notes and class presentations of the following topics. 1. ICHD 3 2. Common dravyas used in Shirorogas (Common patent and classical formulations) 3. NLHT 2.1. At iyoga Ayoga, Purva, Pradhana and Pashchat karma and Research updates on Aschotana, Seka, Pindi and Vidalaka. Thank you 1:03 PM

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ICHD 3 International Classification Headache Disorders 2018 criteria complete classification

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netra tarpana Ayurveda eye treatment seka vidalaka randomized clinical

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SHALAKYA TANTRA - NETRA ROGA

BAMS Undergraduate Notes


TOPIC 1: ICHD-3 (International Classification of Headache Disorders, 3rd Edition)

Introduction

The International Classification of Headache Disorders, 3rd Edition (ICHD-3) was published in January 2018 in Cephalalgia by the International Headache Society (IHS). It is the globally accepted diagnostic and classification system for all headache disorders. ICHD-3 is evidence-based, replacing ICHD-2 (2004) and ICHD-3 beta (2013). It is relevant to Shalakya Tantra because headaches form a major subset of Shirorogas.
Key principle: ICHD-3 uses a hierarchical, alphanumeric coding system. Diagnosis is based on meeting defined criteria (number of attacks, duration, character, associated features, not better accounted for by another diagnosis).

Overall Structure of ICHD-3

ICHD-3 is divided into 3 Parts plus an Appendix:
PartCategories
Part I - Primary Headaches1. Migraine; 2. Tension-type headache; 3. Trigeminal autonomic cephalalgias; 4. Other primary headache disorders
Part II - Secondary Headaches5-12 (headaches attributed to another cause)
Part III - Neuropathies & Facial Pains13. Cranial neuralgias; 14. Other headache disorders
AppendixResearch entities, probable diagnoses

PART I: PRIMARY HEADACHES

1. Migraine

1.1 Migraine without aura
  • Diagnostic criteria (POUND mnemonic):
    • A. At least 5 attacks fulfilling B-D
    • B. Duration 4-72 hours (untreated or unsuccessfully treated)
    • C. At least 2 of: Unilateral, Pulsating, Moderate/severe intensity, Aggravated by routine physical activity
    • D. At least 1 of: Nausea/vomiting, Photophobia + Phonophobia
    • E. Not better accounted for by another ICHD-3 diagnosis
1.2 Migraine with aura
  • Aura = reversible focal neurological symptoms (usually 20-60 minutes)
  • Sub-types:
    • 1.2.1 Migraine with typical aura (visual, sensory, speech/language aura)
      • 1.2.1.1 Typical aura with headache
      • 1.2.1.2 Typical aura without headache
    • 1.2.2 Migraine with brainstem aura (formerly "basilar migraine")
    • 1.2.3 Hemiplegic migraine
      • 1.2.3.1 Familial hemiplegic migraine (FHM) - types 1, 2, 3, others
      • 1.2.3.2 Sporadic hemiplegic migraine
    • 1.2.4 Retinal migraine
1.3 Chronic migraine
  • Headache on ≥15 days/month for >3 months
  • ≥8 days/month meeting migraine criteria
  • Requires at least 5 previous attacks of 1.1 or 1.2
1.4 Complications of migraine
  • 1.4.1 Status migrainosus (>72 hours)
  • 1.4.2 Persistent aura without infarction
  • 1.4.3 Migrainous infarction
  • 1.4.4 Migraine aura-triggered seizure (migralepsy)
1.5 Probable migraine
  • Meets all but one criterion for 1.1 or 1.2
1.6 Episodic syndromes associated with migraine
  • 1.6.1.1 Cyclical vomiting syndrome
  • 1.6.1.2 Abdominal migraine
  • 1.6.2 Benign paroxysmal vertigo
  • 1.6.3 Benign paroxysmal torticollis

2. Tension-type Headache (TTH)

  • Bilateral, pressing/tightening (non-pulsating), mild to moderate intensity
  • NOT aggravated by routine activity
  • NO nausea; photophobia OR phonophobia (not both) may be present
TypeFrequency
2.1 Infrequent episodic TTH<1 day/month (<12 days/year)
2.2 Frequent episodic TTH1-14 days/month for >3 months
2.3 Chronic TTH≥15 days/month for >3 months
2.4 Probable TTHMeets all but one criterion

3. Trigeminal Autonomic Cephalalgias (TACs)

Characterized by: unilateral head pain + ipsilateral cranial autonomic features (lacrimation, conjunctival injection, nasal congestion, ptosis, miosis, eyelid edema)
TypeDurationFrequencyDistinguishing Feature
3.1 Cluster headache15-180 min1-8/dayNocturnal, restlessness; M>F
3.1.1 Episodic clusterCluster periodsRemission >3 months
3.1.2 Chronic clusterNo remission-
3.2 Paroxysmal hemicrania2-30 min>5/dayAbsolute response to indomethacin
3.3 SUNCT5-240 sec3-200/dayConjunctival injection + tearing
3.3.1 SUNCTShort-lasting neuralgiform + conj.inj + tearing
3.3.2 SUNAShort-lasting neuralgiform + cranial autonomic (not necessarily SUNCT)
3.4 Hemicrania continuaContinuous-Indomethacin-responsive, continuous unilateral
3.5 Probable TAC

4. Other Primary Headache Disorders

CodeDisorderKey Features
4.1Primary cough headacheTriggered by cough/Valsalva; bilateral, short
4.2Primary exercise headacheDuring/after exercise; bilateral, pulsating
4.3Primary headache associated with sexual activityBefore/during orgasm
4.4Primary thunderclap headacheSudden, peak in <1 min
4.5Cold-stimulus headacheIce cream headache
4.6External-pressure headacheContinuous pressure (tight hat/goggles)
4.7Primary stabbing headacheJabbing, multiple locations, seconds
4.8Nummular headacheCoin-shaped, 1-6 cm, scalp
4.9Hypnic headacheOnly during sleep, wakens patient, ≥10 days/month
4.10New daily persistent headache (NDPH)New onset, unremitting, from day 3

PART II: SECONDARY HEADACHES (5-12)

5. Headache attributed to Trauma/Injury to Head and/or Neck

  • 5.1 Acute post-traumatic headache (within 7 days of injury)
  • 5.2 Persistent post-traumatic headache (>3 months)
  • 5.3 Headache attributed to whiplash
  • 5.4 Persistent headache attributed to whiplash (>3 months)
  • 5.5 Headache attributed to craniotomy

6. Headache attributed to Cranial/Cervical Vascular Disorder

  • 6.1 Ischemic stroke / TIA
  • 6.2 Headache attributed to non-traumatic intracranial hemorrhage (SAH - "thunderclap", worst headache of life)
  • 6.3 Unruptured vascular malformation (AVM, aneurysm)
  • 6.4 Arteritis (Giant cell arteritis - temporal headache + jaw claudication in elderly)
  • 6.5 Carotid/vertebral artery pain
  • 6.7 Cerebral venous thrombosis (CVT)

7. Headache attributed to Non-vascular Intracranial Disorder

  • 7.1 Raised intracranial pressure (IIH - idiopathic intracranial hypertension)
  • 7.2 Low CSF pressure (postural headache)
  • 7.3 Intracranial neoplasm
  • 7.4 Intrathecal injection

8. Headache attributed to Substance or Its Withdrawal

  • 8.1 Substance-induced (nitric oxide donors, PDE inhibitors, alcohol, cocaine, histamine, CGRP)
  • 8.2 Medication overuse headache (MOH) - use of analgesic/triptan >10-15 days/month for >3 months
  • 8.3 Substance withdrawal (caffeine, opioid, estrogen)

9. Headache attributed to Infection

  • 9.1 Intracranial infection (meningitis, encephalitis)
  • 9.2 Systemic infection (viral, bacterial)

10. Headache attributed to Disorder of Homeostasis

  • 10.1 Fasting headache
  • 10.3 Headache attributed to hypothyroidism
  • 10.4 Dialysis headache
  • 10.7 Headache due to hypertension (including pre-eclampsia, hypertensive crisis)

11. Headache/Facial Pain from Cranial Structure Disorders

  • Eyes (glaucoma, refractive errors - important for Shalakya Tantra)
  • Sinuses, nose, teeth, temporomandibular joint, cervical spine
  • 11.3.1 Headache attributed to acute glaucoma
  • 11.3.2 Headache attributed to refractive error

12. Headache attributed to Psychiatric Disorder

  • Somatization, psychotic, depressive, anxiety, PTSD disorders

PART III: NEUROPATHIES AND FACIAL PAINS (13-14)

13. Painful lesions of cranial nerves

  • 13.1 Trigeminal neuralgia
    • 13.1.1 Classical (compression by blood vessel)
    • 13.1.2 Painful trigeminal neuropathy (herpes zoster = postherpetic neuralgia)
    • 13.1.3 Idiopathic
  • 13.2 Glossopharyngeal neuralgia
  • 13.7 Occipital neuralgia
  • 13.12 Burning mouth syndrome
  • 13.10 Persistent idiopathic facial pain (PIFP)

14. Other Headache Disorders

  • 14.1 Headache not elsewhere classified
  • 14.2 Headache unspecified

ICHD-3 Appendix

Contains probable/research diagnoses not yet fully validated:
  • A1. Menstrual migraine subtypes
  • A3. Chronic migraine alternative criteria
  • A6. Vestibular migraine (A1.6.6)
  • A12. Headache attributed to psychiatric disorder refinements

Correlation with Ayurvedic Shirorogas

ICHD-3 DiagnosisAyurvedic Equivalent
Migraine without auraArdhavabhedaka (Vata-Pitta)
Cluster headacheSuryavarta
Tension-type headacheVataja Shiroroga
Hemicrania continuaAnantavata
New daily persistent headacheSannipataja Shiroroga
Trigeminal neuralgiaShankhaka


TOPIC 2: COMMON DRAVYAS USED IN SHIROROGAS

Classical Ayurvedic Classification of Shirorogas

Sushruta describes 11 Shirorogas:
  1. Vataja Shiroroga
  2. Pittaja Shiroroga
  3. Kaphaja Shiroroga
  4. Sannipataja Shiroroga
  5. Raktaja Shiroroga
  6. Krimija Shiroroga
  7. Suryavarta
  8. Anantavata
  9. Ardhavabhedaka
  10. Shankhaka
  11. Shunyashirorogas (some texts include this)

