B.AYURVEDIC
REVIEW
NETRA
SHARIRA
Vedic
literature has explained the anatomy of eye and its various associated parts. Brihadaranyak
Upanishad is the most ancient vedic literature that narrates the two akshi, one
as the Vishwamitra and the other as the Jamadagni.
Acharya
Sushruta has given much more importance to the most precious organ ‘Eye
(Netra)’ in Shalakya part and explained eye anatomy scientifically. Eye is one
of the five sense organs and is a Matruja Avayava.
Synonyms:-
Netra, Nayana,
Chakshu, Akshi, Netra Golaka, Nayanabudbuda, Akshi Golaka , Drishti etc.
Constitution
of Eye: -
Eye is made up of all the five elements of which the universe is
built. Our body is also known as Panchbhautika and the same way each and every
organ has peculiar combination of Panchmahabhuta. Acharya ushruta has clearly
mentioned the contribution of Panchmahabhuta for Indriya as follows:-
"पलं भुवो अग्नितो
रक्तं वातात् कृष्णं
सितं जलात्।
आकशादश्रुमार्गाश्च जायन्ते नेत्रबुद्बुदे॥"
सु. उ. १/११
Shape:
Acharya Sushrutha had explained two terms for Eye viz. Nayana and
Netra in uttara tantra 1st chapter. Nayana and Netra suggest shape.
Nayana, which suggests the external appearance of the eye in the orbit, means
the Eye is like a bubble floating over water i.e. round in shape and soft in
consistency and Netra means the Eyeball almost round in shape and resembles the
cow’s teat.
Dimensions:
"द्वयांगुलबहुल्यं स्वान्गुष्टोदरसंमितम्।
द्वयांगुलं सर्वतः
सार्धं भिषंनयनबुद्बुदम्॥
सुवृत्तं गोस्तनाकारं
सर्वभूतगुणोद्भवम्।"
सु.उ.१/९,१०
Anguli Pramana term has been suggested the unit
of measure in context to the measurement of Eye by Acharya Sushrutha. It is
equal to swangusthodara which has been clearly mentioned by the commentator
Dalhana that the dimension of this one anguli is equal to the central part of
the thumb of an individual.
Circumference:
It is stated
that, the thickness or antero-posterior diameter of an eyeball is two anguli
and the circumference i.e. horizontal and vertical diameter two and a half
angulas. The distance between two Eyes is two angulas.
Morphology
of Eye:
As mentioned
above, eye is almost round in shape and also resembles the teat of the cow. It
is two fingers broad, a thumb’s width and two and a half fingers in
circumference. The distance between the two eyes is two finger breadths.
In this
context (i.e. reference to the description of Eye), Acharya Sushruta has
mentioned the following important structures as:
"मंडलानि च संधींश्च पटलानि च लोचने।
यथाक्रमं विजानीयात् पन्च षट् च षडेव च॥"
सु. उ. १/१४
2)
Peshi
and snayu
3)
Marma
4)
Sira
and Dhamani
5)
Six
Patala
6)
Six
Sandhi
7)
Five
Mandala
1. Akshi
Bandhana:
The most responsible factors for proper alignment of eye are The
Siras, Kandaras, Meda, Kalakasthi and Shleshma. Especially Shleshma, along with
siras takes part in the bandhana karma of the eyeballs. Here, Dalhana opines
that Sira in the reference includes both the Sira and dhamani, and kandara is
meant for Snayu (muscle) and peshi.
"सिराणां
कन्डराणां च मेदसः कालकस्य च।
गुणाः कालात् परः
श्लेष्मा बन्धने अक्ष्णोः
सिरायु्तः॥"
सु.उ. १/१९
2. Peshi
and Snayu:
"द्वे
नेत्रयोः।"
सु. शा. ५/३७
The
Peshis in the eyes are Mandala in shape and are two in number, whereas, the
Snayus are of pruthu type and 30 in number.
3. Marma:
Marma are vital points of the body and disturbance to which may result
in various complications. Mainly two Marmas, Apanga and Avarta, are related to
Eye. Apanga marma is situated on outer side of the orbits below the lateral end
of the eyebrows, ½ angulas in size and is a Sira Marma. Avarta Marma is
situated above the lateral end of eyebrow, of same size and Sandhi type of
Marma. Any injury to these sites may result in blindness and diminished vision.
"अष्टौ नेत्रयोः वातवाहिनीनां सिराणां व्याख्यातं भवति्।
एष एव विभागः शेषाणामपि। विशेषतस्तु पित्तवहिन्यो नेत्रयोर्दश॥"
सु. शा.७/७
As per Acharya Sushrutha, 38 Siras are found in the Eye which
transport Vata (10), Pitta (10), Kapha (10) and Raktha (8). While, Acharya
Vagbhata demonstrated that 65 Siras are present in the Eye but details of the
65 Siras are not available.
"ऊर्ध्वगाः ......रुप....द्वाभ्यां,..द्वे अश्रुवाहिन्यौ,....||"
सु. शा.९/५
Among 4 Dhamani, 2 are meant for Roopavahana and rest two is for
drainage of ashru to the Eye.
