computer vision syndrome ss-mys

“APPLICATION OF AYURVEDA SIDDHANTA IN

THE MANAGEMENT OF COMPUTER VISION

SYNDROME”

By

Dr. K.S.DUTTA SHARMA.G, B.A.M.S.,

Dissertation submitted to the Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore.

In the partial fulfillment of the requirements for the degree of

DOCTOR OF MEDICINE (AYURVEDA)

in

AYURVEDA SIDDHANTA

Under The Guidance of

Dr.K.NASEEMA AKHTAR M.D. (Ayu) Professor,

Department of Post-Graduate Studies in Ayurveda Siddhanta, G.A.M.C., Mysore.

Co-Guide

Dr.T.R.SHANTALA PRIYADARSHINI M.S. (Ayu) Asst. Professor

Department of Post-Graduate Studies in Ayurveda Siddhanta, G.A.M.C., Mysore.

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE,

MYSORE. 2008

Ayurmitra

TAyComprehended

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,

GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.

DECLARATION

I hereby declare that this Dissertation “Application of Ayurveda Siddhanta

in the Management of Computer Vision Syndrome” is a bonafide and genuine

research work carried out by me under the guidance of Dr.K.Naseema Akthar,

Professor, Department of Post Graduate Studies in Ayurveda Siddhanta,

Government Ayurveda Medical College, Mysore.

Date : Signature of the Candidate

Place: Mysore Name: Dr. K.S.Dutta Sharma.G

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA



CERTIFICATE

This is to certify that the dissertation entitled “Application of Ayurveda Siddhanta

in the Management of Computer Vision Syndrome” is a bonafide research work

done by Dr.K.S.Dutta Sharma.G in partial fulfilment of the requirement for the

degree of Doctor of Medicine (Ayurveda).

Date: Signature of the Guide

Place: Mysore Dr.K.Naseema Akthar M.D. (Ayu).,

Professor

Department of Post Graduate Studies In Ayurveda Siddhanta, Government Ayurveda Medical College,Mysore.




CERTIFICATE

This is to certify that the dissertation entitled “Application of Ayurveda Siddhanta

in the Management of Computer Vision Syndrome” is a bonafide research work

done by Dr.K.S.Dutta Sharma.G in partial fulfilment of the requirement for the

degree of Doctor of Medicine (Ayurveda).

Date: Signature of the Co-Guide

Place: Mysore Dr. T.R.Shantala Priyadarshini M.S. (Ayu)., Asst Professor Department of Post Graduate Studies In Ayurveda Siddhanta, Government Ayurveda Medical College,Mysore.


DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA

GOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.

ENDORSEMENT BY THE HOD, PRINCIPAL /

HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “APPLICATION OF

AYURVEDA SIDDHANTA IN THE MANAGEMENT OF COMPUTER

VISION SYNDROME” is a bonafide research work done by Dr.K.S.Dutta

Sharma.G under the guidance of Dr. K.Naseema Akthar Professor, Department of

Post Graduate Studies in Ayurveda siddhanta, Government Ayurveda Medical

College, Mysore.

Seal & Signature of the HOD Seal & Signature of the Principal

Dr. N.Anjaneya Murthy Dr. Ashok D.Satpute

Date: Date:

Place: Mysore Place: Mysore

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA.



COPY RIGHT

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this dissertation /

thesis in print or electronic format for academic / research purpose.

Date : Signature of the Candidate

Place : Mysore Dr. K.S.Dutta Sharma.G

© Rajiv Gandhi University of Health Sciences, Karnataka

Dedicated to…

My Loving Parents &

Dearest Brothers

ACKNOWLEDGEMENT

At this moment of submitting this dissertation in this Post Graduate study, my

head bows down with great humility at the feet of almighty Mother Chamundeshwari and

Lord Dhanwantari, without whose blessing, I would not have been able to attain these

stages in my life.

I express my heartfelt and profound sense of gratitude to my beloved, Professor

and HOD, Department of PG Studies in Ayurveda Siddhanta, GAMC, Mysore,

Dr.N.Anjaneya Murthy for his constant guidance, continuous supervision and help at

every stage of this study.

Words cannot express the zeal of ecstasy while depicting my deep source of

gratitude to my proficient guide Dr Naseema Akhtar.Her fruitful suggestions, optimistic

view & motherly affection showered on me during this whole period & inspired me to

accomplish this work in all aspects.

Words cannot express the zeal of ecstasy while depicting my deep source of

gratitude to my proficient Co-guide Dr.T.R.Shantala Priyadarshini. Her fruitful

suggestions, optimistic view & motherly affection showered on me during this whole

period of study & inspired me to accomplish this work in all aspects.

I am also thankful to Dr. Ashok D. Satpute, Principal, GAMC, Mysore, for his

support during the period of my study.

I would like to place on record my heartfelt thanks and deepest sense of gratitude

to my respected teachers Dr.V.A.Chate, Dr Venkata Shivudu for their keen observation

and valuable recommendations throughout the dissertation and without whom my

dissertation would not have taken this shape.

I would like to place on record my heartfelt thanks to Dr.Rajendra, Dr.Anand

Katti, for their patient hearing during times of my frustration and for offering valuable

suggestions and inspiration from time to time during my P.G. studies.

I express my enormous amount of thanks to my colleague’s & fabulous

classmates, Dr.Savitha, Dr.Soubhagya, Dr.Yogesh, Dr.Vijayalakshmi, Dr.Abdul,

Dr Naveen, Dr L.N.Shenoy, and Dr Savita. H, and all P.G. colleagues, who made my

stay in college very joyful and educative.

I convey my thanks to my junior P.G. Colleagues Dr.Pankaj, Dr.Rajesh,

Dr.Annapooorani, Dr.Aparna,Dr Ranjith,Dr Kalyani,Dr Ramesh & Dr Geetha for

their help and overall support.

I remain ever thankful to physician Dr.Ramachandra Naik, internees Dr.

Aravind, Dr Vinutha and all other hospital staff for their valuable support during the

course of the study.

I extend my deepest regards to Mr. Subbanna, Smt. Varalakshmi, Mr.

Basavaraju & Mr.Somashekhar Librarians, GAMC, Mysore, for their generous help

during the course of my work.

At the same time, it gives me immense pleasure to remember my respected

Parents and brothers with a great dedication towards them with whose blessings,

inspiration and moral support; I have been able to reach this height.

I personally thank Dr. Lancy D’Souza for helping in statistical analysis and

interpretation.

I acknowledge thanks to all persons who have helped me directly or indirectly

with apology for my inability to identify them individually.

Small things make perfection but perfection is not a small thing. I seek pardon

& apologize for any errors which might be remained in the work.

Date:

Place: Dr. K.S.Dutta Sharma.G

LIST OF ABBREVIATION

A.H. Astanga Hridaya

A.S. Astanga Sangraha

CH Charaka

CD Chakradatta

CS Charaka Samhita

Ckp Chakrapani

MN Madhava Nidana

Sa.Sa Sarangdhara Samhita

Su.Sa Sushruta Samhita

VAG Vagbhata

AOA American Optometric Asssociation

MW Monier Williams Sanskrit English Dictionary

CVS Computer Vision Syndrome

BP Bhavaprakasha

YR Yogaratnakara

AK Amarakosha

VK Vaidyaka Kosha

VSS Vaidyaka Shabda Sindhu

RN Raja Nighantu

MK Medini Kosha

SKD Shabda Kalpa Druma

SS Statistically significant

HS Highly Significant

NS Non Significant

ABSTRACT

Background and Objective

Computer Vision Syndrome is a Vikara of Chakshurendriya, occurring due to

Astmendriyartha samyoga and atiyoga of Chakshurendriya. Aggravated Tridosha, Vata

and Pitta Dosha, in particular, are the prime factors involved in the pathogenesis. And it

very well co-relates with that of Netra roga poorvaroopa.

CVS is a multifactorial condition commonly observed in the Computer users.

According to the survey conducted by ‘India Today’, the prevalence of the disease in

98% of software professionals. Considering the grave nature of the disease with its higher

incidence, it has been selected for the present study to find out a better cure.

Though Nidanaparivarjana is much highlighted and praised in the context of

chikitsa, it is not possible always to follow especially in a disease like CVS. In the

present study Triphala Yashtimadhu Yoga a Chakshushya Rasayana is selected in the

form of choorna owing to easy palatability, so that one can perform routine activities

without interruption.

The objective of this present study was to understand the disease based on

Ayurvedic concepts and to evaluate the effect of Triphala Yashtimadhu Yoga in patients

of CVS.

Methods

Study Design - A conceptual study and a single blind clinical Study.

Intervention – Total 30 patients were selected randomly and assigned into a single group

and administered with Triphala Yashtimadhu Choornam in the dosage of 12 grams BD

(in divided dose)

Data was collected before commencement of treatment, after completion of treatment and

after follow up. The data was analyzed using contingency coefficient and other statistical

tests.

Results

Effect of Triphala Yashtimadhu Choorna showed highly significant results in parameters

such as Dry and irritated eyes, Redness of eyes, Tearing eyes, Headache, Burning in eyes,

Blurred vision and Photophobia.

Interpretation and Conclusion

Ayurvedic siddhantas are eternal and can be applied in understanding any disease.

Triphala Yashtimadhu Yoga a Chakshushya Rasayana is effective in a disease caused due

to Asatmendriyartha Samyoga.

Key Words

Computer Vision Syndrome

Netra Roga

Asatmendriyartha Samyoga

Triphala Yashtimadhu Yoga

CONTENTS

Page No #

Introduction 1

Objectives 3

Review of Literature

Hetu 4

Trividha Hetu 11

Netra Shareera 18

Netra Roga 28

Netra Roga Chikitsa 41

Drug Review 48

Computer Vision Syndrome 56 Previous works 65

Materials 66

Methods 67

Observation 76

Results

Discussion 117

Conclusion 143

Recommendation for Future Study 144

Summary 145

Bibliography 147

Annexure i-xii

LIST OF TABLES

Sl.No. Table Name Page No

1. Showing the Synonyms of Hetu from various Sanskrit books 06

2. Showing the Synonyms of Hetu according to various classics 06

3. Showing the Asatmendriyartha samyoga of Gnanendriya 14

4. Showing the panchamahabhuta and its dominant parts in eye 18

5. Showing the chakshurendriya panchapanchaka 21

6. Showing the classification of Netra roga according to various acharyas 30

7. Showing the Netra roga nidana according to various Acharya 32

8. Showing the Netra roga nidana according to various commentators 33

9. Showing the lakshana of netra roga based on dosha predominance 35

10. Showing the dosha predominace in lakshanas of CVS 36

11. Netra Roga dosha predominant Lakshana in comparision to CVS 36

12. Showing the comparision of CVS with various netra roga in Ayurveda 40

13. Showing the pathya in netra roga 44

14. Showing the apathya in netra roga 45

15. Showing the rasa panchaka of drug 53

16. Distribution of patients according to Age group 76

17. Distribution of patients according to Sex 76

18. Distribution of patients according to Occupation 77

19. Distribution of patients according to Education 77

20. Distribution of patients according to Marital status 77

21. Distribution of patients according Socio Economic status 77

22. Distribution of patients according to Religion 78

23. Distribution of patients according to Locality 78

24. Distribution of patients according to Diet 78

25. Distribution of patients according to Diet pattern 79

26. Distribution of patients according to Rasa Sevana 79

27. Distribution of patients according to Sleep 79

28. Distribution of patients according to Duty 80

29. Distribution of patients according to Addiction 80

30. Distribution of patients according to TV watching 80

31. Distribution of patients according to duration of occupation 81

32. Distribution of patients according to duration of working hours 82

33. Distribution of patients according to working hours in a week 82

34. Distribution of patients according to prakruthi 83

35. Distribution of patients according to sara 83

36. Distribution of patients according to samhanana 83

37. Distribution of patients according to pramana 84

38. Distribution of patients according to satmya 84

39. Distribution of patients according to satwa 84

40. Distribution of patients according to agni 84

41. Distribution of patients according to vyayama shakthi 85

42. Distribution of patients according to desha 85

43. Distribution of patients according to chief complaints 85

44. Assessment of chief complaints before treatment 86

45. Showing the result on Schirmers test-I 97

46. Showing the result on Distant Vision 97

47. Showing the result on Near Vision 98

48. Showing the result on Dry & irritated eyes 99

49. Showing the result on Rednes of eyes 99

50. Showing the result on tearing eyes 100

51. Showing the result on Headache 101

52. Showing the result on Burning eyes 101

53. Showing the result on Blurred Vision 102

54. Showing the result on Photophobia 103

55. Showing the result on Contact lens discomfort 103

56. Showing the result on Slowness in focusing 104

57. Showing the result on Changes is colour perception 105

58. Showing the result on Pain in Shoulder 105

59. Showing the result on Pain in Neck 105

60. Showing the result on Pain in back 106

61. The response of the therapy for individual symptoms after treatment 107

62. The response of the therapy for individual symptoms after follow up 108

63. Statistical analysis of Whole treatment results 109

LIST OF CHARTS

Sl.No. Table Name Page No

1. Showing the classification of Hetu 8

2. Showing the classification of kala 8

3. Showing the physiology of vision (netra roopa grahana) 22

4. Showing the samprapthi of Netra roga 38

5. Showing the Netra roga samanya chikitsa 43

LIST OF PHOTOGRAPHS

Sl.No Particulars Page No

1 Showing the Raw Drugs in Triphala Yashtimadu Yoga 54

2 Showing the Prepared Medicine 55

3 Showing the Schirmers Test Strips 71

4 Showing the Schirmers Test Procedure 71

LIST OF GRAPHS

Sl.No. Particulars Page No

1. Distribution of Patients According to Age 88

2. Distribution of Patients According to Sex 88

3. Distribution of Patients According to Occcupation 89

4. Distribution of Patients According to Educational Status 89

5. Distribution of Patients According to Marital Status 90

6. Distribution of Patients According to Socio Economic Status 90

7. Distribution of Patients According to Religion 91

8. Distribution of Patients According to Locality 91

9. Distribution of Patients According to Diet 92

10. Distribution of Patients According to Diet Pattern 92

11. Distribution of Patients According to Rasa sevana 93

12. Distribution of Patients According to Nidra 93

13. Distribution of Patients According to Duty 94

14. Distribution of Patients According to Vyasana 94

15. Distribution of Patients According to Work duration 95

16. Distribution of Patients According to Agni 95

17. Distribution of Patients According to Symptoms 96

18. Drug effect on Schirmers test - I 110

19. Drug effect on Dry Eyes 110

20. Drug effect on Red Eyes 111

21. Drug effect on Tearing Eyes 111

22. Drug effect on Headache 112

23. Drug effect on Burning Eyes 112

24. Drug effect on Blurred Vision 113

25. Drug effect on Photophobia 113

26. Drug effect on all symptoms before after & follow up of trial 114

27. Clinical improvement in Dry Eyes 115

28. Clinical improvement in Red Eyes 115

29. Clinical improvement in Tearing Eyes 115

30. Clinical improvement in Headache 116

31. Clinical improvement in Burning Eyes 116

32. Clinical improvement in Blurred Vision 116

Introduction1

Ayurveda Siddhanta & Computer Vision Syndrome

INTRODUCTION

Ayurveda the science of "Ayu" – deals with maintenance of health and relief

from the disease. This can be successfully achieved only when we follow the norms

laid in Ayurveda. Apart from its rich and renounced heritage, Ayurveda has a rare

charm and glory of its own. As a great healer of the suffering mankind its contribution

is eminent and unique.

Ayurveda has put forward Siddhantas that are eternal and can be applied to

understand the disease in all its aspects, in its diagnosis and treatment.Trisutra

Siddhanta and Panchalakshana Siddhanta are a few among those Sidddhantas that are

time tested and can be applied to understand any disease irrespective of time.

With the advent of time inevitable changes in food habits, life styles,

occupational challenges and environment has lead to the manifestation of new

disorders. Computer Vision Syndrome is one among such disorders occurring in

computer professionals characterized by complex eye and vision problems related to

near work which are experienced during working with computers involving both

ocular and non ocular symptoms. The catastrophic effects of this disorder are low

work performance, agony, extreme discomfort that hampers daily routine. Negligence

towards it could cost ones career resulting in Physiopsychological upset and severe

eye problems.

The problem is grave according to American Optometric Association with an

incidence in 75% -90% of employees working with Computers and more people are

likely to suffer in the future due to rapid growth of jobs in IT sector in India. So it is

the need of the hour to find a holistic solution to this problem.

In the present context I have taken Computer Vision Syndrome and made

effort to explain it on the basis of Ayurveda Siddhanta like Hetu,trividha hetu,panch

lakshana nidana and the general line of management mentioned in Ayurveda samhitas

for aganthuja netra roga. So this study is intended to study and understand “Computer

Vision Syndrome” a disorder not mentioned in Ayurvedic classics based on various

Introduction2


Ayurveda Siddhanta and to find out a suitable Chikitsa Siddhanta based on the above

observations, from these prospects the present study has been taken.

It also comprises of a clinical study to evaluate the efficacy of Triphala

Yashtimadhu Yoga and its efficacy on symptoms with a time span of sixty days for

treatment and also its focus being on reliving of symptoms and management of the

disease.

The first part is mainly concerned with the review of literature regarding

various aspects of the disease such as, nirukti, bheda, paribhasha, Hetu, Trividha hetu

and Nidana panchaka etc, are reviewed and elaborately discussed. The second part

consists of details of clinical trials of the effect of Triphala Yashtimadhu Yoga on

Computer Vision Syndrome.

It comprises of the materials and the methods used for the study, the results

and the observations of the study and the discussion on them. A summary of the study

is provided in the last part of the dissertation with some suggestions for the future

studies.The study has shown that Ayurveda has a significant role to play in the

management of Computer Vision Syndrome.

Objective3


OBJECTIVES OF THE STUDY

The present study was undertaken with the following objectives

1. To understand Trividha hetu involved in causation of Computer Vision Syndrome.

2. To understand the disease based on Pancha Lakshana Nidana.

3. To make an analytical study on the role of Prakruthi, and occupational influence in

causation of the disorder.

4. To evaluate suitable Chikitsa based on the above observations.

5. To evaluate the efficacy of TriphalaYasthimadhu yoga in patients of Computer

Vision Syndrome clinically.

Review of Literature4


HETU

According to Ayurveda a vyadhi is generally studied under the five main

headings to understand the entire process of a disease manifestation. They are Nidana,

Purvaroopa, Roopa, Upashaya and Samprapti respectively, also called as Nidana

Panchaka1. Among these nidana panchaka ‘Hetu’ stands first and forms the base or

root cause for the latter stages viz, purvaroopa, roopa etc. A vyadhi is never devoid of

its hetu. Even the Karyakarana sidhantha confirms that a karya / vyadhi are not devoid

of its karana / hetu2. Further it can be said that a wise treatment begins with nidana

parivarjana as told by Acharya Sushruta i.e., “Nidanaparivarjanameva chikitsa”. Thus

hetu plays a chief role in roga nidana and its chikitsa also.

Derivation

This is a “pumling” word3

Hetu = hi gatou (dhatu) 4 + Tuna pratyaya

Hi- to send forth, to impel, to promote

Hi- hinoti, hita

1. Hinoti vyapnoti karyam iti 5

Hinothi- To promote further

Vyapnothi- pervading, penetrating, to spread throughout

The word meaning of hetu is that which promotes and spreads the karya and is a

karana.