Section A: Common Dravyas (Medicinal Plants/Substances) Used

1. Key Single Drugs (Ekakala Dravyas)

DravyaBotanical NamePropertiesUsed in
BhringarajaEclipta albaKeshya, Rasayana, Vata-Kapha shamakSuryavarta (swaras + goat milk)
Pathya (Haritaki)Terminalia chebulaTridoshahara, RasayanaAll Shirorogas
ShatavariAsparagus racemosusPittahara, VataghnaPittaja, Raktaja Shiroroga
Dashamula10 roots combinedVata-Kapha hara, ShothaharaVataja, Ardhavabhedaka
AshwagandhaWithania somniferaVataghna, Balya, RasayanaVataja Shiroroga
VidangaEmbelia ribesKrimighna, KaphaharaKrimija Shiroroga, Ardhavabhedaka
GuduchiTinospora cordifoliaTridoshahara, RasayanaAll types
NimbaAzadirachta indicaKrimighna, KaphaharaKrimija Shiroroga
Shigru beejaMoringa oleifera (seed)KrimighnaKrimija Shiroroga
KumariAloe veraPittahara, VataghnaPittaja, Suryavarta
UshiraVetiveria zizanioidesPittahara, SheetalaPittaja Shiroroga
ChandanaSantalum albumPittahara, SheetalaPittaja Shiroroga
KarpuraCinnamomum camphoraSheetala, VedanasthapanaPittaja, Suryavarta
ShunthiZingiber officinaleVata-Kaphahara, DipanaVataja, Kaphaja Shiroroga
TrikatuShunthi+Pippali+MarichaDeepana, PachanaKrimija, Kaphaja
ShirishaAlbizia lebbeckVisha-Krimi nashakArdhavabhedaka, Shankhaka
KritamalaCassia fistula (swarasa)DetoxifyingSuryavarta
ApamargaAchyranthes asperaKrimighnaSuryavarta (nasya)

2. Drugs for Lepa (External Application to Head)

LepaDrugs UsedIndication
Kumkum Ghrita LepaKumkum (saffron) + gheePittaja Shiroroga
Sarvadi LepaCompound lepaGeneral Shiroroga
Suryavartabeeja LepaSeeds of Suryavarta plantSuryavarta
Satavaryadi LepaShatavari + other dravyasPittaja, Vataja
Chandanadi LepaChandana, Madhuka, UshiraPittaja (burning headache)
Bhringaraja LepaBhringaraja swarasVataja, Suryavarta

3. Tailas Used in Shiroabhyanga (Head Massage)

TailaKey DrugsIndication
Ksheerabala TailaBala + milkVataja Shiroroga, Ardhavabhedaka
Dashmoola TailaDashamulaVataja, Kaphaja Shiroroga
Mahamayura GhritaComplex formulationVataja Shiroroga, Shirobheda
Rasnadi TailaRasna + other dravyasVataja Shiroroga
Baladi TailaBala groupVataja Shiroroga
Trivrit TailaTrivritPittaja, Raktaja
Bala TailaBala (Sida cordifolia)Vataja

Section B: Classical Formulations (Shastra Siddha Yoga)

1. Rasa Yoga (Herbo-mineral Preparations)

Dose: 125-250 mg; Anupana: honey or lukewarm water
FormulationKey IngredientsIndicationReference
Shirahshooladi Vajra RasaVajra (diamond processed), Suta, GandhakaArdhavabhedaka, Suryavarta, severe headacheB.R.
Sutashekhara RasaShankha bhasma, Svarna gairika, Shunthi, Nagavalli svarasaPittaja Shiro-shoola, gastric disturbancesB.R.
Godanti BhasmaGodanti (gypsum/selenite) bhasmaMigraine-type, Pittaja ShirorogaB.R.
Chandrakanta RasaCompound Rasa with Chandrakanta maniPittaja, SuryavartaB.R.
Mahalakshmi Vilas RasaComplex, Suvarna-containingChronic Shirorogas, TridoshajaB.R.
Shirashoolavajra RasaVajra bhasma basedIntense Shiroroga, VatajaB.R.
Swashakuthara RasaCompoundPitta ShirorogaBh. Pr.

2. Kwatha (Decoctions)

Dose: 20-40 ml twice daily; Anupana: water
FormulationKey DrugsIndication
Pathyadi KwathaPathya (Haritaki), Nimba, Guduchi, Haridra, AmalakiArdhavabhedaka, Vataja-Pittaja Shiroroga; Rakta-prasadaka
Dashmoola Kwatha10 rootsVataja Shiroroga, Ardhavabhedaka
Mahaman Jishthadi KwathaManjishtha + compoundRaktaja Shiroroga

3. Ghrita (Medicated Ghee)

Dose: 10-20 ml; Anupana: warm water/milk
FormulationIndication
Mahamayura GhritaVataja Shiroroga, Nasya in Shiroroga
Ksheerabala TailaVataja (also used as Nasya)
Panchatikta GhritaKrimija Shiroroga, Kshayaja
Triphala GhritaGeneral (also netra roga)
Ksharpi (purified ghee) with Vatanashaka dravyasKshayaja Shiroroga

4. Churna (Powders)

FormulationIndication
Sitopaladi ChurnaKaphaja Shiroroga
Trikatu ChurnaKaphaja, Krimija
Triphala ChurnaAll types (Rasayana)

Section C: Patent Formulations

Patent MedicineManufacturerKey IngredientsIndication
Pathyadi Kwatha (ready-made)Arya Vaidya Sala, Kottakkal; DaburPathya, Nimba, GuduchiArdhavabhedaka, migraine
Godanti Bhasma (patent)Dabur, BaidyanathGodanti (calcium sulfate)Pittaja Shiroroga, migraine
Shirahshooladi Vajra RasaBaidyanath, DaburVajra + compoundSevere headache
Sutashekhara RasaDabur, Arya Vaidya SalaCompound herbo-mineralPittaja, chronic headache
Brihat Vata Chintamani RasaDaburSuvarna, Vata-hara compoundVataja chronic Shiroroga
Mahalakshmi Vilas RasaBaidyanathSuvarna bhasma basedTridoshaja Shiroroga
Ksheerabala (101)Arya Vaidya SalaBala+milk processed oilVataja Shiroroga, nasya
Brahmi GhritaMultipleBrahmi, compoundShirah-shoola with psychological component
Himalaya RumalayaHimalayaGuggul, ShallakiHead pain associated with cervical
Dabur ShilajitDaburShilajatu + compoundKshayaja Shiroroga
Nardostachys (Jatamansi) formulationsMultipleJatamansiPsychogenic headache, stress headache

Nasya Preparations (important in Shirorogas):

  • Anu Taila - classic multiherb oil, widely used Pratimarsha/Marsha Nasya in all Shirorogas
  • Shadbindu Taila - 6-seed oil; Vataja, Kaphaja Shiroroga
  • Ksheerabala Taila - Vataja
  • Narayana Taila - Vataja
  • Bhringa Raj Taila (patent) - Dabur, Himalaya - Vataja, hair loss with headache

Pathyapathya in Shirorogas

Pathya (beneficial):
  • Old ghee, Shali rice, Shashti shali, Yusha (soups), milk
  • Vegetables: Patola, Shigru, Vastuka, Karvellaka
  • Fruits: Mango, Amalaki, Dadima, Matulunga, lemon, grapes, coconut
  • Liquids: Milk, coconut water, Kanji, Takra
Apathya (to avoid):
  • Vegadharana (suppression of natural urges - sneezing, yawning, sleep, lacrimation)
  • Cold drinks, Dahi, Lassi
  • Kaphavardhaka diet
  • Excessive screen time, stress
  • Exposure to cold wind, sun


TOPIC 3: NLHT 2.1 - NETRA KRIYA KALPA PROCEDURES

A. Ati-yoga and Ayoga (Complications of Excess/Deficient Treatment)

Netra Kriya Kalpa - Overview

The term Kriya Kalpa = Kriya (chikitsa/treatment) + Kalpa (vidhi/method).
Netra Kriya Kalpas are local therapeutic procedures applied directly to the eye for treatment of Netra Rogas.
Seven Main Kriya Kalpas (as per Acharyas):
Kriya KalpaS.D.S.S.A.H.C.S.B.P.
Aschyotana+++++
Seka+++-+
Tarpana+++-+
Putapaka+++-+
Anjana+++++
Pindi+---+
Vidalaka/Bidalaka+--++

Ati-yoga (Over-treatment / Excessive Application)

When any Kriya Kalpa is applied in excess dose, duration, or frequency:
General Ati-yoga features:
  • Excessive dryness (Rukshata) of the eye
  • Burning sensation (Daha)
  • Inflammation
  • Watering (Ashru srava)
  • Redness (Rakta netra)
  • Photophobia
  • Reduced visual acuity
Specific Ati-yoga:
  • Aschyotana ati-yoga: Excessive tearing, irritation, conjunctival congestion
  • Seka ati-yoga: Swelling, heaviness, cold sensation
  • Tarpana ati-yoga: Alasya (sluggishness), heaviness of eyes, reduced near vision
  • Anjana ati-yoga: Burning, excessive tearing, photophobia

Ayoga (Under-treatment / Insufficient Application)

When any Kriya Kalpa is applied in insufficient dose, duration, or frequency:
General Ayoga features:
  • Disease not cured (Dosha not expelled)
  • Persistence of original symptoms
  • Mild or no therapeutic effect
Specific Ayoga:
  • Aschyotana ayoga: No reduction in symptoms, disease persists
  • Tarpana ayoga: Continued Rukshata (dryness), Vata symptoms persist
  • Anjana ayoga: Secretions remain, inflammation persists
Samyak Yoga (proper application) = disappearance of original symptoms, no new complications, clear vision, comfortable eye.

B. PURVA KARMA, PRADHANA KARMA, PASHCHAT KARMA

General Framework (Trividha Karma)

All Netra Kriya Kalpas are performed in three stages:
StageMeaningPurpose
Purva KarmaPre-procedurePrepare the patient and eye; mobilize doshas
Pradhana KarmaMain procedureActual therapeutic application
Pashchat KarmaPost-procedureConsolidate effect, avoid complications

C. DETAILED NOTES ON FOUR PROCEDURES


1. ASCHYOTANA (Instillation of Drops)

Definition: The procedure where medicine is applied drop by drop into the eye. The word comes from Aa + Shchyu + Ta + Lyu pratyaya = "Samyak Ksharana Sheela" (continuous dripping).
Shloka reference: "Sarveshamaakshiroganam aadyam aashchotanam kshyam | Raktodakam dughshashrudam daharagakshirwah bahishanam ||" (Su.Su. 23/1)
Meaning: Aschyotana is the first line of treatment (Aadya Upakrama) in all eye diseases.
Types (as per Sushruta):
  • Snehana Aschyotana - oily, for Vata
  • Lekhana Aschyotana - scraping/drying, for Kapha
  • Ropana Aschyotana - healing, for Pitta
Dravyas used:
  • Swarasa (fresh juice)
  • Kashaya (decoction)
  • Ksheera (milk preparations)
  • Hima (cold infusion)
  • Phanta (hot infusion)
  • Ghrita (medicated ghee)

Purva Karma (Pre-procedure for Aschyotana):

  1. Inform the patient about the procedure
  2. Patient lies comfortably in supine position in Kriyakalpa theatre
  3. Face cleaned gently
  4. Any eye secretions wiped away with clean cotton
  5. Mild Swedan (fomentation) if indicated (not always done for Aschyotana)

Pradhana Karma (Main procedure):

  1. Eyes opened by physician using left hand (index and thumb hold lids open)
  2. Aschyotana dravya taken in a dropper or small bowl held in the right hand
  3. Height: 2 Angulas (finger breadths) above the eye
  4. Drops instilled near Kaninika Sandhi (inner canthus)
  5. Number of drops: 10-12 drops per eye
  6. Patient asked to blink gently to distribute medicine

Pashchat Karma (Post-procedure):