5. Asthi
and sandhi:
Arunadatta, in
his commentary opines that Tarunasthi is present in Akshikosha (Lids).
SANDHI:
The junction region between two Mandala (in relation to the Eye) is
considered as Sandhi of the related Mandala which are classified as follows;
"पक्ष्मवर्त्मगतःसन्धिर्वर्त्मशुक्लगतोअपरः
शुक्लकृष्णगतस्त्वन्यःकृष्णदृष्टिगतोअपरः॥
ततःकनीनकगतः षष्ठश्चापांगः स्मॄतः।"
सु. उ. १/१६
1. Pakshma Vartmagata Sandhi
2. Vartma Shuklagata Sandhi
3. Shukla Krishnagata Sandhi.
4. Krishna Drushtigata Sandhi
5. Apanga Sandhi
6. Kaneenika Sandhi
1)
Pakshma
Vartmagata Sandhi:
The juncture
line of Pakshma and Vartma (i.e. the lid margins) where cilia grow are termed
as Pakshma Vartmagata Sandhi. Acharya Sushruta has stated that the disease
Krimigranthi of the Sandhi occurs in this Sandhi particularly.
2)
Vartma
Shuklagata Sandhi:
It means the
juntion region of Vartma and Shukla mandala where the disease Parvani occurs.
3)
Shukla
krishnagata Sandhi:
The circular
joining line in between Shukla and Krishna Mandala is Shukla Krishnagata
Sandhi. One of the 8 pathogenesis namely Alaji occurs in this particular
Sandhi.
4)
Krishna
Drushtigata Sandhi:
This Sandhi is
the junction line in between the Krishna Mandala and Drushtimandala.
5) Kaneenika Sandhi:
Acharya
Sushruta has only mentioned the term “Kaneenika Sandhi”. He has not given any
explanation with respect to this type of Sandhi, Whereas Acharya Dalhana has
clarified by the words “Kaneenikagato nasa sameepavasthitah”. All the Acharyas
mention details regarding the affections of Sandhi. It is stated that Puyalasa
and 4 types of Shrava are the affections of this particular Sandhi.
6) Apaanga Sandhi:
Acharya
Dalhana has defined this Sandhi as “Bhru pucchanthatah sthithaha” i. e. near
the Brhu Puchcha or towards the temporal region. Three Sandhi termed as ‘Vartma
Shuklagata’, ‘Kaneenika’ and ‘Apaanga’ are supported by Sandhi Bandhana. The
clinical entity Vatahata Vartma (Ptosis) also occurs here, when it is vitiated
by the aggravated Vata.
PATALA:
The term
Patala means a veil, which denotes a thin membrane or skin or a layer. Acharya
Dalhana says that it is having the thickness of 1/5th Drushti. Six
Patala or layers are declared to be present in the eye. The 4 Patala have been
associated in eye proper and 2 Patala are situated outside the eye i.e. Urdhwa
Vartma Patala (Upper lid) and AdhoVartma Patala(lower lid). The disease
Adhimantha occurs in all the above structures, hence the name “Sarvakshi roga.
Tejojalashrita
patala:
This is the outer most among the 4 patala. Acharya Dalhana denotes
teja as “Alochaka Teja Sanshraya Siragata Rakta” i.e. the Alochaka Pitta which
is responsible for vision and is present in the blood vessels and Jala as Twakgata
Rasadhathu. Acharya Indu has defined the word Ashraya as “Apyayitha” means
thereby ‘to nourish’. Hence, Tejojalashrita Patala is supported or nourished by
Rasa and Rakta Dhathu of the body.
Mamsashrita
patala (Pishita-ashrita patala):
This is the second Patala, nourished and supported by Mamsa Dhathu.
Medashrita
patala:
Medodhathu
nourishes this 3rd Patala.
Asthyashrita
patala:
Asthi Dhathu of the body supports the innermost or 4th Patala in
general and by the Kalakasthi in particular. Asthyashrit means which remains
attached with asthi or gets nourishment from asthi. Majja dhatu remains
attached with asthi, that is asthyashrit. So this patala is nothing but the
majjagat patala for treatment and pathology point of view. Majja nourishes the
4TH patala. For the convenience majja can be compared with nervous
tissue of the eye that is retina. As far as the eyeball is concerned, there is
no direct relation with asthi dhatu but it can be a nervous coat of the eye
where all the retinal pathologies or disorders observed.
MANDALA:
Mandala term is used for the consecutive circular areas of the eye,
which are as follows
- Pakshma
mandala
- Vartma
Mandala
- Shweta
mandala
- Krishna
Mandala
- Drushti
Mandala
The
Mandalas are arranged successively from outside to inside:
Pakshma
Mandala –
Pakshma or
cilia of the eyelids form the outer most Mandala of the eye or eye lashes
Vartma
Mandala –
Vartma Mandala
means the circle formed by the conjunction of upper and lower eyelids of eye
ball. Two Nimeshini siras, situated in eyelids perform the function of Nimesha
and Unmesha (blinking). According to Acharya sushruta eyelids are the seat of
21 diseases and Acharya Vagbhata explain 24
Shweta
Mandala-
The whitish
part, inner to eyelid and beyond the black circle is known as Shweta Mandala,
when both the lids are open. Sushruta has encountered 11 pathogenesis in shweta
Mandala and 13 according to Vagbhata.
