridu Kshaara should be used for Kshaarakarma of Raktapittaja Ars`ha.

Pradhaanakarma:

• Yantranaa positioning The position should lie down in a supine position on a bed or a table with legs spread to expose the anus for better view and to facilitateKshaarakarma.
• In case of a child or a serious patient, the patient should lie on the lap of the assistant (in such a manner that the patients body above waist, lies on the lap of assistant.)
• The patients anus should face east.
• His waist should be elevated by keeping a pillow below his waist.
• The patient should be asked to raise his legs and should be given lithotomic position.
• Then the assistant should apply lubrication to anus and insert lubricated Ars`ha Veekshan`a Yantra, slowly and steadily through the anal opening.
• Then the patient is asked to do Pravaahan`a (straining).
• Due to this the Ars`ha will be visible in the Ars`ha Veekshan`a Yantra.
• The Kshaara should be taken over a Jambvosht`ha S`halaakaa Yantra which is covered by the cloth at one end.
• The physician should pull the Ars`ha slightly upwards or press the upper part of Ars`ha so that the root of the Ars`ha is visible and apply the Kshaara at the root ofArs`ha.
• After application of Kshaara the Ars`ha Veekshan`a Yantra should be closed with hand for a time required to count 100 numbers.
• Then the Kshaara is applied again till the symptoms of proper Kshaarakarma are achieved.
• When the Ars`ha looks like ripe Jambu or Avasanna (shrinked) or slightly Nata (bent), Kshaara should be washed off with Kaanji, Dadhimastu, S`hukta or Phalaamla Rasa. Then ghee and Yasht`imadhu should be applied.
• Then the Ars`ho Yantra should be removed gently.
• Kshaara karma should be done for one Ars`ha at one time. After 7 days Kshaara should be applied to another Ars`ha and so.
• The Kshaara should be applied to Ars`ha on right side initially then to that on left side, then back and then front.
• In case of prolapsed piles the Kshaara should be applied without using any instrument.

Pas`hchaatkarma:

• Abhyanga should be done over anus and the area around anus.
• Avagaaha should be done with hot water and Parisheka with cold water. (According to some Parisheka with hot water should be done.)
• Then the patient should be asked to rest for a while.