  1. Fluid flowing out wiped with clean cotton
  2. Mrudu Sweda (mild warm fomentation) applied over closed eyelids
  3. Patient rests for a few minutes
  4. Avoid rubbing eyes
  5. Avoid cold wind, dust, bright light immediately after
Indications: All Netra Rogas, especially:
  • Conjunctivitis (Abhishyanda - Vataja/Pittaja/Kaphaja)
  • Epiphora (Ashru srava)
  • Early Timira (cataract)
  • Corneal ulcers (Shukra)
  • Blepharitis
Contraindications: Severe corneal perforation, active eye injury

2. SEKA (Continuous Stream of Liquid over the Eye)

Definition: A continuous stream (dhara) of medicated liquid poured over the closed or open eye from a vessel held at a specific height.
"Sekam Swasthasyopadesha Ch Rohitaksha Pramano Ha" - the stream should be thin, continuous, uniform.
Types:
  • Vataja Seka - warm, oily preparation
  • Pittaja Seka - cold, sweet preparations
  • Kaphaja Seka - warm, pungent preparations
Vessels used: Kumbha (pot), Pana Patra, or specially made Seka Patra.
Height of pouring:
  • 2 Angulas from eye (standard)
  • Warm preparations: Height may be slightly more
  • Cold preparations: Closer to eye

Purva Karma (Pre-procedure for Seka):

  1. Patient positioned in supine position
  2. Eye area cleaned gently
  3. Mild oleation (Snehana) of eyelid margins
  4. Mild Swedan (fomentation) around the eyes if Vataja or Kaphaja condition
  5. Patient informed about the sensation of continuous pouring

Pradhana Karma (Main procedure):

  1. Patient lies with eyes open or closed depending on indication
  2. Lukewarm or cold medicated liquid prepared
  3. Poured as a thin, uninterrupted stream (dhara) over the eye
  4. Stream directed from inner to outer canthus (Kaninika to Apanga Sandhi)
  5. Duration: Until the patient shows signs of Samyak Yoga (comfort, clarity)
  6. Liquid collected in a tray placed below
  7. Can be recollected and poured again if required

Pashchat Karma (Post-procedure):

  1. Wipe excess liquid with clean cotton
  2. Gentle massage of eyelids
  3. Dhoomapana (medicated smoke inhalation) may be given
  4. Light fomentation
  5. Rest; avoid exposure to bright light, cold, dust
  6. Samsarjana Krama (light diet) if part of intensive therapy
Indications:
  • Pittaja Abhishyanda (acute conjunctivitis with burning)
  • Adhi-mantha (glaucoma with burning)
  • Shukta (conjunctivitis with discharge)
  • Early Patalagata Roga
Contraindications: Kaphaja rogas with excessive secretion (drying effect needed instead)

3. PINDI (Pad/Bolus Application over the Eye)

Definition: Application of a medicated bolus (pind = lump/pad) soaked in or prepared from medicinal substances, placed over the closed eyelid.
The word Pindi = a compacted bolus or bundle tied in cloth or leaf.
Types:
  • Vataja Pindi - warm, oily, Vata-shamana herbs
  • Pittaja Pindi - cool, Pitta-shamana herbs (Chandana, Madhuka, etc.)
  • Kaphaja Pindi - warm, Kapha-shamana, sharp herbs
Preparation:
  • Drugs are ground (Kalka) or soaked
  • Tied in clean, thin cloth
  • Bolus is dipped in appropriate medicated liquid before application

Purva Karma (Pre-procedure for Pindi):

  1. Face cleaned; excess secretions removed
  2. Gentle Abhyanga (massage) around eyes
  3. Mild Swedana around periorbital area
  4. Pindi material prepared - herbs selected based on Dosha
  5. Bolus prepared, cloth bound, soaked in warm/cool decoction

Pradhana Karma (Main procedure):

  1. Patient in supine position with eyes gently closed
  2. Pindi (bolus) placed over closed eyelids
  3. Maintained with gentle, uniform pressure - neither too firm nor too loose
  4. Duration: As per Dosha (typically 15-30 minutes; Vata longer, Pitta shorter)
  5. If bolus dries, re-soaked in warm decoction and reapplied
  6. Patient kept comfortable; no movement

Pashchat Karma (Post-procedure):

  1. Pindi removed gently
  2. Eyes cleaned with warm water
  3. Anjana (collyrium) may be applied
  4. Gentle Swedana if required
  5. Rest in dim light
Indications:
  • Swelling of eyelids (Pothaki, Pakshmagata Roga)
  • Timira (early cataract)
  • Vataja Abhishyanda
  • Post-trauma periorbital edema
  • Chronic conjunctivitis

4. VIDALAKA / BIDALAKA (External Paste Application)

Definition: Application of a medicated paste (lepa) over the external surface of the eyelid (not inside the eye). The paste is applied over the closed lids.
Vidalaka = Vi + Dal + aka = that which opens/clears the passages (vilayana/lekhana action)
Difference from Anjana: Anjana is applied inside the conjunctival sac; Vidalaka is applied outside over the lids.
Preparation:
  • Drug is made into a smooth paste (Kalka) using appropriate liquid vehicle
  • Consistency: thick enough to stay on eyelids without dripping
  • Applied at appropriate temperature
Types:
  • Snigdha Vidalaka - oily, for Vataja
  • Ruksha Vidalaka - dry/astringent, for Kaphaja
  • Sheeta Vidalaka - cool, for Pittaja

Purva Karma (Pre-procedure for Vidalaka):

  1. Patient informed; seated or supine position
  2. Eyes and eyelids cleaned
  3. Hair away from forehead (tied)
  4. Mild Abhyanga of lids if required
  5. Paste prepared with fresh drugs

Pradhana Karma (Main procedure):

  1. Patient keeps eyes gently closed
  2. Medicated paste applied uniformly over outer surface of eyelids
  3. Applied from medial to lateral canthus
  4. Thickness: Approximately 1 Angula thick
  5. Duration: Until paste dries or as prescribed (typically 20-30 minutes)
  6. Patient advised not to open eyes during procedure
  7. Paste should not enter the eye

Pashchat Karma (Post-procedure):

  1. Paste removed carefully with clean cloth/cotton
  2. Eye area cleaned with warm water
  3. Anjana applied if needed
  4. Avoid exposure to bright light and dust
  5. Rest
Indications:
  • Kaphaja Abhishyanda (mucopurulent conjunctivitis)
  • Pothaki (trachoma-like conditions)
  • Adimantha (glaucoma - Kaphaja type)
  • Timira (early cataract) - Lekhana type
  • Vataja Vartma (eyelid) disorders
Contraindications: Open wounds on lids, active corneal ulcers

D. SAMYAK YOGA LAKSHANAS (Signs of Proper Application)

ProcedureSamyak Yoga (Proper effect)
AschyotanaClarity of vision, reduced burning/discharge, comfort
SekaAlleviation of burning, comfort, reduced redness
PindiReduction of swelling, pain relief, improved sensation
VidalakaReduction of Kapha secretions, clarity, lids feel lighter

E. RESEARCH UPDATES

1. Aschyotana - Recent Evidence

Study (2025) - Frontiers in Medicine [PMID: 41647025]
  • Sreelekha PS et al., Frontiers in Medicine (2025)
  • A 30-patient, single-arm study in Meibomian Gland Dysfunction (MGD)
  • Protocol: Pratimarsha Nasya (Anu oil) daily for 30 days + Aschyotana with Moringa oleifera leaf drops + Avagundana (warm fomentation with Triphala decoction) for first 15 days
  • Outcomes: OSDI, TBUT, Schirmer's Test I, fluorescein staining, meibomian gland expressibility
  • Results: Significant improvement in all parameters (p < 0.001); fluorescein staining reduced to nil; no adverse effects
  • Conclusion: Simple Ayurvedic regimen including Aschyotana is effective and non-invasive for MGD in primary care settings
  • Limitation: Single-arm, small sample (needs controlled trials)

2. Seka - Research context

  • Seka is functionally comparable to continuous eye irrigation or ocular lavage in modern ophthalmology
  • Used in washout of chemical injuries (emergency irrigation mirrors Seka concept)
  • Recent Ayurveda research uses Triphala Kashaya and Rose water-based Seka in conjunctivitis and dry eye conditions

3. Pindi - Research context

  • Pindi with Avagundana (warm bolus fomentation) is studied in Dry Eye Disease (DED) and MGD
  • The 2025 Frontiers study above used Avagundana (a variant of Pindi technique) as part of the protocol with significant improvement in TBUT and meibomian expressibility

4. Vidalaka - Research context

  • Vidalaka with Kaphahara drugs (e.g., Triphala, Haridra paste) has been studied in trachoma-like conditions
  • Lekhana Vidalaka is compared to lid scrub therapy in blepharitis
  • Proposed mechanism: Bioactive compounds in paste formulations are absorbed transdermally through thin eyelid skin into periorbital tissues

5. Shigru Pallava Eye Drops (Aschyotana-type application) Trial

Protocol [PMID: 40443906]
  • Devarajan D & Rajagopala M, F1000Research (2025)
  • RCT protocol: Shigru Pallava (Moringa oleifera) Arka as topical eye drops (1 drop, 4 times daily) as add-on to standard care in Primary Open-Angle Glaucoma (POAG)
  • Plus Rasayana oral formulation (Rasayana Churna + Saptamrita Lauha + Yashada Bhasma)
  • Primary outcomes: Optic nerve function (visual field, RNFL thickness), IOP
  • CTRI registration: CTRI/2023/06/053681
  • Status: Ongoing recruitment

F. QUICK COMPARISON TABLE: FOUR PROCEDURES

FeatureAschyotanaSekaPindiVidalaka
Form of drugDropsContinuous streamSolid bolus/padPaste
Application siteInside eye (canthus)Over open/closed eyeOver closed lidsOver closed lids
Height2 Angulas2+ AngulasDirect contactDirect contact
Number/quantity10-12 dropsContinuous flow1 bolus1 Angula thick paste
DurationShortModerate15-30 min20-30 min
Contact with globeDirect (cornea/conjunctiva)DirectIndirect (via lids)Indirect (over skin)
Tissue contact timeLeastModerateLongerLongest
Primary actionSamshodhana, ShamanaShamana, SekaStambhana, RopanaLekhana, Ropana
Best forAll Netra Rogas (1st line)Pittaja, burningVataja, swellingKaphaja, secretions

G. NLHT MEANING

NLHT = Netra Loka Hita Tantra or more commonly in the curriculum context:
  • N = Netra (Eye)
  • L = Local (local procedures)
  • H = Hita (therapeutic)
  • T = Tantra (specialty)
In the BAMS syllabus, NLHT 2.1 typically refers to the 2nd year, 1st unit of the Netra Local Hita (treatment) section covering Kriya Kalpa procedures.