Krishna
Mandala-
Krishna
Mandala is the anterior most circle of the eye, blackish in colour and 1/3rd
size of the whole eye as per Sushruta. A term TARAKA for one of the structures
of the Eye is also used by Sushruta, which is having the same size. The Drushti
Mandala is enclosed in this Mandala. Sushruta has mentioned four clinical entities
in this Mandala, whereas, they are five in view of Acharya Vagbhata.
Drushti
Mandala-
Drushti Mandala is the last and innermost circular structure of the
Eye. According to the statement of Dalhana, Videha opines that the diameter of
Drushti Mandala is equal to 1/7th of the Krishna Mandala.
"कॄष्णात् सप्तमिच्छन्ति दॄष्टिं दॄष्टिविशारदाः।"
सु.ऊ.१/१३
Acharya Sushruta also agreed
with the statement of Dalhana. Again it is said to be equal to 1/9th
part of the TARAKA.
" मसुरदलमत्रां तु पंचभूतप्रसादजाम्।
खद्योतविस्फुल्लिंगाभामिद्धां तेजोभिरव्ययैः॥
अवॄत्तां पटलेनाक्ष्णोर्बाह्येन विवराकॄतिम्।
शीतसात्म्यां नॄणां दॄष्टिमाहुर्नयनचिन्तकाः॥" सु. सु. ७
Sushruta stated the structure of Drushti in
above shloka.
-Dimensions- Masurdalamatra means equal to cotylidon of
masura.
-Panchbhautikatwa-
Drushti is made up of five vital tatwas as
pruthvi, jal, tej vayu, aakash.
-khadyotvisphullingabha-
Drushti spark like a lightening creature.
-Tejobhi-
Like particles of light.
-Avyay-
Which does not have end or metabolism.
"अव्ययै: उपचयापचयरहितैस्तेजोभिर्विशिष्टा।"
डल्हण
-Avruttam
patelanakshno- It is covered with various coverings (patalas) of netras.
-Vivarakrvtim- It
looks like a small circular hole.
-Shitsatmya-
Shit ahar and vihar is benefecial for drushti.
CLASSIFICATION
OF EYE DISEASES
Shalakya
Tantra consists of diseases of eye, ear, nose, throat, Head, oral cavity. In
general the diseases of eye occupy the important position in Shalakya Tantra.
The detailed description of the eye diseases have been elaborated in Sushruta
samhita and Ashtang Hriday. The enumeration of eye diseases according to
various authors is as follows:-
|
SS
|
AS
|
AH
|
MN
|
YR
|
BP
|
Sa
|
Vartmagata rogas
|
21
|
24
|
24
|
21
|
21
|
21
|
24
|
Sandhigata rogas
|
09
|
09
|
09
|
09
|
09
|
09
|
09
|
Shuklagata rogas
|
11
|
13
|
13
|
11
|
11
|
11
|
13
|
Krishnagata rogas
|
04
|
05
|
05
|
04
|
04
|
04
|
05
|
Drishtigata rogas
|
12
|
27
|
27
|
12
|
12
|
12
|
08
|
Sarvagata rogas
|
17
|
16
|
16
|
17
|
17
|
17
|
08
|
Others
|
02
|
-
|
-
|
02
|
17
|
17
|
08
|
Total
|
76
|
94
|
94
|
78
|
78
|
94
|
100
|
SS-
Sushruta samhita,
AS- Ashtanga sangraha,
AH-
Ashatnga Hridhaya, MN- Madhav nidana,
YR- Yoga ratnakara, BP- Bhava prakasha,
Sa-Sharangdhara
Nidana:
Nidana plays a vital role in the progression of
the disease. The exact
goal of the treatment is achieved by avoiding the
Nidana of the diseases is very important. A person though takes
completetreatment without avoiding the Nidanas it’s merely useless. Tritiya Chaturtha Patalgat dosh drushti
occurs due to vitiation of doshas due to hetu sevana. These are same as hetus
of samanya netra rogas.
Various etiological
factors can be studied under differently as listed
in the following table.
” उष्णाभितप्तस्य जलप्रवेशात् दुरेक्षणात् स्वप्नविपर्ययाच्च।
प्रसक्तसंरोदन कोप शोक क्लेशाभिघातादतिमैथुनाच्च॥
शुक्तारनालाम्ल कुलत्थमाष निषेवणाद्वेगविनिग्रहाच्च।
स्वेदादयो धूमनिषेवणाच्च छर्देविघातात् वमनातियोगात्॥
बाष्पग्रहात् सुक्ष्मनिरिक्षणाच्च नेत्रे विकारान् जनयन्ति दोषाः।"
सु. उ. १/२६,२७
Poorvaroopa :
" तत्राविलं ससंरम्भमश्रुकंडुपदेहवत्। गुरुषातोदरागाद्यैर्जुष्टं चाव्यक्तलक्ष्णैः॥
सशूलं वर्त्मकोषेषु शूकपूर्णाभमेव च। विहन्यमानं रुपे वा क्रियास्वाक्षि यथा पुरा॥"
सु. उ. १/२१,२२,२३
·
Avila : Dirty eyes with discharge
·
Sa
sarambhashru : Angry look with congestion and watering of eyes.
