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SECTION - B

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Q.II SHORT ANSWER QUESTIONS

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1. Netra Kriyasharir (Physiology of Eye)

• Prithvi (Earth) - forms the muscular/solid part (Mamsa/Meda)
• Jala (Water) - forms the white part (Kapha, sclera)
• Agni (Fire) - responsible for vision (Alochaka Pitta)
• Vayu (Air) - governs eye movements
• Akasha (Space) - present in the channels (Srotas)

• Alochaka Pitta is the most important - it resides in the retina and is responsible for visual perception (Drishti karma). It processes light entering through the pupil.
• Vyana Vata - controls eye movements
• Tarpaka Kapha - lubricates the eyes and maintains moisture
• Pachaka Pitta - assists in colour perception

1. Light (Tejas) enters through the pupil (Krishna Mandala)
2. Alochaka Pitta at the retina processes the image
3. The image is carried via Manovaha Srotas to the Manas (mind)
4. The Atma (soul) perceives the object

1. Drishti Mandala (Pupil/Retina)
2. Krishna Mandala (Iris/Cornea)
3. Shukla Mandala (Sclera)
4. Vartma Mandala (Eyelids)
5. Pakshma Mandala (Eyelashes/Conjunctiva)

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2. Vartmagat Rogas (Eyelid Diseases)

1. Vartmashtila - hard, stone-like swelling on eyelid (Chalazion)
2. Shushkaarsha - dry, rough, itchy lid margin (Tylosis/Blepharitis)
3. Vataparyaya - eyelid turned outward (Ectropion)

• Lepa (medicated paste application)
• Anjana (collyrium)
• Aschyotana (eye drops)
• Seka (eye wash)
• Raktamokshana (bloodletting) for rakta-dominant conditions
• Kriya Karma (surgical procedures) for conditions like Lagana, Pakshma Shatha

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3. Krimigranthi and Netra Strav Vyadhis (According to Ayurveda and Modern Science)

• Ayurveda: Described by Sushruta as a Vartmagat Roga. A worm (Krimi)-infested, granulomatous, pus-forming lesion of the eyelid margin. Caused by aggravated Kapha and Rakta. Features: itching, discharge, granulomatous mass on lid.
• Modern correlation: Meibomian gland dysfunction, infected Chalazion, or parasitic infestation of lid glands.
• Chikitsa (Ayurveda): Lekhana (scraping), Raktamokshana (bloodletting), Pratisarana (rubbing with medicines), Krimi-nashaka (antiparasitic) drugs like Vidanga, Palasha.
• Modern treatment: Antibiotics (topical/systemic), warm compresses, incision and curettage.

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4. Samanya Chikitsa of Netra Roga (General Treatment of Eye Diseases)

• Vamana (therapeutic emesis) - for Kaphaj Netra rogas
• Virechana (purgation) - for Pittaj Netra rogas
• Nasya (nasal administration) - very important in Shalakya; Pratimarsha Nasya daily
• Raktamokshana (bloodletting via Siravyadha or Jaloka) - for Raktaj conditions

1. Aschyotana - Instillation of medicated drops; first treatment of choice
2. Seka (Parisheka) - Stream of medicated liquid poured over closed eyes; good for burning, redness
3. Anjana - Application of collyrium (kohl):
   • Lekhana Anjana - scraping type (for thick secretions)
   • Ropana Anjana - healing type
   • Prasadana Anjana - soothing type
4. Bidalaka - Application of thick medicated paste on outer lid
5. Pindi - Medicated poultice placed on closed eye
6. Putapaka - Instillation of meat/herb juice processed by indirect heat; for deep-seated conditions
7. Tarpana - Bathing the eye in medicated ghee (Netra Tarpana); for degenerative conditions
8. Karnapurana - Filling ear canal with oil (indirect benefit via nervus connections)
9. Vidalaka - Another form of local application

• Avoid dust, smoke, wind, strong sunlight
• Avoid excessive reading, screen time
• Avoid suppression of natural urges (tears)
• Adequate sleep

• Ghee, milk, Triphala, Amalaki
• Avoid spicy, sour, fried foods
• Avoid viruddha ahara (incompatible food)

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5. Oshtharoga (Diseases of the Lips)

• Aggravation of Vata, Pitta, Kapha doshas through dietary factors
• Excessive use of bitter, dry, hot, sour foods
• Trauma to lips
• Excessive licking of lips
• Sun/wind exposure