2. Pum hi tanu kaarane anumithi sadhane vyape phale cha

It is the pumlinga shabda with synonyms like karana, anumiti, sadhana, vyape, phale.

Definition

1. Seti kartavyatako rogotpaadaka heturnidaanam6

The factor which causes rogotpatti by vitiating the dosha is called nidaana

2. Tatra nidaanam kaaranam7

Etiological factor or causative factor

3. Vyadhi utpattti hetuhu nidaanam The factor which is responsible for the disease causation or manifestation.

4. Tatra hetuhu utpattikaaranam Hetu is a causative factor (karana) for vyadhi.



5. Hetus tad udbhave 8

Hetu is that which gives rise to disease

*In all the above context hetu = nidanam, hetu and nidanam are used as samanartha

HISTORICAL REVIEW OF HETU

A) Veda kala

Rogotpadaka karanas are shareeragata mala roopavisha, krimi, vata, pitta and kapha.9

B) Mahabharata

Sheeta, Ushna, and Vayu are the cause for shareerika vyadhis is found in Shantiparva

16th adhyaya.

C) Samhita kala

a. Brihat Trayee

1. Charaka Samhita: Acharya Charaka has explained hetu in sutra sthana 1st, 11th,

25th, and 28th chapter. In nidana sthana 1st chapter and in shareera sthana1st & 2nd

chapter and in vimana sthana 6th chapter.

2. Sushruta Samhita: Acharya Sushruta has explained hetu in sutrasthana 3rd hapter,

explained it as an ‘upaya’ and karaka hetu.

3. Asthang Hrudaya: Acharya Vagbhata has explained hetu in sutrasrhana 1st chapter

and also under nidanapanchaka in nidanasthana 1st chapter.

b. Laghu Trayee

1 Madhava nidana explained in 1st chapter about hetu.

2 Bhavaprakasha: Bhavamishra mentioned and described hetu in Rogaprateekara

prakarana the 7th chapter of poorvakhanda.

c. Other classical texts

1 Astanga Sangraha: Acharya Vagbhata described hetu in sutrasthana 1st, 22nd

chapter and under nidana panchaka in nidana sthana 1st chapter.

2 Yogaratnakara: Has explained that kupita malas are the nidana for all the diseases.

Kupitamala here means vata, pitta and kapha.

3 Gadanigraha: Gadanigrahakara explained hetu under rogagnana sadhana in

jwaradhikara.



d.Recent Ayurvedic literature

1. Nidanachikitsa hastamalaka: Vd Ranajit rai desai expalained hetu under nidana

panchaka.

2. Doctrines of pathology in Ayurveda: Dr K.R.Srikantha Murthy described hetu in

9th chapter

3. Ayurveda Vikriti Vignaan: Vd Vidyadhar shukla explained hetu in 20th chapter

under nidana panchaka.

Table No.1 Synonyms of Hetu as per Sanskrit texts

Types of hetu AK VK RN MK VSS 1. Hetu - - - - 2. Karana - - 3. Nidana - - - - 4. Aadikarana - - - - 5. Anumiti - - - - 6. Sadhana - - - - 7. Vyape - - - - 8. Phale - - - - 9. Roganirnaya - - - - 10. Beejam - - - - 11. Roga Hetu - - - -

Synonyms of Hetu

Various synonyms as per different classics are as follows. All of them give common

meaning as hetu \ karana10

Table No.2 Synonyms of Hetu as per Ayurveda Samhita

Sl.no CS11 Ckp12 AS AH13 MN14 BP15

1 Hetu

2 Nimitta

3 Aayatana

4 Karta - - -

5 Karana

6 Pratyaya



7 Samutthana - - -

8 Utthana - - - - -

9 Nidana - - -

10 Yoni - - - -

11 Mukha - - - - -

12 Mula - - -

13 Karaka - - - - -

14 Prerana - - - - -

15 Prakruthi - - - - -

16 Nibandha - - - - -

Types of Hetu

According to Madukosha tika 16 the hetu’s are broadly classified according to their

role in causation of a disease.

A) Dvividha hetu:

1) a) Bahya b) Abhyantara

2) a) Utapadaka b) Vyanjaka

B) Trividha hetu: 1. a) Asatmendriyartha Samyoga b) Prajnaparadha

c) Parinaama.

2. a) Dosha hetu b) Vyadhi hetu c) Ubhaya hetu.

C) Chathurvidha hetu: a) Sannikrishta b) Viprakrusta c) Vyabhichari

d) Pradhanika



Ati.Y Ayo Mit.y

Importance of Hetu

The Ttrisutra of Ayurveda explained in Charaka Samhita states that the

knowledge of hetu, linga, aushadha is applicable to both swastha and atura. Hetu is

considered the first among trisutra, also denoting its importance as karana for roga

and arogya. Kala, artha and karma are 3 types of hetu and its tri vikalpa i.e., atiyoga

1. Sannikrishta, 2. Viprakrishta 3. Vyabhichari 4. Pradhanika

Hetu

1. Astamendriyartha samyoga

2. Prajnaparadha 3. Parinaama

Dosha Hetu Vyadhi Hetu Ubhaya Hetu

Dhi Dhrti Smrti

Vibhramsha 1. Bahya Hetu 2.Abhyantara Hetu 1. Vyanjaka 2. Utpadaka

Hetu

Spars Twakha

Samavayi Dushya

AsamavayiDosha dushya sammurchana

(dhatu & mala)

Nimitta

Mithyahara vihara

Parinama (kala)Prajnaparadha (Karma)Asatmendiyartha Samyoga (Artha)

Gandha Ghrana

Rasa Jihwa

Rupa Chaksu

Sabda Srotra

Ati.y Ayo Mith.

Manasika VachikaKayika

Ati.y Ayo Mith.y Ati.y Ayo Mith.y Ati.y Ayo Mith.y



ayoga and mithyayoga are the cause for diseases and their samyagyoga (of indriyartha

prajna, and parinama) is the cause for health. So it can be understood that Roga Hetu

are Atiyoga, Ayoga and Mithyayoga of Kala,Artha,Karma and Arogya Hetu are

samyagyoga of Kala,Artha,Karma.

Utility of Hetu

Hetu is helpful in knowing

1. Vyadhi karana:

Hetu is karana for vyadhi. So by knowing the hetu involved the vyadhi Karana

and its severity is known.

2. Vyadhi vinischaya:

If there is any doubt regarding the diagnosis of a disease, observation of the

etiological factors leads to the confirmation of vyadhi.

3. Sadhya asadhyata:

Hetu is very helpful to decide the sadhyasadhyata of a vyadhi. Alpa hetu causes

alpa Lakshana in a vyadhi and its sukhasaadhya lakshana.

4. Upashaya anupashaya:

Upashaya is opposite to hetu and anupashaya is similar to hetu.

5. Chikitsa:

Nidana is a synonym for hetu and nidana parivarjana is a type of chikitsa.

MODERN REVIEW

Etiology or Cause18

Hetu word is synonymous to etiology in modern medical literature.

Derivation

Eti-ol-o-gy or Aeti-olo-gy,

Aitia - a charge, accusation, cause

Logos (logy) – word of speech, treatise, discourse

Aitia + logos = the doctrine of causes,

So the word meaning of etiology can be derived as

The discourse about the cause of a disease



Definition

The study of causes specifically the cause of disease 19

or

The science dealing with causes of disease 20.

In modern terms there are two major classes of etiological factors

1. Intrinsic or genetic

2. Acquired (infectious, chemical, nutritional, physical)

Knowledge or discovery of the primary cause remains the backbone on which the

diagnosis can be made, a disease understood or a treatment adopted.

The four aspects of a disease process that form the core of pathology are

1. Etiology- cause

2. Pathogenesis- the mechanism of its development.

3. Morphology- the structural alterations/changes induced in cells and organs of the

body.

4. Symptoms/Clinical manifestations - the functional consequences of morphologic

changes.

In Ayurveda a disease is studied under 5 stages (Nidana panchaka) and in

modern it is studied in 4 stages. In both these medical systems etology/hetu is the first

and foremost factor which denotes the cause / causative factor of a disease.



TRIVIDHA HETU

INTRODUCTION

In Ayurvedic classics it’s often stressed that trividha hetu namely

Asatmendriyartha samyoga, Prajnaparadha and Parinaama are the prime cause in the

disease origin especially of shareerika and manasika21. Though varieties of hetu

classification have been made like dvividha, trividha, chaturvidha etc but all these

hetus can be incorporated under single heading as trividha hetu. Among these trividha

hetu again we can find the specific role of single hetu in different diseases, eg-

Asatmendriyartha samyoga, plays an important role in indriyajanya vyadhis22.Thus

trividha hetu occupy a broader place in the field of hetu.

Definition

The hinayoga atiyoga and mithyayoga of artha, karma and kala is termed as treeni

aayatanani or trividha hetu23.

Types

Asatmendriyartha samyoga, prajnaparadha and parinaama are of three type’s each24

HISTORICAL REVIEW OF TRIVIDHA HETU

Upanishad

In Shwetashwaropnishad ‘Kaalo hi naama sarva bhutanaam aviparitanaama hetu’ is

mentioned.

Bhagavadgeeta

In 2nd chapter indriya nigraha as the cause for sukha has been men

Samhita kaala

a. Brihat Trayee

Charaka samhita

1st, 11th, 20th, 25th, 28th chapters in sutrasthana. 1st chapter in nidanasthana. 1st

and 2nd chapter in shareersthana explains about trividha hetu.

Sushruta samhita

Acharya Sushruta has explained Asatmendriyartha samyoga, and

Prajnaparadha as hetu in 61st chapter of uttaratantra, mithyayoga, ayoga and atiyoga

of artha, karma as apasmara hetu and also explanation of kala is available in

sutrasthana 6th chapter.



Astanga Sangraha

Vagbhata sutrasthana explains trividha hetu in 1st, 22nd chapters and in 1st

chapter of nidanasthana.

Astanga Hrudaya

1st and 12nd chapter of sutrasthana, and under nidanapanchaka in nidanasthana.

Laghutrayee

Madhava Nidana-1st chapter explains about trividha hetu

d. Recent Ayurvedic literature

1. Nidanachikitsa hastamalaka: Vd Ranajit rai desai expalained hetu under nidana

panchaka.

2. Doctrines of pathology in Ayurveda: Dr K.R.Srikantha Murthy described hetu in

9th chapter

3. Ayurveda Vikriti Vignaan: Vd Vidyadhar shukla explained hetu in 20th chapter

under nidana panchaka.

Trividha Hetu Importance

1. For all sorts of vedana the trividha hetu in the form of dhi, dhriti and smriti

vibhramsha, karma, kaala samprapti and asatmendriyartha samyoga are main

causes.25

2. The mithyayoga, ayoga and atiyoga of Kaala (parinaama varshadi ritu), Buddhi

(prajna), Indriyartha (shabda, sparshadi, bhogya dravya guna karma) are the main

cause in all type of shareerika and manasika vikaras26.

3. This is again strengthened by charaka in sutrasthana stating them as ‘treeni

aayatanani’ & ‘nidanatrayi’ respectively27.

4. It is further declared by charaka in shareera sthana, that it is trividha hetu only viz

(Astmendriyartha adi….) as main cause in the disease origin28.

ASATMENDRIAYRTHA SAMYOGA

Introduction

The literal meaning of Asatmendriyartha is a state unfavourable for the indriya

with their vishaya. The word indriyartha is applied for jnanendriya only which are



five in number viz (Shabda, Sparshadi, etc).The hina yoga, atiyoga and mithya yoga

of indriyas with their respective vishyas create unfavourable situation specifically to

indriyas and thereby to the body causing a disease. Among trividha hetu’s it is the

nearest or immmediate cause in the disease manifestation.

Asatmya

Derivation

‘Asatmya’ word is formed by derived by adding two upasarga A+SA to Atma shabda

then the word Asatmya is formed. A+sa+atma = asatmya

Definition

Asatmya – Those vishaya of indriya creating unfavorable state for body and mind29

Indriya

Derivation

Indriya- derived from ‘Ida’ dhatu and ‘gha’ pratyaya meaning it is the ruler of the body.

Definition

Prana is termed as Indra and its linga is indriya. So, that which gives sensory

knowledge is called indriya.

Artha

Vishaya or knowledge attained through a particular indriya is called artha. Indriya

vishyas viz shabda, sparsha roopa rasa adi are the indriyarthas of shrotrendriya,

Sparshendriya etc

Samyoga

Derivation

It is derived from adding Sama (upasarga) + yuj (dhatu) + gha (pratyaya)

Definition

Samyogam nama dwayorbahoonaam vaa dravyanam samhatee bhavaha. Combination

of two or more dravyas is called Samyoga.

Types

Depending upon the indriya, its indriyartha and its hina, ati or mithya yoga the

asatmendriyartha samyoga is classified as follows30



Table No.3 Asatmendriyartha Samyoga of Gnanendriya

Indriya Indriya Artham

Atiyoga Ayoga Mithyayoga

Karna Shravanam

Ati Shravanam

Ashravanam Uccha,parusha,bhishanadi shravanam

Twak Sparshanam

Ati Sparshanam

Asparshanam Abhighata,visha,vaatadi sparshanam

Chakshu Darshanam

Ati Darshanam

Adarshanam Sookshma,atidoora,bhaswa darshanam

Nasa Ghranam Ati Ghranam Aghranam Putya,medhyati,teekshna,ugra, ghranam

Jihwa Rasanam Ati Rasanam Arasanam Apathy,vishama,arasa grahanam

PARINAAMA

Introduction

Parinaama in general means avastha or parivartana brought by the influence of

kala. Acharya charaka had used tha word ‘kaala’ for parinaama31.since ati, hina and

mithya yoga of kaala brings dosha vitiation in the shareera and causes vyadhi. In

ayurveda kaala is also given importance and its explaination is found in many places

in classics.

Derivation

It is derived from ‘pari’ upasarga, ‘nama’ shabda and ‘ghama’ pratyaya.

Meaning of which is transformation32

Kaala

Ka + Aa+ La = Kaala

The lakaar and akaar of kaala shabda and lakaar of lee dhatu when unites the

kaala shabda occurs.Similarly, the one which destroys the entire things of the world

and assemble them together and also brings all the karya dravya to their destruction.

Definition

‘Sa sookshmamapi kalaam na leeyate iti’

That which does not stay even for the fraction of second and is gatisheela is

called kaala33



Types

Though variety of classification of kaala is elaborately explained by our

acharyas 34 but for the vyadhi utapatti and chikitsa purpose the entire kaala is divided

into four in one samvtsara and again in the trividha kaala namely sheeta, ushna and

varsha are the main under which the remaining kaala is to be considered and treatment

can be carried based on this kaala only35.

Kaala Chart

Importance of Parinaama

1. The hina, ati or mithya yoga of any of the seasonal variation becomes a cause for

vyadhi utapatti36.

2. Parinaama is also understood as ‘kaala’ and since kaala is transforming the results

of shubha ashubha karma, dharma and adharma etc.,37

Kaala

Samvatsara

1. Visarga 2. Adana

Trividha Shadvidha Dvadashavidha

1. Sheeta 2. Ushna 3. Varsha

1. Sishira 2. Vasanta 3. Grishma 4. Varsha 5. Sharat 6. Hemanta

1. Magha 2. Phalguna 3. Chaitra 4. Vaishakha 5. Jyesta 6. Aashada 7. Shravana 8. Bhadrapada 9. Ashwaija 10. Kartika 11. Margasirsha 12. Pushya

Dvividha



3. The kaalaja rogas are powerful in their respective kaala and hence their treatment

should be done in advance to subdue their effect38.

4. For the kaalaja swabhavika rogas like jara, mrityu, there is no treatment i.e.

akalajanya jaradi conditions are treatable39.

PRAJNAPARADHA

Introduction

The very literal meaning of prajna is consciousness. It is one of the

important hetu among trividha hetu. Some commentators limit the meaning of prajna

to intellect, however the definition of prajnaparadha stating as the error of dhi, dhruti,

and smriti resulting ashubha karma of kaya, vacha and mana surpasses this limitation

of merely intellectual error40. The word ‘karma’ is used for prajnaparadha. The word

karma has a very wide meaning indicating the karma of kaya, vacha and manasa as

well as purvajanmakrita and sadyojanmakrita too. The word ashubha karma in the

definition states that disturbed state of dhi, dhriti, and smriti respectively. The hina, ati

and mithya yoga of such karma causes vyadhi utapatti. Thus prajnaparadha occupies

an important place in trividha hetu.

Derivation

It is derived from jna (mulashabda) – jnayate iti shabda, ‘pra’ upasrga, jnayate iti

artha i.e, prajna and its aparadha forming prajnaparadha41.

The word prajnaparadha is a karmadhari samasa composed of two words – Prajna –

To know/ understand (especially a way or mode of buddhi)

Aparadha – An offence

Prajna

It is a streelinga shabda representing buddhi tattva of saraswati devi.

Aparadha

It is a pumlinga shabda derived from ‘apa’ and’ radha’ dhatu..

Definition

The ashubha karma brought about by kaya, vacha and manas in the disturbed

state of dhi, dhriti and smriti is said or defined as prajnaparadha.

Types

As per the definition it is classified into 3 types viz kayika, vachika and

manasika with again its three subtypes as hina, ati and mithyayoga respectively.



Prajnaparadha as major cause for diseases

It is stated in the classics that the rogotapatti of jwaradi rogas (viz. jwara,

raktapitta, gulmadi…etc) are started because of dharma hrasa or adharma in dwapaara

yuga. Along with it there is decline in the quality of sasya also.42

The factors like lobha, abhidroha and kopa are included under adharma in

janapadodhwansa adhyaya. It is mentioned in classics that for vatadi dusti and

adharma the prajnaparadha is the moola yoni or karana43. This clearly indicates that, it

is the prajnaparadha only in the form of adharma as the root cause in the jwaradi

rogas.

In the manifestation of almost all the disease the trividha hetu viz

asatmendriyarthadi always exists. However, prajnaparadha is the prime root in all the

disease maniefestation accompanied with asatmendriyartha samyoga and kaala. This

can be understood by nidanokta samprapti of diseases, which will reveal the fact that

all the diseases are caused by the stimuli of prajnaparadha associated with

asatmendriyartha samyoga and parinaama.



NETRA SHAREERA

Importance of Eyes

One need not emphasize the importance of the eyes as scriptures say

‘Sarvendriyanaam Nayanam Pradhaanam’ “nothing in this world is as good and

perfect as, unaided vision”. Eyes were greatly valued by ancient Indians and much

importance was accorded to their protection and care.

Historical review

The description of eye can be traced in Vedic litrature.The divine Vaidyas,

Ashwini used to perform ophthalmic operations with the knowledge of anatomy. The

Brhadāranyaka Upanishad narrates about Akşhi. Chakshushopanishat is also devoted

to eye care.

The Uttara Tantra of sushruta samhita gives a vivid description of the eye, its

anatomical description, along with classification of its diseases and their management

is explained in detail44.

Synonyms of eye

Akşi, Cakşu, Dŗşţi, Netra, Nayana and Lochana are the different synonyms

used in Ayurveda Samhitas. The synonyms related to the organ of sight are Akshi,

Netra, Nayana, and Lochana these words are used in anatomical sense and Netra is a

widely used word for the organ of sight45-.