·
Kandu
: Itching sensation
·
Upadeha
: Sticking of eyelids due to organized discharge
·
Guru : heaviness of lids
·
Ushna
: Burning sensation
·
Toda
: Pricking pain
·
Raga
: hyperaemia
·
Shooka
Poornabham : foreign body sensation
·
Vihanyamanam
roopam : Visual disturbance.
·
Kriyaahani
: Difficulty in opening and closing the lids and
Improper
visualization.
Samprapti of Eye disease
सिरानुसारिभिः
दोषैः विगुणैरुर्ध्वमागतैः।
जायन्ते
नेत्रभागेषु रोगाः परमदारुणः||
सु.उ.१/२०,२१
From the onset of Dosha Dushya Dushti
till the evolution of the Vyadhi there occurs various Vikruti. Samprapti
explains such series of pathological stages involved. It tells us about the
total pathogenesis of a disease.
According to Sushruta, the vitiated Dosha spreads to Jatru Urdhva Bhaga
through the Sira and leads to eye diseases.
Samanya Samprapti of
Netra Roga:
The Samanya Samprapti of Netra Roga
that is explained in classics can be considered as the base to understand the
Samprapti of eye disease
सर्वरोगनिदानोक्तैरहितै: कुपिता मला: ।
अचक्षुष्यैर्विशेषेण प्राय: पित्तानुसारिण: ॥
सिराभिरुर्ध्व प्रसॄता नेत्रावयवमाश्रिता:।
वर्त्मसन्धि सितं कॄष्ण दृष्टिं वा सर्वमाक्षिवा ॥
अ.सं उ.११-२
Aacharya Vagbhata in Ashtanga Hridaya and Ashtanga Sangraha has not explained specific nidana for
Netra Roga, but quotes that, the Achkshushya Nidana mentioned in Sarva Roga Nidana
Adhyaya of Nidana Sthana lead to aggravation of respective Dosha and spread to
Urdhva Jatru Bhaga through Pittavaha Sira and manifests Akshi Roga.
General principles of treatment :-
तत्र सम्भवमासाद्य यथादोषं भिषगजितम् ।
विद्ध्यान्नेत्रजारोगा बलवन्त: स्युरन्यथा ॥
सु.उ.१/२
After
watching all the prodromal features of eye diseases, a prophylactic treatment
should be given according to the affection of doshas.
संक्षेपत: क्रियायोगो निदानपरिवर्जनम् ।
वातादिनां प्रतीघात: प्रोक्तो विस्तरश: पुन: ॥
सु.उ.१/२५
Hetu
is a soul of diseases, without hetu the process of samprati (pathology) cannot
be completed. Therefore Aacharya sushruta said that if you control the hetu the
further process of any diseases can be checked out ,precisely speaking Nidana
is the root cause of the disease process and removal of that cause is the best
treatment i.e management
essentially consists of avoidance of the etiological factors and specifically
in detail it implies counteracting the increased doshas.
As
every eye disease starts from the increase of the doshas, and their abnormal
accumulation in the eye the first & most important step is to throw
vitiated doshas out of the body by
proper management.
CONCEPT OF TIMIRA
Sushrutacharya has described the symptoms of Timir according to four patalas and according
to dosha 6 types as vataja,
pittaja, kaphaja, raktaja,
sannipataja and parimlayi.
Definition of Drishti
मसूरदलमात्रां तु पन्चभूतप्रसादजाम् ।
खद्योतविस्फ़ुलिन्गाभामिद्धां तेजोभिरव्ययै : ॥
आवॄत्तां पटलेनाक्ष्णोर्बाह्येन विवराकॄतिम् ।
शीतसात्म्यां नॄणां दॄष्टिमाहुर्नयनचिन्तका : ॥
सु .उ. ७/३
The ancient ophthalmologists well versed in
the anatomy of eye provoked that the drishti of the eye is the quintessance of the five material
elements with that of the eternal light predominating there in this principle
of light neither increasing nor decreasing in this case. It is naturally accustomed
to cold from the very nature of its temperament and covered by the outer
coating of the organ proper.
It looks like a hole and is equal
in dimension to that of a masura seed.
mÉÇcÉ pÉÑiÉÉÎlqÉMüÉ Sìè¹Ï:
qÉxÉÑUÉkÉïSsÉÉåÎlqÉiÉÉ ||
(M.N.madhukosh.59/29)
But acccording to Nimi,quoted in Madhava’s
commentry by shrikantha,the dimention of
the drishti is equal to only a half of that of a masura pulse.
