Now we shall describe the (surgical) measures to be employed for curing a case of Linga-nasa (obstruction or choking up at the pupil with a cataract) due to the action of the deranged Kapha. In cases where the deranged Dosha in the organ, i.e., the affected part of the organ docs not appear semicircular or thin in the middle, nor, fixed, (hard) nor irregular (in shape), nor marked by a large number of lines or a variety of tints, or where it does not resemble a pearl or a drop of water in shape, or if it docs not become painful and red coloured, the patient should be first treated with Sneha and Sveda at a season of the year which is neither too cold nor too hot for the purpose. Then the hands, etc., of the patient should be secured with proper fastenings and he should be made to sit, looking simultaneously (with his two eyes) at (the tip of) his nose. Then the intelligent surgeon leaving off two portions of the white part of the eye-ball from the end of the Apanga (the end of the eye) and having fully and carefully drawn apart the eye-lids with his thumb and the index and the middle fingers, should insert the Yava-vaktra (needle) instrument * through the sides of the natural apperture-like point near the external angles of the eye, neither above nor below, care being taken not to pierce the veins. The left eye should be pierced with the right hand, and the right with the left. The satisfactory nature of the operation (perforation) should be presumed from the characteristic report or sound and the emission of a drop of water † from the affected region, following upon the perforation. 34-35.
* Both S'rikantha Datta and S'ivadasa, the commentators respectively of Vrinda and Chakradatta, read meaning that the S'alaka (rod) should be made of copper.
† Blood would come out if the perforation be not satisfactorily done.
Instantly with the perforation the affected organ should be sprinkled over with breast-milk. The Salaka should be retained in its place and the diseased growth or appearance (cataract), whether fixed or mobile, should be duly fomented from the outside with the help of the tender leaves of Vayu-subduing efficacy, and the region of the Drishti-mandala should be subsequently scraped with the (pointed) end of a Salaka. The mucus or phlegm (Kapha) accumulated in the affected eye should be removed by asking the patient to snuff it off by closing the nostril on the other side of the operated eyeball. The part should be regarded as. properly scraped when it would assume the glossiness of a resplendent cloudless sun and would be free from pain. Then the Salaka (rod) should be gently withdrawn as soon as it would be able to perceive vision, and then the (affected) eye should be sprinkled over with clarified butter and bandaged with a piece of linen. During this period * the patient should be laid on his back in a comfortable chamber (free from dust and smoke), and be warned against indulging in all those bodily functions such as eructation, coughing, yawning, spitting, sneezing, etc. The regimen of diet and conduct thereafter should be the same as observed by one internally treated with a Sneha (See Chapter XXXI (Medicinal Uses (Both Internal And External) Of The Snehas , I.e., Oleaginous Substances (Snehaupayogika-Chikitsita), Chikitsita-stha'na). 36-A.
The bandage should be removed on every fourth day, and the organ should be washed with the decoction of the drugs of Vayu-subduing properties and bandaged again with a fresh one. The eye should be (mildly) fomented on every fourth day as before, so that the bodily Vayu might not be aggravated. This rule should be followed for ten days, as it would impart a fresh vigour to the sight. After-measures (such as snuffs, errhines, Tarpanas, etc.) should then be employed and the Diet should consist of light articles of food and be given only in moderate quantities. 36.
† The period during which these rules should he followed is 'seven days' according to Vagbhata. But according to Dallana it is only the period during which the operation lasts.
Persons declared unfit for venesection (viz., infants, old men, etc.) in the chapter on venesection * should not be subjected to any surgical operation, in cases of Nilika except at the place mentioned before (viz. the natural aperture - Daiva-krita Chhidra). 37.