Panchabhautika concept of Netra

The Netra, like all other organs of the body is made up of Panchamahabhutas

and drushti is pancha maha bhuta prasasda bhaga.Sushruta has clearly mentioned the

contribution of Panchamahabhutas as follows46

Table No 4. Panchamahabhoota dominant parts in netra

Mahabhoota Part

Prithvi Mamsabhaga (muscular portion) Jala Shweta bhaga (white portion)

Tejas (Agni) Rakta bhaga (red portion) Vayu Krishna bhaga (black portion)

Akasha Ashru marga/ Srotas (tear channels)



Netra Rachana47

Situation: Siras is the uttamanga of the body. All the senses are situated in it and

supported by the head. Netra are the two among the seven external openings of the

Shiras

Shape: Acharya Sushruta in Sushruta Samhita Uttartantra has described Netra as

“Suvrittam, Gostanakaram Nayana Budbudam”, which denotes the shape and

consistency of the Netra.

Size: The measurements of the eyeball was described by Sushruta as 2 Angula

Bahulya (anterio posteriorly) or equal to central part of ones own thumb

(swangushtodara sammitam) and 2½ Angula Sarvata sardham (circumference).

Parts of Netra

The anatomical parts present in eye consists of 5 Mandala, 6 Sandhi and 6

Patala.The same division was adopted by Vagbhatta, Madhavakara and Bhavamishra

also.

Mandala

The word Mandala is made from root ‘Mad’ + ‘Klach’ pratyaya means,

covering circular areas or concentric circles. The are 5 Mandala

1) Pakshma Mandala

2) Vartma Mandala

3) Shweta Mandala

4) Krishna Mandala

5) Drishti Mandala

Sandhi

Sandhis are the junctional areas between two Mandalas. The Sandhis are

important as far as the pathogenesis of the diseases is concerned, because the diseases,

of one Mandala may spread to another through these junctional areas. They are

1. Pakshma – Vartma gata Sandhi

2. Vartma – Shukla gata Sandhi

3. Shukla – Krishna gata Sandhi

4. Krishna – Drishti gata Sandhi



5. Apanga Sandhi

6. Kaneenika Sandhi

Patala

V.S. Apte, in his Sanskrit – English dictionary describes the meaning of Patala

as a film or coating over the eyes. According to Monier Williams, it can be considered

as a layer of the eyeball.

The thickness of each Patala is 1/5th of the Drishti Mandala.There are 2

Vartma Patalas and 4 Akshi Patalas. The Vartma Patalas can be considered as the

layers of the Vartma – the eyelids and palpebral conjunctiva

The four Akshi Patalas are related to the eyeball itself. 1st Patala Tejas + Jala,

2nd Patala Mamsa (Pisita or Mamsashrita), 3rd Patala Medas Medoashrita, 4th Patala

Asthi –Asthyashrita.

Akshi Bandhana

Sirā, Kandarā, Meda and Kālakāsthi aid in maintaining the position of netra.

Sira & Dhamani There are 38 Sirā which transport Vāta (8), Pitta (10), Kapha (10) and Rakta

(10) in the Netra. Vāgbhata has mentioned 65 Sirā in the Netra the two Dhamani are

in each eye for transmission of Roopa (visual impulses) to the mind and other

dhamani are for ashru vahana.

Peshi and snayu

Mandala (circular) type of Peshi and Pruthu (broad) type of Snayu are found in

the eyes. They are respectively two and thirty in number.

Asthi and sandhi

Netra are situated in Akshi kosha surrounded by Tarunasthi

Marma

‘Apānga’ a Sira Marma and ‘Avarta’ a Sandhi Marma are related with Netra.

Any injury to these sites may result in loss or impairment of vision.



Description of Drishti

Etymology

Drish + ‘Ktin Karane’ pratyaya meaning there by a “tool to see”

Drishti is described by Sushruta as:

Masura dala matra (size of a Masura dala)

Prasada of Panchamahaboota

Covered by the external Patala

Khadyotavisphulingabha (Sparkling like a glow worm)

Shape resembles a hole (Vivirakritim)

Benefited with cold things

Drishti means vision. All the anatomical structures through which light passes to

reach the retina including the optical zone of cornea, aqueous humour, lens, vitreous

humour and retina can be included in the Drishti as per many scholars.

CONCEPT OF DRISHTI IN AYURVEDA

Visual perception, like all other sensory phenomena, is dependent upon the

state of mind and soul. Acharya Charaka has described this process as the conjuncture

of soul, mind and the sense organ with their objects. Kashyapa classifies senses into

Sannikrishta Indriyas and Viprakrishta Indriyas. Eyes and ears are Viprakrishta

Indriyas, where in object need not directly fall on the senses. Eyes are developed with

sufficient skills to perceive the object from a sufficiently large distance.

The theory of Panchapanchaka given by Acharya Charaka depicts the

phenomenon of sensory perception by enumerating the five important factors that take

part in this process. They are Indriya, Indriya Dravya, Indriya Artha, Indriya

Adhisthana and Indriya Buddhi. In case of eye, these factors are as follows

Table No.5. Indriya panchapanchaka of netra

Indriya Chakshu

Indriya Dravya Tejas

Indriya Artha Rupa

Indriya Adhishthana Eyes (2 Netra)

Indriya Buddhi Chakshurbuddhi



Impulses from both these Akshis are collected at Chakshu47 (Indriya), which is

only one in number. Further it will be analyzed at the level of Chakshurbuddhi

(Indriya Buddhi) to give actual knowledge of the objects.The subtypes of Doshas like

Prana Vayu and Vyana Vayu are specifically held responsible for Vata Karmas,

Alochaka Pitta for Darshana and Tarpaka Kapha for Akshi Tarpana.

Eyes are most important among the five Jnanendriyas. So its function can be

considered as the function of Jnanendriya. The physiology of vision can be

summarized as follows

Indriyartha (Object)

Vata

Indriyavayava

Chakshurvaisheshika Alochaka Pitta

Indriya Samvedaka (nerve impulse)

Prana Vayu

Buddhi (occipital cortex)

Buddhirvaisheshika Alochaka Pitta

Pratyakshajnana

(Atma – seat of knowledge)

Similar ideas are reflected in the description of two phases of Chakshurbuddhi48. The

momentary knowledge is obtained by Kshanika Chakshurbuddhi, which will be

further confirmed in the second stage by Nischayatmika Chakshurbuddhi, according

to Chakrapanidatta.



ANATOMY OF EYE

Introduction

Even though the eye is small, it serves a very important function i.e. sense of

sight. Vision is arguably the most useful of the five senses and is one of the primary

means to gather information from the surroundings. Eye is often compared to a

camera. Two eye balls are situated in the two bony orbits of the norma-frontallis of

the skull49 and protected by eye lids and eye lashes. Each eye ball is a cystic structure

kept distended by the pressure inside it. Each of them gathers light and then

transforms that light into a “picture”.

Dimensions of an adult eye ball

Antero-posterior diameter 24mm

Lateral diameter 23.5mm

Vertical diameter 23mm

Circumference 75mm

Volume 6.5ml

Weight 7gms

Coats of the eye ball

The eye ball comprises of three coats

1) The outer fibrous tunic = sclera and cornea

2) The middle vascular tunic = iris, ciliary body and choroids

3) The inner nervous tunic = retina

Interior of the eyeball has the following structures

1) Aqueous humor

2) Lens

3) Vitreous

The accessory structures are

1) Eyebrows

2) Eyelids and eyelashes

3) Lacrimal apparatus



Sclera

The sclera forms posterior 5/6 of the eye ball. It has received its name from its

extreme dense fibrous tissue which is hard and maintains the shape of eyeball. Its

external surface is white in colour.

Cornea

The cornea is a transparent anterior one-sixth of the fibrous coat of the eyeball.

It is almost circular in outline.It is convex anteriorly and projects like a dome in front

of the sclera. The cornea is dense and of uniform in thickness throughout; its posterior

surface is perfectly circular in outline, and exceeds the anterior surface slightly in

diameter. its separated from iris by the aqueous humour in the anterior chamber.

Iris The iris has received its name from its various colors in different individuals.

It is a thin, circular, contractile disk, suspended in the aqueous humor between the

cornea and lens, and perforated a little to the nasal side of its center by a circular

aperture, the pupil. On its periphery it is continuous with the ciliary body, and is also

connected with the posterior elastic lamina of the cornea by means of the pectinate

ligament; its surfaces are flattened, and look forward and backward, the anterior

toward the cornea, the posterior toward the ciliary processes and lens. The iris divides

the space between the lens and the cornea into an anterior and a posterior chamber.

Retina

The Retina is soft, semitransparent, having a purple tint in the fresh state,

owing to the presence of a coloring material named rhodopsin or visual purple; but it

soon becomes clouded, opaque, and bleached when exposed to sunlight. Exactly in

the center of the posterior part of the retina, corresponding to the axis of the eye, is an

oval yellowish area, the macula lutea; in the macula is a central depression in the

fovea centralis. At the fovea centralis the retina is exceedingly thin, and the dark color

of the choroid is distinctly seen through it. About 3 mm to the nasal side of the macula

lutea is the entrance of the optic nerve (optic disk), the circumference of which is

slightly raised to form an eminence (colliculus nervi optici) the arteria centralis retinæ

pierces the center of the disk.



This is the only part of the surface of the retina which is insensitive to light, and it is

termed the blind spot.

Aqueous humor

The aqueous humor fills the anterior and posterior chambers of the eyeball. It

is small in quantity, has an alkaline reaction, and consists mainly of water, less than

one fiftieth of its weight being solid matter, chiefly chloride of sodium.

Crystalline lens

The lens is made up of soft cortical substance and a firm, central part, the

nucleus.The crystalline lens, enclosed in its capsule, is situated immediately behind

the iris, in front of the vitreous body, and encircled by the ciliary processes, which

slightly overlap its margin. The lens is a transparent, biconvex body, the convexity of

its anterior being less than that of its posterior surface.

Eyebrows

Eye brows are two arched eminences of integument, which surmount the

upper circumference of the orbits, and support numerous short, thick hairs, directed

obliquely on the surface.

Eyelids

Eyelids are two thin, movable folds, placed in front of the eye, protecting it

from injury by their closure. The upper eyelid is the larger, and the more movable of

the two, and is furnished with an elevator muscle, the Levator palpebrae superioris.

Eyelashes

Eyelashes are attached to the free edges of the eyelids; they are short, thick,

curved hairs, arranged in a double or triple row: those of the upper eyelid, more

numerous and longer than those of the lower, curve upward; those of the lower eyelid

curve downward, so that they do not interlace in closing the lids.

Lacrimal apparatus

Lacrimal apparatus consists of the lacrimal glands, which secretes the tears

and convey the fluid to the surface of the eye, and its excretory ducts, the lacrimal



ducts, the lacrimal sac, and the nasolacrimal duct by which the fluid is conveyed into

the cavity of the nose.

Physiology of vision

In some ways the eye is like a camera. Its optical elements focus the image of

objects on a light sensitive film- the Retina, while ensuring the correct amount of light

makes the proper exposure. In order to achieve clear vision, light reflected from

objects within the visual field is focused to the retina of both eyes. The processes

involved in producing a clear image are –

a) Refraction of the light rays by the lens and camera

b) Accommodation of the eyes to light

The retina is the photosensitive part of the eye. The light sensitive cells are the

rods and cones. When light falls upon the retina, it acts as a stimulus to the rods and

cones, which serve as the sensory nerves endings. An image focused on the retina

stimulates photo receptors, which transduce the light stimulus into receptor potential

and pass the information on to bipolar cells. Bipolar cells, in turn communicate

ganglion cells, which project their axons to the lateral geniculate body of the

thalamus. From the thalamus, fibers carrying visual nerve impulses extend to the

primary visual center in the occipital lobe.In the outer segment of the photoreceptors,

the transduction of light into electrical signals takes place. The first step in this

process is absorption of light by rhodopsin/iodopsin (photopigments). These photo

pigments have two parts -

i) A glycoprotein - Opsin

ii) Derivative of Vitamin A - Retinal

Vitamin A derivates are formed from the carotenoids. Photopigments are

coloured proteins in outer segment membranes that undergo structural changes upon

light absorption. They initiate the events that lead to production of a receptor

potential. The single type of photopigment in rods is called rhodopsin. A cone

contains one of the three different kinds of photopigments, thus there are three types

of cones. Retinal is the light absorbing portion of all visual photopigments. In the

human retina, there are four different opsins, one for each cone photopigment and one

for rhodopsin. Small variations in the amino acid sequences of the different opsins

permit the rods and cones to absorb different colours of incoming light. Rhodopsin



absorbs blue to green light most effectively whereas the three cone photo pigments

most effectively absorb blue, green or yellow to red light. Retinal exists in two forms.

a) Cis b) Trans.

In darkness, it has a bent shape called cis – retinal. When it absorbs light it

straightens out to a shape called Trans-retinal forming Cis Trans Isomerisation cis to

Tran’s conversion is called isomerisation and it is the first step in transduction.

Forming of a visual image begins with isomerisation of particular photopigments in

certain rods and cones.

After this process, several unstable substances form and disappear. In about a minute,

transretinal completely separates from the opsin. In darkness, an enyme called retinal

isomerase can reconvert Trans to cis – retinal, which then binds to opsin and reforms

a functional photopigment. This is called regeneration.This process is contributed by

large storage of vitamin A by pigment epithelium.



NETRA ROGA

The diseases occurring in various parts of the Netra are termed as Netra roga

Historical review of netra roga

1. Veda kaala

a) In Yajurveda Taittareeya sakha explanation of drushti prapti is mentioned50.

b) In Atharvana veda explanation is available about Andhatwa nivarana and

importance of drushti.

2. Upanishad & Purana kala

a) In Garuda purana explanation of netra roga is available

b) In Koushika sutra netra roga lakshana and chikitsa are explained.

c) In Ramayana darkness in forest is denoted by thr word “timira” which is also a

netra roga51.

3. Darshana kaala

a) In vedantha darshana anitya type of netra drushti and timira are explained.

b) In bouddha darshana symptoms of timira and other eye diseases are mentioned52.

4. Samhita kaala

Bruhatrayee

a) Acharya charaka mentioned netra rogas in trimarmeeya chikitsa adhyaya of

chikitsa sthana.

b) Acharya sushruta explained netra roga and their chikitsa in detail in uttaratantra.

c) Acharya vagbhata explained netra roga and their chikitsa in detail in uttarasthana.

Laghutrayee

a) Madhavakara in Madhavanidana explained nidana and lakshana of netra rogas in

Netraroganidana adhyaya.

b) Bhavamishra in Bhavaprakasha explained netra roga and their chikitsa in detail

under Netrarogaadhikara.

c) Sarangadhara explained netra roga and their chikitsa in detail in uttarakhanda.



Other classical texts

a) Harita Samhita explained Netra roga and their chikitsa in netra roga chikitsa

adhyaya.

b) Yogaratnaka explained Netra roga and their Chikitsa

c) Chakradatta also explained Netra roga and their Chikitsa under chikitsa

prakarana.

Recent books

a) Dr Vishwanath Dwivedi in ‘Nimi tanthra’ book explained Netra roga and their

Chikitsa

b) Dr Ravindra Chandra Choudary in ‘Shalakya Vignana’ text book explained Netra

roga and their Chikitsa

c) Dr D.Lakshman Acharya in ‘Shalakya Tantra’ text book explained Netra roga and

their Chikitsa

d) Dr P.K.Shantakumari in text book ‘Opthalmology in Ayurveda’ explained Netra

roga and their Chikitsa

Classification of Netra Roga

Ayurveda Samhitas have classified the diseases according to nature of

occurrence and the site of occurrence. The netra roga also can be classified as

follows

Nature of Occurrence53

1. Aadi Bala Pravrutta- Includes hereditary disorders acquired from mother and

father.

2. Janma Bala Pravrutta- Includes Congenital abnormalities

3. Dosha Bala Pravrutta- Eye Problems caused by Dosha vitiation.

4. Sanghatha Bala Pravrutta. – Abhighata janya netra roga due to factors like

bhoutikaabhighata,yantrika,abhighata,rasayanika,abhighata,keetanu,suryavalokana

,agni,aatapa,atiyoga,ayoga and mithyayoga of drushti, seeing very bright light etc,.

5. Kala Bala Pravrutta- Netra roga caused due to seasonal changes.

6. Daiva Bala Pravrutta Netra roga caused due to natural calamities, accidents etc.

7. Swabhava bala pravrutta – Netra roga due to Senile or age related changes.



Table No. 6 Netra Rogā according to different Āchārya 54-59

Su.Sa AS AH MN YR BP SA KT Sandhigata Rogās 09 09 09 09 09 09 09 09

Varthmagata Rogās 21 24 24 21 21 21 24 27

Śhuklagata Rogās 11 13 13 11 11 11 13 13

Kŗişhņagata Rogās 04 05 05 04 04 04 05 06

Sarvagata Rogās 17 16 16 17 17 17 16 16

Pakşhmagata Rogās - - - 02 02 02 - -

Dŗşhtigata rogās 12 27 27 12 12 12 27 25

Bahyaja 02 - - 02 - 02 - - Total 76 94 94 78 78 78 94 96

NIDANA OF NETRA ROGA60 -63

After discussing the definition derivations and classification of the netra roga

it is very essential to concentrate on etiological factors that are responsible for the

causation of the disease.

Nidana is one of the five factors of diagnosis of any disease called as nidana

panchaka. It is the factor which is the cause of any diseases. It is also that factor which

directs us towards a diagnosis of disease.

Nidana is classified into different groups in Ayurvedic classics on different

basis. Some of them are in relation to the time taken in causing a disease and some are

on the basis of their diagnostic significance.In this chapter the causative factor of

netra roga will be dealt for the study of netra roga process.

Nidana is categorized broadly into two main divisions:

1) General causative factor (samanya nidana)

2) Specific causative factor (vishesha nidana)

General etiological factors are responsible for the manifestation of all varieties

of where as the specific etiological factors are responsible for the specific variety of

netra roga.The Nidana Panchaka consists of Nidana, Purvaroopa, Lakshana, Upashaya



and Samprapti which help to understand the disease in detail.The Nidana Panchaka of

Netra Roga is explained below.

Acharya Charaka in sutrasthana 18 chapter Trishotheeya adhyaya says that it’s

not necessary to name all the diseases and it’s not possible also to name them.an

intelligent physician should diagonise the disease, basing on dosha because the same

tridosha getting prakopa due to various factors gets lodged in various parts of shareera

and causes various diseases. Thus this Siddhanta of Acharya Charaka is valid in

understanding new diseases like CVS which though not mentioned in Ayurveda

Samhitas can be understood by applying panchlakshana nidana as follows.