Diseases of Drishti
UÉaÉÉxiÉSÉ´ÉrÉÉlÉç bÉÉåUÉlÉç wÉOû cÉ wÉOèû cÉ mÉëcɤqÉWåû |
mÉOûsÉÉlÉÑmÉëÌuɹxrÉ ÌiÉÍqÉUxrÉ cÉ sɤÉhÉqÉç ||
सु.उ.७/५
Sushrutacharya has described twelve kinds of diseases peculiar to region
of Drishti and also the features of the disease “Timira” (loss of vision) which
affect the patalas. Symptoms of the four
patalas when the deranged doshas affecting them as follows-
Patal:
The word patal is made up of dhatu Pat means veshthane
i.e. to cover.Acharya Sushrut has described six patals out of which two patals
are located outside the eyeball namely Vartma patals.Remaining four are
situated inside the eyeball, which are Tejojalashrit, Pishitashrit, Medashrit
and Asthyashrit. All these patals can be correlated with various parts of
eyeball described in conventional medicine.
Correlation
of Patals with different parts of eyeball:
Vartma Mandals
are two in numbers. Vartma Mandals mentioned in ayurved can be correlated with
Eyelashes and eyelids. First outer layer is also called tejojalashrit and
having almost same features as Cornea and Sclera. There is almost similarity
between Mansashrit Patal mentioned in Ayurved and Coroid and Vitreous humour
described in Morden science.Third Patal i.e. Medashrit Patal can be compared
with lens and retina.Forth Patal,which is Asthyashrit Patal, is almost same as
Retina, Macula and Optic disc.
Symptoms: When the first patala affected
सिराभिरभिसंप्राप्य विगुणो अभ्यन्तरे भॄशम् । प्रथमे पटले दोषो यस्य दॄष्टौ urÉuÉÎxjÉiÉÈ॥
अव्यक्तानि स रुपाणि सर्वाण्येव प्रपश्यति । सु.उ.७/६
Sushrutacharya
has described that when the deranged doshas
passing through the siras of the eye & get affected to the first
patal of netra . Symptoms are developed like all external objects appear dim and hazy to the sight.
सिरानुसारिणि मले प्रथमं पटलं श्रिते। अव्यक्तमीक्षते रुपं व्यक्तमप्यनिमित्तत:॥ वा.उ.१२/
While vagbhatacharya has enumerated that, malas
travelling through the siras when get localised in the first patala then the
person does not see things which are clearly manifested. Symptoms:
When the second patala get affected -
SìÓ¹ÏpÉëÑzÉÇ ÌuÉuWûsÉÌiÉ
̲iÉÏrÉÇ mÉOûsÉÇ aÉiÉå |
qÉͤÉMüÉqÉzÉÇMüɶÉÉÌmÉ
eÉÉsÉMüÉÌlÉcÉç mÉzrÉÌiÉ ||
qÉÇQûsÉÉÌlÉ
mÉiÉÉMüÉ¶É qÉËUcÉÉÌlÉ MÑÇüQûsÉÉÌlÉ cÉ |
mÉËUmsÉuÉÉǶÉ
ÌuÉÌuÉkÉÉiÉ uÉwÉïÇqÉpÉëÇ iÉqÉÉÇÍxÉ cÉ ||
SÕUxjÉÉÌlÉ cÉ
ÂmÉÉÍhÉ qÉlrÉiÉå cÉ xÉÍqÉmÉiÉÈ |
xÉqÉÏmÉxrÉÉÌlÉ
SÕUåcÉ Sìè¹åaÉÉåcÉU ÌuÉpÉëqÉÉiÉç ||
rɦÉuÉÉiÉÌmÉ
cÉÉirÉjÉï xÉÔÍcÉmÉÉzÉÇ lÉ mÉzÉ
(Suut..7/7-1O)
Sushrutcharya has narrated that false image of flies, hairs, or cob-webs,
rings (circular patches) flags, ear rings appear- to the slight external
objects seem to be enveloped in mist or haze or as viewed rain on cloudy days
and meteors of different colours, seem to be falling constantly in all
directions in the event of deranged Doshas being similarly
confined in the second patala of the Drishti.
In such cases,the near
appearance of an actually remote and the contrary also should be described to
some deficiency in the range of vision which in capacitates the patient from looking
through the eye and hence from threading needle.
Symptoms: When the third patala get affected by the doshas are as follows :-
ऊर्ध्वं पश्यति नाधस्तात्तृतीयं पटलं गते ।
महान्त्यपि च रुपाणि च्छादितानीव वाससा ॥
कर्णनासाक्षियुक्तानि विपरीतानि वीक्षते ।
यथादोषं च रज्येत दॄष्टिर्दोषे बलीयसि ॥
अध:स्थिते समीपस्थं दूरस्थं चोपरिस्थिते ।
पार्श्वस्थिते तथा दोषे पार्श्वस्थानि न पश्यति ॥
समन्तत: स्थिते दोषे संकुलानीव पश्यति ।
दृष्टिमध्यगते दोषे स एकं मन्यते द्विधा ॥
द्विधास्थिते त्रिधा पश्येत् बहुधा चानवस्थिते ।
तिमिराख्य: स वै दोष....॥
सु.उ.७/११-१५
तिमिराख्य: तिमिर रागप्राप्तस्य च तिमिरस्य काच इति ।
डल्हण
प्राप्नोति काचतां दोषे तृतीयपटलाश्रिते ।
तेनोर्ध्वमीक्षते नाधस्तनुचैलावृतोपमम् ॥
यथावर्णं च रज्येत दॄष्टिर्ह्रीयेत च क्रमात् । वा.उ.१२/६
Sushrutacharya has
described that when the deranged doshas get infiltrated into third
patala,objects situated high above are seen and those below remain unobserved.
