Concepts of Parasurgical procedure in treatment of eye disease : An Ayurvedic discussion.

: The parasurgical procedures have been given special place in shastrakarma by Acharya Sushruta & these procedures are more helpful and effective where medicine or surgery will not give those results what we expect. As we all know the father of surgery Acharya sushruta has described parasurgical procedures are Agni Karma, Kshara karma Raktamokshna are amongst these parasurgical procedures. In modern science it is used as heat cauterization,alkali burn and bloodletting. This article deals with various aspects of parasurgical process and its use in presentcontext.


Introduction:
In Indian system of ayurveda medicine, Acharya Sushruta explained parasurgical procedures are Bheshaja Karma (Medicinal use), Kshara karma (Chemical cauterization), Agni Karma (Heat  cauterization) and Raktamokshana (Bloodletting) etc. parasurgical procedures explain to treat eye diseases like pakshmakopa,puyalasa, Abhisyanda and Adhimantha etc. The true meaning of this article to discuss the various basic concepts of para-surgical to treat eye diseases.
In modern science surgeons get trained in various techniques and now a days equipments become more advance but the basic principle are already explained very earlier in ayurveda in vedic era. The procedures like heat cauterization and chemical burn used to remove the affected tissue from infectious area to prevent spread of organisms. Bloodletting procedure to wash out impure blood and increase immunity against infective foci.
Indications when to perform parasurgical procedures  The disease contraindicated for surgery  The patent is in balyavastha, or very stressed for any procedure  Surgical instruments are not available  Possible treatment without surgical treatment

Materials and Methods:
All the references of para-surgical procedures are collected and complied from Sushruta Samhita and other Ayurvedic Scriptures, research papers and Journals of Ayurveda.
Acharya Sushruta described yantra in sutrasthana along with upyantra and Anushastra. Agni, Kshara and Raktamokshana by jaluka are described under upyantra as well as anushastra.

Aims and Objectives:
Aims-To discuss the concept of the parasurgical procedures in eye diseases.

Objectives-
To understand the concept of parasurgical procedures in treatment of eye diseases.
To elaborate the ancient science and it's effects which replicate also in modern science.

Agnikarma and Ksarakarma
Agnikarma will cure the otherwise incurable conditions with medicines, or surgery. The diseases cured by Agnikarma will not reoccur 7 .

Raktamoksana
Raktamoksana is an important therapeutic procedure in Shalya tantra . It prevents skin diseases, swollen glands, general swelling and diseases of the blood, if done at regular firstly Ghritpan than Sira vyadha is done.

 In Raktaja abhishyand: Repeated
Shiravydha is done. Jaloukavcharan is also useful.  In chronic diseases of eye (Pilla rog)-Shiravydhya and virechan is done for completerecovery.  In Pothaki: Jaloukavcharan is recommended.

Probable mode of action of agni karma
The local thermo therapy may increase tissue metabolism which may leads to excretion of the unwanted metabolites and toxins. Heat may stimulate lateral spinothalmic tract (SST) which leads stimulation of descending pain inhibitory fibre (DPT) which release of endogenous opoid peptide which binds with opoid receptors at substantia gelatinosa rolandi which inhibit release of P-substance (Presynaptic inhibition) and blockade oftransmission pain sensation occurs E-ISSN: 2320-7329

Probable mode of action of kshara karma
Kshara has shodhana, ropana, shoshana, stambhan, vilyana and lekhana properties. Shodhana property helps in elimination or expulsion of unwanted and harmful substance from the wound. It helps in desquamation of sloughs (debridement) and draining of pus. Ropana property helps in healing of wound due to anti-septic action of kshara. Shoshana property helps in drying up and absorption of mucus discharge that gets collected in ulcer bed promoting the granulation. Stambhan property of kshara helps contraction of opposing edges of ulcer to promote healing and vilyana property cause liquefaction and dissolving of localized unhealthy tissue. Hence by all these properties of kshara, healing property becomes faster.
Probable mode of action of raktamokshana karma Raktamokshana removes vitiated doshas which cause the aliment. This modality falls under purificatory therapies, which cleanse the body and helps in maintenance of health.

Discussion:
Disease which is not curable by Bhesaja, Shastra, Ksarakarma in that place Agnikarma plays major role to cure those disease. Agnikarma is one of the methods to control Haemorrhage when other procedure is failed and also agni has prime role for sterilization. Dalhana has mentioned Agnitapta sastra prevent sepsis in surgical procedure. Agnikarma is also useful after Sastra karma to avoid reccurence. Vata kapahaja vyadhisare best managed by this as vata and kapha possess sheeta guna, for this to neutralizethe vata and kapha dosha require opposite guna treatment that is ushna chikitsa, ushna guna and agni having anyonyasritabhava, hence agnikarma virtue of its ushna, tikshna sukshma and laghu property breaks srotovarodha, which produced by vata and kapha dosha. Thus nirama kapha and vata dosha are neutralized. it also acts like a dosha dushya vighatana karaka because ushna guna performs two functions. Firstly by stimulating i.e. utkleshana of dhatva agni and due to this action sama dhathu (localized ama) is digested and secondly ushna guna dilated the channels of srotas. Due to this srotovarodha removed (clearing the respective srota channel), which was formed by doshadushya samurchana in khavaigunya at dhathu (tissue).

Conclusion:
Its applications are widely practiced in modern surgical practice-viz cauterization, laser, radiation etc. Acharya Sushruta has advocated five Upakarma for the management of Sira, out of them Agnikarma is the best one. It is an ambulatory treatment modality and affordable to the common man. It deals with the action of thermal energy in the human body. It is a potent and minimally invasive para surgical procedure which has wide application in pain, recurrent occurrence and in unwanted growth conditions. Even today we can practice safely with all precaution in case of recurrent Trichiasis, and for same management in chronic glaucoma. It is hypothetically stated that it is probably capable to break down various cycles of painful adhesions. For this E-ISSN: 2320-7329 final conclusion more clinical research will be necessary (such as animal experiment).