Table No. 7 Netraroga Nidana

No Etiological factors of Netra Roga

Su.Sa MN BP YR

1. Ushna Abhitaptasya Jala Pravesha

2. Doorekshana

3. Swapna Viparyaya

4. Prasakta Samrodana

5. Kopa

6. Shoka -

7. Klesha

8. Shiro Abhighata

9. Atimaithuna

10. Shukta Aranala

11. Amla

12. Kulattha

13. Masha Atinishevana

14. Vega vinigraha

15. Ati Swedana

16. Ati Dhooma Nishewana

17. Rajo nishevana

18. Chardi vighata

19. Vamanaatiyoga

20. Bhashpanigrahat

21. Sookshma nireekshanat

22. Ati vega yaanaat - - -

23. Rutu viparyaya -

24. Atidravapana -

25. Atimadyapana -

26. Upasarga -



Acharya Dalhana while commenting on uttaratanthra 19th chapter ‘Nayanabhighata

pratishedha adhyaya’ has mentioned about Abhighata nidana causing netra roga by

amoortha dravyas like vata,atapa,dhooma,raja,keeta, makshika, mashaka,

“Ahita ashanaat, Bhrusha bhasva chala sookshma veekshanaatcha”.

According to Acharya Nimi Nidana for netra roga are ahita aahara and visual contact

with excessively sparkling, fast moving and minute objects.

Pujyapada Muni in Netra Prakashika gives the following nidanas wrong way

of oil bath -either in excess or less, witch craft, drug addiction, weight lifting ,staring

at luminous objects like sun,jwala-nireekshana etc cause netra roga.

Table No. 8 Netra roga Nidana according to Commentators

Ckp Dal

Avakshira shayya - +

Shiro ucchitha - +

Kshara sevana - +

Darshana ayoga + +

Darshana atiyoga + +

Darshana mithya yoga + +

Bhasavarna + +

Upasarga - +

Acharya Chakrapani73 while commenting on Matrashitiya adhyaya of Charaka

Samhita sutrasthana in the context of guru and laghu aahara and its relation to agni

says that “the eye is the seat of tejas. Perception of vision occurs due to the union of

the eye with tejas. The same tejas if excess causes loss of vision or impairs the

vision”.



POORVAROOPA

The feebly manifested symptoms which are produced during the processes of

sthana samshaya avastha of kriya kala in the manifestation of disease process are

known as poorva rupas65.

Poorvaroopa are that group of signs and symptoms appearing in milder form

and indicative of forth coming disease.

The description of prodromal symptoms of netra roga was not given separately

in all Ayurvedic texts but only Acharya Sushruta had mentioned them in uttaratanthra.

Poorvaroopa of Netra roga are explained in general for all eye diseases and are as

follows. All these lakshana are alpa vyaktha in the poorva roopavastha of netra roga.

So the general poorva rupas explained in the context of netra roga are considered here.

1. Avila

2. Samrambha

3. Ashru

4. Kandu

5. Upadeha

6. Guru

7. Oosha

8. Toda

9. Ragayuktam

10. Sashoolam vartma-kosheshu

11. Shukapurnabham

Acharya Dalhana commenting on this state’s another version i.e.,

kandupoornopadehavat (excess Itching) is present instead of ashrupoornopadehavat

(excess lacrimation) and sa shoolam as ishat shoolam i.e., mild pain are present in this

stage. Purva roopa has not been specifically mentioned by Acharya Charaka and

Vagbhata and it is implied that the lakshnas in lesser intensity are to be considered as

poorva roopa of netra rogas.



ROOPA

The stage of disease manifestation where the signs and symptoms are

exhibited clearly is the vyakthavasta and such a group of clinical features is called as

roopaor lakshana of the disease.

This roopa can be very specific to a disease and indicative of the underlying

pathology. This can be subjective or objective however, it becomes the main aid in

diagnosis due to clear cut manifestation of disease at this stage.

Generally rupa are classified into samanya and vishista rupas. Under samanya

Roopa/Lakshanas the following Lakshanas can be considered based on dosha

predominance according to Acharya Charaka66.

Table No.9 Dosha predominant lakshana in netra roga

Vata Pitta Kapha

Alparaga Daha Shuklopadeha

Upadeha Atiruja Bahu picchila ashru

Toda Raga Guruta

Bheda

Peetopadeha Kandu

ROOPA wsr TO CVS

Signs and symptoms of Computer Vision Syndrome and the probable dosha vitiation

involved in it is being considered based on the signs and symptoms as follows. The

signs & symptoms of CVS can vary but mostly include

Eye Irritation (Dry Eyes, Itchy Eyes, Irritated Eyes)

Red Eyes

Blurred Vision (Distance Or Near),

Headaches

Light Sensitivity,

Double Vision

Backache

Neck Ache

Muscle Fatigue



Eye Strain

Difficulty Refocusing the Eyes.

Table No.10 CVS symptoms and their dosha involvement

The lakshana of netra roga based on dosha predominance wsr to CVS is compared

here.

Table No.11 Netra Roga Lakshana in comparision to CVS

Vata Lakshana CVS

Alparaga Redness

Upadeha Excessive secretions of eye / stickiness

Toda Mild pain (pricking)

Bheda

Tearing pain

Pitta Lakshana

Symptoms Ayurvedic terms Dosha vitiation

Dry and irritated eyes Visushka Netra / Rooksha Netra

Vata

Eye Strain Netra Klama Vata Blurred vision Avila Darshanam Pitta Red Eyes Netra Raaga Pitta Burning Eyes Netra Daha Pitta Excessive lacrimation Ashru Bahulata Vata Double vision Dwidha pashyati (Mithya

darshana) Vata

Difficulty in focusing Roopa darshana asahyata (heena tarpita lakshana)

Vata

Change in colour perception Vikruta varna patavam Vata / Pitta

Photophobia Prakasha Asahyatva Vata / Pitta Headache Sirashoola Vata/Pitta Pain in shoulder, neck and back. Greeva, Bahu ,

Kati Shoola Vata

Contact lens discomfort --------------- -

Slowness in changing focus Alpa kriya laghava of netra

Vata



Daha Burning sensation

Atiruja Excessive pain

Raga Redness

Peetopadeha Yellow discoloration -

Kapha Lakshana

Shuklopadeha

White discoloration -

Bahu picchila ashru

Excess sticky secretions in eyes -

Guruta

Heaviness

Kandu Itching

UPASHAYA

Upashaya-Anupashaya67

The Ahara-Vihara-Aushadha, which helps to relieve disease symptoms, is

called as Upashaya and that which cause aggravation of the symptoms is called

Anupashaya.In the context of netra roga direct reference is available about Upashaya

& Anupashaya. Hence, all those factors mentioned under anupashaya along with

apathyas and nidana can be considered as Anupashaya and in Upashaya those factors

which relieve symptoms of Netra roga, can be included. Upashaya and Anupashaya

for netra roga will be discussed in detail under netra roga pathyapathya and samanya

chikitsa.

SAMPARPTHI

After discussing nidana it is very essential to consider samprapti of the disease

proper. Samprapti is that, which explains disease process starting from dosha dusti,

their spread and the manifestation of the disease. Thus complete knowledge of

samprapti is very essential in planning the successful treatment.The samanya

samprapthi of netra roga according to various Acharyas is as follows.



Charaka68

Charaka considers netraroga under trimarmeeya rogas and its samprapthi is

explained as the dusta vayu reaches the indriyas and manifests loss of function of that

sense organ (loss of vision if it’s the eye,etc) .In the same sloka he says that if dushta

vayu gets inside the sira it manifests as mild pain, (mandaruk) oedema, (shofa) dries

up, (Shusyathi) excessive pulsation, (Spandathe) loss of sensation, (supathata)

constriction or decrease in size (tanvyo means thinning),dilatation or increase in size

(mahatyo means to become bigger ) of the sira.

Sushruta69

The doshas are vitiated due to achakshushya nidana and enter the urdhwagata

siras, lodge in the various parts of the eye and manifest as netrarogas.Commenting on

the above Dalhana says "the siras referred here are the netragata siras, the term

Netrabhaga means the different structures of the eye, and according to some it means

netraraaji i.e., the capillaries supplying the eye.

Vagbhata70

The doshas getting vitiated by achakshushya nidana as mentioned in sarvaroga

nidana with predominance of pitta dosha enter the urdwagata siras, and lodging in

different parts of the eye manifest the netrarogas

Illustration Showing the Scheme of Samprapti in Netra Roga

Achakshushya Nidana Sevana

Dosha Vruddhi and Dosha Dushti

(Nidana sevana continued)

Dosha prakopa with predominance of Vata and Pitta Dosha

Spreading of dosha in the body through all sira and srotas

Entry of doshas into Urdhwagata Sira



Urdhwagati of Prakupita Dosha through the Urdhwagata Sira

Sthana Samshraya of Prakupita Dosha in various parts of the Netra

Poorvaroopa lakshana

Manifestation of Netra Roga

Samprapti Ghataka

Dosha- Vata Pitta Pradhana Tri Dosha

Dooshya- Rasa,Rakta,Mamsa,Medas

Srotas- Netragata Sira

Srotodusti- Sanga,Atipravrutti

Udbhava sthana- Chakshu (Netra)

Vyaktha sthana-Netra

Sanchara sthana- Urdhwagata Sira

Rogamarga- Madhyama

Adhisthana- Chakshurendriya

Swabhava- Chirakari

VYAVACCHEDAKA NIDANA

Before confirming the diagnosis of CVS, it has to be differentiated from other

diseases which mimic netra roga with some specific symptoms. For this one should

take proper examinations as well as investigations in order to differentiate it from

other diseases which have similar specific symptoms mentioned in Ayurveda Samhita.

For this the following disorders can be considered.



Table 13.Comparision of CVS with Netra Roga mentioned by various Acharyas

The lakshanas of CVS resemble the lakshana of the diseases mentioned in

Ayurveda, as above but a detailed examination and interrogation is necessary to rule

out the above said diseases.CVS is not a very severe disease, compared to the diseases

taken for Vyavacchedaka nidana and CVS is also always associated with patients

working with computers.these diseases may occur along with CVS and make the

condition severe and worse but CVS cannot be compared as such with any of theses.

SADHYASADHYATA

Before going to start the chikitsa of a particular disease one should know about

the sadhyasadhyata of a disease, i.e. According to prabhava, the diseases are classified

as Sadhya and Asadhya. Sadhya is subdivided as sukha sadhya and krichra sadhya,

asadhya is subdivided as yapya and pratyakheya.

CVS is an easily curable condition i.e., sukhasadhya if chikitsa is started early

and if nidanaparivarjana and pathya are followed properly. But if nidana parivarjana

and pathy are not followed by computer user’s then CVS becomes a kricchra sadhya

or yapya vyadhi.

UPADRAVA

In Ayurveda, Acharyas has not described the Upadrava separately for

individual netra roga but mentioned that if netraroga are left untreated they become

chronic and lead to complications like timira

Name of disease Charaka Sushruta As Ah Mn

Vatabhishyanda -

Sushkaakshipaka -

Asopha -

Sasopha -

Sirotpata -



NETRA ROGA CHIKITSA

“Yaabhihi kriyaabhihi jaayanthe shareere dhatava samaah

Sa chikitsa vikaaranaam karma tat bhishaja smrutham” (Ch .su.16/34)

Chikitsa is that procedure/entity which brings the bodily components to a state of

normalcy. In general, Chikitsa for any roga is told as

Samshodhanam Samshamanam nidaanasya cha varjanam

etavatbhishajaa karyam roge roge yatha vidhihi (Ch-vi 7/30)

The management principles of Netra Roga in general consist of avoidance of

etiological factors as the first line of management. The second principle is to counter

act increased Vata and other Doshas in the poorvaroopa stage itself, because if

neglected these diseases progress rapidly and become incurable in later stages.

Management of netra roga can be broadly classified into71

a) Nidana parivarjana (Prophylactic measures)

It is the first line of treatment of any disease and it is most important line of

treatment for Netra roga also.It indicates that the root of Samprapti process is nidana

and it must be avoided for best management of the disease. In netra roga the factors

which are mentioned as Nidana of the disease should be avoided.Nidana parivarjanam

includes avoiding by all means the etiological factors leading to aggravation of dosha,

vyadhi and apathya.

b) Vaatadi dosha shamanam (Curative measures)

Vaatadi dosha shamanam includes treating the aggravated doshas involved in

causing Netra roga by shamana and shodhana.

Aushadha

In Nayanabhighata pratishedha adhyaya Acharya Dalhana says that

pittaabhishyanda, raktaabhishyanda and vataabhishyanda chikitsa is to be followed in

abhighataja netra rogas with drugs having drushti prasaadana properties, like Nasya,

Aalepa, snigdha dravya which are drushtiprasaadajanana should be used.



Triphala is said to be drug of choice in case of Netra Roga with various Anupana.

Based on the involvement of Doşās. This drug is Cakşuşya, Rasāyana along with

Deepana, Pācana properties. A number of herbal and animal drugs like madhu, ghrita,

yashtimadhu etc are mentioned as Chakshushya in the Samhitas and Nighantus where

as many mineral drugs are described in the text books of Rasashastra, which can be

used in treating various netra roga.

Kriyakalpa72

Sushruta has recommended ‘Kriyakalpa’ for the management of netra roga, along

with other types of treatment. They can be advocated in almost all eye diseases and it

comprises of Tarpana, Putapaka, Anjana, Aschyotana and Seka.Later scholars like

bhavaprakasha have advocated the use of Swarasa and Arka for local use in Netra

roga.

Shastra karma

The shalya treatment of Netra roga begins with shastra karma including chedana

etc procedures to relieve Rakta and mamsa dushti.

Panchakarma

Panchakarma is indicated for sarva deha gata dosha shodhana, A number of

nasya, vamana and vasti yoga are also described for Netra Roga based on the dosha.

Pathyaapathya73

Pathysevana plays a major role both in prevention and cure of netra roga.

According to Sushruta, the person who is having the habit of regularly taking old

Ghrita prepared from Shatavari or Amalaki, Yava cooked with sufficient quantity of

Ghrita and the decoction of Triphala etc, by taking these ane has no reason to fear

from even the severest form of Netra Roga.

The cooked vegetables of Jivanti, Sunishannaka, Tanduliya, good quantity of

Vastuka, Moolakapotika and jangala mamsa are beneficial for eyesight. Patola,

Karkotaka, Karavellaka, Vartaka, Tarkari, Karira fruits, Shigru and Aartagala etc,. all

these vegetables cooked with Ghrita also promote eyesight. Acharya Vangasena

supports the same views.



Acharya Bhavaprakasha has mentioned that use of certain procedures like Lepa,

Abhyanjana, Sechana, Dhavana, etc. in the sole of foot are beneficial for the

improvement of eyesight

Aştāňga Hŗdaya advocates Raktamokşaņa, Virecana, purity of mind, relaxation,

Anjana, Nasya, meat of birds, oil. (A. S. Ut. 13/99-100). Pādābhyanga and

Pādarakşādhāraņa, Śitodaka Parişeka, Śitodaka Snāna, Śitodaka Gandūşadhāraņa,

Dakşiņamāruta,keeping palmar region of the hands to the eyes are stated for the

rejuvenation of the eye sight74.

The Chakshushya regimen mentioned in the classics is be useful in controlling

the progress of the disease. A combination of the above said drugs, in the form of oral

supplement, and kriyakalpas will play a definite role in the management of netra roga.

NETRA ROGA SAMANYA CHIKITSĀ

Nidana Parivarjana Dosha Shamana (Shodhana/Shamana)

Sthanika Sarvadehika

Aushadha Shastra Panchakarma

Aushadha Kriya Kalpa

Triphala Seka Chedana Snehana Pathyapathya

Yashtimadhu Āścyotana Bhedana Swedana Vishrama

Saptamritaloha Pindi Lekhana Vamana

Etc.drugs Bidālaka Vyadhana Virecana

Tarpana Raktamoksana Basti

Putapāka Kshara karma Nasya

Anjana Agnikarma

Netra vyayama Jalukavacharana



The samanya chikitsa of netra roga are mentioned above but to plan a chikitsa

Siddhanta for a disease not mentioned in samhita the following points are to be

considered.

CVS is a netra roga caused due to Nija and Aganthu karana janya dosha

prakopa.

Nidana parivarjana is the first line of treatment in all aganthuja rogas.

Vataadi dosha shamana is the second line of treatment for the prakupita dosha

causing specific lakshana in this particular vyadhi.

In Nayanaabhighata Pratishedha adhyaya Acharya Sushruta mentioned netra

prasadana janana, drushtiprasadajanana drugs should be used along with

vaatabhishyanda chikitsa.i.e. procedures like aschotana ,tarpana putapaka and

Rasayana.

PATHYA APATHYA

Practicing appropriate Pathya-Apathya along with the treatment of disease is

one of the unique characteristics of Ayurvedic science. Classical texts emphasize that

success or failure of the treatment depends to a large extent on the practice of Pathya

and Apathya. The food articles, drugs and regimens which do not affect the body and

mind adversely are regarded as Pathya and in the same way which adversely affects

the body are considered to be Apathya75.

By following the Pathya and avoiding apathya mentioned in the Ayurvedic

classics one can maintain his healthy vision and prevent it from many diseases.

Table 14.Pathya in Netra Roga

Aahara Su.Sa AH YR CD

Yava

Godhuma -

Sali -

Shastika -

Mudga -

Kodrava -

Saindhava -

Sharkara -



Varsha jala - - -

Aushadha

Triphala

Amalaki

Punarnava -

Dadima -

Yashtimadhu

Shatavari -

Karavellaka -

Kustumburu -

Patola -

Draksha -

Lodhra -

Godugdha

Goghruta

Jangala mamsa

Karma

Shirobhyanga

Padabhyanga

Netra aschotana

Chatra dharana

Padatra dharana

Manasika

Manasika santulana

Sattwa pradhana

Table 15.Apathya in Netra Roga

Aahara Su.Sa AH YR CD

Pathrashaka

Pinyaka -

Dadhi -

Matsya -



Amla sura

Atiyoga of Lavana

Teekshna -

Katu -

Ushna -

Guru

Atyamla -

Vidahi -

Vihara

Kshudha & other vega dharana

Abhighata

Suryavalokana

Diwaswapna

Ratrijagarana

Rukshata atisevana

Utkatasana

Bhashpa sevana

Dhooma sevana

Manasika

Chinta

Shoka

Bhaya

Krodha

Kriya

Ativamana

Ati virechana

Ati nasya

Mithya yoga of netra kriyakalpa

“Ahita ashanaat sada nivrutti,

Bhrusha bhasva chala sookshma veekshanaatcha”



According to Acharya Nimi76 apathya for netra roga are ahita aahara and visual

contact with excessively sparkling, fast moving and minute objects.By judiciously

applying the above said principles netra roga can be prevented and treated.



DRUG REVIEW

DRUG REVIEW OF TRIPHALA YASHTIMADHU YOGA

Acharya Vagbhata recomends Triphala mixed with honey and ghee to be taken

in the night to improve visual acuity77.

Amalaki and yasthimadhu pacifies pitta and alleviates defects of vision

according to Vangasena78.

Nimi opines that taking Triphala and Yasthimadhu churna with ghee and honey

at night, consuming wholesome diet and amalaki water helps one attain excellent

vision79.