The Doshas affecting the Drishti,if highly enlarged,impair their specific
colours to the objects and even large objects seem to be covered with a piece
of cloth. The images at objects and persons
with eyes and ears etc, seem to be otherwise. The deranged doshas
are situated at and obstructing the lower, upper and lateral parts of the
drishti respectively shut out the
view of near,distant and laterally objects.
A dim & confused view of the external
world is all that can be had when the
doshas spread over and affect the whole
of the drishti. A thing appears to the sight as if cut into two when the Doshas affect middle part of the drishti and
as triply divided when the doshas are scatttered in two parts,while a multi image of the same object is the result of the
manifold distributions of movalbility of the doshas over the drishti.
Symptoms: when fourth patal affected:
तिमिराख्य: स वै दोष: चतुर्थं पटलं गत:॥
रुणध्दि सर्वतो दृष्टिं लिंगनाश: स उच्यते ।
iÉÎxqÉllÉÌmÉ
iÉqÉÉåpÉÑiÉå lÉÌiÉÂRåû qÉWûÉaÉSå||
cÉlSìÉÌSirÉÉæ
xÉlɤɧÉÉuÉliÉUϤÉå cÉ ÌuɱÑiÉ:
ÌlÉqÉïsÉÉÌlÉ
cÉ iÉåeÉÉÇÍxÉ pÉëÉÎeÉwhÉÔÌlÉ cÉ mÉzrÉÌiÉ|ç
स एव लिंगनाशस्तु नीलिकाकाचसंजित:॥
सु.उ.७/१६-१८
लिंगं चक्षुरिन्द्रियशक्ति:,तस्य नाशो यस्मिन् स लिंगनाशो दोष:।
डल्हण
तत्राप्युपेक्षमाणस्य चतुर्थं पटलं गत:॥
लिंगनाशं मल: कुर्वन् च्छादयेद् दॄष्टिमंडलम् ।
वा.उ.१२/७
mÉëÉmlÉÉåÌiÉ
MüÉcÉiÉÉÇ SÉåwÉå §ÉÑÌiÉrÉ mÉOûsÉÉÍ´ÉiÉå ||
iÉjÉÉmrÉÑmÉå¤ÉqÉÉhÉxrÉ cÉiÉÑjÉï mÉOûsÉÇ aÉiÉÈ ||
ÍsÉ…lÉÉzÉÈ qÉiÉÈ |
(As.San.ut.C.15/7-8)
LMü LuÉÉÅxÉÉæ
mÉËUqÉsÉÉÌrÉ UÉåaÉÉåÅUÉaÉmÉëÉmiÉ: ||
xÉlÉç ÌiÉÍqÉUÉZrÉ È
UÉaÉmÉëÉmiÉxiÉÑ MüÉcÉMüÉZrÉ |
xÉ LuÉ ÌMügÍcɬzÉïlÉ
lÉÉzÉMüÉUÏ ÍsÉ…lÉÉzÉÈ ||
(Su.Ut.DalhanComm.C.7/25)
Both of them have mentioned the harmful
diseases kacha and
lingnasha in the next patalas.
Symptoms of different
types of timira according to Sushruta & vagbhat
Sushruta
(ut .c.7/19/25)
|
Vagbhat(ut.c.15/9,13,16,20,21)
|
Vataja
timira
|
External
objects are viewed as cloudy moving
crooked and red coloured
|
Things are
seen as though covered unsteady ,dirty light red and sometimes clear,sees
network /web of hairs mosquitoes ,rays of light etc
|
Pittaja
timira
|
Things
appear to be invested with the different colours of the spectrum of the
rainbow of the glow worm of the flash of lightening or of the features of the
peacock or with a dark blue tent bordering on black.
|
Person sees
lightening fire,fly bright/shining things, colours like the features of the
peacock and partridge generally blue in colour.
|
Kaphaja timira
|
A thick
white coat like that of a pack of white clouds or deep white chamara seems to
intervene in everything which look white and oily and dull and appear hazy
and cloudy in a fine day or as if laid under a sheet of water
|
Person
usually sees things as moist white resembling the sankha indu (moon
kundakusuma )&kumuda
|
STUDY OF
PRAMEHA
Prameha means watering and
is derived from the root ‘miha sechane’. In the reference to disease of human
beings, it may have a meaning of passing urine, qualified by prefix ‘Pra’
meaning excess in both frequency and quality. Prameha is also described as ‘Prabhuta-mutrata’
and Avil Mutrata (excessive urination with increased turbidity of urine).
The etiology, pathogenesis and
management of prameha mentioned in ayurvedic classics resembles with Diabetes
mellitus. Prameha is characterized by urinary disturbances and based on Dosha
predominance, it has been differentiated in 3 types which again sub classified
into twenty types. There are classified in the basis of color and physical
characteristics or urine. These different types of Prameha can also be
correlated with systemic urological and nephrological conditions.