1. Vataja Oshtha Koppa - Dry, cracked, rough lips with pain (Cheilitis sicca)
2. Pittaja Oshtha Koppa - Burning, inflamed, reddish-yellow lips with ulceration
3. Kaphaja Oshtha Koppa - Swollen, white, itchy, pale lips
4. Tridoshaja - Features of all three
5. Kshata Oshtha - Traumatic lesion of lip (Laceration)
6. Oshtha Pratichaya - Vesicular eruption on lip (Herpes labialis)
7. Mandakaushtha - Slow-healing lip ulcer
8. Oshtha Arbuda - Tumour/neoplasm of lip (Lip carcinoma)

• Cheilitis (angular, actinic, allergic)
• Herpes labialis (HSV-1)
• Lip carcinoma (squamous cell carcinoma)
• Lip fissures

• Vataj: Snehana, Basti, oil-based Lepa; ghee application
• Pittaj: Virechana, cooling herbs (Chandana, Ushira), ghee + honey application
• Kaphaj: Raktamokshana, Lekhana, dry-powder Lepa
• Shastrakarma for Arbuda - Chedana (excision)
• Pathya: Avoid dry, spicy food; use lip balms, ghee locally

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6. Nasa Sharir, Anatomy of Nose and Physiology of Olfaction

• The nose is divided into two nostrils by the Nasasepti (nasal septum/Setu)
• Nasaputa - nostrils (two)
• Gandha Grahana Sthana - olfactory area at the top of nasal cavity
• Nasa Mula - Root of nose (bridge)
• Nasa Agra - Tip of nose

• Kapha predominates in Nasa (hence colds = Kaphaj disorder)
• Connected to Shira (head) - Nasya reaches brain through nasal passages

• "Nasahi Shiraso Dwaram" - the nose is the gateway to the head (Charaka)
• Pranadhara Srotas (respiratory channels) originate from Hridaya and Mahasrotas, open at Nasa
• Pranavayu enters through the nose
• Olfactory function resides in Ghrana Indriya (organ of smell)

• Bony part: Nasal bones + frontal process of maxilla
• Cartilaginous: Upper lateral, lower lateral (alar), septal cartilages
• Tip (Columella), Alae, Dorsum

• Divided by septum (cartilage anteriorly, vomer + perpendicular plate posteriorly)
• Lateral wall has 3 turbinates (conchae): Superior, Middle, Inferior
• Meatus below each turbinate: Superior meatus (posterior ethmoidal cells drain), Middle meatus (frontal, maxillary, anterior ethmoidal sinuses drain), Inferior meatus (nasolacrimal duct opens)
• Floor = hard palate
• Roof = cribriform plate of ethmoid (olfactory area)
• Choanae = posterior openings into nasopharynx

• Olfactory (CN I) - smell
• Ophthalmic (V1) via anterior ethmoidal - anterior septum
• Maxillary (V2) via nasopalatine, posterior nasal - posterior septum and lateral wall

• Ghrana Indriya (organ of smell) is the sense organ for Gandha (smell)
• Connected to Prithvi Mahabhuta
• Prana Vayu assists olfaction
• The olfactory information reaches Manas (mind) for perception

1. Olfactory epithelium - located in superior nasal cavity (roof, superior turbinate, upper septum); area ~2 cm²
2. Receptor cells - Bipolar neurons; 6-10 million; dendrites bear olfactory cilia (with G-protein coupled odorant receptors - over 350 types in humans)
3. Signal transduction:
   • Odorant molecules dissolve in mucus
   • Bind to specific receptor proteins (OR genes, Nobel Prize 2004 - Buck & Axel)
   • Activates adenylyl cyclase → cAMP → opens cation channels → depolarization
4. Transmission: Olfactory receptor neurons → axons pass through cribriform plate → Olfactory bulb → Olfactory tract → Piriform cortex, amygdala, entorhinal cortex (limbic system - hence smell evokes strong memories/emotions)
5. Olfactory system is unique - only sensory system that does NOT relay through thalamus before reaching cortex

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7. Differential Diagnosis of Migraine Headache (Ayurveda and Modern Science)

• "Ardha" = half; "Avabhedaka" = severe splitting pain
• Predominantly Vataja and Pittaja condition
• Site: Half of the skull (temporal/orbital region)
• Characters: Throbbing, splitting, piercing pain; worsens with light and sound