HARITAKI80

Name Haritaki

Botanical name Terminalia chebula retz

Family Combretaceae

Synonyms Abhaya,Amrutha,Pathya,Putana,Jaya,

Avyatha,Haimavathi,Kayastha,Vayastha,

Siva,Chetaki,Pranadaa,Jivanthi,Rohini,

Vijaya,Shreyasi

Rasa Pancharasa (Lavana Varjita) Guna Laghu Ruksha Virya Ushna Vipaka Madhura Prabhava Tridoshaghna,Deeepana,Prajasthapana, Medhya,Chakshushya,Hrudya,Anulomana, Rasayana

Parts used Phala, Phalamajja

Gana Charaka-Jwaraghna,Arśoghna,Kāsaghna,

Kustaghna,Prajāsthāpana

Suśhruta-Āmalakyādi, Parushakādi, Triphalā



Vāgbhata-Parushakādi

Chemical composition Fruit:Anthraquinone,Glycosides, Chebulic

Acid, TannicAcid, Terchebin, Vit-C

Fruitkernel:Arachidic acid,

Oleic acid, Palmitic acid, Behenic acid

& Stearic acid

Flower: Chebulin.

Pharmacological activity

Antimicrobial, Antifungal, Antibacterial, Antistress,Antispasmodic,

Hypotensive,Antihepatitis B virus activity, Inhibitory activity against

HIV-1Protease.

VIBHITAKI81

Name Vibhitaki

Botanical Name Terminalia bellerica roxb

Family Combretaceae

Synonyms Akshaphala,Karshaphala,Kalidruma,

Bhootavasa,Kaliyugalaya,Trilinga

Rasa Kashaya

Guna Laghu Ruksha

Virya Ushna

Vipaka Madhura

Prabhava Tridoshahara

Karma Keshya,Krimihara,Vatahara,Chakshushya

Parts Used Phala, Phalamajja

Gana Charaka-Jwarahara, Kāsahara, Virechanopaga

Suśhruta-Mustādi, Triphalā

Vāgbhata-Mustādi

Chemical Composition Fruit:Fructose,Galactose,Mannitol,Glucose,

Rhamnose,B-Sitosterol


Antihistaminic, purgative, antifungal, blood pressure dipressent, activity against viral

hepatitis and vitiligo, bronchodialator, antispasmodic, CNS stimulant.



AMALAKI82

Name Amalaki

Botanical Name Emblica officinalis

Family Euphorbiaceae

Synonyms Abhaya,Amruthaphala,Dhatri,

Vayastha,Sitaphala,Tishyaphala,

Sriphala,Vrishya,Vayasya.

Rasa Amlapradhana Pancharasa

Guna Snigdha,Sita

virya Sita

Vipaka Madhura

Doshaghnata Tridoshahara

Karma Vayasthapana,Rasayana,Vrishya,

Chakshushya,pramehahara,raktapittahara

Parts used Phalamajja

Gana Charaka-Jwaragna,Kāsagna,Virechanopaga,

Kustagna, Vayasthāpana

Suśhruta - Amalakyadi, Parushakādi, Triphalā

Vāgbhata – Parushakadi

Chemical Composition Vit-C, Phyllembin, Linolic acid, Indole Acetic

acid,Axyubrin,Corialgin,Trigaloyl Glucose.

Elagic acid, and salts


Antimicrobial, anti fungal, anti inflammatory, anti bacterial, anti ulcer, spasmolytic,

mild CNS depressant, hypolipidemic, antiatherosclerotic, antimutagenic, antioxidant,

and immunomodulator.

YASHTIMADHU83

Name Yashtimadhu

Botanical Name Glycyrrhiza Glabra



Family Fabaceae

Synonyms Klitaka,Madhuka,Madhuyashti,Madhulika

Rasa Madhura

Guna Guru,Snigdha

Virya Sita

Vipaka Madhura

Doshaghnata Kaphavata Shamaka, Tridoshahara

Karma Netrya,Swarya,Rasayana,Vrishya,Chakshushya

Parts used Root

Chemical composition Glycyrrhizine, Glycyrrhizic acid,

Iso Neo Liquirtin, Liquirtinogen, Glabrin,

Licoridin,

GHRITA84

Name Ghrita

Zoological Name Bos taurus

Family Herbivora

Synonyms jeevaneeya, pavithra, navaneetha,

Sarpi, adhara, aajya, havi, amrutahva

Rasa Madhura

Guna Guru, Snigdha, mrudu, yogavahi

Virya Sita

Vipaka Madhura

Doshaghnata Pitta vata Shamaka, Tridoshashamaka,rasayana

Karma Rasayanaparam,chakshushya,jeevaneeya,

Buddhi, smruthivardhaka

Chemical composition 5gms of ghee contains vit-A 165 I.U,

vit -D 25 I.U.Copper- 0.075%

MADHU85

Name Madhu

Zoological Name APIS

Family Orthropoda



Synonyms Makshika,Kshaudra,Madhvika,Sharadam,

Varati,Bhringavantham,Pushparasodbhavam,

Kusumasavam,Pushparasam.

Rasa Madhura, kashaya anurasa

Guna Sheeta,Laghu,Ruksha

Virya Sita (Ch) Ushna (Su,Bp)

Vipaka Katu (A.S)

Doshaghnata Tridoshashmaka,mainly Kapha shamaka.

Karma Chakshushya, chhedi,vishaharavatala

Uses Indicated in netra roga,krimi,

medovikara,shwasa,hikka,

atisara and is yogavahi.

Chemical composition Glucose- 84.9% Sucrose-2.69%

Alkaloids-0.12% water-10.03%

Sp.gravity-1.36 nitrogen-1.29%

The above table shows that the compound drug possesses predominance of

Madhura, Kashaya rasa, Guru Snigdha guna, Sheeta virya, Madhura vipaka.

Madhura rasa is told as Shadindriya prasadaka by Acharya Charaka.

All the drugs are having Chakshushya,Rasayana,Netrya,karma.

Hence acts as Vatapitta Shamaka by virtue of its Rasa, Guna Vipaka Virya and Dosha

Karmata,and by combination they act as Chakshushya,Rasyana and Tridosha shamaka



Table No.16 Rasa panchaka of Drugs in Triphala Yashtimadhu Yoga

Rasa Guna Virya Vipaka Dosha Karma

Drug Name M A L K T K

S LA

GU

RU

SU

U S M A K V P K

Haritaki + + - + + + + - + - + - + - - + + +

Vibhitaki - - - - - + + - + - + - + - - + + +

Amalaki + + - + + + - + - + - + + - - + + -

Yashtimadhu

+ - - - - - - + - + - + + - - + + -

Madhu + - - - - + - + + - + + - - + - - +

Ghrita + - - - - - - + - + - + + - - + + -



FIGURES SHOWING THE DRUGS IN TRIPHALA YASHTIMADHU YOGA

Haritaki Aamalaki

Vibhitaki Yashtimadhu




Triphala Choorna Yashtimadhu Choorna

Ghrita Madhu



COMPUTER VISION SYNDROME (CVS)

As we entered the 21st century, the growing use of computers be at home or

office, brings with it an increase in health risks, especially sense organs, more so the

eyes.

A WHO press release (1998) mentions that glare and reflections from VDT

displays are a source of eyestrain and headache. Surveys of computer workers reveal

that vision related problems are most frequently reported health problems, occurring

in over 70 percent of computer workers. The pain and discomfort associated with the

problem can affect workplace performance and domestic activities also. With a few

preventative measures, however, the symptoms associated with CVS can be easily

avoided86.

Definition of CVS

The American Optometric Association (AOA) defines Computer Vision

Syndrome as “The complex of eye and vision problems related to near work which

are experienced during or related to computer use” CVS is a temporary condition

resulting from focusing the eyes on a computer display for protracted, uninterrupted

period of time87.

Incidence

Most studies indicate that computer operators, who view their Video Display

Terminals (VDTs), report more eye-related problems than non-VDT office workers.

A number of investigators have reported that visual symptoms occur in 75-90% of

VDT workers. In contrast to the popular conception regarding carpal tunnel

syndrome, a study released by NIOSH (National Institute of Social Health USA)

showed that only 22% of VDT workers have musculoskeletal disorders89.

A survey of optometrists in USA indicated that 10 million eye examinations

are annually done primarily because of visual problems at VDTs. This study

delineated the series of symptoms which eventually called as CVS. The causes for

these visual symptoms are a combination of individual visual problems, poor

workplace conditions and improper work habits. The above mentioned survey also

concluded that two-thirds of the complaints were related to vision problems while

one-third was due to environmental factors. Many people have marginal vision



disorders which do not cause symptoms when performing less demanding visual

tasks. However, it has also been shown that VDT users also have a higher incidence

of complaints than non-VDT users in the same environment.

Etiology of CVS

The main causes of CVS include an unsuitable environment and the improper

use of eyeglasses or contact lenses along with that working at a computer is more

visually demanding than doing other standard office work such as reading printed

documents etc., aspects of the design of the computer video display such as screen

resolution and contrast, image refresh rates and flicker, and screen glare, as well as

working distances and angles all may contribute to worker symptoms.

In order to accomplish specific computer related tasks, frequent eye

movements from work document to the computer screen, or from the screen to the

keyboard and back again, are performed. In addition, as the object being viewed

changes, so does the need for a change in eye focusing to maintain a clear image.

These changes occur repeatedly during computer use. The flexibility of the lens

within the eye and weakening of the ciliary muscle gradually decreases with age

(onset of presbyopia) which affects most people after age 40. The normal blink rate in

human eyes is 16-20 per minute. Studies have shown the blink rate decreases to as

low as 6-8 blinks/minute for persons working on the computer screen. This leads to

dry eyes.

Additionally, the near focusing effort required for such long hours puts strain

on ciliary muscles of the eye. This induces symptoms of asthenopia and leads to a

feeling of tiredness in the eyes after long hours of work. Some patients present with

inability to properly focus on near objects after a short duration. This can be seen in

people aged around 30-40 yrs of age, leading to a decrease in the accommodative and

focusing mechanisms of the eye. This can be a setting in due to early presbyopia.

Signs & symptoms of CVS

The signs & symptoms of CVS can vary but mostly include


Red Eyes


Headaches



Light Sensitivity,

Double Vision

Backache

Neck Ache

Muscle Fatigue

Eye Strain,


Symptoms and their manifestation

Dry and irritated eyes

Dry and irritated eye is one among the most common problem of Computer

and VDT users. It is also termed as VDTS Video Display Terminal Syndrome.The

frontal surface of the eye is covered with a tissue consisting of lacrimal glands which

secrete the tears. These tears cover the eye surface and maintain moisture for the

normal functioning of the eye. They also help to maintain the proper oxygen balance

of the external eye structures and maintain optical properties of the visual system.

The normal tear layer is cleaned off and refreshed by the blinking action of the

eyelids.

The blink reflex is one of the fastest reflexes in the body. However, these blink

rate varies with different activities faster when we are very active, slower when we are

steady or concentrating. Research has shown that the blink rate of VDT workers

dropped very significantly during work at a Computer/VDT compared to before and

after work. Possible explanations for the decreased blink rate include concentration on

the task or a relatively limited range of eye movements. The size of the eye opening is

related to the direction of gaze- as we gaze higher, the eyes open wider. The amount

of evaporation roughly relates to eye opening, the higher gaze angle when viewing a

VDT screen results in faster tear loss and reduced percentage of blinks which result in

dry eyes leading to irritation.

Red eyes

Eyes appear red because of the excess flow of blood to the capillaries in the

eye.Sometimes it may be also due to soreness in the eye. This may be due to poor

office ergonomics and unclean environment.



Headache

Headache is one of the ‘discomfort’ symptoms of CVS and is the primary

reason, for which most people seek an eye examination. Visual headaches occur more

frequently, often occur toward the front of the head, occur most often toward the

middle or end of the day, and can occur on one side of the head more than the

other.VDT workers most likely get tension-type headaches. These can be precipitated

by many forms of stress, including anxiety and depression; numerous eye conditions,

including astigmatism and hyperopia; improper workplace conditions, including glare,

poor lighting, and improper workstation setup are the predisposing factors.

Burning eyes Blinking is very essential to maintain the moisture of the eye surface. When

the blinking rate slows down due to continuous viewing the eyes become dry and

cause burning sensation.

Blurred vision

The ability of the eye to change its focal power is called accommodation and

varies due to many factors. An image that is not focused accurately will appear

blurred.Blurred vision symptoms can result from refractive error (e.g., hyperopia,

myopia, and astigmatism), improper prescription lenses, presbyopia (age-related

focusing problem) or other focusing disorders. Considering the working environment,

blurred images can also arise from a dirty screen, poor viewing angle, reflected glare

or a poor quality or defective monitor. All of these factors should be considered when

this symptom occurs.

Double vision

Double vision is a very uncomfortable and unacceptable condition for the visual

system. Double vision is a serious symptom and can be caused by several factors. A

complete eye examination is indicated if this symptom persists.

Photophobia / glare sensitivity The eyes are designed to be stimulated by the light and to control the amount

of light entering the eyeball. Lighting conditions in office environment are foreign to

the natural lighting and can cause an adverse reaction to light. The largest single



factor in the workplace is glare which is mostly caused by large disparities in

brightness in the field of view. It is much desirable to eliminate bright sources of light

from the field of view and strive to obtain a relatively even distribution of luminance.

A person is at greater risk to experience discomfort glare when the source is brighter

and when it is closer to the point of attention.

Neck, shoulder and back ache It is often heard in medical circles that ‘the eyes lead the body’. Nature has

designed our visual system to be so dominant that we will alter our body posture to

accommodate any deficiency in the way we see. In many office situations the vision

of a worker is compromised and they must adapt their posture to ease the strain on the

visual system. Uncomfortable seating arrangements and continuous, working with

computers for longer duration in the same posture causes pain in shoulder, neck and

back.

Contact lens discomfort This is commonly found in regular Contact lens users. Computer viewing

results in decreasing blinking rates to one third of normal, while the straight-ahead

gaze needed to look at a screen exposes to more air. Combined, this causes the eye to

dry out and become itchy much faster than usual.If frequent blinking is not enough to

eliminate the dryness and itching, an ophthalmologist prescribed eye drops made

especially for contact lenses can be used.

Changes in colour perception Changes in colour perception results from long working hours,long standing

eye pathologies and flickering colours resolution of VDT screen.

Fatigue It is a general symptom of tiredness because of improper work station conditions.It can also occur due to mental tension, work overload or long working hours. Eyestrain

Eyestrain is one of those vague terms that have different meanings. The term

eye care professionals use for eyestrain is asthenopia (AS-then-OH-pee-ah),.



asthenopia is defined as the subjective complaint of uncomfortable, painful and

irritable vision caused from problems such as focusing spasm, difference of vision in

each eye, astigmatism, Hyperopia (far-sighted), Myopia (near-sighted), excess light,

voluntary focusing, eye coordination difficulties, etc., In the VDT environment,

eyestrain in all of its manifestations may be caused by a number of different

environmental and visual conditions97.

Aggravating factors

The symptoms of CVS can be further aggravated by

Long working hours

Improper lighting conditions (ie. bright overhead lighting or glare)

Air moving past the eyes (e.g. overhead vents, direct air from a fan).

Altered sleeping habits

Refraction errors

Age

Although CVS has not been found to cause any permanent damage to the eyes, its

painful symptoms can affect performance at work and home90.

Treatment modalities for CVS

In the opinion of AOA four hours of continuous work on a computer was considered

safe. The treatment modalities followed for the management used in CVS include91

a. Medical

b. Non medical

Medical

Analgesics

Topical NSAIDs

Topical Steroids

Topical Cycloplegics

Topical Anesthetics

Sedatives/ Anxiolytics



Non Medical

Looking away from the computer screen and blinking periodically

Use of convergence and divergence exercises

Use of bifocals, trifocals or any spectacles for protection of eyes.

Viewing angle /Ergonomics

Anti glare screens

Medical

The treatment adopted in modern medicine is for symptomatic relief comprising

regular usage of above said drugs based on the predominance of symptoms and no

definite cure is promised.

Non Medical

Looking away from the computer screen and blinking periodically92

Proper rest to the eye and its muscles is recommended to relieve the associated

eye strain. Giving the eyes and body frequent breaks from computer work to reduce

eye and muscle fatigue is recommended.Since prolonged computer use requires a

person to sit in the same position for an extended period, taking time out to stand,

stretch and look around will not only help muscles, but will also give the eyes a

chance to relax. If the opportunity to get up for full breaks is not frequently available,

then “mini” breaks will suffice by looking up from the computer into the distance

about every 15 minutes. Frequent blinking or the use of eye drops too, will keep eyes

from drying out and feeling itchy. A routinely recommended approach is to

consciously blink the eyes every now and then (this helps replenish the tear film), and

look out of the window into a distance object or the sky - (this provides rest to the

ciliary muscles). One of the catchy phrases is the "20-20-20 rule": every 20 minutes,

focus the eyes on an object 20 feet (6 meters) away for 20 seconds. This basically

gives a convenient distance and time frame for a person to follow the advice from the

ophthalmologist. Otherwise, the patient is advised to close his/her eyes (which have a

similar effect) for 20 seconds, at least every half hour or even more frequently.

Eyeglasses

A visit to an ophthalmologist for update of prescription is the first step in

improving the effectiveness of optical aids in eliminating the symptoms of CVS.



Patients should be sure to include information on special lifestyle concerns, such as

computer use, to help the doctor find the right prescription for their needs. With this in

mind, the doctor may find that a person who does not normally need glasses should

wear them when using a computer. Additionally, the ophthalmologist can diagnose

whether another unsuspected disease is the cause of certain symptoms and

recommend treatment options

Viewing angle /Ergonomics101

Various studies have shown that viewing angle can be a contributing factor in

the occurrence of asthenopia.Taptagaporn et al as well as Quaranta et al.

recommended a downward gaze so as to work comfortably on VDT. When the

computer operator keeps the terminal at about eye level rather than below eye level.

Jaschinski et al. in their study found that high screens at or above the eye level

reported result in greater eyestrain and asthenopia than low screens.

Anti glare screens

Use of antiglare filters over VDT screens has been associated with shorter, less

frequent and less intense eye complaints.some Studies had proved that significantly

lower prevalence of asthenopia in the subjects who used antiglare screen. Similar was

the observation in those who adjusted the contrast and brightness of the monitor

screen as per their need.



LIST OF PREVIOUS WORKS

1. ‘The Study of Trividha Hetu wsr to present day life style and Asatmendriyartha

Samyoga of Chakshurindriya’.Pawar Vishali Dinakar, Dept of Ayurveda

Siddhanta B.V.College of Ayurveda, B.V.University, Pune, 2002.

2. ‘A Study on Computer Vision Syndrome and its management with Indigenous

medicine –A clinical study’.- Siddhapur Chandrasekhar.M, Dept of Shalakya,

G.A.M.C.Bangalore, RGUHS 2002.

3. Effect of selected yoga techniques in “Computer Vision Syndrome” in

comparison with selected Ayurvedic modalities.- Venkata Krishna.K.V, Dept of

Svasthavritta, Govt Ayurveda College, Trivandrum University, 2003.

4. A Study on Asatmendriyartha Samyoga wsr to Chakshurendriya’-Archana

D.Jugale, Dept of Ayurveda Siddhanta BNMET Ayurveda College, Bijapur,

RGUHS, 2007.

Materials and Methods66


MATERIALS AND METHODS

MATERIALS

1. Literary study

2. Drugs

3. Instruments

Collection of Materials

1) Literary Study

The Literary source for the present study was obtained from, vedic scriptures,

classical texts of Ayurveda, Sanskrit dictionaries, Modern texts, published articles in

reputed journals and also from various media like internet etc.,followed by a

retrospective study of related research works.