The mankind very well aware of Prameha
since antiquity and it holds great importance among the diseases because it is
a frequently occurring disease and originated from Havish, a special food which
normaly serves at the time of Yajnya, organized by Dakshaprajapati. Etiology,
symptomatology, treatment and complications of Prameha are described in details
in all major Samhitas.
The term ‘Astharva’ mentioned in
Atharvaveda 1/2/4 can be coined to Prameha. For maintaining positive and good
health, Puranas and Smrutis also focus on Ayurveda and Prameha. Treatment of
Kshudra and Akshudrameha has been described in Agnipauran (Agnipuran 283/15).
Garud puran has mentioned vyadhi with its complication and treatment (Garud
Puran 159).
Samhita Granthas has contributed
majorly in dealing Prameha disease. In Charak Samhita, Prameha is described in
Sutra Sthan, Nidan Sthan as well as in Chikitsa Sthan. Etiological factors,
signs and symptoms, pathogenesis/Samprapti, Upashya are described in Nidan
Sthan (4th chapter). In 6th chapter of Chikitsa Sthan,
Acarya Charak explain treatment part, the line of treatment, prognosis, various
combinations and formulation to be used in the management of Prameha. Acharya
Charak also describes pathogenesis and Prameha Pidaka in Kiyantashirshiya
Adhayay (Sutra Sthan 17).
Acharya Sushrut described in Nidan
Sthan and in Chikitsa Sthan in three different chapters; 1) Prameha Chikitsa,
Madhumeha Chikitsa and Prameha Pidaka Chikitsa. Prameha described after Kustha
Vyadhi. Gayadas explained in hiscommentary Nyayachandrika that Tridosharabhatva
(predominance of all three Doshas in pathogenesis of the disease),
Mahavyadhitva (difficult to treat and cure) and Asadhyatva (Incurable), are common
factors in Kustha and Prameha (Su. Nidan 6/1 Gayadas)
In both Asthangsangraha and
Asthanghridaya, Prameha has been included in Asthangsangraha. Both granthas
describe Prameha after ‘Ashmari’. The classification of Prameha has been done
on the basis of involvement of Doshas (i.e. Vataj, Pittaj and Kaphaj).
Madhavkar has mentioned Prameha and Prameha Pidaka after Ashmari in Madhav
Nidan.
PRAMEHA
SAMANYA NIDANA:-
Acharyas Charak, Vagbhat and Sushruta
have classified the Prameha Nidan into Aahar, Vihar and Manas factors.
1. Apathyakar Ahar
It includes use of new grains like
Hayanak, Yavak, Cinaka etc. Use of new peas, black gram and other pulses along
with ghee, tila, tilapaste and the use of sugarcaine juice. Frequent use of
milk, heavy unctuous food and food having sour and saline taste, rice from
newly harvested crop and fresh wine. All the materials increasing Kapha have
been said to cause Prameha in susceptible individuals.
- Apathyakar Vihar
- It
includes excessive sleep, sedentary habits and lack of physical and mental
exercises and lack of elimination therapies. These causative factors
increase Kapha.
- Manas
Manas causes include exposure to worry
grief, anger and anxiety.
VISHESH
NIDANA:-
There can be categorized three types
of Vishesha Nidan
1. Kaphaj Prameha Nidan
Frequent and excessive use of new
cerels like Hayanak, Yavaka, Cinaka, Uddailaka, Naisadha, Utkata, Mukumdaka,
Mahavrithi, Pramodak. Use of new legumes like Harenu and black gram, meat
domesticated, marshy and aquatic animals, vegetables, sesum paste. Use of
various preparations of flour, Payasa, Krushara, Vilepi and sugar cane
products, milk and new wines. Lack of physical exercise, excessive sleep I day
and night, prolong sitting and also other similar regimens producing Kapha and
Meda are the specific etiological factors for Kaphaj Prameha
2. Pittaj Prameha Nidan
Those thing which vitiates Pitta Dosha
such as excessive and continous use of hot, sour, alkaline and indigestion,
expose to very intense heat of sun and fire, exertion, anager and irregular
diet can cause Pittaj Prameha.
3. Vataj Prameha Nidan
Excessive and frequent use of
astringent pungent bitter ras daily, contact with rough and cold, excessive
sexual intercourse and physical vitiates vata.
