Herbal Ophthalmology

“Discovery consists in seeing what everyone else has seen and thinking what no one else has thought.”
– Albert Szent-Gyorgi –

Note: Parts of this chapter were excerpted from Dr. Abel’s book The Eye Care Revolution (Kensington Books, 1999).

The sense organs are our window into the world.  Few of us truly realize how precious sight and hearing and our other senses are until we are threatened with their loss.  For example, vision loss is the one of the greatest fears of our aging population, second only to fear of cancer.  The variegated cacophony of lights and sounds in the modern world distorts and alters our senses, too often separating and thus barring us from appreciating Nature’s true beauty and healing power.  The sound of a bird’s chatter, the rustling of the leaves in the wind, and the glint of the last ray of sunlight over a still lake have become sought-after luxuries in this chaotic modern world, when long before they were a daily blessing.

According to the ancient Ayurvedic doctor-sages, the five senses are gifts from the Gods of the Five Elements.  The God of Fire draws the light of vision into our eyes; the God of Earth brings smells to our nose; the Sky God carries sounds to our ears; the Water God carries tastes to our tongue; and the Air God imbues our skin with feeling.  Echoing this ancient insight, I believe it is essential to our health and happiness that we learn to protect, nurture and sharpen our senses. On this website we will discuss how to optimize eye health, and to preserve our precious vision.

A Simplified Description of the Eye

The eye uses light to create vision.  The skull contains two eye sockets, which are made of bone and layered with fat.  The eyeball itself, which rests in the fat of the socket, is a ping-pong ball-like structure that consists of three layers, or coats.  The tough outer coat is made of collagen, and the circular fingernail-size area of collagen at the front, which is transparent to let in light, is called the cornea.  The rest of the outer coat is white (“white of the eye”), and is called the sclera.  This coating continues all the way around the eye to the back, where it becomes the outer coating of the optic nerve, which enters the eye from the back.  The inside of the eyeball contains the iris, lens, and two fluids called aqueous humor and vitreous humor.

The middle layer of the eyeball (covered by the sclera) is muscle-like and embedded with a web-like supply of small nutrition-bringing arteries and waste-removing veins.  It is called the uvea, or uveal tract.  The front part of the uvea forms into the iris, the colored portion of the eye which opens and closes to control light intake, the middle is the circular ciliary muscle, and the back is the choroid.  The pupil is the opening in the iris.  Behind the iris is the lens, which is suspended from the ciliary body.  The ciliary body can focus the lens and secretes the thinner fluid (aqueous humor) which fills the small space behind between the cornea and the lens.  If this fluid gets congested or obstructed, it contributes to elevated eye pressure or glaucoma.

The cornea and the lens focus light onto the rods and cones of the retina.  Called the retina, it catches the light focused by the cornea and the lens.  These photoreceptor cells send nerve fibers to the optic nerve, which forms a cable leaving the back of the eyeball. Thus, focused light is converted to electrical impulses that go back to the brain for interpretation.

Attached to the eyeball are six muscles that control the movements of the eyes so they move together harmoniously.  The eyelids, lashes and overhanging brow protect the eye from harmful external elements, such as dust and overly intense light.  The thickly fat-layered orbit protects the eyeball against external blows and trauma.

Ancient Ophthalmology

It seems certain that organized ophthalmology started with Ayurveda.  One of the original eight branches of Ayurvedic medical study is the Shalakya Tantra (Mouth, Eyes, Ears, Nose and Throat).  The fascinating story of the genesis of this early medical division is recorded in the Charaka Samhita, the earliest classic of Ayurvedic medicine (c.  2,500 BC), and the most detailed of all ancient medical texts.  This book records the story of how specialists in each of the eight branches were chosen during a years-long ancient world medical gathering in the Himalayas.

Patriarchal eye specialist Videhadhipati Janaka, the King of Videha, championed the ancient school of Shalakya Tantra.  Videha was located within what is now known as the district of Janakapura in Nepal.  According to Dr. Mana, Dr. Janaka, like the scholars heading each of the other schools, was charged with compiling the practical knowledge gained by different physicians of his era in his field.  He wrote the first authentic textbook in the field, the Videha Tantra, and the comprehensive practical knowledge of Ayurvedic ophthalmology was a major chapter of this work.  This text was lost.  However, Dr. Susruta, the well-known contemporary of Dr. Janaka, and the head of the surgical school, quoted sections of the Videha Tantra in detail in his Susruta Samhita, devoting an entire section to the Shalakya Tantra.

