A Critical Review of Vataja Timira, Kacha and Linganasha

Introduction

Shalakya tantra is one among the eight branches of Ayurveda that deals with diseases of Urdhwajatru. Acharya Dalhana and Raja Bhartrihari consider Nayana as Pradhana Indriya and responsible for Rupagrahana (vision). It is a highly specialized sense organ serving the most important function of vision. Almost 90% of knowledge is perceived only through eyes. Humans are mostly dependent on the vision for their day-to-day work. Hence any disturbance in this sense organ has great impact on life. The diseases with features of visual disturbances are mentioned under Drishtigata Rogas. Netra is composed of Mandala, Sandhi and Patala. Mandalas are various visible parts that appear in the form of circles, when the eye is open. Netra sandhis are the junctional areas of Netra Mandalas.¹

According to Moneir Williams, Patala means ‘veil, cover, a film over the eyes, an enclosing membrane of the eye’. The term Patala denotes a thin membrane with the thickness of 1/5th of the width of Drishti. Two Patalas are known to be in eyelids and are called Bahya Patalas, while other four Patalas are situated inside the eye in which Timira, a most alarming disease manifests. The four Patala are Tejo-jalashrita, Pishitashrita, Medashrita and Asthyashrita patala. Usually, counting begins from outside to inside, as in the case of Krishnamandala, where the injury to the first Patala indicates damage to the external layer. Contrary to it, counting begins from inside to outside in case of Nija Rogas. The vitiated Vatadosha ascends to the Jatrurdhwa, gets lodged in Patalas and produces Timira, Kacha and Linganasha.² The word Timira indicates blurriness of vision whereas Linganasha indicates total loss of vision. In the Timira, Doshas affect Prathama and Dwitiya patala, whereas in kacha it affects Tritiya Patala and in Linganasha, Chaturtha Patala is affected. These are classified based on Dosha involvement as Vataja, Pittaja, Kaphaja, Raktaja, Parimlayi and Sannipataja. ³ The clinical features of Timira, Kacha and Linganasha are dependent on Dosha which is dominantly vitiated, whereas the severity depends on the number of Patalas involved. Ultimately, Timira, Kacha, Linganasha are progressive loss of vision starting from infrequent blurriness of vision to complete loss of vision.

Timira

The word Timira is derived from root ‘Tim’ with ‘Unadi’ suffix ‘Kirach’ to form the Timira. The meaning of Timira according to Amarakosha is darkness.

Laxanas of Vataja Timira by Acharya Sushruta are Roopa brama, Avila, Arunabha and Vyaviddha darshana, ⁴ whereas Acharya Vagbhata includes Vyaviddha, Chala, Avila,

Arunabhasa, Muhur prasannata darshana and perception of Jaala, Kesha, Mashaka and Rashmi. ⁵ No obvious signs are seen in this stage, thus subjective parameters are the only way to assess Timira. Laxanas of Vataja timira are tabulated below (Table 1).

Kacha

Laxanas according to Acharya Sushruta are Arunaraga prapti,⁶ whereas Acharya Vagbhata explained Druk aruna, Aasyam anaasikam, Chandradeepaadi anekata and Vakram avakram darshana.⁷ This stage can be assessed both subjectively and objectively. Laxanas of Vataja kacha are tabulated below (Table 2).

Linganasha

Laxanas according to Acharya Sushruta are Aruna, Chanchalata and Parusha darshana,⁸ whereas Acharya Vagbhata explained Spashta arunabhatva, Visteernata, Sookshmata and Hatadarshana.⁹ These Laxanas except Hatadarshana can be assessed both subjectively and objectively. Laxanas of Vataja linganasha are tabulated here (Table 3).

Materials and Methods

Source of information: Critical review pertaining to Timira, Kacha, Linganasha from

• Paraadakara shastri H.S, editor, Ashtangahrdaya of Vagbhata with the commentaries of Sarvangasundara of Arunadatta and Ayurvedarasayana of Hemadri, Uttarasthana

• Acharya JT, editor, Susruta Samhita of Susruta, Uttaratantra

• Khurana AK. Comprehensive Ophthalmology, 4th edition.

Discussion

Timira, Kacha and Linganasha are the stages of Drishtinasha. In some cases, Timira progresses to Linganasha while in some cases it restricts to the Timira stage. As there are various Laxanas mentioned in these stages, we cannot compare it to one particular disease. Laxanas of these stages are analyzed with the signs and symptoms of various eye diseases in contemporary science.

Thus, with the above table we can consider

• Simple myopia, irregular astigmatism, keratoconus, intermediate uveitis, non-ischemic CRVO, immature senile cataract, PDR and NPDR as Timira.

• Aphakia, ARMD, retinal detachment, posterior uveitis, diabetic maculopathy and mature senile cataract as Kacha.

• Vitreous hemorrhage, CRAO, ischemic CRVO and advanced diabetic eye diseases as Linganasha.

Chikitsa

In Chikitsa, Nidana parivarjana plays an important role. Samanya chikitsa of Timira is Snehana, Raktamokshana, Virechana, Nasya, Anjana, Shirobasti, Basti, Tarpana, Lepa and Seka, according to the Doshas. Table 5 and 6 shows Chikitsa of timira

Siramokshana is contraindicated in case of Ragaprapti i.e in Kacha. But if it is necessary, Jaloukacharana is indicated.²⁸ Table 7 includes indications of Dhatu Pradoshaja Chikitsa in Timira.

Choice of Chikitsa

• Consideration of Dhatu Pradoshaja Chikitsa in Timira Dhatu means body constituents and Pradhushana means vitiation. Thus, Dhutupradhushana means vitiation of Dhatus by Doshas. Here we can consider that Patalagata dhatus are vitiated by Vata dosha. Hence, we can adopt Dhatu Pradhushana Chikitsa in Timira.

Conclusion

Timira, Kacha and Linganasha are the progressive diseases of Drishti Mandala which present with blurriness of vision to complete loss of vision. In the Timira stage, Doshas affect the Prathama and Dwitiya patala,whereas in Kacha, they affect tritiya and in Lingamasha, Chaturtha Patala is affected. Features of Vataja Timira, Kacha and Linganasha are seen in different diseases of the retina. Hence these can be compared with many retinal diseases as mentioned above. As these are progressive diseases, early detection and treatment plays an important role in the prevention of progression. In the treatment aspect, one can follow Samanya chikitsa, dhatu pradoshaja chikitsa or samanya vishesha siddhanta chikitsa.

Conflict of Interest

Nil