A Systematic Review of Viddha Karma in Shalakya Tantra: Concept, Applications, and Clinical Relevance

Background: Viddha Karma is a para-surgical therapeutic procedure described in Ayurveda under Rak-tamokshana (bloodletting), involving precise puncture of specific anatomical sites to alleviate vitiated Doshas, particularly Rakta and Pitta. In Shalakya Tantra—the branch of Ayurveda dealing with diseases of the head and sense organs—Viddha Karma is employed in conditions affecting the eyes, ears, nose, and oral cavity. Despite its textual prominence, there is limited consolidated clinical evidence exploring its applications and therapeutic outcomes in Shalakya disorders. Objectives: To systematically review classical concepts, clinical indications, procedural techniques, and evidence-based applications of Viddha Karma in Shalakya Tantra, and to evaluate its clinical relevance and correlation with contemporary medical interventions such as acupuncture, microneedling, and minor surgical techniques. Methods: A comprehensive literature search was conducted in Ayurvedic classi-cal texts (Sushruta Samhita, Ashtanga Hridaya, Sharangadhara Samhita), and electronic databases including PubMed, AYUSH Research Portal, DHARA, Google Scholar, and IndMED, covering literature up to May 2025. Inclusion criteria comprised clinical studies, case reports, textual reviews, and observational studies that men-tioned Viddha Karma in Shalakya disorders (Netra, Karna, Nasa, Mukha Rogas). PRISMA 2020 guidelines were followed to screen, select, and analyse the data. Data extraction focused on disease condition, procedural meth-od, anatomical site, number of sittings, outcomes, and safety profile. Results: Out of 186 initially identified rec-ords, 27 articles and textual citations met the inclusion criteria. The majority of studies highlighted its effective-ness in Netra Roga (e.g., Abhishyanda, Adhimantha), Karna Roga (Karna Shula, Karna Nada), and Mukha Ro-ga (Danta Shula, Oshtha Shotha). The review found that Viddha Karma, when applied with anatomical preci-sion, led to a significant reduction in pain, congestion, and inflammatory symptoms. Modern parallels were drawn between acupuncture, which stimulates neurovascular activity, and microneedling, which promotes tissue remodelling. However, clinical trials were limited in number and often lacked uniform methodological rigour. Conclusion: Viddha Karma is a valuable yet underexplored Ayurvedic para-surgical intervention in Shalakya Tantra with promising therapeutic outcomes. This review emphasises the need for well-designed clinical trials to standardise the procedure, assess safety, and establish its integration with modern therapeutics. Bridging ancient procedural wisdom with contemporary clinical science could enhance management strategies for sensory organ disorders.