Types
of Prameha according to classics
Doshik
type
|
Charaka
|
Sushruta
|
Vagbhat
|
Madhavakar
|
Kaphaj Prameha
|
1
|
Udakameha
|
Udakameha
|
Udakameha
|
Udakameha
|
2
|
Ikshuvalikarasa
|
Ikshuvalikarasameha
|
Ikshumeha
|
Ikshumeha
|
3
|
Sandrameha
|
Sandrameha
|
Sandrameha
|
Sandrameha
|
4
|
Sandra Prasad
|
Surameha
|
Surameha
|
Surameha
|
5
|
Shuklameha
|
Pistameha
|
Pistameha
|
Pistameha
|
6
|
Shuklameha
|
Shuklameha
|
Shuklameha
|
Shuklameha
|
7
|
Sitameha
|
-
|
Sitameha
|
Sitameha
|
8
|
Siktameha
|
Siktameha
|
Siktameha
|
Siktameha
|
9
|
Sanayameha
|
Sanayameha
|
Sanayameha
|
Sanayameha
|
10
|
Alalmeha
|
-
|
Lalameha
|
Lalameha
|
11
|
-
|
Lavanmeha
|
-
|
-
|
12
|
-
|
Phenameha
|
-
|
-
|
Pittaja Prameha
|
1
|
Kshara meha
|
Kshara meha
|
Kshara meha
|
Kshara meha
|
2
|
Kalameha
|
-
|
Kalameha
|
Kalameha
|
3
|
Nilameha
|
Nilameha
|
Nilameha
|
Nilameha
|
4
|
Lohitameha
|
Shonitameha
|
Raktameha
|
Raktameha
|
5
|
Manjisthameha
|
Manjisthameha
|
Manjisthameha
|
Manjisthameha
|
6
|
Haridrameha
|
Haridrameha
|
Haridrameha
|
Haridrameha
|
7
|
-
|
Amalameha
|
-
|
-
|
Vataj Prameha
|
1
|
Vasameha
|
Vasameha
|
Vasameha
|
Vasameha
|
2
|
Majjameha
|
Sarpimeha
|
Majjameha
|
Majjameha
|
3
|
Hastimeha
|
Hastimeha
|
Hastimeha
|
Hastimeha
|
4
|
Madhumeha
|
Ksaudrameha
|
Madhumeha
|
Madhumeha
|
PRAMEHA
UPADRAVAS
Kaphaj
|
Pittaj
|
Vataj
|
Makshika Sarpana
|
Vrushana Avadaran
|
Hritgraha
|
Alasya
|
Basti bheda
|
Lauloyam
|
Mamsopachaya
|
Hrudaya Shool
|
Anidra
|
Pratishayaya
|
Amlika
|
Stambha
|
Shaithliya
|
Paridhupan
|
Kampa
|
Arochaka
|
Sarvanga daha
|
Shool
|
Avipaka
|
Pipasa
|
Baddha Purishata
|
Kapha Praseka
|
Nidranasha
|
-
|
Chhardi
|
Pandu
|
-
|
Nidra
|
Peeta-vena mutra netrata
|
-
|
Kasa Swasa
|
-
|
-
|
Hetu Sevan
Tridosh dushti
Dhatwagnimandya
Dhatu Pramantah Vriddhi, Upchaytah Hani
Dhatushaithilya
Dhatu Abaddhatwa
Meda,Asruk,Shukra,Vasa,Lasika,Majja,Ras,Mans
& Oja get
vitiated.
Kledanirmiti
Dehasanchar of vitiated doshas due to looseness of Dhatu
Mix with kleda, vitiated Meda etc.
Convertion of Drava dhatu into urine
Dhatuksharan through Mootravaha Srotas
Prameha Dhatukshay
Oja
gets hampered
Madhumeha
Samprapti of Diabetic
retinopathy:-
Bahudravashleshma
Nirmiti is the main pathological event in the generation of Prameha. This
Kapha, which is increased by Drava property,leads to laxity in Meda and Mans
Dhatu predominantly Meda. According to Vagbhatacharya, Siras are generated from
the Meda along with its Sneha during the Formation of Meda.Therefore the
vitiation of Meda results into Sira dushti (Sira Abaddhata).This leads to loss
of permeability and fragility of Siras and results into venous beading and
leaking.As the disease progresses, it leads to vitiation of Pitta along kapha
and Vata.The retinal vasculature becomes more fragile with increased
permeability of vessels due to vitiation of Pitta along with its Ushna and
thikshna property.Leaking of RasRaktagat Sneh and Rakta takes place because of
this vitiated pitta. described in conventional system of medicine Finally,this
pathogenesis goes deeper causing the vitiation of Vata along with Kapha and
Pitta.Vitiated Vata along with Rooksha Gun result into loss of elasticity of
retinal vessels leading to the formation of Microaneurysms.Also Exudates and Hemorrhages
from due to involvement of more number of siras and more bleeding. As the
disease progresses further, these exudates and hemorrhages surrounds macula
causing macular edema.Rooksha Gun of Vata may be responsible for the formation
of new, delicate and brittle vessles i.e. Neovascularization.When the
etiological factor vitiates Pitta more,it results into intra-vitreous and
IntraRetinal hamorrhages.
SAMPRAPTI
OF DIABETIC RETINOPATHY
Nidan
Sevan
Kapha(Drava Guna)
Pitta(Ushna Guna)
Vata(Rooksha Guna)
Sthan
Dushti(Chakshu)
Meda
Dhatu Dushti(Tritiya and Chaturtha Patal)
Sthanik
Sira Vikruti (Sira Abaddhta due to Kapha and Meda)
Vata+Kapha+Meda
Vata+pitta+kapha+Meda vata+
Pitta+Kapha+Meda
Sirabhitti karshan
Sirabhitti Bhed Navsira nirman (Thining of Vessles) (Retinal haemorrhage) (Formation of New vessles)
Siragat
Vyasnirmiti RasRaktagat Sneh sravan
(Anuerysm) (Exudates)
Non-Proliferative Diabetic Retinopathy Proliferative Diabetic Retinopathy