2) Drugs

The ingredients comprises of Triphala (Harithaki, Vibhitaki, Amalaki) and

Yashtimadhu. Triphala and Yashthimadhu were taken in equal quantity. All these raw

drugs were properly identified and purchased from NKCA pharmacy Mysore.

PREPARATION OF MEDICINE


Haritaki 4 kg

Vibhitaki 4 kg

Amalaki 4 kg

Yashtimadhu 12 kg

The obtained raw drugs were cleaned, finely powdered and sieved through

strainer to get a sookshma choorna.A total of 22 kg of raw drug was obtained with

wastage of 2 kg.For Anupana patients were advised to mix Madhu and Ghrita during

the administration of medicine.All the patients were advised to take Dabur Honey,

and Cow Ghee manufactured from Nandini Dairy as both are easily available over the

counter.



INSTRUMENTS

1. Snellen’s distant vision chart

2. Jaeger’s near vision chart

3. Schirmer’s test strips – Conta care opthalmics and diagnoistics ltd vadodra

4. Torch light - Everyday electronics ltd

METHODS

AIM

The present study was undertaken to study the disease Computer Vision

Syndrome based on Ayurveda Siddhantas like Trividha Hetu, Panchalakshana Nidana

and to find out a suitable chikitsa siddhanta and the efficacy of TriphalaYashtimadhu

yoga in this disease clinically.

OBJECTIVES

1. To understand Trividha hetu involved in causation of Computer Vision

Syndrome.

2. To understand the disease based on Pancha Lakshana Nidana.

3. To make an analytical study on the role of Prakruthi, and occupational influence

in causation of the disorder.

4. To evaluate a suitable Chikitsa based on the above observations.

5. To evaluate the efficacy of TriphalaYasthimadhu yoga in patients of Computer

Vision Syndrome clinically.

RESEARCH DESIGN

OBSERVATIONAL STUDY

Patients were diagnosed as having Computer Vision Syndrome based on a

detailed questionnaire including signs and symptoms (Annexure-II). The general and

specific examination was carried out as per the Ayurvedic and modern parameters.

The data was collected after enquiring different nidanas.Those nidanas were collected

and analyzed under the heading of nidana including Prajnaparadha in the form of

aharaja, viharaja etc., and the role of sleep pattern, nature of work and its duration and

its role on the disease were studied.



CLINICAL STUDY

All the patients of CVS were administered Triphala Yashtimadhu yoga to

evaluate the efficacy of the drug clinically.

SOURCE OF PATIENTS

Patients from OPD, IPD, other referrals and special camps conducted in

GAMC and hospital Mysore were selected for the study, appropriately satisfying the

selection criteria.

METHOD OF COLLECTION OF DATA

1. Patients suffering from CVS belonging to either sex were selected randomly

and made into a single group.

2. Informed consent was obtained before study.

3. Those patients were registered and studied with a case-sheet proforma prepared

for the study based on history of signs and symptoms, no of working hours,

habits, TV watching, duration of work,aahara sevana,agni,prakruthi, etc.

SELECTION CRITERIA

1. Patient diagnosed as having CVS

2. Patients were selected with respect to age irrespective of sex, caste, occupation

and socio economical status.

3. Patients fulfilling inclusion criteria.

4. Patient willing to participate in the study were selected by explaining the

intervention in detail.

INCLUSION CRITERIA

1. Patients indulging in occupation of working with computers for more than 4

hours a day having signs and symptoms of Computer Vision Syndrome

2. Patients of either sex.

3. Patients between the age group of 20-50 Years.

EXCLUSION CRITERIA

1. Patients suffering from chronic systemic diseases.

2. Degenerative eye diseases and severe ocular problems including high myopia.



3. Patients suffering from congenital ocular Anomalies.

DIAGNOSTIC CRITERIA

The diagnosis of CVS was made based on a questionnaire containing signs and

symptoms index stated by AOA (American optometric Association).

SAMPLING METHOD

Total 30 patients of Computer Vision Syndrome were randomly selected and

made in to a single group.

STUDY DESIGN

Present study was observational and a single blind clinical study with pre and

post test design,

INVESTIGATIONS

TESTS FOR DISTANT VISION BY SNELLEN’S CHART

Distant central vision is estimated with snellens chart. The snellen’s chart is

placed at 6 meters or 20 feet distance from the patient. The patient is asked to sit on a

stool facing the chart at 6 meters distance and asked to read the prints of the

chart.(Each eye may be closed alternately for the reading of individual eyes).The chart

contains different sized prints in 8 lines, from bigger size to smaller from top to

bottom. Each line is marked with a specific number. They are (from top to bottom)

60, 36, 24, 18, 12, 9, 6, 5.If the patient is able to read up to 6 number row; his vision is

6/6- normal. If the patient is able to read only first line his vision is 6/60. 2nd line 6/36:

3rd line 6/24,: 4th line 6/18,: 5th line 6/12,: 6th line 6/9,: 7th line 6/6,: and 8th line 6/5.

TESTS FOR NEAR VISION BY JAEGER’S TEST TYPES

Visual acuity at the ordinary reading distance is assessed by using reading test

types of varying sizes. The notation being based on the printer’s point system. The

smallest point is N14 and largest is N1. The near vision is recorded as the smallest

type which the patient can read comfortably.



SCHIRMER’S TEST- I

This test measures the rate of tear formation or basic tear function. It

determines whether the eye produces enough tears to keep it moist. This test is used

when a person experiences very dry eyes or excessive watering of the eyes. It poses

no risk to the subject. Schirmer's test uses paper strips inserted into the eye for several

minutes to measure the production of tears.In this test both eyes are tested at the same

time.

A negative (more than 10 mm of moisture on the filter paper in 5 minutes) test

result is normal. Both eyes normally secrete the same amount of moisture. A young

person normally moistens 20 mm of each paper strip.Physiologically Hypolacrimation

occurs with ageing.

Procedure

This test consists of placing a small strip of filter paper inside the lower eyelid.

Take a 5 x 30 mm strip of no 41 Whatman filter paper. A 5mm tab is folded and

gently inserted into the lower lid (conjunctival sac). The eyes are closed for 5 minutes.

The paper is then removed and the amount of moisture is measured. If the wetting is

less than 10 mm after 5 minutes. It is diagnostic of dry eye. The normal range is 10-

25mm in 5 minutes.

TORCH LIGHT

Eye examination was done by the torch.



SCHIRMERS TEST STRIPS

SCHIRMERS TEST -1



INTERVENTION

1. All the 30 patients were administered with Triphala Yashtimadhu choorna.

2. The drug is administered with anupana of of ghrita and madhu in

asamapramana (unequal quantity) i.e., more quantity of Ghrita was advised

than Madhu in the ratio of 2:1.

3. The dose of drug administered is 12 grams per day (1 karsha) in divided doses

of 6 grams twice a day.

4. The time of administration of drug is once in early morning, and once in night

before sleep.

5. The duration of treatment is for 60 days.

6. Data was collected before treatment, after completion of treatment and at the

end of follow up.

7. All the patients were advised to avoid aahara like madyapana, dadhi, teekshna,

katu, amla, vidahi and abhishyandi aahara, upavasa and vishamashana.

8. All the patients were advised to avoid vihara like dhoomapaana, doorekshana,

swapna viparyaya, ratri jagarana, ushna jala sira snana,vegadharana, bhaya,

shoka, kopa, atimaithuna, dhooma ,raja sevana, excessive exposure to sun light

etc.,

9. All the patients were advised to do abhyanga to siras and pada, wash their eyes

with cold water frequently and take aahara which is madhura, snigdha, and

also advised to take ghrita in their aahara.

10. All the patients were advised to reduce the duration of TV watching from their

regular watching duration.

11. All the patients were advised to follow the 20-20-20 rule mentioned by AOA.

12. All the patients were advised to take short breaks frequently, and adjust the

seating position and to use spectacles if they are having previously.

ASSESSMENT FOR CLINICAL IMPROVEMENT

Clinical improvement in the signs and symptoms of CVS after the trial were

assessed based on the reduction of the individual signs and symptoms and overall

severity as below. The values are compared with before treatment after treatment and



follow up by utilising the normal values for objective parameters and grading for

subjective parameters.

GRADING FOR SUBJECTIVE VARIABLES

IRRITATION IN THE EYE

I0- No Irritation in the Eye

I1- Irritation occurs after 1 hour of working and disappears after work

I2-Irritation occurs after 1 hour of working and continues for 2 hrs after withdrawal

from work.

I3- Irritation continues for the whole day and relieved after sleep

REDNESS OF EYES

R0- No Redness of Eyes

R1- Redness occurs after 1 hour of working and disappears after work

R2- Redness occurs after 1 hour of working and continues for 2 hrs after

withdrawal from work.

R3- Redness continues for the whole day and relieved after sleep

TEARING OF EYES

T0- No tears

T1- Tearing occurs after 1 hour of working and disappears after work

T2- Tearing occurs after 1 hour of working and continues for 2 hrs after withdrawal

from work.

T3- Tearing continues for the whole day and relieved after sleep

HEADACHE

H0- No Headache

H1- Headache occurs after 1 hour of working and disappears after work

H2- Headache occurs after 1 hour of working and continues for 2 hrs after


H3- Headache continues for the whole day and relieved after sleep



BURNING IN EYES

Bu0- No Burning in Eyes

Bu1- Burning in Eyes occurs after 1 hour of working and disappears after work

Bu2- Burning in Eyes occurs after 1 hour of working and continues for 2 hrs after


Bu3- Burning in Eyes continues for the whole day and relieved after sleep

BLURRED VISION

Bl0- No Blurred vision

Bl1- Blurred vision occurs after 1 hour of working and disappears after work.

Bl2- Blurred vision occurs after 1 hour of working and continues for 2 hrs after


Bl3- Blurred vision continues for the whole day and relieved after sleep

DIPLOPIA

D0- No Diplopia

D1- Diplopia occurs after 1 hour of working and disappears after work

D2- Diplopia occurs after 1 hour of working and continues for 2 hrs after withdrawl

from work.

D3- Diplopia continues for the whole day and relieved after sleep

OBSERVATIONAL PARAMETERS

1. Photophobia Present/ absent

2. Contact lens discomfort Present/ absent

3. Slowness in changing focus of eyes Present/ absent

4. Changes in colour perception Present/ absent

5. Pain in shoulder Present/ absent

6. Pain in Neck Present/ absent

7. Pain in Back Present/ absent



GRADING FOR CLINICAL IMPROVEMENT OF INDIVIDUAL SYMPTOMS

AND OVERALL SEVERITY IS GRADED AS BELOW

CD Clinically detiorated i.e., increase in severity score against the initial score.

CS Clinically stable i.e., severity score remains same against the initial score.

CI-1 Encouraging i.e., one degree reduction in severity score against the initial

score

CI-2 Good i.e., two degree reduction in severity score against the initial score

CI- 3 Excellent i.e., three degree reduction in severity score against the initial

score

DATA COLLECTION

Data was collected before treatment, after treatment and at the end of follow up.

ASSESSMENT

Assessment of the patients was made before the treatment after treatment and

at the end of follow up. The data was collected and analysed for the total score before

treatment, after treatment and after follow up was assessed by using.

• Chi-square test

• Frequencies / Descriptives

• Contingency Co efficient

• Paired-Samples T Test

• Repeated measure ANOVA

Analysis was done through SPSS for Window (Statistical Presentation System Software),

version 14.0, evaluation version (SPSS, 2005, SPSS Inc. New York).

Observations 76


OBSERVATIONS

Total 30 patients coming under the inclusion criteria were randomly taken for

the clinical study and made into a single group. Observations in the present study

were done in three stages.

i) General Observations for all the patients

ii) Observations on Nidanas in Computer Vision Syndrome

iii) Result related observations pre, post treatment and follow up.

GENERAL OBSERVATIONS

In the present study total 42 patients were registered, out of which 12 patients

discontinued the treatment during various stages of the clinical study and with 30

patients the clinical study was completed.

Table No.17 Age wise distribution of 30 patients with CVS

Age in years No. of patients Percentage (%)

21-30 yrs 21 70.0%

31-40 yrs 3 10.0%

41-50 yrs 6 20.0%

AGE

In present study there was limitation for age. The patients of the age between 20-50

yrs were selected. It was found that the patients of age group between 21-30 yrs are 21

(70.0%) 31-40 yrs are 3 (10.0%) 41-50 yrs are 6 (20.0%).

Table No.18 Sex wise distribution of 30 patients with CVS

Sex group No. of patients Percentage (%)

Male 16 53.33%

Female 14 46.66%

SEX

In the present study it was observed that more number of patients were males i.e., 16

(53.33%) and female patients were 14 (46.66%).

Observations 77


Table No.19 Occupation wise distribution of 30 patients with CVS

Occupation No. of patients Percentage (%) Students 1 3.33%

Software professionals 11 36.66% Office Clerk 8 26.66% Accountants 4 13.33%

Medical transcription 2 6.66% Call centre employee 4 13.33%

OCCUPATION

In this study it was observed that majority of the patients were software professionals

are 11 (36.66%) office clerk category were 8 (26.66%), accountants 4 (13.33%), call

centre employees 4 (13.33%), medical transcriptionists 2 (6.66%) and students were 1

(3.33%).

Table No.20 Education wise distribution of 30 patients with CVS

Education No. of patients Percentage (%)

Graduation 24 80.0%

Post- Graduation 6 20.0%

EDUCATION

In the present study it was found that the majority of patients are graduates

i.e., 24 (80.0%) and Post graduates were 6 (20.0%).

Table No.21 Marital status wise distribution of 30 patients with CVS

Marital Status No. of patients Percentage (%)

Unmarried 18 60.0%

Married 12 40.0%

MARITAL STATUS

In the present study it was observed that majority of patients were unmarried.i.e.

18 (60.0%) and married were i.e., 12 (40%).

Table No.22 Socio economic status wise distribution of 30 patients with CVS

Socio economic status No. of patients Percentage (%)

Middle class 23 76.66%

Observations 78


Upper middle class 6 20.0% Rich 1 3.33%

SOCIO ECONOMIC STATUS

In the present study it was found that majority of the patients belong to middle

class i.e., 23 (76.66%) upper middle class were 6 (20 %) and rich are 1 (3.33%).

Table No.23 Religion wise distribution of 30 patients with CVS

Religion No of patients Percentage

Hindu 24 80.0%

Muslim 2 6.66%

Christian 1 3.33% Others 3 10.00%

RELIGION

In the present study it was observed that majority of patients were from Hindu

community i.e., 24 (80.0%) from Muslim community are 2 (6.66%) from christian

community are 1 (3.33%) and others (Jain) are 3 (10.0%) respectively.

Table No.24 Locality wise distribution of 30 patients with CVS

Habitat No. of patients Percentage (%) Urban 28 93.33 Rural 2 6.66

LOCALITY

In the present study it was found that the patients from urban residency are more i.e.,

28 (93.33%) and patients belonging to Rural were 2 (6.66%).

Table No.25 Diet wise distribution of 30 patients with CVS

Diet Pattern No. of patients Percentage Vegetarian 15 50%

Mixed 15 50%

Observations 79


DIET

In the present study it was found that the patients with vegetarian diet are 15 (50%)

and mixed diet are 15 (50%) both are equally present.

Table No.26 Diet pattern wise distribution of 30 patients with CVS

Diet Pattern No. of patients Percentage

Vishamashana 26 86.77%

Samashana 4 13.33%

DIET PATTERN

In the present study it was found that the patients following vishamashana are more

i.e., 26 (86.77%) and patients following samashana were 4 (13.33%).

Table No.27 Rasa Sevana wise distribution of 30 patients with CVS

Rasa Sevana No. of patients Percentage

MAL 5 16.66%

MALK 21 70.0%

MALKT 2 6.66%

Sarvarasa 2 6.66%

RASA SEVANA

In the present study it was found that the patients taking 4 rasa MALK are 21 (70.0%)

taking 3 rasa MAL are 5 (16.66%) and taking 5 rasa MALKT are 2 (6.66%) and

taking all the 6 rasa are also 2 (6.66%).

Table No.28 Sleep wise distribution of 30 patients with CVS

Sleep Pattern No. of patients Percentage

Sound Sleep 15 50%

Disturbed 15 50%

SLEEP

In the present study it was found that the patients with sound sleep are 15 (50%) and

disturbed sleep are 15 (50%) both are equally present.

Observations 80


Table No.29 Duty wise distribution of 30 patients with CVS

Duty Shift Pattern No. of patients Percentage

Day Shift (Ratri Swapna) 15 50%

Night Shift (Diwaswapna) 15 50%

DUTY

In the present study it was found that the patients working in day shifts (doing ratri

swapna) are 15 (50%) and those working in night shift (doing diwa swapna) are 15

(50%) both are equally present.

Table No.30 Addiction wise distribution of 30 patients with CVS

Addiction No. of Patients Percentage Milk 1 3.33% Tea 24 80.0%

Coffee 5 16.66% Smoking 7 23.33% Alcohol 7 23.33%

Tobacco chewing 2 6.66% ADDICTION

In the present study it was found that the patients having the habit of drinking tea

were 24 (80%) habit of smoking were 7 (23.33%) drinking alcohol were 7 (23.33%)

drinking coffee were 5 (16.66%) and tobacco chewing were 2 (6.66%) and taking

milk were only 1 (3.33%) respectively

Table No.31 TV watching duration wise distribution of 30 patients with CVS

Duration in hours No of Patients Percentage 1 9 30%

2 12 40%

3 4 13.33%

4 4 13.33%

5 1 3.33%

Observations 81


WORK DURATION

In the present study it was found that the patients having the habit of watching TV for

5 hours were 1 (3.33%) for 4 hours are 4 (13.33%),, for 3 hours are 4 (13.33%), for 2

hours are 12(40%), for 1 hour are 9 (30%), respectively.

Table No.32 Duration of Occupation wise distribution of 30 patients with CVS

Duration No of Patients Percentage 3 months 1 3.33%

4 months 2 6.66%

6 months 1 3.33%

7 months 1 3.33%

10 months 1 3.33%

1 year 5 16.66%

2 year 3 10%

3 year 5 16.66%

4 year 1 3.33%

5 year 4 13.33%

6 year 2 6.66%

7 year 2 6.66%

8 year 2 6.66%

OCCUPATION

In the present study it was found that the patients working with computers from 8

years were 2 (6.66%) 7 years were 2 (6.66%) 6 years were 2 (6.66%) 5 years were 4

(13.33%) 4 years were 1 (3.33%) 3 years were 5 (16.66%) 2 years were 3 (10%) 1

year were 5 (16.66%). And patients working from 3,6,7 and 10 months were 1 each

i.e.total 4 (13.33%) and 4 months were 2 respectively (6.66%)

Observations 82


Table No.33 Duration of working with computers wise distribution of CVS patients

Duration No of Patients Percentage 3 hr 1 3.33%

4 hr 2 6.66%

5 hr 3 10%

6 hr 3 10%

7 hr 1 3.33%

8 hr 8 26.66%

9 hr 2 6.66%

10 hr 3 10%

12 hr 4 13.33%

15 hr 2 6.66%

16 hr 1 3.33%

In the present study it was found that the patients working with computers for 16 hrs

were 1 (3.33%) 15 hrs were 2 (6.66%) 12 hrs were 4 (13.33%) 10 hrs were 3 (10%) 9

hrs were 2 (6.66%) 8 hrs were 8 (26.66%) 7 hrs were 1 (3.33%) 6 hrs were 3 (10%) 5

hrs were 3 (10%) 4 hrs were 2 (6.66%) 3 hrs were 1 (3.33%)

Table No.34 Duration of computers work in a week wise distribution of CVS patients

Duration No of Patients Percentage 4 days 1 3.33%

5 days 4 13.33%

6 days 15 50%

7 days 10 33.33%

DURATION OF WORK

In the present study it was found that the patients working with computers for 7 days a

week were 10 (33.33%) for 6 days a week are 15 (50%), for 5 days a week are 4

(13.33%), for 4 days a week are 1 (3.33%), respectively.