In the years following the origin of the school of Videhadhipati, numerous scholars–Drs.  Janaka, Nimi, Katyayana, Gargya, Shataki, Saunaka, Chakshusa, among others– contributed their unique knowledge to the field of eye disease.  Their original commentaries and books are not available, having also been lost.  Our knowledge of them comes from existing references to their books.  One of the most important sources is the Madhava Nidana, written by Dr. Madhavarara in the 13th Century.  Atankadarpana by Sri Kanthadatta in the 15th century also contains many commentaries on ophthalmic diseases.

As with Ayurveda, TCM scholars report that the earliest books mentioning eye diseases were lost.  During the Sui dynasty (581-618 AD), a book by Dr. Tsao Yuan-Fang called Physiology of Diseases (Zhu bin yuan ho nen), discussed various eye diseases in chapter 26.  During the magnificent T’ang dynasty (618-906 AD), there was a rapid integration of foreign and domestic influences from Confucianism, Taoism and Buddhism.  Dr. Sun Si-Miao’s classic book One Thousand Golden Formulas (Qian jin yao fang) introduced over 80 eye formulas.  Dr. Wang Tao’s Secret Medical Book (Wai t’ai pi yao – c.  725) mentioned numerous eye treatments that were specifically ascribed to Ayurvedic influences brought in by travelling monks (Den et al., 1995).  Newly introduced medical procedures included surgery for cataracts using the Ayurvedic techniques mentioned earlier (albeit with golden needles), and the use of artificial eyes made from beads.  The almost identical classification of glaucoma and cataracts by color (white cataracts, blue cataracts etc.) is a starkly clear confirmation of the Ayurvedic influence.  The T’ang dynasty set up programs to promote medical education, and from that time forward ophthalmology was separated as a distinct medical discipline.

In 1998, Dr. Abel and I traveled to Nepal to meet with Dr.  Mana, and we prevailed upon him to formulate a rescension of the Ayurvedic knowledge of eye diseases.  We compiled Dr. Mana’s information into an unpublished manuscript entitled Ayurvedic Ophthalmology (Bajracharya et al., 1998). This book contains Dr. Mana’s detailed translation of the first recorded cataract operation from Susruta Samhita, about 2,500 years ago. For a description of the procedure (see below) Please note that in order for this to make sense in English, it was necessary to draw some information from other contemporary surgical descriptions.

The Cherokee also have a tradition of cataract surgery over a thousand years old. They did couching, or pushing the cataract down through a small incision, which has the advantage of preserving the lens.  According to David Winston, AHG, dean of the Herbal Therapeutics School of Botanical Medicine, eye drops such as bull-nettle (Solanum carolinense) and hoary-pea (Tephrosia virginiana) would be used to desensitize the eye.  The same herbs would be used internally for pain, along with Indian pipe (Monotropa uniflora) and turkey corn (Dicentra canadensis ).  One person would hold the eyelid, and another would perform the surgery with a sharp blade of grass.

Ophthalmology and Herbs in the West
Although reports of many remedies for various eye conditions exist in the Western herbal and Eclectic traditions, it is clear that they have been minor parts of these traditions.  Dr. Rudolph Weiss, in his textbook Herbal Medicine states that “Generally speaking, not much can be achieved with herbal drugs for eye diseases.” (Weiss, 1988).

However, certain medicines have always stood out, such as jaborandi (Pilocarpus species), which was widely used in folk medicine for dry mouth and eye diseases.  By 1648, Spanish botanical writers seemed aware of its use, and in 1875 the alkaloid pilocarpine was isolated.  It is used in the form of eye drops to treat glaucoma.  Drs. Ellingwood and Lloyd, in their 1919 classic American Materia Medica, Therapeutics and Pharmacognosy, mention that “ophthalmologists claim excellent results from its use (jaborandi) in a number of diseases of the eye.”

An ophthalmic textbook by Dr.  Kent Foltz, MD, published in 1900, details the homeopathic and herbal treatments used by Eclectic physicians for various eye diseases.  In his preface, Dr. Foltz states “That drug action is the same in ocular lesions as in other organs in unquestionable, but this fact is ignored as a general rule, and the local application of remedies alone is usually dwelt upon to the exclusion of other equally as important measures .  .  .  The generally accepted plan of treating the eye as an independent and isolated organ should be abandoned .  .  .  on account of the influence exerted by remote structures (Foltz, 1900).  It is clear that Dr. Janaka, Dr. Tsao, and Dr. Foltz and their colleagues laid the philosophical and practical groundwork for holistic ophthalmology in the past, stressing whole body interactions.  Now, with the impetus given by modern breakthroughs in nutritional biochemistry and with attention to discoveries and clues from our herbal ancestors, we are in a position to find effective new solutions for serious chronic eye diseases.