Summary Table: Quick Revision

TopicKey Points
ICHD-314 main categories; 3 parts + appendix; Primary (1-4), Secondary (5-12), Neuralgias (13-14)
Migraine criteria5 attacks, 4-72h, 2 of UPMA features, 1 of nausea/photo-phonophobia
TTHBilateral, pressing, mild-moderate, no nausea, <15 days/month (episodic)
TACUnilateral + autonomic; Cluster=longest, SUNCT=shortest, Paroxysmal hemicrania=indomethacin-responsive
Shirorogas dravyasBhringaraja, Dashamula, Pathya, Shirisha for different types; Pathyadi Kwatha, Shirahshooladi Vajra Rasa as key formulations
Aschyotana10-12 drops, 2 Angulas height, inner canthus, 1st line of all Netra Rogas
SekaContinuous stream, 2 Angulas, Pittaja; irrigates and cleanses
PindiBolus over closed lids, 15-30 min, Vataja swelling
VidalakaPaste over lids, Lekhana, Kaphaja, 20-30 min

Sources: ICHD-3 (IHS, Cephalalgia 2018); Sushruta Samhita Uttaratantra; Ashtanga Hridayam Uttaratantra; Bhaisajya Ratnavali; Shalakya Tantra textbooks; WJPSR (2025) Vol 4:1; Frontiers in Medicine (2025) PMID 41647025; F1000Research (2025) PMID 40443906; Saudi Journal of Integrative Traditional MedicineAll three topics are covered above. Here is a quick guide to what you got:

What's included in your notes:
Topic 1 - ICHD-3:
  • Full 3-part classification with all 14 categories
  • Diagnostic criteria for Migraine (1.1, 1.2, 1.3), TTH types, all TACs with distinguishing features
  • All other primary headaches (4.1-4.10)
  • Secondary headaches (5-12) with clinical pearls
  • Cranial neuralgias (13)
  • Ayurvedic correlation table (e.g., Ardhavabhedaka = Migraine, Suryavarta = Cluster headache)
Topic 2 - Shirorogas Dravyas:
  • 17 key single drugs with botanical names, properties, and specific Shiroroga indications
  • Lepas and Tailas with drug names and indications
  • Classical formulations: Rasa Yoga, Kwatha, Ghrita, Churna - with doses, anupana, and references
  • Patent formulations table (Dabur, Baidyanath, Arya Vaidya Sala, Himalaya)
  • Pathyapathya for Shirorogas
Topic 3 - NLHT 2.1 Kriya Kalpa:
  • Ati-yoga and Ayoga features (general + procedure-specific)
  • Samyak Yoga signs
  • Detailed Trividha Karma (Purva/Pradhana/Pashchat) for all four: Aschyotana, Seka, Pindi, Vidalaka
  • Step-by-step procedural notes
  • Comparison table of all four procedures
  • Research updates: 2025 MGD study (PMID 41647025), 2025 Glaucoma RCT protocol (PMID 40443906)

Generate a PPT presentation on these 3 BAMS topics for class delivery

Reading File
Reading File
Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or missing"

Running Command

mkdir -p /home/daytona/workspace/bams-shalakya-ppt

Now I'll write the comprehensive PPT script - a rich, well-designed presentation across all three topics:
Writing File

~/bams-shalakya-ppt/generate.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Shalakya Tantra Department";
pres.title = "BAMS Shalakya Tantra - Shirorogas & Netra Kriya Kalpa";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
// Deep teal/navy academic theme — professional, medical, Ayurvedic warmth
const C = {
  navy:     "0D2B4E",   // dominant dark
  teal:     "0F6B74",   // accent teal
  gold:     "C9922A",   // warm Ayurvedic gold accent
  cream:    "F5EFE0",   // warm cream body bg
  white:    "FFFFFF",
  offwhite: "F0F4F8",
  text:     "1A1A2E",
  subtext:  "3A4A5C",
  lightblue:"D6E8EE",
  palegreen:"D8EFE1",
  palegold: "FDF3DC",
  lightred: "FDECEA",
  darkgold: "A67520",
  teallight:"C5E8EC",
  red:      "C0392B",
  green:    "1A6B3C",
};

// ─── HELPER FUNCTIONS ────────────────────────────────────────────────────────

function sectionDivider(title, subtitle, colorBg, num) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: colorBg } });
  // Decorative top bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.505, w: 10, h: 0.12, fill: { color: C.gold } });
  // Big number
  s.addText(num, {
    x: 0.3, y: 0.8, w: 2, h: 3, fontSize: 110, bold: true, color: C.gold,
    transparency: 60, align: "left", valign: "middle", margin: 0
  });
  // Title
  s.addText(title, {
    x: 2.2, y: 1.5, w: 7.5, h: 1.4, fontSize: 36, bold: true,
    color: C.white, align: "left", valign: "middle", margin: 0,
    charSpacing: 1
  });
  if (subtitle) {
    s.addText(subtitle, {
      x: 2.2, y: 3.0, w: 7.5, h: 0.9, fontSize: 17, color: C.gold,
      align: "left", valign: "top", margin: 0, italic: true
    });
  }
  return s;
}

function titleSlide() {
  const s = pres.addSlide();
  // Full dark bg
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  // Gold band top
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: C.gold } });
  // Teal accent left bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.18, w: 0.06, h: 5.445, fill: { color: C.teal } });
  // Decorative circle bg
  s.addShape(pres.ShapeType.ellipse, { x: 6.5, y: -1, w: 5.5, h: 5.5, fill: { color: C.teal }, line: { color: C.teal } });
  s.addShape(pres.ShapeType.ellipse, { x: 7, y: -0.5, w: 4.5, h: 4.5, fill: { color: C.navy }, line: { color: C.navy } });

  s.addText("SHALAKYA TANTRA", {
    x: 0.5, y: 0.5, w: 9, h: 0.55, fontSize: 13, bold: true, color: C.gold,
    align: "left", charSpacing: 5, margin: 0
  });
  s.addText([
    { text: "Shirorogas & ", options: { color: C.white } },
    { text: "Netra Kriya Kalpa", options: { color: C.gold } }
  ], {
    x: 0.5, y: 1.1, w: 8.5, h: 1.5, fontSize: 38, bold: true,
    align: "left", valign: "middle", margin: 0
  });

  s.addText([
    { text: "Topic 1: ", options: { bold: true, color: C.teallight } },
    { text: "ICHD-3  |  ", options: { color: C.offwhite } },
    { text: "Topic 2: ", options: { bold: true, color: C.teallight } },
    { text: "Dravyas in Shirorogas  |  ", options: { color: C.offwhite } },
    { text: "Topic 3: ", options: { bold: true, color: C.teallight } },
    { text: "NLHT 2.1 – Kriya Kalpa", options: { color: C.offwhite } }
  ], {
    x: 0.5, y: 2.75, w: 9, h: 0.65, fontSize: 13, align: "left", margin: 0
  });

  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 3.55, w: 6.5, h: 0.003, fill: { color: C.teal } });

  s.addText("BAMS Undergraduate  |  Shalakya Tantra (Netra Roga)  |  Academic Year 2025–26", {
    x: 0.5, y: 3.7, w: 9, h: 0.4, fontSize: 11.5, color: C.subtext,
    align: "left", margin: 0, italic: true
  });
  return s;
}

function agendaSlide() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.1, fill: { color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.08, h: 5.625, fill: { color: C.navy } });

  s.addText("CONTENTS", {
    x: 0.4, y: 0.18, w: 9, h: 0.55, fontSize: 11, bold: true, color: C.gold,
    charSpacing: 5, align: "left", margin: 0
  });
  s.addText("What We Cover Today", {
    x: 0.4, y: 0.7, w: 9, h: 0.6, fontSize: 26, bold: true, color: C.navy,
    align: "left", margin: 0
  });

  const items = [
    { num: "01", title: "ICHD-3", sub: "International Classification of Headache Disorders, 3rd Edition — Structure, Primary, Secondary & Neuropathic headaches; Ayurvedic correlation", color: C.navy },
    { num: "02", title: "Dravyas in Shirorogas", sub: "Key single drugs, classical formulations (Rasa Yoga, Kwatha, Ghrita) and patent medicines used in Shirorogas", color: C.teal },
    { num: "03", title: "NLHT 2.1 — Netra Kriya Kalpa", sub: "Ati-yoga & Ayoga; Purva, Pradhana & Pashchat Karma; Detailed procedures + Research updates on Aschyotana, Seka, Pindi & Vidalaka", color: C.gold },
  ];

  items.forEach((it, i) => {
    const y = 1.5 + i * 1.2;
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: y, w: 0.7, h: 0.75, fill: { color: it.color }, radius: 4 });
    s.addText(it.num, { x: 0.4, y: y, w: 0.7, h: 0.75, fontSize: 18, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    s.addText(it.title, { x: 1.25, y: y, w: 8.3, h: 0.32, fontSize: 16, bold: true, color: C.navy, align: "left", valign: "bottom", margin: 0 });
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  });
}

// Slide with header bar + bullet content
function contentSlide(title, topic, bullets, bgColor, accentColor) {
  const s = pres.addSlide();
  bgColor = bgColor || C.white;
  accentColor = accentColor || C.navy;
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: bgColor } });
  // Top header
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: accentColor } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.06, fill: { color: C.gold } });
  s.addText(topic, { x: 0.4, y: 0.07, w: 9, h: 0.3, fontSize: 9, bold: true, color: C.gold, charSpacing: 4, align: "left", margin: 0 });
  s.addText(title, { x: 0.4, y: 0.38, w: 9.2, h: 0.52, fontSize: 22, bold: true, color: C.white, align: "left", valign: "middle", margin: 0 });

  // Bullet items
  const items = bullets.map((b, i) => {
    if (typeof b === "string") {
      return { text: b, options: { bullet: { indent: 20 }, breakLine: i < bullets.length - 1, fontSize: 15, color: C.text, paraSpaceBefore: 4 } };
    } else {
      // { text, sub } for sub-bullet or { heading } for bold heading
      if (b.heading) {
        return { text: b.heading, options: { breakLine: true, bold: true, fontSize: 15, color: accentColor, paraSpaceBefore: 8 } };
      }
      return { text: b.text, options: { bullet: { indent: 20 }, breakLine: true, fontSize: 15, color: C.text, paraSpaceBefore: 3 } };
    }
  });

  s.addText(items, { x: 0.35, y: 1.1, w: 9.3, h: 4.35, align: "left", valign: "top", margin: 8, wrap: true });
  return s;
}

// Two-column slide
function twoColSlide(title, topic, leftTitle, leftItems, rightTitle, rightItems, accentColor) {
  const s = pres.addSlide();
  accentColor = accentColor || C.navy;
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offwhite } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: accentColor } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.06, fill: { color: C.gold } });
  s.addText(topic, { x: 0.4, y: 0.07, w: 9, h: 0.3, fontSize: 9, bold: true, color: C.gold, charSpacing: 4, align: "left", margin: 0 });
  s.addText(title, { x: 0.4, y: 0.38, w: 9.2, h: 0.52, fontSize: 22, bold: true, color: C.white, align: "left", valign: "middle", margin: 0 });

  // Left col
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.1, w: 4.5, h: 4.3, fill: { color: C.white }, line: { color: accentColor, width: 1.5 } });
  s.addText(leftTitle, { x: 0.3, y: 1.1, w: 4.5, h: 0.45, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", margin: 0,
    fill: { color: accentColor } });
  const lItems = leftItems.map((b, i) => ({
    text: b, options: { bullet: { indent: 12 }, breakLine: i < leftItems.length - 1, fontSize: 13, color: C.text, paraSpaceBefore: 4 }
  }));
  s.addText(lItems, { x: 0.45, y: 1.6, w: 4.2, h: 3.6, align: "left", valign: "top", margin: 4, wrap: true });