Observations 83


Table No.35 Prakruthi wise distribution of 30 patients with CVS

Prakruthi No. of patients Percentage (%)

Vata pitta 15 50.0%

Vata kapha 5 16.7%

Kapha pitta 10 33.33%

PRAKRUTHI

In the present study among 30 patents 15 patients (50%) had Vata pitta prakruthi, 5

patients (16.66%) had Vata kapha prakruthi and 10 patients (33.33%) belong to kapha

pitta prakruthi.

Table No.36 Sara wise distribution of 30 patients with CVS

Sara No. of patients Percentage (%)

Avara 0 0%

Madhyama 30 100%

Pravara 0 0%

In the present study all the 30 patients (100%) were having madhyama sara.

Table No.37 Samhanana wise distribution of 30 patients with CVS

Samhanana No. of patients Percentage (%)

Avara 1 3.33%

Madhyama 29 96.66%

Pravara 0 0%

SAMHANANA

Among 30 patents 29 patients (96.66%) had madhyama samhanana, 1 patient (3.33%)

has avara samhanana.

Table No.38 Pramana wise distribution of 30 patients with CVS

Pramana No. of patients Percentage (%)

Avara 0 0%

Madhyama 30 100%

Pravara 0 0%

Observations 84


PRAMANA

OIn the present study all the 30 patients (100%) were having madhyama pramana.

Table No.39 Satmya wise distribution of 30 patients with CVS

Satmya No. of patients Percentage (%) Avara 1 3.33%

Madhyama 29 96.66% Pravara 0 0%

SATMYA

Among 30 patients 29 patients (96.66%) had madhyama satmya and 1 patient (3.33%)

had avara satmya.

Table No.40 Satwa wise distribution of 30 patients with CVS

Satwa No. of patients Percentage (%) Avara 4 13.33%

Madhyama 26 86.66% Pravara 0 0%

SATWA

Among 30 patents 26 patients (86.66%) had madhyama satwa and 4 patients (13.33%)

had avara satwa.

Table No.41 Agni wise distribution of 30 patients with CVS

Agni No. of patients Percentage (%)

Manda 8 26.66%

Vishama 18 60.0%

Teekshna 4 13.33%

Sama 0 0%

AGNI

Among 30 patents 18 patients (60%) had Vishamagni, 8 patients (26.66%) had

mandagni and 4 patients (13.33%) were having teekshna agni.

Observations 85


Table No.42 Vyayama Shakthi wise distribution of 30 patients with CVS

Vyayama Shakthi No. of patients Percentage (%)

Avara 2 6.66%

Madhyama 28 93.33%

Pravara 0 0%

VYAYAMA SHAKTI

Among 30 patents 28 patients (93.33%) had madhyama vyayama shakti, and 2

patients (6.66%) were having avara vyayama shakti.

Table No.43 Desha wise distribution of 30 patients with CVS

Desha No. of patients Percentage (%) Anupa 24 80.0% Jangala 6 20.0%

Sadharana 0 0% DESHA

Among 30 patents 24 patients (80%) belong to Anupa Desha, and 6 patients (20%)

belong to Jangala Desha respectively.

Table No.44 Chief complaints wise distribution of the patients with CVS

Symptoms No of patients Percentage Dry & Irritated eyes 24 80% Redness of eyes 25 83.33% Tearing in eyes 18 60% Headache 28 93.33% Burning in eyes 30 100% Blurred vision 17 56.66% Diplopia 0 0% Photophobia 20 66.66% Contact lens discomfort 5 16.66% Slowness in changing focus of eyes

12 40%

Changes in colour perception

1 3.33%

Pain in shoulder 25 83.33% Pain in Neck 27 90% Pain in Back 21 70%

Observations 86


CHIEF COMPLAINTS

In the present study it was observed that patients having Dry & Irritated eyes were 24

(80%),Redness of eyes were 25 (83.33%),Tearing of eyes are 18 (60%),Headache

were 28 (93.33%),Burning in eyes were 30 (100%),Blurred vision were 17 (56.66%)

Diplopia were 0 (0%),Photophobia are 20 (66.66%),Contact lens discomfort are 5

(16.66%),Slowness in changing focus of eyes are 12 (40%),Changes in colour

perception of eyes are 1 (3.33%),Pain in shoulder are 25 (83.33%),Pain in Neck are

27 (90%) and having Pain in Back are 21 (70%)

Table No.45 Assessment of subjective symptoms before treatment

Dry & Irritated Eyes

Majority of patients are from Grade-2,in 17 patients, (56.66%) Grade-3 were 6

patients, (20%) Grade-1 were 1 pt, (3.33%) and Grade-0 i.e., normal were 6 patients

(20%)

Redness Of Eyes

Majority of patients are from Grade-2 20 patients, (66.66%) Grade-3 were 4 patients,

(13.33%) Grade-1 were 1 pt, (3.33%) and Grade-0 i.e., normal were 5 patients

(16.66%)

Symptoms Grade 0 Grade 1 Grade 2 Grade3

Dry & Irritated

Eyes

6 20% 1 3.33% 17 56.66% 6 20%

Redness Of Eyes 5 16.66% 1 3.33% 20 66.66% 4 13.33%

Tearing In Eyes 12 40% 5 16.66% 13 43.33% 0 0%

Headache 2 6.66% 1 3.33% 20 66.66% 7 23.66%

Burning In Eyes 0 0% 2 6.66% 19 63.33% 9 30%

Blurred Vision 13 43.33% 4 13.33% 10 33.33% 3 10%

Diplopia 30 100% 0 0% 0 0% 0 0%

Observations 87


Tearing In Eyes

Majority of patients are from Grade-2 13 patients, (43.33%) Grade-3 were 0 patients,

(0%) Grade-1 were 5 patients, (16.66%) and Grade-0 i.e., normal were 12 patients

(40%).

Headache

Majority of patients are from Grade-2 20 patients, (66.66%) Grade-3 were 7patients,

(23.33%) Grade-1 were 1 patients, (3.33%) and Grade-0 i.e., normal were 2 patients

(6.66%).

Burning in Eyes


(30.0%) Grade-1 were 2 patients, (6.66%) and Grade-0 i.e., normal were 0 patients

(0%).

Blurred Vision


(13.33%) Grade-3 were 3 patients, (10%) and Grade-0 i.e., normal were 13 patients

(43.33%).

Diplopia

None of the patients were having Diplopia. All the 30 patients (100%) were normal.

INTERVENTION BASED OBSERVATIONS

1. All the patients selected for the study are having on or the other signs and

symptoms of CVS.

2. All the patients followed pathyapathya without interruption and discontinuity.

3. All the patients took the drug treatment without interruption and discontinuity.

4. The drug dose was adjusted to 12 grams divided in 2 equal doses of 6 grams

each.

5. Patients were comfortable at the end of treatment.

6. There were no complications observed in patients during the study.

7. Patients received the drug treatment for 60 days.

Observations 88


ILLUSTRATION TO SHOW DISTRIBUTION OF AGE AMONG THE 30 PATIENTS TAKEN FOR STUDY

ILLUSTRATION TO SHOW DISTRIBUTION OF SEX AMONG THE 30 PATIENTS TAKEN FOR STUDY

Observations 89


ILLUSTRATION TO SHOW DISTRIBUTION OF OCCUPATION AMONG THE 30 PATIENTS TAKEN FOR STUDY

ILLUSTRATION TO SHOW DISTRIBUTION OF EDUCATION AMONG THE 30 PATIENTS TAKEN FOR STUDY

Observations 90


ILLUSTRATION TO SHOW DISTRIBUTION OF MARITAL STATUS AMONG THE 30 PATIENTS TAKEN FOR STUDY

ILLUSTRATION TO SHOW DISTRIBUTION OF SOCIO ECONOMIC STATUS AMONG THE 30 PATIENTS TAKEN FOR STUDY

Observations 91


ILLUSTRATION TO SHOW DISTRIBUTION OF RELIGION AMONG THE 30 PATIENTS TAKEN FOR STUDY

ILLUSTRATION TO SHOW DISTRIBUTION OF LOCALITY AMONG THE 30 PATIENTS TAKEN FOR STUDY

Observations 92


ILLUSTRATION TO SHOW DISTRIBUTION OF DIET AMONG HE 30 PATIENTS TAKEN FOR STUDY

ILLUSTRATION TO SHOW DISTRIBUTION OF DIET PATTERN AMONG THE 30 PATIENTS TAKEN FOR STUDY

Observations 93


ILLUSTRATION TO SHOW DISTRIBUTION OF RASA SEVANA AMONG THE 30 PATIENTS TAKEN FOR STUDY

ILLUSTRATION TO SHOW DISTRIBUTION OF NIDRA AMONG THE 30 PATIENTS TAKEN FOR STUDY

Observations 94


ILLUSTRATION TO SHOW DISTRIBUTION OF DUTY AMONG THE 30 PATIENTS TAKEN FOR STUDY

ILLUSTRATION TO SHOW DISTRIBUTION OF VYASANA AMONG THE 30 PATIENTS TAKEN FOR STUDY

Observations 95


ILLUSTRATION TO SHOW DISTRIBUTION OF WORK DURATION AMONG THE 30 PATIENTS TAKEN FOR STUDY

ILLUSTRATION TO SHOW DISTRIBUTION OF AGNI AMONG THE 30 PATIENTS TAKEN FOR STUDY

Observations96


ILLUSTRATION TO SHOW DISTRIBUTION OF SYMPTOMS AMONG THE 30 PATIENTS TAKEN FOR STUDY

Results97


RESULTS RELATED OBSERVATIONS

OBJECTIVE PARAMETERS

Table No.46 Showing the result on Schirmers Test-I Assessment Mean

Length SD N

Before 21.8667 2.87358 30

After 22.5000 3.17045 30

Schirmers Test -I

Follow up 22.5000 3.17045 30

Source Sum of

Squares df Mean

Square F Significance

Change 8.022 2 4.011 26.913 .000 Error

change 8.644

58 .149

P = .000 HS

SCHIRMERS TEST-I Before treatment the Mean Length was 21.8667 with SD of 2.87358, after treatment

Mean Length was 22.5000 with SD of 3.17045 after follow up the Mean Length was

22.5000 with SD of 3.17045,

P values for overall changes from before treatment to after treatment and after

treatment to follow up is found to be statistically significant at .000.

This shows that the wetting in eyes increased from before treatment to after treatment

and remained stable during the follow up period.

Table No.47 showing the result on Distant Vision (Snellen’s Chart)

Assessment 6/6D 6/9D 6/12D 6/18D 6/24D 6/60D N

Before 16 3 2 3 5 1 30

After 17 2 2 3 5 1 30

Follow up 17 2 2 3 5 1 30

Results98


P = 1.000 NS DISTANT VISION BY SNELLEN’S CHART P values for overall changes from before treatment to after treatment and after

treatment to follow up is found to be statistically non significant at 1.000.

This shows that the Acuity for Distant Vision in both eyes remained same from before

treatment to after treatment and follow up in 29 paitients and in 1 patient the visual

acuity improved from 6/9 to 6/6 and remained stable during follow up period.

Table No.48 showing the result on Near Vision (Jaeger’s Chart)

Assessment N5 N6 N7 N8 N12 N13 N14 N

Before 1 4 1 1 2 18 3 30

After 1 4 1 1 2 17 4 30

Follow up 1 4 1 1 2 17 4 30

Symmetric Measures Value Approx. Sig.

Nominal by Nominal Contingency Coefficient

.049 1.000

N of Valid Cases 90 P = 1.000 NS

NEAR VISION BY JAEGER’S CHART P values for overall changes from before treatment to after treatment and after

treatment to follow up is found to be statistically non significant at 1.000.

This shows that the Acuity for Near Vision in both eyes remained same from before

treatment to after treatment and follow up in 29 paitients and in 1 patient the visual

acuity improved from N13 to N14 and remained stable during follow up period.

Symmetric Measures Value Approx. Sig. Nominal by

Nominal Contingency Coefficient

.060 1.000

N of Valid Cases 90

Results99


SUBJECTIVE PARAMETERS

Table No.49 Showing the result on Dry and Irritated Eyes Assessment Mean SD N

Before 1.7667 1.00630 30

After .7000 .74971 30

Dry and

Irritated Eyes Follow up .7333 .73968 30

Source Sum of

Squares df Mean


Change 22.067 2 11.033 43.831 .000 Error change

14.600 58 .252

P = .000 HS

DRY AND IRRITATED EYES

Before treatment the Mean grading was 1.7667 with SD of 1.00630, after treatment

Mean grading was 0.7000 with SD of 0.74971 after follow up the Mean grading was

0.7333 with SD of 0.73968,


treatment to follow up is found to be statistically highly significant at .000 HS.

This shows that the symptom Dry and Irritated Eyes reduced from before treatment to

after treatment but slightly increased during the follow up period.

Table No.50 Showing the result on Redness of eyes

Assessment Mean SD N

Before 1.7667 .89763 30

After .6667 .75810 30

Redness of eyes

Follow up .7333 .73968 30

Source Sum of

Squares df Mean Square F Significance

Change 22.822 2 11.411 59.211 .000 Error change 11.178 58 .193

P = .000HS

Results100


REDNESS OF EYES



0.7333 with SD of 0.73968.



This shows that the symptom Redness of Eyes reduced from before treatment to after

treatment but slightly increased during the follow up period.

Table No.51 Showing the result on Tearing in eyes


Before 1.0333 .92786 30

After .4000 .56324 30

Tearing in eyes

Follow up .3667 .55605 30

Source Sum of

Squares df Mean



P = .000 HS

TEARING IN EYES



0.3667 with SD of 0.55605.



This shows that the symptom Tearing in Eyes reduced from before treatment to after

treatment and further decreased during the follow up period

Results101


Table No.52 Showing the result on Headache Assessment Mean SD N

Before 2.0667 .73968 30

After .7667 .77385 30

Headache

Follow up .7333 .78492 30

Source Sum of

Squares df Mean



P = .000 HS

HEADACHE

Before treatment the Mean grading was 2.0667 with SD of .73968, after treatment


0.7333 with SD of 0.78492.


treatment to follow up is is found to be statistically highly significant at .000 HS

This shows that the symptom Headache reduced from before treatment to after

treatment and further decreased during the follow up period.

Table No.53 Showing the result on Burning in eyes Assessment Mean SD N

Before 2.2333 .56832 30

After .8000 .80516 30

Burning in eyes

Follow up .8000 .80516 30

Source Sum of

Squares df Mean



P = .000 HS

Results102


BURNING IN EYES



0.8000 with SD of 0.80516,


treatment to follow up is is found to be statistically highly significant at .000 HS

This shows that the symptom Burning in Eyes reduced from before treatment to after

treatment and remained stable during the follow up period.

Table No.54 Showing the result on Blurred vision


Before 1.1000 1.09387 30

After .3333 .75810 30

Blurred vision

Follow up .3333 .75810 30

Source Sum of

Squares df Mean Square F Significance

Change 11.756 2 5.878 20.159 .000 Error change

16.911 58 .292

P = .000 HS

BLURRED VISION



0.3333 with SD of 0.75810.


treatment to follow up is found to be statistically highly significant at .000 HS

This shows that the symptom Blurred Vision reduced from before treatment to after

treatment and remained stable during the follow up period.

Results103


OBSERVATIONAL PARAMETERS Table No.55 Showing the result on Photophobia

Assessment Absent Present Total Before 10 20 30 After 26 4 30

Photophobia

Follow up 25 5 30

Value Approx. Sig. Nominal by Nominal

Contingency Coefficient

.463 .000

N of Valid Cases 90 P = .000 HS

PHOTOPHOBIA


treatment to follow up is is found to be statistically highly significant at .000

Out of total 30 patients, 20 patients (66.66%) had photophobia before treatment. After

treatment 16 (53.33%) patients got relieved, but 4 patients (13.33%) persisted with

Photophobia. After the completion of follow up 5 patients (16.66%), persisted with

photophobia with increase in 1 patient (3.33%).

Table No.56 Showing the result on Contact Lens Discomfort


Contact Lens Discomfort

Follow up 26 4 30



.045 .914

N of Valid Cases 90

P = .914 NS

CONTACT LENS DISCOMFORT


treatment to follow up is is found to be statistically non significant at .914

Results104


Out of total 30 patients, 5 patients (16.66%) had Contact Lens Discomfort. After

treatment only 1 (3.33%) patient got relieved,but 4 patients (13.33%) persisted with

Contact Lens Discomfort. After the completion of follow up 4 patients (13.33%),

persisted with Contact Lens Discomfort. This shows that during follow up period the

condition is stable.

Table No.57 Showing the result on Slowness in Focusing


Slowness in

Focusing Follow up 24 6 30

P = .129 NS

SLOWNESS IN FOCUSING



Out of 30 patients, 12 patients (40%) had Slowness in Focusing. After treatment 6

(20%) patients got relieved,but 6 patients (20%) persisted with Slowness in

Focusing.After the completion of follow up 6 patients (20%), persisted with Slowness

in focusing with no further decrease. This shows that during follow up the condition is

stable.

Table No.58 Showing the result on Change in Colour Perception


Change in Colour

Perception Follow up 29 1 30

Value Approx. Sig.Nominal by Nominal Contingency

Coefficient .000 1.000

N of Valid Cases 90 P = 1.000 NS

Value Approx. Sig. Nominal by

Nominal Contingency Coefficient

.209 .129

N of Valid Cases 90

Results105


CHANGE IN COLOUR PERCEPTION


treatment to follow up is is found to be statistically non significant at 1.000

Out of 30 patients, only 1 patient (3.33%) had Change in Colour Perception.After

treatment no relief was found in Change in Colour Perception.After the completion of

followup patient, persisted with Change in Colour Perception without any

improvement. This shows that during follow up the condition is stable without any

relief.

Table No.59 Showing the result on Shoulder pain


Shoulder Pain Follow up 12 18 30



.209 .127

N of Valid Cases 90 P = .127 NS

SHOULDER PAIN



Out of 30 patients, 25 patients (83.33%) had shoulder pain.After treatment 5 (16.66%)

patients got relieved,but 20 patients (66.66%) persisted with Shoulder pain. After the

completion of follow up 18 patients (60%), persisted with shoulder pain and 2 patients

(6.66%) got relieved in follow up period.

Table No.60 Showing the result on Neck pain


Neck Pain Follow up 7 23 30

Results106




.147 .372


NECK PAIN



Out of 30 patients, 27 patients (90%) had neck pain .After treatment 3 (10%) patients

got relieved, but 24 patients (80%) persisted with neck pain. After the completion of

follow up 23 patients (76.66%), persisted with shoulder pain and 1 patients (3.33%)

got relieved in follow up period. The result obtained regarding the parameter shoulder

pain is showing statistically non significant result with relief only in 4 patients.

