Shalakya Tantra शालाक्य तन्त्र

Diseases of the eye, ear, nose, throat, head and teeth · Third (Final) Professional (Tritiya Varsha) · AyUG-SK

Papers

• Paper I — Shalakya Tantra (Netra Roga)
• Paper II — Karna, Nasa, Mukha, Danta, Shiro Roga

Units in this subject

Study notes

Everything above the clavicle — eye, ear, nose, mouth, teeth and head. Named for the shalaka, the probe. The eye alone carries seventy-six named disorders, which is why Netra Roga usually gets its own paper.

Netra — structure and function

• Netra rachana: the five mandala (pakshma, vartma, shukla, krishna, drishti), six sandhi, and the patala — the four layers.
• Drishti and the classical account of vision; Alochaka pitta.
• Netra roga: seventy-six in Sushruta's count, distributed across the sites — 9 sandhigata, 21 vartmagata, 11 shuklagata, 4 krishnagata, 17 sarvagata, 12 drishtigata, 2 bahyagata (asadhya is a prognosis, not a site — listing it as the seventh group is a common textbook error).

Kriyakalpa

• The ocular procedures: Tarpana, Putapaka, Seka, Ashchyotana, Anjana, Pindi and Vidalaka (also transliterated Bidalaka — one procedure, not two).
• Indications and the samyak lakshana for each — this is a favourite question.
• Anjana types: lekhana, ropana, prasadana.

Karna, Nasa, Mukha and Shiro roga

• Karna roga: 28 types. Karnapurana and karna dhupana.
• Nasa roga: 31 types. Nasya is the treatment of the whole region.
• Mukha roga: 65 types across the sites — oshtha, danta mula, danta, jihva, talu, kantha, sarvasara.
• Shiro roga: 11 types including ardhavabhedaka (hemicrania) and suryavarta.

Modern ophthalmology and ENT

• Refractive errors and their correction; cataract; glaucoma; conjunctivitis; corneal ulcer; retinal disease in outline.
• Ear: otitis externa and media, deafness, vertigo. Nose: sinusitis, epistaxis, polyps, deviated septum. Throat: tonsillitis, pharyngitis, laryngitis.
• The Arka and Snuhi latex keratitis cases belong here as much as in Agada Tantra — they are a leading cause of preventable corneal injury in rural India, and both plants are in Laisha's library with that finding recorded.

Netra rachana and kriya sharira

• Five mandala: pakshma, vartma, shukla, krishna, drishti. Four patala. Six sandhi.
• The eye is described as predominantly tejas in composition, with each mandala attributed to a mahabhuta.
• Alochaka pitta and its two subdivisions in later texts.
• Modern correlation: patala with the corneal, aqueous, lens and vitreous layers — approximate, and disputed among commentators, so present it as a correlation.

Nasa roga

• Thirty-one types. Pratishyaya, Pinasa, Nasarsha, Nasapaka, Putinasa, Raktapitta.
• Nasya is the principal treatment of the whole urdhva jatru region, which is why it sits in both this subject and Panchakarma.
• Modern: allergic rhinitis, sinusitis, epistaxis, nasal polyps, deviated nasal septum.

Karna roga

• Twenty-eight types. Karnashula, Karnanada, Karnasrava, Badhirya, Karnakandu, Krimikarna.
• Karnapurana (filling with warm oil) and karna dhupana (fumigation) are the procedures.
• Modern: otitis externa and media, wax, foreign body, tinnitus, sensorineural versus conductive deafness, vertigo.
• Sudden sensorineural hearing loss is an emergency and needs referral within days — worth stating.

Mukha and Danta roga

• Sixty-five types across seven sites: oshtha 8, dantamoola 15, danta 8, jihva 5, talu 9, kantha 17, sarvasara 3. They must sum to 65 — a student who adds the row is checking the source.
• Danta dhavana with specified twigs — Khadira, Nimba, Arka, Karanja — chosen by prakriti.
• Gandusha and Kavala: the mouth-holding procedures, four types each.
• Modern: caries, periodontal disease, oral submucous fibrosis and oral cancer — the last two being critical in a country with high areca and tobacco use, and worth linking to the Khadira entry, since khadira is in paan but is not what causes the harm.

Refraction and common procedures

• Myopia, hypermetropia, astigmatism, presbyopia and their correction.
• Visual acuity testing and the recording convention.
• Cataract surgery in outline; the classical Netra shalaka (couching) and its abandonment.
• When to refer immediately: sudden visual loss, red painful eye, trauma, chemical or latex injury.

Timira, Kacha and Linganasha — the patala staging

• The single most examined topic in Shalakya. Drishti has four patala, and the dosha descends through them in order: first patala gives blurred vision, second gives confused distance vision and diplopia, third gives disturbance by direction of gaze, fourth is complete loss.
• TIMIRA is the dosha in the first and second patala — vision is disturbed, the pupil still transmits. KACHA is the third patala — the pupil looks changed. LINGANASHA is the fourth — sight is gone. They are one disease at three depths, not three diseases.
• Six types by dosha: vataja, pittaja, kaphaja, raktaja, sannipataja and parimlayi. Parimlayi linganasha is asadhya; kaphaja linganasha is the one amenable to shalya — this is the classical cataract couching indication.
• Vataja timira sees objects moving and unsteady; pittaja sees rainbow colours and darkness; kaphaja sees white and things appear covered; raktaja sees red.
• Chikitsa: tarpana, putapaka, nasya, anjana and shirovirechana in the first two patala; shalya karma (couching) only in kaphaja linganasha, and Sushruta Uttaratantra 17 describes it.

The other netra roga counts

• ABHISHYANDA four — vataja, pittaja, kaphaja, raktaja — and it is the gateway disease: untreated abhishyanda becomes adhimantha.
• ADHIMANTHA four, by the same doshas. The distinguishing feature is pain radiating to half the head, and vataja adhimantha destroys vision in seven days, pittaja in five, raktaja in three — the day counts are asked.
• ARMA five: prastari, shukla, lohita, adhimamsa and snayu arma. Treatment is chhedana; snayu arma is the one that recurs.
• SHUKRA four and its treatment differs by depth. Ajakajata is the iris prolapse through a corneal perforation and looks like a goat's dropping, which is what the name says.
• KRIYAKALPA: Sushruta gives FIVE — tarpana, putapaka, seka, ashchyotana and anjana. Pindi and vidalaka are later additions that make seven; say which list you are giving.
• Netra roga total: Sushruta 76 by site (9 sandhigata, 21 vartmagata, 11 shuklagata, 4 krishnagata, 17 sarvagata, 12 drishtigata, 2 bahya). Vagbhata gives 94. Asadhya is a prognosis, not a site, and listing it as a group is a common textbook error.

Where the texts disagree

• The count of 76 netra roga is Sushruta's; Vagbhata's enumeration differs in the subdivision of the vartma gata roga.
• The patala theory of timira, kacha and linganasha is Sushruta's, and the correspondence to modern cataract is an interpretation rather than a translation.
• The number of mukha roga is 65 in Sushruta and is counted differently by Vagbhata.

Commonly confused

• Timira, Kacha and Linganasha - one process at three patala.
• Arma (a growth on the sclera) and Adhimantha (an acute painful eye).
• Pratishyaya (acute) and Dushta pratishyaya (chronic).
• Tarpana and Putapaka - both nourishing, different preparation.

Practise it, and prove it