  // Right col
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  s.addText(rightTitle, { x: 5.2, y: 1.1, w: 4.5, h: 0.45, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", margin: 0,
    fill: { color: accentColor } });
  const rItems = rightItems.map((b, i) => ({
    text: b, options: { bullet: { indent: 12 }, breakLine: i < rightItems.length - 1, fontSize: 13, color: C.text, paraSpaceBefore: 4 }
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  return s;
}

// Table slide
function tableSlide(title, topic, headers, rows, accentColor) {
  const s = pres.addSlide();
  accentColor = accentColor || C.navy;
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: accentColor } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.06, fill: { color: C.gold } });
  s.addText(topic, { x: 0.4, y: 0.07, w: 9, h: 0.3, fontSize: 9, bold: true, color: C.gold, charSpacing: 4, align: "left", margin: 0 });
  s.addText(title, { x: 0.4, y: 0.38, w: 9.2, h: 0.52, fontSize: 22, bold: true, color: C.white, align: "left", valign: "middle", margin: 0 });

  const tableData = [
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    ...rows.map((row, ri) => row.map(cell => ({
      text: cell,
      options: { fontSize: 11, color: C.text, fill: ri % 2 === 0 ? C.white : C.offwhite, align: "left" }
    })))
  ];
  s.addTable(tableData, {
    x: 0.25, y: 1.1, w: 9.5,
    border: { type: "solid", color: "CCCCCC", pt: 0.5 },
    rowH: 0.38,
    fontFace: "Calibri"
  });
  return s;
}

// Procedure step slide (numbered steps in boxes)
function procedureSlide(title, topic, stepGroups, accentColor) {
  const s = pres.addSlide();
  accentColor = accentColor || C.teal;
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.offwhite } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: accentColor } });
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  // stepGroups: [{label, items:[...]}] — 3 columns
  stepGroups.forEach((grp, gi) => {
    const x = 0.25 + gi * 3.2;
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    s.addText(grp.label, { x, y: 1.08, w, h: 0.48, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
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      text: `${i+1}.  ${it}`,
      options: { breakLine: i < grp.items.length - 1, fontSize: 12.5, color: C.text, paraSpaceBefore: 5 }
    }));
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    s.addText(txtItems, { x: x + 0.12, y: 1.65, w: w - 0.2, h: 3.7, align: "left", valign: "top", margin: 6, wrap: true });
  });
  return s;
}

// ─── TITLE ────────────────────────────────────────────────────────────────────
titleSlide();
agendaSlide();

// ═════════════════════════════════════════════════════════════════════════════
// TOPIC 1: ICHD-3
// ═════════════════════════════════════════════════════════════════════════════
sectionDivider("ICHD-3", "International Classification of Headache Disorders, 3rd Edition", C.navy, "1");

// Slide: Overview
contentSlide(
  "Introduction to ICHD-3", "TOPIC 1 — ICHD-3",
  [
    { heading: "What is ICHD-3?" },
    "Published in January 2018 in Cephalalgia by the International Headache Society (IHS)",
    "3rd edition — replaces ICHD-2 (2004) and ICHD-3β (2013)",
    "Globally accepted diagnostic & classification system for ALL headache disorders",
    "Evidence-based; previous editions were primarily expert-opinion-based",
    { heading: "Structure" },
    "14 main categories arranged in 3 Parts + Appendix",
    "Uses hierarchical alphanumeric coding (e.g., 1.1, 1.2.3.1.2)",
    "Diagnosis = meeting defined criteria for number, duration, character, associated features",
    { heading: "Relevance to Shalakya Tantra" },
    "Headaches = major subset of Shirorogas — ICHD-3 provides modern differential diagnosis framework",
    "11 Shirorogas described by Sushruta map well to ICHD-3 categories",
  ],
  C.white, C.navy
);

// Slide: 3-Part Structure
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  s.addText("ICHD-3 Overall Structure", { x: 0.4, y: 0.38, w: 9.2, h: 0.52, fontSize: 22, bold: true, color: C.white, align: "left", valign: "middle", margin: 0 });

  const parts = [
    { label: "Part I", title: "Primary Headaches", color: C.navy, items: ["1. Migraine", "2. Tension-type headache", "3. Trigeminal autonomic cephalalgias (TACs)", "4. Other primary headaches"] },
    { label: "Part II", title: "Secondary Headaches", color: C.teal, items: ["5–12. Headaches attributed to another condition (trauma, vascular, infection, drugs, homeostasis, etc.)"] },
    { label: "Part III", title: "Neuropathies & Facial Pain", color: C.gold, items: ["13. Cranial neuralgias & facial pain", "14. Other headache disorders"] },
  ];
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// Slide: Migraine - Criteria
contentSlide(
  "1. Migraine — Diagnostic Criteria", "TOPIC 1 — ICHD-3",
  [
    { heading: "1.1  Migraine Without Aura  (≥5 attacks fulfilling B–D)" },
    "B. Duration 4–72 hours (untreated or unsuccessfully treated)",
    "C. ≥2 of: Unilateral | Pulsating | Moderate/severe intensity | Aggravated by routine activity",
    "D. ≥1 of: Nausea/vomiting | Photophobia + Phonophobia (both)",
    "E. Not better accounted for by another ICHD-3 diagnosis",
    { heading: "1.2  Migraine With Aura  (≥2 attacks with aura)" },
    "Aura = reversible focal neurological symptom(s) lasting 5–60 min (usually visual, sensory, speech)",
    "1.2.1 Typical aura  |  1.2.2 Brainstem aura  |  1.2.3 Hemiplegic  |  1.2.4 Retinal",
    { heading: "1.3  Chronic Migraine" },
    "Headache ≥15 days/month for >3 months; ≥8 days/month meeting migraine criteria",
    { heading: "1.4  Complications of Migraine" },
    "Status migrainosus (>72h)  |  Persistent aura without infarction  |  Migrainous infarction  |  Migralepsy",
  ],
  C.white, C.navy
);

// Slide: Migraine subtypes table
tableSlide(
  "Migraine — Subtypes at a Glance", "TOPIC 1 — ICHD-3",
  ["Code", "Type", "Key Feature"],
  [
    ["1.1", "Migraine without aura", "Most common; no neurological aura; POUND criteria"],
    ["1.2.1", "Typical aura with / without headache", "Visual scintillations, scotoma, sensory symptoms"],
    ["1.2.2", "Brainstem aura", "Dysarthria, vertigo, tinnitus, diplopia, ataxia"],
    ["1.2.3.1", "Familial hemiplegic migraine", "Motor aura; autosomal dominant; CACNA1A, ATP1A2 genes"],
    ["1.2.3.2", "Sporadic hemiplegic migraine", "Same as FHM without family history"],
    ["1.2.4", "Retinal migraine", "Monocular visual symptoms; fundoscopic changes"],
    ["1.3", "Chronic migraine", "≥15 days/month, ≥8 migraine days/month"],
    ["1.6.2", "Benign paroxysmal vertigo", "Episodic vertigo in children; migraine precursor"],
    ["A1.6.6", "Vestibular migraine (Appendix)", "Vestibular symptoms + migraine history"],
  ],
  C.navy
);

// Slide: TTH
contentSlide(
  "2. Tension-type Headache (TTH)", "TOPIC 1 — ICHD-3",
  [
    { heading: "Characteristics (contrast with migraine)" },
    "Bilateral location (not unilateral)",
    "Pressing / tightening quality (NOT pulsating)",
    "Mild to moderate intensity",
    "NOT aggravated by routine physical activity",
    "NO nausea or vomiting",
    "Photophobia OR phonophobia (not both simultaneously)",
    { heading: "Classification by Frequency" },
    "2.1  Infrequent episodic TTH — <1 day/month  (<12 days/year)",
    "2.2  Frequent episodic TTH — 1–14 days/month for >3 months",
    "2.3  Chronic TTH — ≥15 days/month for >3 months (>180 days/year)",
    "2.4  Probable TTH — meets all but one criterion",
    { heading: "Ayurvedic Correlation" },
    "Vataja Shiroroga — stress (Shoka, Bhaya, Trasa) as triggering factors",
  ],
  C.white, C.navy
);

// Slide: TACs
tableSlide(
  "3. Trigeminal Autonomic Cephalalgias (TACs)", "TOPIC 1 — ICHD-3",
  ["Type", "Duration / Attack", "Frequency", "Key Feature"],
  [
    ["3.1 Cluster Headache", "15–180 min", "1–8 per day (cluster period)", "Nocturnal; restlessness; M > F; ipsilateral autonomic features"],
    ["3.1.1 Episodic Cluster", "Cluster period then remission", "Remission >3 months", "Most common cluster type"],
    ["3.1.2 Chronic Cluster", "No remission > 3 months", "Continuous cluster periods", "Difficult to treat"],
    ["3.2 Paroxysmal Hemicrania", "2–30 min", ">5/day", "ABSOLUTE RESPONSE TO INDOMETHACIN"],
    ["3.3.1 SUNCT", "5–240 sec", "3–200/day", "Conjunctival injection + Tearing = hallmark"],
    ["3.3.2 SUNA", "5–240 sec", "1–200/day", "Cranial autonomic features but not SUNCT-specific"],
    ["3.4 Hemicrania Continua", "Continuous (baseline)", "With exacerbations", "Continuous unilateral; INDOMETHACIN-RESPONSIVE"],
    ["3.5 Probable TAC", "Meets most criteria", "—", "Awaiting confirmation diagnosis"],
  ],
  C.navy
);

// Slide: Other Primary Headaches
tableSlide(
  "4. Other Primary Headache Disorders", "TOPIC 1 — ICHD-3",
  ["Code", "Disorder", "Key Trigger / Feature"],
  [
    ["4.1", "Primary Cough Headache", "Cough, Valsalva; bilateral, short duration"],
    ["4.2", "Primary Exercise Headache", "Physical exertion; bilateral, pulsating"],
    ["4.3", "Primary Headache with Sexual Activity", "During or before orgasm"],
    ["4.4", "Primary Thunderclap Headache", "Peak intensity in <1 minute; rule out SAH"],
    ["4.7", "Primary Stabbing Headache", "Jabbing stabs, multiple locations, seconds"],
    ["4.8", "Nummular Headache", "Coin-shaped 1–6 cm area; round/elliptical on scalp"],
    ["4.9", "Hypnic Headache", "ONLY during sleep; wakens patient; ≥10 days/month"],
    ["4.10", "New Daily Persistent Headache", "New onset, unremitting from day 3; no prior history"],
  ],
  C.navy
);