• Attacks lasting 4-72 hours
• Unilateral pulsating pain, moderate-severe intensity
• Aggravated by physical activity
• Nausea/vomiting, photophobia + phonophobia
• With or without aura (visual, sensory, speech disturbances preceding headache)

• Cortical Spreading Depression (CSD) - wave of depolarization followed by depression, responsible for aura
• Trigeminovascular activation - release of CGRP (calcitonin gene-related peptide) → neurogenic inflammation
• Serotonin (5-HT) plays key role

• Nasya (Shodhan/Shamana), Shirodhara, Shirobasti, Virechana
• Drugs: Godanti bhasma, Shirashooladi Vajra Rasa, Pathyadi Kwath
• Lifestyle: Avoid triggering foods (sour, spicy), irregular meals, stress

• Acute: NSAIDs, triptans (sumatriptan), ergotamine, antiemetics
• Prophylaxis: Propranolol, topiramate, valproate, amitriptyline, CGRP monoclonal antibodies (erenumab)

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8. National Oral Health Programme (NOHP)

• Increase awareness about oral hygiene
• Reduce prevalence of dental caries and periodontal diseases
• Provide preventive, promotive, curative oral healthcare
• Integrate oral health into general health services

1. Preventive and Promotive:
   • Oral health education in schools
   • Fluoridation of water (where deficient)
   • Pit and fissure sealants
   • Tobacco cessation programs
   • Diet counseling (reducing sugar intake)
2. Curative:
   • Dental clinics at District hospitals, PHCs, CHCs
   • Mobile dental units for rural areas
   • School dental health programs
3. School Oral Health Program:
   • Annual oral health checkups
   • Oral health education
   • Referral services
4. Targets (National Health Policy):
   • Reduce dental caries prevalence in children
   • Universal access to basic oral healthcare
   • Training of ASHA/ANM workers in basic oral health promotion
5. AYUSH Integration:
   • Triphala mouthwash, neem datun (twig), oil pulling (Gandusha/Kavalagraha) promoted as traditional oral hygiene practices

• DMFT index (Decayed, Missing, Filled Teeth) - for caries
• CPI (Community Periodontal Index) - for periodontal disease

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Q.III LONG ANSWER QUESTIONS

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1. Pooyalas (Puyyalasa) and Upnah - Acute and Chronic Dacryocystitis

• "Puya" = pus; "Alasa" = sluggishness/accumulation
• Described as a Sandhi-gata Roga (disease of the angle/canthus) by Sushruta
• Located at the inner canthus (Kaneenika Sandhi)
• Features: Swelling at inner canthus, purulent discharge, pain, fever
• Dosha: Pitta + Kapha dominant

• "Upnah" refers to a collection/abscess at the inner canthus
• Slow-forming, chronic, painless swelling at inner canthus
• Predominantly Kaphaja
• Corresponds to Chronic Dacryocystitis

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• Most commonly a complication of chronic dacryocystitis
• Organisms: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas (in infants)
• Congenital NLD obstruction (in neonates - Dacryocystitis neonatorum)

• Sudden onset
• Severe pain and tenderness at inner canthus (below medial canthal tendon)
• Red, hot, swollen skin over lacrimal sac area
• Epiphora (watering of eye)
• Fever, malaise
• Purulent discharge on pressing sac (regurgitation test positive)
• May point and rupture → lacrimal fistula

• Syringing and probing (after acute phase)
• Dacryocystography (DCG)
• CT scan (if suspected orbital cellulitis)

• Systemic antibiotics: Co-amoxiclav (amoxicillin + clavulanate); or oral fluoroquinolones
• Hot fomentation
• Topical antibiotic drops
• Once pointing: Incision and drainage (I&D) of abscess
• After resolution: Dacryocystorhinostomy (DCR)

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• Primary NLD obstruction (idiopathic in post-menopausal women, most common)
• Secondary: Trauma, sinusitis, rhinitis, granulomatous diseases (TB, sarcoid), post-radiotherapy
• Neonatal: Failure of canalisation of NLD membrane (Valve of Hasner doesn't open at birth)

• Chronic epiphora (most common symptom)
• Regurgitation of mucopurulent material on pressure over lacrimal sac (Regurgitation test positive)
• Swelling at inner canthus (lacrimal sac mucocele)
• No acute pain or fever
• Recurrent conjunctivitis