Treatment of Eye Diseases

Both the specific understandings of ocular anatomy and biochemistry, as well as systemic, nutritional and energetic considerations are necessary to diagnose treat chronic eye diseases with herbs. Formula development emphasizes the use of very specific herbs that remove inflammation and blood congestion from the eye. This is because from the traditional (and now modern) point of view certain herbs (as well as foods) have an affinity for ocular tissue.

Knowledge of the correlation between vitamin A intake and vision has been known for a long time, and we now know that specific carotenoids are equally beneficial to the eye.  Lutein, zeaxanthin and lycopene  should be included in everyone’s diet for prevention. To get lutein and zeaxanthin, eat lots of spinach, collard greens, kale and mustard greens. The red carotenoid lycopene is found in watermelon, guava and pink grapefruit, though tomatoes are by far the best source.  Lycopene is made more bio-available by cooking in oil, so using tomato sauce with some olive oil is probably best. To get high enough levels of lutein to treat eye diseases, supplementation is necessary, and a few companies are now producing this nutrient in pill form.

There are many herbs used traditionally for eye problems. In our clinic we commonly use buddleia flower (me meng hua or B.  officinalis), chrysanthemum flower, lycium fruit (gou qi zi or L.  chinense), cooked and raw rehmannia root,  elderberry, celosia seed (qing xiang zi or C.  argentea),boswellia gum, turmeric root, wild asparagus root, blueberry or bilberry fruit, tien chi root and triphalaConch shell (shi jue ming or Haliotidis diversicolor) and tortoise shell (gui ban) are also used, the former to “drain fire downward,” and the latter to nourish the blood and “suppress Liver wind” (for deficiency and mild sedation).  We will refer to these herbs often as we discuss formulas for eye conditions in this website.


Cataract Surgery, 2,500 years ago – A Recension

To have a successful white cataract operation, wait until the lens is completely opacified.  Otherwise relapse may occur.  After the operation, problems such as brain injury, over-exertion, over-indulgence in sex, vomiting, or fainting can be the cause of relapsing cataract.  Also, post-operative infection can be a cause of relapse.

Before operating, the condition of the cataract has to be checked very well.  There are several contra-indications.  If the opacity of cataract has the shape of a half moon, or a water bubble, or a pearl, there should be no operation.  The same is true if the cataract is not movable, or irregular, or thin at the center, or painful, or red.

The operating room must be neat and clean.  Cataract operations are best done during the seasons with moderate temperature, and there should be minimal interference from wind or sun.  Before the operation, the patient should imbibe a greasy meal and rest, to ensure strength.  When they arrive for surgery, a warm moist compress should be placed over the eyes as a preparation.  The patient should then be placed in a sitting position.  This is better because the patient has to lock their vision inwardly onto the nose to hold the eyes steady.

An instrument called Yavavakra is used for the operation.  It is very important to handle the instrument in the proper way, requiring that the surgeon have full confidence.  The eye has to be properly opened surgically.  Remember that the piercing should be at the center of the conjunctiva, thus avoiding veins.  The incision should start laterally and move medially.  Piercing upward or downward or in the opposite direction is prohibited.

While piercing, when the instrument enters towards the pupil, some water bubbles will come out making a sound.  At that time, place drops of woman’s breast milk into the eye to control the pain and irritation.  A warm compress made of sedative herbs should be applied around the eyes.

After that, the white coating of the mucus of the lens has to be pushed or scratched out.  Any part of it left inside the lens area has to be dislodged by having the patient blow hard with their nose closed.  When the operation is completed, the eye becomes clear just like the sky without clouds, and the patient feels better with no pain.  This is the sign of a properly done operation.  He can see!

After removing the instrument, apply a medicinal ghee ointment over the operated area, and place on a proper bandage.  After that, the patient should have complete bed rest, lying on the back.  During the recovery time, the patient should have no burping, coughing, shaking of the body etc.  He should stay motionless in a disciplined way.

Then, every three days the bandage should be changed, and the eye washed out with a decoction of plants that control the irritation and pain (Vata).  A new compress should be applied around the eye.  This treatment should be continued for at least for ten days.  After that, the patient can have normal activity, but still taking a light diet.  It is not advised to operate on a patient if they are suffering from old age, asthma, bronchitis, pulmonary tuberculosis, or any other serious disease.