// Slide: Secondary Headaches
contentSlide(
  "Part II: Secondary Headaches (5–12) — Overview", "TOPIC 1 — ICHD-3",
  [
    { heading: "Category 5 — Trauma/Injury" },
    "Acute post-traumatic (within 7 days) vs Persistent (>3 months) | Whiplash headache",
    { heading: "Category 6 — Vascular" },
    "SAH = 'thunderclap' / worst headache of life | Giant cell arteritis = temporal + jaw claudication | CVT",
    { heading: "Category 7 — Non-vascular Intracranial" },
    "IIH (raised ICP, papilloedema) | Low CSF pressure (orthostatic) | Neoplasm",
    { heading: "Category 8 — Substance & Withdrawal" },
    "MOH (Medication Overuse Headache) — analgesic/triptan >10–15 days/month for >3 months",
    "Caffeine withdrawal | Alcohol | NO donors | CGRP-induced",
    { heading: "Category 10 — Homeostasis" },
    "Hypertensive crisis | Fasting headache | Hypothyroidism",
    { heading: "Category 11 — Cranial Structures (Shalakya relevance!)" },
    "11.3.1 Acute angle-closure glaucoma | 11.3.2 Refractive error | Sinusitis | TMJ",
  ],
  C.white, C.navy
);

// Slide: Part III + Ayurvedic Correlation
twoColSlide(
  "Part III + Ayurvedic Correlation", "TOPIC 1 — ICHD-3",
  "Part III: Neuralgias & Facial Pain",
  [
    "13.1 Trigeminal neuralgia",
    "  - Classical (vascular compression)",
    "  - Post-herpetic neuralgia",
    "  - Idiopathic",
    "13.2 Glossopharyngeal neuralgia",
    "13.7 Occipital neuralgia",
    "13.10 Persistent idiopathic facial pain (PIFP)",
    "13.12 Burning mouth syndrome",
    "",
    "14. Other (unclassified, unspecified)",
  ],
  "ICHD-3 ↔ Ayurveda Correlation",
  [
    "Migraine w/o aura → Ardhavabhedaka",
    "Migraine w/ aura → Ardhavabhedaka (Pittaja-Vataja)",
    "Cluster headache → Suryavarta",
    "Tension-type headache → Vataja Shiroroga",
    "Hemicrania continua → Anantavata",
    "New daily persistent HA → Sannipataja Shiroroga",
    "Trigeminal neuralgia → Shankhaka",
    "Thunderclap / SAH → Shankhaka (acute)",
    "Krimija Shiroroga → Infection-related HA (Cat 9)",
  ],
  C.navy
);

// ═════════════════════════════════════════════════════════════════════════════
// TOPIC 2: DRAVYAS IN SHIROROGAS
// ═════════════════════════════════════════════════════════════════════════════
sectionDivider("DRAVYAS IN SHIROROGAS", "Classical & Patent Formulations", C.teal, "2");

// Slide: 11 Shirorogas
contentSlide(
  "Sushruta's 11 Shirorogas", "TOPIC 2 — DRAVYAS IN SHIROROGAS",
  [
    { heading: "Nidana (Causes)" },
    "Vegavidarana (suppression of urges), Ruksha Ahara, Ratri Jagarana",
    "Pratataekshana (prolonged downward gaze), mental stress, cold/wind exposure",
    { heading: "11 Types (Su.Ut.26)" },
    "1. Vataja Shiroroga    2. Pittaja Shiroroga    3. Kaphaja Shiroroga",
    "4. Sannipataja Shiroroga    5. Raktaja Shiroroga    6. Krimija Shiroroga",
    "7. Suryavarta    8. Anantavata    9. Ardhavabhedaka",
    "10. Shankhaka    11. Shayyarogas (some texts)",
    { heading: "General Chikitsa Upakrama" },
    "Snehana, Swedana, Nasya, Dhoomapana, Virechana, Vamana, Lepa, Shirobasti, Raktamokshana",
  ],
  C.white, C.teal
);

// Slide: Key Single Drugs Table
tableSlide(
  "Key Single Dravyas in Shirorogas", "TOPIC 2 — DRAVYAS IN SHIROROGAS",
  ["Dravya", "Botanical Name", "Properties", "Indication"],
  [
    ["Bhringaraja", "Eclipta alba", "Keshya, Rasayana, Vata-Kapha shamaka", "Suryavarta (swaras + goat milk)"],
    ["Pathya (Haritaki)", "Terminalia chebula", "Tridoshahara, Rasayana, Deepaniya", "All Shirorogas"],
    ["Shirisha", "Albizia lebbeck", "Vishaghna, Krimighna", "Ardhavabhedaka, Shankhaka"],
    ["Dashamula", "10 roots", "Vataghna, Shothahara, Brimhana", "Vataja, Ardhavabhedaka"],
    ["Ashwagandha", "Withania somnifera", "Vataghna, Balya, Rasayana", "Vataja Shiroroga"],
    ["Vidanga", "Embelia ribes", "Krimighna, Kaphahara", "Krimija, Ardhavabhedaka"],
    ["Guduchi", "Tinospora cordifolia", "Tridoshahara, Rasayana, Jwaraghna", "All types"],
    ["Ushira", "Vetiveria zizanioides", "Pittahara, Sheetala, Dahnashaka", "Pittaja Shiroroga"],
    ["Shunthi", "Zingiber officinale", "Vata-Kaphahara, Deepana", "Vataja, Kaphaja Shiroroga"],
    ["Shigru Beeja", "Moringa oleifera", "Krimighna, Kaphahara", "Krimija Shiroroga"],
  ],
  C.teal
);

// Slide: Dravya groups
twoColSlide(
  "Lepa & Taila Dravyas in Shirorogas", "TOPIC 2 — DRAVYAS IN SHIROROGAS",
  "Shirolepa (External Head Pastes)",
  [
    "Kumkum Ghrita Lepa — Pittaja (burning)",
    "Sarvadi Lepa — General Shiroroga",
    "Chandanadi Lepa — Chandana + Madhuka + Ushira — Pittaja (burning HA)",
    "Satavaryadi Lepa — Pittaja, Vataja",
    "Suryavartabeeja Lepa — Suryavarta",
    "Bhringaraja Lepa — Vataja, Suryavarta",
  ],
  "Shiroabhyanga Tailas (Head Massage Oils)",
  [
    "Ksheerabala Taila — Vataja (also Nasya)",
    "Dashamula Taila — Vataja, Kaphaja",
    "Rasnadi Taila — Vataja",
    "Baladi Taila — Vataja",
    "Trivrit Taila — Pittaja, Raktaja",
    "Mahamayura Ghrita — Vataja, complex cases",
    "Narayana Taila — Vataja (also Nasya)",
  ],
  C.teal
);

// Slide: Classical Rasa Yoga Table
tableSlide(
  "Classical Formulations — Rasa Yoga (Herbo-Mineral)", "TOPIC 2 — DRAVYAS IN SHIROROGAS",
  ["Formulation", "Key Ingredients", "Dose & Anupana", "Indication"],
  [
    ["Shirahshooladi Vajra Rasa", "Vajra bhasma, Suta, Gandhaka", "125–250 mg; Honey", "Ardhavabhedaka, Suryavarta, severe HA"],
    ["Sutashekhara Rasa", "Shankha bhasma, Svarna gairika, Shunthi, Nagavalli svarasa", "250 mg; Honey", "Pittaja Shiro-shoola + gastric disturbances"],
    ["Godanti Bhasma", "Godanti (calcium sulfate/gypsum)", "250 mg; Honey/water", "Pittaja Shiroroga, migraine-type"],
    ["Chandrakanta Rasa", "Compound rasa with Chandrakanta mani", "125–250 mg; Milk", "Pittaja, Suryavarta"],
    ["Mahalakshmi Vilas Rasa", "Suvarna bhasma-based complex", "125 mg; Honey/milk", "Tridoshaja, chronic Shirorogas"],
    ["Shirovajra Rasa", "Vajra bhasma-based compound", "125–250 mg; Honey", "Vataja severe Shiroroga"],
    ["Swashakuthara Rasa", "Compound", "125 mg; Honey", "Pitta Shiroroga"],
  ],
  C.teal
);

// Slide: Kwatha + Ghrita
twoColSlide(
  "Classical Formulations — Kwatha & Ghrita", "TOPIC 2 — DRAVYAS IN SHIROROGAS",
  "Kwatha (Decoctions) — Dose: 20–40 ml",
  [
    "Pathyadi Kwatha:",
    "  Pathya, Nimba, Guduchi, Haridra, Amalaki",
    "  Indication: Ardhavabhedaka, Vataja-Pittaja; Rakta prasadaka",
    "  Reference: WJPR (2025)",
    "",
    "Dashamoola Kwatha:",
    "  All 10 roots",
    "  Indication: Vataja, Ardhavabhedaka",
    "",
    "Mahamanjishthadi Kwatha:",
    "  Manjishtha + compound",
    "  Indication: Raktaja Shiroroga",
  ],
  "Ghrita (Medicated Clarified Butter) — Dose: 10–20 ml",
  [
    "Mahamayura Ghrita — Vataja; Nasya",
    "Ksheerabala Taila (also Ghrita) — Vataja; Nasya",
    "Panchatikta Ghrita — Krimija, Kshayaja",
    "Triphala Ghrita — General + Netra Roga",
    "Ksharpi (purified ghee) + Vatanashaka dravyas — Kshayaja Shiroroga",
    "Brahmi Ghrita — Psychogenic headache",
    "",
    "Nasya Tailas:",
    "Anu Taila — All Shirorogas (Pratimarsha/Marsha Nasya)",
    "Shadbindu Taila — Vataja, Kaphaja",
  ],
  C.teal
);

// Slide: Patent Medicines
tableSlide(
  "Patent Formulations — Common OTC/Clinical Products", "TOPIC 2 — DRAVYAS IN SHIROROGAS",
  ["Patent Medicine", "Manufacturer", "Key Ingredients", "Indication"],
  [
    ["Pathyadi Kwatha (ready)", "Arya Vaidya Sala / Dabur", "Pathya, Nimba, Guduchi", "Ardhavabhedaka, migraine"],
    ["Godanti Bhasma (patent)", "Dabur, Baidyanath", "Godanti (calcium sulfate)", "Pittaja Shiroroga, migraine"],
    ["Sutashekhara Rasa", "Dabur, AVS", "Compound herbo-mineral", "Pittaja, chronic headache"],
    ["Ksheerabala 101", "Arya Vaidya Sala", "Bala + milk processed oil (101x)", "Vataja Shiroroga; Nasya"],
    ["Brihat Vata Chintamani Rasa", "Dabur", "Suvarna, Vata-hara compound", "Vataja chronic Shiroroga"],
    ["Mahalakshmi Vilas Rasa", "Baidyanath", "Suvarna bhasma based", "Tridoshaja Shiroroga"],
    ["Brahmi Ghrita (patent)", "Dabur, Baidyanath", "Brahmi + compound", "Psychogenic/stress headache"],
    ["Anu Taila (patent)", "Multiple", "Multi-herb oil", "Nasya in all Shirorogas"],
    ["Bhringraja Taila", "Dabur / Himalaya", "Bhringaraja extract", "Vataja, hair loss + HA"],
  ],
  C.teal
);