• Acute dacryocystitis
• Lacrimal fistula
• Orbital cellulitis (dangerous)
• Corneal ulcer (from purulent discharge)

• Sac syringing (flow obstructed)
• Dacryocystography (DCG) - shows site of obstruction
• Nasal endoscopy (to assess nasal anatomy)

1. Conservative: Sac massage (Crigler's massage in neonates), topical antibiotics (limited)
2. Surgical:
   • DCR (Dacryocystorhinostomy) - Gold standard; creates a new pathway between lacrimal sac and nasal cavity (middle meatus); success rate >90%
   • External DCR (McIntosh's operation) vs. Endoscopic/Endonasal DCR (increasingly preferred)
   • In neonates: Probing and syringing under GA (if conservative fails after 1 year)
3. For lacrimal fistula: Fistulectomy

• Acute (Puyyalasa): Lepa with cooling herbs, Raktamokshana (Jaloka/leeches at inner canthus), Virechana, Pittahara diet, topical Durva/Chandana lepa; if abscess - Chedana (incision)
• Chronic (Upnah): Seka with Triphala kwath, Nasya (Pratimarsha), Lekhana Anjana, Sthanik swedana, Raktamokshana; Kaphahara chikitsa (Vamana)
• Drugs: Triphala, Haridra, Manjishtha, Nimba (anti-infective); Yashtimadhu, Chandana (for Pitta)

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2. Netra Kriyakalpa (Ocular Therapeutic Procedures)

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• Definition: Instillation of liquid medicine into the eye (drop by drop)
• First-line local treatment for most Netra Rogas
• Technique: Patient lies down; lower lid gently pulled down; drops instilled from height of 2 angula (finger widths) above the eye; patient blinks gently
• Dose: 4-6 drops at a time; 4-6 times a day
• Types: Aqueous (jala), oily (sneha), milk-based (kshira)
• Indications: Conjunctivitis, early cataract, eye strain, redness, dryness
• Modern equivalent: Eye drops

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• Definition: Continuous or intermittent stream of medicated liquid poured over the closed or open eye
• Height: 4 angula for vataja, 3 for pittaja, 2 for kaphaja
• Temperature: Warm (anushna) for Vata, cool for Pitta, slightly warm for Kapha
• Duration: Until symptoms subside
• Indications: Burning, redness, pain, vascular engorgement, conjunctivitis
• Modern equivalent: Continuous eye irrigation

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• Definition: Application of a thick layer (paste) of medicine on the outer surface of both eyelids
• The paste is thick (unlike Lepa applied thin)
• Duration: Applied and left for a fixed time, then washed
• Indications: Kaphaj conditions - swelling, heaviness of lids, sticky discharge
• Drugs used: Chandana, Triphala, Nimba paste

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• Definition: A medicated bolus/pad is prepared with herbs, wrapped in cloth, and placed over the closed eye
• Provides continuous drug release and mild heat
• Indications: Degenerative conditions, dryness, vataj conditions, late-stage conditions
• Drugs: Amalaki, Haritaki, boiled herbs in ghee

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• Definition: Retention of medicated ghee (ghrita) over the eye by creating a dam of flour paste (dough ring) around the eye socket
• The eye is submerged/bathed in warm medicated ghee for a defined duration
• Procedure:
  1. Patient lies supine
  2. Flour dough ring placed around the orbit creating a well
  3. Warm medicated ghee poured into the well
  4. Patient blinks intermittently
  5. Maintained for 100-200 matra kala (few minutes)
  6. After, paste removed; eyes washed with lukewarm water
• Duration: 3-7 days (based on condition)
• Indications: Vataj Netra roga, degenerative conditions, Timira (cataract), dry eye, nyctalopia (night blindness), weakened vision, computer vision syndrome
• Ghee preparations: Triphala ghrita, Jeevaniya ghrita, Mahatriphala ghrita
• Contraindications: Acute infection, discharge-heavy conditions
• Modern parallel: Warm oil compresses, punctal plug for dry eye

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• Definition: Instillation of juice extracted from medicinal substances by indirect heating (putapaka method = wrapped in clay and baked in fire, then juice collected)
• More potent than Aschyotana
• Types:
  • Mamsa Putapaka (meat-based)
  • Kshira Putapaka (milk-based)
  • Madhu Putapaka (honey-based)
• Indications: Deep-seated conditions, degeneration, severe dryness

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• Definition: Application of medicated collyrium (kajal-like) to the inner surface of the lower lid
• Types:
  • Lekhana Anjana (scraping/clearing) - for kaphaj secretions, thick discharge
  • Ropana Anjana (healing) - for ulcers, erosions
  • Prasadana Anjana (soothing/clarity-giving) - for vision improvement
• Technique: Anjana Shalaka (probe) dipped in medicine and applied with a gentle stroke to the inner conjunctival surface of lower lid
• Frequency: Daily or as directed
• Drugs: Saindhava (rock salt), Tuthaka (copper sulfate - Lekhana), Rasanjana, Shata dhaut ghrita (Ropana), Sauviranjana
• Modern parallel: Topical medications in ointment form

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1. Seka → 2. Aschyotana → 3. Bidalaka → 4. Pindi → 5. Tarpana → 6. Putapaka

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• Always precede with Mukha Shudhi (face cleansing) and Nasya
• Patient should be calm and relaxed
• Avoid during acute inflammation for nourishing procedures (Tarpana)
• Post-procedure: Protect from sunlight, wind
• Pathya: Light diet, no strain on eyes

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3. Pratishyay (According to Ayurveda and Modern Science)

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• Intake of dry, cold, incompatible food
• Exposure to dust, smoke, pollen, cold wind
• Excessive intake of astringent/cold foods
• Swimming, working in wet conditions
• Suppression of natural urges (especially sneezing)
• Viruddha ahara (incompatible foods)

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• Mild sneezing
• Watering of eyes
• Itching sensation in nose and palate
• Mild headache

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• Nasal discharge (varies by dosha)
• Nasal obstruction (Nasa Avarodha)
• Sneezing (Kshavatu)
• Loss of smell (Gandhanasha)
• Headache (Shirashoola)
• Change in voice quality
• Loss of taste

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• Karna Shool (ear pain - Eustachian tube dysfunction)
• Shiro Shool (chronic headache)
• Timira (vision disturbance)
• Pinasa (chronic sinusitis)
• Tonsillitis, bronchitis

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• Vamana (Kaphaj) - induced vomiting with Madanaphala/Yashtimadhu
• Nasya - most important treatment for Nasa Roga
  • Shodhan Nasya (Virechana) with Tikshna oils (Anu taila, Shadbindu taila)
  • Pratimarsha Nasya (2 drops of medicated oil daily)
• Dhumpan (medicated smoke inhalation) - for Kaphaj: with Haridra, Nimba, Vacha

• Internal medicines: Sitopaladi Churna, Trikatu, Haridra Khanda, Vyoshadi Gutika
• Nasal steam inhalation with Ajwain, Eucalyptus

• Pralepa on forehead (Chandana, Haridra)
• Nasal drops: Anu taila, Shadbindu taila
• Gandush (medicated gargling)

• Warm water, light food
• Avoid cold, dry, sour foods
• Rest, warm clothing

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• Most common - affects ~25% of population
• Type I hypersensitivity (IgE-mediated)
• Seasonal (SAR) - pollens; Perennial (PAR) - dust mites, pet dander
• Features: Paroxysmal sneezing, watery rhinorrhea, nasal itch, bilateral obstruction
• Diagnosis: Skin prick test, serum specific IgE, nasal smear (eosinophilia)
• Treatment: Antihistamines (cetirizine, loratadine), intranasal corticosteroids (fluticasone - first line), leukotriene antagonists (montelukast), immunotherapy (SCIT/SLIT)

• Vasomotor rhinitis (no allergic cause) - triggered by temperature, smoke, pollution
• Infectious rhinitis (common cold, URTI)
• Drug-induced (Rhinitis medicamentosa - rebound from decongestant overuse)
• Hormonal (pregnancy rhinitis)

• Primary (unknown cause) or Secondary (post-surgical, granulomatous)
• Features: Crusting, foul smell (Ozaena), widened nasal cavity, Anosmia, empty nose syndrome
• Organisms: Klebsiella ozaenae
• Treatment: Nasal irrigation, antibiotics, surgical narrowing of nasal cavity (Young's operation for bilateral closure in severe cases)

• Rhinovirus (most common), Coronavirus, RSV, Adenovirus
• Self-limiting, 7-10 days
• Treatment: Symptomatic - decongestants, antihistamines, saline irrigation