// Slide: Pathyapathya
twoColSlide(
  "Pathyapathya in Shirorogas", "TOPIC 2 — DRAVYAS IN SHIROROGAS",
  "Pathya (Beneficial)",
  [
    "Old ghee, Shali rice, Shashtika shali",
    "Yusha (soups), milk, Dhanvamamsa",
    "Vegetables: Patola, Shigru, Vastuka, Karvellaka",
    "Fruits: Amalaki, Dadima, Matulunga, lemon, grapes, coconut",
    "Liquids: Coconut water, Kanji, Takra (buttermilk)",
    "Adequate sleep, stress-free routine",
    "Avoidance of Vega-dharana",
  ],
  "Apathya (to Avoid)",
  [
    "Vegadharana — sneezing, yawning, sleep, lacrimation",
    "Cold drinks, Dahi, Lassi, ice cream",
    "Kaphavardhaka heavy diet",
    "Excessive screen exposure (Pratataekshana)",
    "Cold wind, direct sunlight",
    "Emotional stress (Shoka, Bhaya, Trasa)",
    "Irregular dietary habits",
    "Alcohol, tamasic diet",
  ],
  C.teal
);

// ═════════════════════════════════════════════════════════════════════════════
// TOPIC 3: NLHT 2.1 — NETRA KRIYA KALPA
// ═════════════════════════════════════════════════════════════════════════════
sectionDivider("NLHT 2.1 — NETRA KRIYA KALPA", "Ati-yoga · Ayoga · Purva · Pradhana · Pashchat Karma\nAschyotana · Seka · Pindi · Vidalaka", C.gold, "3");

// Slide: Overview of Netra Kriya Kalpa
contentSlide(
  "Netra Kriya Kalpa — Introduction", "TOPIC 3 — NLHT 2.1",
  [
    { heading: "Definition" },
    "Kriya = Chikitsa (treatment)  |  Kalpa = Vidhi (method / procedure)",
    "Local therapeutic procedures applied directly to the eye for Netra Roga management",
    { heading: "Seven Main Kriya Kalpas" },
    "1. Aschyotana (eye drops)      2. Seka (continuous stream)",
    "3. Tarpana (oleation filling)   4. Putapaka (filtered meat/herb juice)",
    "5. Anjana (collyrium)           6. Pindi (bolus application)",
    "7. Vidalaka / Bidalaka (paste on eyelids)",
    { heading: "Texts that mention them" },
    "All 7 in: Sushruta Samhita, Ashtanga Hridayam, Bhavaprakasha",
    "Charaka Samhita mentions: Aschyotana, Anjana, Bidalaka",
    { heading: "General Principle" },
    "All Kriya Kalpas follow Trividha Karma: Purva → Pradhana → Pashchat",
  ],
  C.white, C.darkgold
);

// Slide: Ati-yoga and Ayoga
twoColSlide(
  "Ati-yoga & Ayoga of Kriya Kalpa", "TOPIC 3 — NLHT 2.1",
  "Ati-yoga (Over-Treatment / Excess)",
  [
    "Excessive dryness (Rukshata) of the eye",
    "Burning sensation (Daha)",
    "Conjunctival congestion, redness",
    "Watering (Ashru srava)",
    "Photophobia",
    "Inflammation, swelling",
    "Reduced visual acuity",
    "",
    "Specific — Tarpana ati-yoga:",
    "  Alasya, heaviness, reduced near vision",
    "Anjana ati-yoga:",
    "  Excessive tearing, burning, photophobia",
  ],
  "Ayoga (Under-Treatment / Deficiency)",
  [
    "Disease not cured — Dosha NOT expelled",
    "Persistence of original symptoms",
    "Mild or no therapeutic effect",
    "No improvement in signs",
    "",
    "Samyak Yoga (Optimal application):",
    "  ✔ Original symptoms disappear",
    "  ✔ No new complications arise",
    "  ✔ Eye feels clear and comfortable",
    "  ✔ Visual clarity restored",
    "  ✔ Patient feels relief",
  ],
  C.darkgold
);

// Slide: Trividha Karma Framework
{
  const s = pres.addSlide();
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  const stages = [
    { label: "PURVA KARMA", sub: "Pre-Procedure", color: C.teal, items: [
      "Inform the patient about procedure",
      "Patient positioned in supine in Kriyakalpa theatre",
      "Face and eye area cleaned gently",
      "Remove excess secretions with cotton",
      "Mild Abhyanga (oil massage) of periorbital area",
      "Swedana (mild fomentation) if indicated",
      "Prepare the dravya (drug)",
      "Purpose: Mobilize doshas, prepare eye tissues",
    ]},
    { label: "PRADHANA KARMA", sub: "Main Procedure", color: C.darkgold, items: [
      "Actual therapeutic application",
      "Specific technique per Kriya Kalpa",
      "Physician observes Samyak Yoga signs",
      "Correct height, quantity, temperature",
      "Duration as per dosha and disease",
      "Patient remains still and comfortable",
    ]},
    { label: "PASHCHAT KARMA", sub: "Post-Procedure", color: C.navy, items: [
      "Wipe excess liquid/paste with clean cotton",
      "Gentle Swedana over closed eyelids (if applicable)",
      "Anjana applied if indicated",
      "Dhoomapana (medicated smoke) — for some",
      "Rest in dim, dust-free environment",
      "Avoid cold wind, bright light, rubbing",
      "Samsarjana Krama (light diet) for intensive therapies",
    ]},
  ];

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// ── ASCHYOTANA ────────────────────────────────────────────────────────────────
contentSlide(
  "Aschyotana — Eye Drop Instillation", "TOPIC 3 — NLHT 2.1",
  [
    { heading: "Definition & Etymology" },
    "Procedure where medicine is instilled DROP BY DROP into the eye",
    "Aa + Shchyu + Ta + Lyu = 'Samyak Ksharana Sheela' (continuous dripping)",
    "Aadya Upakrama — FIRST LINE of treatment in ALL Netra Rogas (Su.Su. 23/1)",
    { heading: "Types (Sushruta)" },
    "Snehana — oily; for Vataja    |    Lekhana — drying; for Kaphaja    |    Ropana — healing; for Pittaja",
    { heading: "Dravyas Used" },
    "Swarasa (fresh juice), Kashaya (decoction), Ksheera, Hima, Phanta, Ghrita",
    { heading: "Key Parameters" },
    "Height: 2 Angulas above eye   |   Site: Kaninika Sandhi (inner canthus)",
    "Drops: 10–12 per eye   |   Physician uses left hand to hold lids, right hand to instill",
    { heading: "Indications" },
    "All conjunctivitis types (Abhishyanda), Ashru srava, early Timira, Shukra (corneal ulcer), Blepharitis",
  ],
  C.white, C.darkgold
);

procedureSlide(
  "Aschyotana — Step-by-Step Procedure", "TOPIC 3 — NLHT 2.1",
  [
    {
      label: "PURVA KARMA", items: [
        "Inform patient about procedure",
        "Supine position in Kriyakalpa theatre",
        "Clean face and remove eye secretions",
        "Prepare Aschyotana dravya (drops)",
        "Mild swedan if Vataja condition",
      ]
    },
    {
      label: "PRADHANA KARMA", items: [
        "Hold lids open with LEFT hand",
        "Dropper/bowl in RIGHT hand",
        "Height: 2 Angulas from eye",
        "Instill at KANINIKA SANDHI (inner canthus)",
        "10–12 drops per eye",
        "Patient blinks gently to distribute",
      ]
    },
    {
      label: "PASHCHAT KARMA", items: [
        "Wipe outflowing fluid with cotton",
        "Apply Mrudu Sweda (warm fomentation) over closed lids",
        "Rest for a few minutes",
        "Avoid rubbing, cold wind, bright light",
        "Observe for Samyak Yoga signs",
      ]
    }
  ],
  C.darkgold
);

// ── SEKA ──────────────────────────────────────────────────────────────────────
contentSlide(
  "Seka — Continuous Stream over the Eye", "TOPIC 3 — NLHT 2.1",
  [
    { heading: "Definition" },
    "Continuous, uninterrupted STREAM (Dhara) of medicated liquid poured over the eye",
    "Stream is thin, uniform, and continuous — 'Rohitaksha Pramana'",
    { heading: "Types" },
    "Vataja Seka — warm oily preparation    |    Pittaja Seka — cool, sweet preparations",
    "Kaphaja Seka — warm, pungent-sharp preparations",
    { heading: "Vessels" },
    "Kumbha (pot), Pana Patra, specially made Seka Patra",
    { heading: "Key Parameters" },
    "Height: 2+ Angulas from eye   |   Direction: Inner to outer canthus (Kaninika → Apanga Sandhi)",
    "Duration: Until Samyak Yoga signs appear   |   Liquid may be recollected and reapplied",
    { heading: "Indications" },
    "Pittaja Abhishyanda (burning conjunctivitis), Adimantha (glaucoma-burning), Shukta, early Patalagata Roga",
    { heading: "Contraindications" },
    "Kaphaja Roga with excess secretion (drying effect needed instead of wetting)",
  ],
  C.white, C.darkgold
);

procedureSlide(
  "Seka — Step-by-Step Procedure", "TOPIC 3 — NLHT 2.1",
  [
    {
      label: "PURVA KARMA", items: [
        "Inform patient; supine position",
        "Clean eye area",
        "Mild oleation (Snehana) of eyelid margins",
        "Mild Swedana if Vataja/Kaphaja",
        "Prepare medicated liquid at appropriate temperature",
        "Tray placed below to collect drainage",
      ]
    },
    {
      label: "PRADHANA KARMA", items: [
        "Eyes open or closed (per indication)",
        "Pour as thin, UNINTERRUPTED DHARA",
        "Direction: Kaninika → Apanga Sandhi",
        "Maintain uniform height and flow",
        "Continue until Samyak Yoga",
        "Liquid collected and can be reused",
      ]
    },
    {
      label: "PASHCHAT KARMA", items: [
        "Wipe excess liquid with cotton",
        "Gentle massage of eyelids",
        "Dhoomapana may be given",
        "Light fomentation if required",
        "Rest; avoid cold, dust, bright light",
        "Samsarjana Krama if intensive therapy",
      ]
    }
  ],
  C.darkgold
);

// ── PINDI ──────────────────────────────────────────────────────────────────────
contentSlide(
  "Pindi — Medicated Bolus Application", "TOPIC 3 — NLHT 2.1",
  [
    { heading: "Definition" },
    "Application of a medicated BOLUS (Pind = compacted lump/bundle) over the closed eyelid",
    "Bolus prepared from medicinal substances tied in clean thin cloth",
    { heading: "Types" },
    "Vataja Pindi — warm, oily Vata-shamana herbs",
    "Pittaja Pindi — cool Pitta-shamana herbs (Chandana, Madhuka)",
    "Kaphaja Pindi — warm, pungent Kapha-shamana herbs",
    { heading: "Preparation" },
    "Drugs ground (Kalka) or soaked → tied in thin clean cloth → dipped in warm/cool decoction before use",
    { heading: "Key Parameters" },
    "Eyes CLOSED throughout    |    Bolus: gentle uniform pressure — not too tight, not loose",
    "Duration: 15–30 min (Vata = longer; Pitta = shorter)    |    Re-soak if bolus dries",
    { heading: "Indications" },
    "Eyelid swelling (Pothaki), early Timira, Vataja Abhishyanda, periorbital edema, chronic conjunctivitis",
  ],
  C.white, C.darkgold
);

procedureSlide(
  "Pindi — Step-by-Step Procedure", "TOPIC 3 — NLHT 2.1",
  [
    {
      label: "PURVA KARMA", items: [
        "Inform patient; supine position",
        "Face cleaned; secretions removed",
        "Gentle Abhyanga around eyes",
        "Mild Swedana to periorbital area",
        "Prepare Pindi — select herbs per dosha",
        "Tie bolus in clean cloth; soak in warm/cool decoction",
      ]
    },
    {
      label: "PRADHANA KARMA", items: [
        "Patient eyes GENTLY CLOSED",
        "Place Pindi over closed eyelids",
        "Apply gentle, uniform pressure",
        "Duration: 15–30 min",
        "Re-soak in decoction if bolus dries",
        "Patient remains still and comfortable",
      ]
    },
    {
      label: "PASHCHAT KARMA", items: [
        "Remove Pindi gently",
        "Clean eyes with warm water",
        "Anjana (collyrium) applied if indicated",
        "Gentle Swedana if required",
        "Rest in dim light",
        "Avoid bright light and dust",
      ]
    }
  ],
  C.darkgold
);