• Sinusitis (most common)
• Otitis media (Eustachian tube dysfunction)
• Asthma exacerbation
• Nasal polyps (Kaphaj Pratishyaya connection)
• Lower respiratory tract extension

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4. Karnaroga (Ear Diseases) According to Ayurveda and Modern Science

• Karna = external ear + canal
• Karna Puta = external auditory canal
• Karna Shankha = bony part
• Karna Mula = root of ear
• Communication with Nasa, Mukha via Srotas

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1. Karna Shoola - Earache; dry, shifting, shooting pain; ear feel dry; no discharge (Otitis externa/OE vataja)
2. Karna Kshveda - Tinnitus; ringing, buzzing sounds in ear; no external cause
3. Badhirya - Deafness; progressive hearing loss; dryness, aging (Sensorineural HL)

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• Vataja: Dry, spasmodic, shooting pain; no discharge; worsens at night
• Pittaja: Burning pain, hot discharge, fever
• Kaphaja: Dull, heavy ache, congestion

• Otalgia = ear pain
• Primary: Otitis externa (swimmer's ear), Otitis media (AOM), Mastoiditis
• Referred: Tonsillitis (via Jacobson's nerve - CN IX), TMJ dysfunction, Dental pain (CN V3), Cervical spine, Laryngeal cancer (CN X)
• Treatment: Depends on cause - antibiotics for AOM, ear drops for OE, analgesics

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• Vataja: Progressive, age-related, no discharge
• Kaphaja: Due to obstruction, wax
• Agantu: Traumatic, noise-induced

• Conductive Hearing Loss (CHL): External/middle ear problem; air-bone gap on audiometry; causes: wax, AOM, OME, otosclerosis, tympanic membrane perforation
• Sensorineural HL (SNHL): Inner ear/cochlear nerve problem; no air-bone gap; causes: presbycusis (age-related), noise-induced, ototoxic drugs, Meniere's disease, acoustic neuroma
• Mixed: Both components

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• Putikarna = pus-producing ear condition
• Pittaj + Kaphaj: yellow-green discharge, foul smell, pain, fever
• Chronic: progressive deafness

• Tubotympanic (Safe) CSOM: Central perforation, mucopurulent discharge, no cholesteatoma; prognosis good
• Atticoantral (Unsafe) CSOM: Marginal/attic perforation, cholesteatoma present; risk of dangerous complications

• Intracranial: Meningitis, brain abscess, sigmoid sinus thrombophlebitis, extradural abscess
• Extracranial: Mastoiditis, facial nerve palsy, labyrinthitis

• Ear toilet (aural suction)
• Topical antibiotic drops (ciprofloxacin)
• Systemic antibiotics for exacerbations
• Surgery: Myringoplasty (for safe CSOM - repair TM perforation); Tympanoplasty + Mastoidectomy for unsafe CSOM; Modified Radical Mastoidectomy (MRM) for cholesteatoma

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• Causes: Noise-induced HL, presbycusis, Meniere's disease, ototoxic drugs (aspirin, aminoglycosides, quinine), otosclerosis, acoustic neuroma, TMJ
• Types: Subjective (only patient hears) vs. Objective (examiner can hear too - pulsatile tinnitus)
• Treatment: TRT (Tinnitus Retraining Therapy), sound masking, CBT, treat underlying cause

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• Fluid in middle ear without signs of acute infection
• Most common in children 2-7 years
• Features: Conductive hearing loss, feeling of fullness, no pain
• Treatment: Watchful waiting (3 months), Otovent (autoinflation), Grommets (ventilation tubes) if persistent

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1. Karna Purana - Filling the ear canal with warm medicated oil (Bilwa taila, Anu taila, Saindhavadi taila); performed for 5-10 minutes; treats most Vataja/Kaphaja rogas
2. Karna Dhumpan - Medicated smoke blown into ear canal (for Kaphaj, wax accumulation)
3. Karna Pratisarana - Application of medicated paste to ear canal walls
4. Nasya - Indirectly benefits Karna (Eustachian tube connection)
5. Shamanaushadhi - Internal medicines based on dosha: Vata - Bala, Ashwagandha, Dashamoola; Pitta - Triphala, Manjishtha; Kapha - Trikatu, Guggul
6. Raktamokshana - Jaloka (leeches) for Pittaj/Raktaj rogas
7. Shastrakarma - Surgery for Arbuda (tumour), foreign bodies

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