// ── VIDALAKA ──────────────────────────────────────────────────────────────────
contentSlide(
  "Vidalaka / Bidalaka — External Paste Application", "TOPIC 3 — NLHT 2.1",
  [
    { heading: "Definition" },
    "Application of medicated PASTE (Lepa) over the EXTERNAL surface of the eyelid (not inside eye)",
    "Vi + Dal + aka = 'that which clears passages' — primarily Lekhana (scraping/drying) action",
    { heading: "Difference from Anjana" },
    "Anjana → applied INSIDE conjunctival sac   |   Vidalaka → applied OUTSIDE over closed lids",
    { heading: "Types" },
    "Snigdha Vidalaka — oily, Vataja    |    Ruksha Vidalaka — astringent/dry, Kaphaja",
    "Sheeta Vidalaka — cool, Pittaja",
    { heading: "Key Parameters" },
    "Eyes CLOSED   |   Thickness: ~1 Angula   |   Duration: 20–30 min (until paste dries)",
    "Paste must NOT enter the eye   |   Consistency: thick enough to stay on lids",
    { heading: "Indications" },
    "Kaphaja Abhishyanda (mucopurulent), Pothaki (trachoma), Adimantha-Kaphaja, early Timira (Lekhana), Vartma disorders",
    { heading: "Contraindications" },
    "Open wounds on lids, active corneal ulcers, severe inflammation",
  ],
  C.white, C.darkgold
);

procedureSlide(
  "Vidalaka — Step-by-Step Procedure", "TOPIC 3 — NLHT 2.1",
  [
    {
      label: "PURVA KARMA", items: [
        "Inform patient; seated or supine",
        "Clean eyes and eyelids",
        "Hair tied away from forehead",
        "Mild Abhyanga of lids if required",
        "Prepare fresh paste (Kalka) from selected drugs",
        "Ensure appropriate temperature and consistency",
      ]
    },
    {
      label: "PRADHANA KARMA", items: [
        "Patient eyes GENTLY CLOSED",
        "Apply paste uniformly over outer lids",
        "Apply from MEDIAL → LATERAL canthus",
        "Thickness: ~1 Angula",
        "Duration: 20–30 min (till paste dries)",
        "Patient must NOT open eyes during",
      ]
    },
    {
      label: "PASHCHAT KARMA", items: [
        "Remove paste carefully with cloth/cotton",
        "Clean eye area with warm water",
        "Anjana applied if needed",
        "Avoid bright light and dust",
        "Rest; observe for Samyak Yoga",
      ]
    }
  ],
  C.darkgold
);

// Comparison Table
tableSlide(
  "Comparison: Aschyotana vs Seka vs Pindi vs Vidalaka", "TOPIC 3 — NLHT 2.1",
  ["Feature", "Aschyotana", "Seka", "Pindi", "Vidalaka"],
  [
    ["Form of Drug", "Drops (liquid)", "Continuous stream", "Solid bolus in cloth", "Paste (Kalka)"],
    ["Application Site", "Inside eye (canthus)", "Over open/closed eye", "Over closed lids", "Over closed lids (skin)"],
    ["Height / Contact", "2 Angulas", "2+ Angulas", "Direct contact", "Direct contact"],
    ["Quantity / Duration", "10–12 drops; short", "Continuous flow; moderate", "1 bolus; 15–30 min", "1 Angula thick; 20–30 min"],
    ["Contact with Globe", "Direct (cornea/conj.)", "Direct", "Indirect (via lids)", "Indirect (over skin)"],
    ["Tissue Contact Time", "LEAST", "Moderate", "Longer", "LONGEST"],
    ["Primary Action", "Samshodhana, Shamana", "Shamana, Seka", "Stambhana, Ropana", "Lekhana, Ropana"],
    ["Best Dosha", "All (1st line)", "Pittaja — burning", "Vataja — swelling", "Kaphaja — secretions"],
    ["Acharya mention", "All 5 texts", "Su, AH, BS, BP", "Su, BP only", "Su, CS, BP"],
  ],
  C.darkgold
);

// Research Updates
contentSlide(
  "Research Updates — Aschyotana & Pindi (2025)", "TOPIC 3 — NLHT 2.1",
  [
    { heading: "Study 1: Aschyotana in Meibomian Gland Dysfunction (PMID: 41647025)" },
    "Sreelekha PS et al., Frontiers in Medicine, 2025",
    "30 patients with MGD; Single-arm open-label study",
    "Protocol: Aschyotana with Moringa oleifera leaf drops + Pratimarsha Nasya (Anu oil) + Avagundana (Triphala fomentation)",
    "Results: OSDI, TBUT, Schirmer's all improved significantly (p < 0.001); Fluorescein staining → nil; No adverse effects",
    "Conclusion: Non-invasive, effective Ayurvedic approach for MGD in primary care",
    { heading: "Study 2: Shigru Pallava (Moringa) Aschyotana in Glaucoma (PMID: 40443906)" },
    "Devarajan D & Rajagopala M, F1000Research, 2025 — RCT Protocol",
    "Shigru Pallava Arka eye drops (1 drop 4×/day) as add-on to standard care in Primary Open-Angle Glaucoma",
    "Outcomes: Visual field indices, RNFL thickness, IOP; CTRI/2023/06/053681",
    "Status: Ongoing recruitment — results awaited",
    { heading: "Pindi / Avagundana Technique" },
    "The above MGD study used Avagundana (warm Triphala bolus application) — mirrors traditional Pindi technique",
    "Significant improvement in meibomian gland expressibility and TBUT with warm bolus fomentation",
  ],
  C.white, C.darkgold
);

// Quick Revision
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  const revRows = [
    ["ICHD-3", "3 Parts + Appendix | 14 categories | Published 2018 | IHS"],
    ["Migraine", "≥5 attacks | 4–72h | UPMA (2 of 4) | Nausea/Photo+Phono | Chronic = ≥15 days/month"],
    ["TTH", "Bilateral | Pressing | Mild-moderate | No nausea | Aggravated by activity — NO"],
    ["TAC", "Cluster = 15–180 min; Paroxysmal hemicrania = INDOMETHACIN; SUNCT = shortest; HC = continuous"],
    ["Shirorogas", "Sushruta = 11 types | Vataja most common | Bhringaraja, Pathya, Dashamula — key drugs"],
    ["Classical Rx", "Pathyadi Kwatha, Shirahshooladi Vajra Rasa, Sutashekhara Rasa, Godanti Bhasma"],
    ["Aschyotana", "Drops | 10–12 | 2 Angulas | Kaninika Sandhi | AADYA UPAKRAMA | All Netra Rogas"],
    ["Seka", "Stream | 2+ Angulas | Kaninika → Apanga | Pittaja | Burns, redness"],
    ["Pindi", "Bolus over closed lids | 15–30 min | Vataja | Swelling, Timira"],
    ["Vidalaka", "Paste on lids | 1 Angula thick | 20–30 min | Kaphaja | Lekhana action"],
  ];

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// ─── CLOSING SLIDE ────────────────────────────────────────────────────────────
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    { text: "• Sushruta Samhita, Uttaratantra — Ch. 24, 26\n", options: { color: C.offwhite, fontSize: 11, breakLine: true } },
    { text: "• Ashtanga Hridayam, Uttaratantra — Ch. 24\n", options: { color: C.offwhite, fontSize: 11, breakLine: true } },
    { text: "• Bhavaprakasha, Madanapalagana\n", options: { color: C.offwhite, fontSize: 11, breakLine: true } },
    { text: "• Bhaisajya Ratnavali, Shirorogadhikara\n", options: { color: C.offwhite, fontSize: 11, breakLine: true } },
    { text: "• Sreelekha PS et al. Front Med. 2025 (PMID: 41647025)\n", options: { color: C.teallight, fontSize: 11, breakLine: true } },
    { text: "• Devarajan D et al. F1000Research. 2025 (PMID: 40443906)\n", options: { color: C.teallight, fontSize: 11, breakLine: true } },
    { text: "• WJPSR Vol 4(1), 2025 — Aaschyotana review\n", options: { color: C.offwhite, fontSize: 11, breakLine: true } },
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// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/bams-shalakya-ppt/BAMS_Shalakya_Shirorogas_NKK.pptx" })
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  .catch(e => { console.error("ERROR:", e); process.exit(1); });
Running Command

cd /home/daytona/workspace/bams-shalakya-ppt && node generate.js 2>&1

Running Command

ls -lh /home/daytona/workspace/bams-shalakya-ppt/BAMS_Shalakya_Shirorogas_NKK.pptx

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BAMS Shalakya Shirorogas NKK

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What's in the presentation (892 KB, 25 slides):

Design: Deep navy/teal/gold academic theme - professional, medical, Ayurvedic warmth. Dark section dividers, white content slides, colored header bars, structured layout.
#SlideContent
1Title SlideAll 3 topics, course & year
2ContentsNumbered agenda with descriptions
3Section Divider 1ICHD-3
4-5ICHD-3 Intro + 3-Part StructureOverview, all 14 categories with Appendix
6-7MigraineDiagnostic criteria (1.1-1.4) + subtypes table
8TTHAll 4 types with Ayurvedic correlation
9TACsComparison table of all 4 TACs
10Other Primary HA4.1-4.10 table
11Secondary HA (5-12)Trauma, vascular, MOH, glaucoma headache
12Part III + Ayurvedic CorrelationNeuralgias + ICHD-3 ↔ Shiroroga mapping
13Section Divider 2Dravyas in Shirorogas
14-19Dravyas Topic11 Shirorogas, single drugs table, Lepa/Taila, Rasa Yoga table, Kwatha/Ghrita, Patent medicines, Pathyapathya
20Section Divider 3NLHT 2.1
21-22Kriya Kalpa overview + Ati/Ayoga7 kalpas, ati-yoga vs ayoga two-column
23Trividha KarmaPurva/Pradhana/Pashchat in 3 columns
24-25AschyotanaTheory + step-by-step procedure slide
26-27SekaTheory + steps
28-29PindiTheory + steps
30-31VidalakaTheory + steps
32Comparison TableAll 4 procedures vs 9 features
33Research Updates2025 MGD study + Glaucoma RCT (PMID cited)
34Quick RevisionAll key points in 2 columns
35Thank You / ReferencesComplete references
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