Table No.61 Showing the result on Back Pain


Back Pain Follow up 11 19 30



.066 .821


BACK PAIN



Out of 30 patients, 21 patients (70%) had Back pain .After treatment 2 (6.66%)

patients got relieved, but 19 patients (63.33%) persisted with Back pain. After the

completion of follow up 19 patients (63.33%), persisted with Back pain and no

patients (0%) got relieved in follow up period. The result obtained regarding the

parameter back pain is showing statistically non significant result.

Results107


RESULT RELATED OBSERVATIONS FOR SYMPTOMS AFTER

TREATMENT

Table 62 The response of the therapy for individual symptoms after treatment

Symptoms CD CS CI-1 CI-2 CI-3

Dry & Irritated eyes 0 2 14 6 2

Redness of eyes 0 2 13 10 0

Tearing in eyes 0 1 15 2 0

Headache 0 2 13 13 0

Burning in eyes 0 2 14 13 1

Blurred vision 0 3 6 7 1

Diplopia - - - - -

EXCELLENT

2 patients (6.67%) with Dry & Irritated eyes, 1 patient (3.34%) with Burning

in eyes and 1 patient (3.34%) with Blurred vision showed excellent response.

GOOD

6 patients (20%) with Dry & Irritated eyes, 10 patients (33.34%) with Redness of

eyes,2 patients (6.67%) with Tearing in eyes, 13 patients (43.34%) with Headache

,13 patients (43.34%) with Burning in eyes, and 7 patients (23.34%) with Blurred

vision showed good response at the end of the treatment.

ENCOURAGING

14 patients (46.67%) with Dry & Irritated eyes, 13 patients (43.34%) with Redness

of eyes,15 patients (50%) with Tearing in eyes, 13 patients (43.34%) with Headache

,14 patients (46.67%) with Burning in eyes,and 6 patients (23.34%) with Blurred

vision showed encouraging response at the end of the treatment.

STABLE

2 patients (6.67%) with Dry & Irritated eyes, 2 patients (6.67%) with Redness of

Results108


eyes,1 patient (3.34%) with Tearing in eyes, 2 patients (6.67%) with Headache ,2

patients (6.67%) with Burning in eyes,and 3 patients (10%) with Blurred vision were

stable and showed no response at the end of the treatment.

DETIORATED

None of the patients showed increase in severity of symptoms.

RESULT RELATED OBSERVATIONS FOR SYMPTOMS AFTER FOLLOW

UP

Table 63 The response of the therapy for individual symptoms after follow up

Symptoms CD CS CI-1 CI-2 CI-3

Dry & Irritated eyes 0 2 15 5 2

Redness of eyes 0 2 15 8 0

Tearing in eyes 0 1 14 3 0

Headache 0 2 13 12 1

Burning in eyes 0 2 14 13 1

Blurred vision 0 3 6 7 1

Diplopia - - - - -

EXCELLENT

2 patients (6.67%) with Dry & Irritated eyes, 1 patient (3.34%) with headache,1

patient (3.34%) with Burning in eyes and 1 patient (3.34%) with Blurred vision

showed excellent response at the end of follow up.

GOOD


eyes,3 patients (10%) with Tearing in eyes, 12 patients (40%) with Headache ,13

patients (43.34%) with Burning in eyes, and 7 patients (23.34%) with Blurred vision

showed good response at the end of follow up.

Results109


ENCOURAGING

15patients (50%) with Dry & Irritated eyes, 15 patients (50%) with Redness of

eyes,14 patients (46.67%) with Tearing in eyes, 13 patients (43.34%) with Headache

14 patients (46.67%) with Burning in eyes,and 6 patients (23.34%) with Blurred

vision showed encouraging response at the end of follow up.

STABLE


eyes,1 patient (3.34%) with Tearing in eyes, 2 patients (6.67%) with Headache ,2

patients (6.67%) with Burning in eyes,and 3 patients (10%) with Blurred vision were

stable and showed no response at the end of follow up.

DETIORATED

None of the patients showed increase in severity of symptoms.

Table.64 STATISTICAL ANALYSIS OF RESULTS

Variable Grading

on Mean SD SE T P-

value Significa

nce BT 1.76 1.0 0.18 AT 0.70 0.74 0.13 6.72 .000 HS

DRY & IRRITATED EYES FU 0.73 0.73 0.13 6.65 .000 HS

BT 1.76 0.89 0.16 AT 0.66 0.75 0.13 7.94 .000 HS

REDNESS OF EYES

FU 0.73 0.73 0.13 7.87 .000 HS BT 1.03 0.92 0.17 AT 0.40 0.56 0.10 5.64 .000 HS

TEARING IN EYES

FU 0.36 0.55 0.10 5.52 .000 HS BT 2.06 0.73 0.13 AT 0.76 0.77 0.14 10.14 .000 HS

HEADACHE

FU 0.73 0.78 0.14 9.63 .000 HS BT 2.23 0.56 0.10 AT 0.80 0.80 0.14 11.56 .000 HS

BURNING IN EYES

FU 0.80 0.80 0.10 11.56 .000 HS BT 1.10 1.09 0.14 AT 0.33 0.75 0.13 4.49 .000 HS

BLURRED VISION

FU 0.33 0.75 0.13 4.49 .000 HS

Results110


RESULTS

ILLUSTRATION SHOWING THE DRUG EFFECT ON SCIRMERS TEST

BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

ILLUSTRATION SHOWING THE DRUG EFFECT ON DRY EYES BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

Results111


ILLUSTRATION SHOWING THE DRUG EFFECT ON RED EYES BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

ILLUSTRATION SHOWING THE DRUG EFFECT ON TEARING EYES BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

Results112


ILLUSTRATION SHOWING THE DRUG EFFECT ON HEADACHE BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

ILLUSTRATION SHOWING THE DRUG EFFECT ON BURNING EYES BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

Results113


ILLUSTRATION SHOWING THE DRUG EFFECT ON BLURRED VISION BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

ILLUSTRATION SHOWING THE DRUG EFFECT ON PHOTOPHOBIA BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

Results114


ILLUSTRATION SHOWING THE DRUG EFFECT ON TOTAL SYMPYOMS BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP

Results115


ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN DRY AND IRRITATED EYES GRADINGS AFTER TREATMENT AND AFTER

FOLLOW UP

ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN REDNESS OF EYES GRADINGS AFTER TREATMENT AND AFTER FOLLOW UP

ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN TEARING OF EYES GRADINGS AFTER TREATMENT AND AFTER FOLLOW UP

Results116


ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN HEADACHE GRADINGS AFTER TREATMENT AND AFTER FOLLOW UP

ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN BURNING

EYES AFTER TREATMENT AND AFTER FOLLOW UP

ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN BLURRED VISION AFTER TREATMENT AND AFTER FOLLOW UP

Discussion117


DISCUSSION ON REVIEW

TITLE OF THE STUDY

“Application of Ayurveda Siddhanta in the Management of Computer Vision

Syndrome.”

This study is intended to understand Ayurveda Siddhantas that can be applied

to understand a new disease, Computer Vision Syndrome in all its aspects, i.e., its

diagnosis prevention and treatment.In this present work an attempt was made to

understand Computer Vision Syndrome based on the Ayurveda Siddhantas like Hetu,

Trividha hetu, Nidanapanchaka, and to find out a sitable Chikitsa and to find the role

of Rasayana in its treatment..

Computer is an Electronic device

Vision is physiological function of cognition

Syndrome A group of symptoms, signs, laboratory findings or physiological

disturbances that are linked by a common anatomical, biochemical or pathological

history.

So CVS means a a group of eye or vision related signs or symptoms occurring in

excessive computer users.

DISCUSSION ON REVIEW OF LITERATURE

Hetu

Definition

The factor which causes rogotpatti by vitiating the dosha is called nidana.

All the definitions of hetu in general mean that hetu is an etiological, causative factor

for a disease manifestation, gives rise to a disease or karana for a vyadhi. Hetu word is

also used as synonymous to nidana in many contexts in the classiscs.

The disease CVS is caused due to working or seeing computer screens continuosly for

longer duration.Here watching computers is the etiological/causative factor for a

disease manifestation; it gives rise to the disease and is a karana for a vyadhi. So in

this disease Computer watching is the hetu or nidana for manifestation of CVS.

Discussion118


Classification of Hetu

The various hetu explained in samhita can be applied here stating their

causative efficacy in disease Computer Vision Syndrome and their nature of

influencing a disease.

Bahya hetu

The external factors causing dosha prakopa are bahya hetu.

Working with computers and watching television for longer duration, looking at fast

moving images and bhasvara vasthu darshana and multiple colours very frequently,

improper lighting arrangement, improper seating position, etc acts as a bahya hetu in

causing Computer Vision Syndrome.

Abhyantara hetu

The hetu present internally is responsible in the disease origin. Ex – Doshas,

vata, pitta kapha, Vatadi dosha prakopa due to various nidana which cause the disease

and its lakshans are to be considered as abhyantara hetu. In Computer Vision

Syndrome already prakupita tridosha due to various nidanas along with existing eye

diseases like Presbyopia, Myopia, Asthenopia, Dry Eye, Glaucoma further aggravate

the severity.These factors act as abhyantara hetu.

Utapadaka hetu

The hetu bringing dosha vitation by its nature as it is the important chief or

potent cause. Ex - Madhura rasa sevana causes increase of kapha

Sitting in uncomfortable positions and following mithya ahara, mithya vihara,

vyasana,etc act as hetu for vatadi dosha prakopa and cause manifestation of disease

and they are to be considered as utpadaka hetu.

Vyanjaka hetu

The hetu stimulating for a disease origin, the hetu excites the already sanchita

dosha to produce disease. Ex– Surya santapa in vasantha rutu acting as a cause for

kaphaja rogas.Following the acts which cause the prakopa of already increased dosha

like ratrijagarana, and alpashana and vishamashana acts as vyanjaka hetu in Computer

Vision Syndrome.

Discussion119


Ubhaya hetu

The hetu responsible for disease considering both dosha and vyadhi.Watching

and working with computers for longer duration causes both vaatadi dosha prakopa

and netra vyadhi thus can be considered under ubhaya hetu.

Sannikrushta hetu

The nearest or immediate cause responsible in the disease origin.Ex –Vatadi

dosha prakopa in disease origin.In Computer Vision Syndrome the sannikrushta hetu

is Asatmendriyartha Samyoga (Atiyoga) of Chakshurendriya.

Pradhanika hetu

A powerful or potent cause capable of producing a disease by itself.

In Computer Vision Syndrome the pradhanika hetu is watching ati bhrusha, bhasvara

chala and sookshma vastu darshana.

DISCUSSION ON TRIVIDHA HETU

Asatmendriyartha samyoga

Among the trividha hetu, the asatmendriartha samyoga is related mainly to

Pancha gnanendriya based on hinayoga, mithyayoga and atiyoga with their vishayas.

The asatmendriyartha samyoga of chakshurendriya are as follows.

Ati Yoga

Ati Darshanam i.e., seeing very bright light or objects for long periods of time.

In the present study the following factors were found which can be considered as

Atiyoga of chakshurendriya like working with computers for more than 8 hrs a day

were 20 patients i.e., (66.67%)

In the present study it was found that all the 30 patients were having the habit

of watching TV which can also be considered under Chakshurendriya Atiyoga.

Ayoga

Adarshanam remaining in dim light or darkness, seeing objects and reading in

dim light or not utilizing the Chakshurendriya properly.In the present study no patient

was found following ayoga of Chakshurendriya.

Discussion120


Mithya yoga

Seeing for a long time those objects which are very near or very far, which are very

minute, which are very bright and sparkling. In the present study it was found that

patients were having the habit of following various Netra indriya mithyayoga like

• Watching computer from very near (10 ‐33.33%)

• Working with computer and watching TV in darkness or dim light or

improper lighting. (6 ‐20.0%)

• Reading small font and watching flickering images (15‐50%)

• Sitting in an improper position while working with computers (15‐50%)

Prajnaparadha

In the present study it was observed that maximum no of patients ie 15 were

working for 6 days a week and 10 patients working 7 days a week with computers

with average of 8.5 hrs a day. In this study it was observed that maximum no of

patients were working with computers from 1 year 5 patients, 3 year 5 patients and 5

years 4 patients with an average working period of 3.5 years with computers. Based

on these observations it can be considered as kayika prajnaparadha atiyoga.

Manasika prajnaparadha is also found in the patients of Computer Vision

Syndrome as most of them are stressed from the nature of the job especially those

working in software companies and call centre.

Vachika prajnaparadha is not found in all the patients except call centre

employees whose nature of job is voice based so have to answer and talk continuously

while attending the calls.

Parinama

The hina, mithya and atiyoga of kaala lead to vatadi dosha prakopa by the

influence of the kaala leading to the diseases manifestation.

In the present study it was observed that more exposure to cold in air

conditioned atmosphere also aggravates vatadi dosha and increases the dryness in

eyes as its not a natural atmosphere.It becomes a factor of kala mithya yoga i.e

different from external natural enviroment and atiyoga i.e,sheeta guna atiyoga causing

dosha prakopa. The duration of work can also be considered under kala i.e., more the

Discussion121


duration the patient is exposed to computer work he is more prone to develop


DISCUSSION ON CHAKSHURENDRIYA

Chakshu is the organ of vision and first and the most important among the

Pancha Gnanendriya.In Ayurveda samhita a lot of importance has been given

regarding this and a detailed discussion regarding its utpatti,its adhishthana,

mahabhoota and its importance. Acharya Nimi in astanga hrudaya says for a blind

person day and night are same even though he is having a lot of wealth stating the

importance of netra.In Sushruta samhita acharya sushruta has explained measures to

protect one’s eyes and the treatment of netra roga in detail in uttaratantra. In

Ayurvedic literature it is also mentioned that “sarvendriyanam nayanam

pradhanam“stating the importance of chakshurendriya.

Sclera

The sclera forms posterior 5/6 of the eye ball. It has received its name from its

extreme dense fibrous tissue which is hard and maintains the shape of eyeball. Its

external surface is white in colour. In Computer Vision Syndrome the sclera turns red

which is called as the red eye due to excessive flow of blood to eye or inflammation

or due to continuous work.

Lacrimal apparatus

These lacrimal apparatus keeps the eye moistened and supplies essential

nutrition and lubrication.In Computer Vision Syndrome due to uninterrupted watching

and reduced blink rate of eyes, the tear secretion decreases or tears quickly get

evapourated and the eye is not properly moistened.This causes the sensation of dry

eye and burning in the eyes.

Muscles of the eye

Eye ball is kept in position by the Ocular muscles.All the muscles help in the

movement of the eye ball in multi directions.Persons working with computer need to

move their eyes frequently as to focus on the screen and on the near by documents

alternatively while entering various data which causes muscle strain resulting in eye

strain, tiredness and pain in the eyes.

Discussion122


DISCUSSION ON NETRA ROGA

Detail description of netra roga is available in in Sushruta uttaratantra along

with their etiology, pathogenesis, symptoms, complications, medical and surgical

treatments and sadhyasadhyata. In the same sthana there is description about the

panchalakshana nidana and samanya chikitsa of aganthuja/abhighataja diseases in

detail. Apart from nija rogas Aganthuja netra roga have also been mentioned caused

due to Abhighata,and other external factors.CVS can be included under bahya or

Abhighata janya netra roga.

DISCUSSION ON NIDANA PANCHAKA

The samanya Nidana of netra roga mentioned in Sushruta Samhita

Uttaratanthra should be considered while eliciting the Nidana of Computer Vision

Syndrome which is also a netra vyadhi.

Nidana

The Nidana of netra roga can be classified as Aaharaja, Viharaja Manasika based on

their cause and their role in aggravating doshas.

1. Aharaja- The aharaja Nidana again can be catogorised as vata prakopaka,pitta

prakopaka and kapha prakopaka nidana.

Vata prakopa nidana: In this present study it was observed that most of the patients

26 (86.77%) were following vishamashan which causes vata prakopa.

Pitta prakopa nidana: In the present study it was found that the patients having the

habit of drinking tea were 24 (80%) drinking alcohol were 7 (23.33%) drinking coffee

were 5 (16.66%) respectively which causes pitta prakopa.

Kapha prakopa nidana:In the present study it was found that 6 (20%) patients take

curd in the night which causes kapha prakopa.

2. Viharaja

Vata prakopa nidana: In this present study it was observed that most of the patients

were following Ratrijagarana (Vata Pitta prakopaka) 15 (50%) patients and

Discussion123


diwaswapna (Vata Kapha prakopaka) were 15 (50%) patients, vegadharana and ,

disturbed sleep 15 (50%) which causes vata prakopa.

Pitta prakopa nidana:In the present study dhooma pana was found in 7 (23.33%)

patients and ratrijagarana in 15 (50%) and madyapana in 7 (23.33%) of patients which

also causes pitta prakopa.

Kapha prakopa nidana: In the present study it was found that 15 (50%) patients

were divaswapna which may cause kapha prakopa.

Manasika- The manasika Nidana mentioned in netra roga Nidana are

kopa,shoka,klesha, Prasaktha smrodana, shrantha, klantha etc mansika bhava.In the

present study most of the patients are stressed and complained of various manasika

bhavas like shrantha,klantha,kopa,Klesha,chinta,udwega.

According to Acharya Nimi Nidana for netra roga are ahita aahara and visual

contact with excessively sparkling, fast moving and minute objects.In the present

study all the 30 patients were found to follow this Nidana of watching excessively

sparkling, fast moving and minute objects while working with computers and

watching TV.

Thus watching and working with computers is the cause for the netra vyadhi

Computer Vision Syndrome and various ahitakara ahara vihara and manasa bhavas

help in promoting the disease further and they in turn also act as sahakari karana.

Poorvaroopa

No specific prodromal symptoms were mentioned for the disease Computer

Vision Syndrome.In the present study the roopa of CVS i.e., burning in eyes, watering

in eyes, dry and irritated eyes, headache, redness of eyes and blurred vision difficulty

in focusing and photophobia with less severity are considered as prodromal

symptoms,as these symptoms are found in patients with less severity.

Roopa/Lakshana

The Visishta lakshanas of Computer Vision Syndrome are

Discussion124



Red Eyes


Headache

Light Sensitivity,

Double Vision

Backache

Neck Ache

Muscle Fatigue

Eye Strain,


In the present study a comparision was made regarding the lakshanas told in

Ayurveda samhitas and their probable dosha involvement which is as follows.

Symptoms Ayurvedic terms Dosha vitiation

Dry and irritated eyes Visushka Netra / Rooksha Netra

Vata

Eye Strain Netra Klama Vata Blurred vision Avila Darshanam Pitta Red Eyes Netra Raaga Pitta Burning Eyes Netra Daha Pitta Excessive lacrimation Ashru Bahulata Vata Double vision Dwidha pashyati

(Mithya darshana) Vata

Difficulty in focusing Roopa darshana asahyata (heena tarpita lakshana)

Vata

Change in colour perception Vikruta varna patavam

Vata / pitta

Photophobia Prakasha Asahyatva Vata / pitta Headache Sirashoola Vata/pitta Pain in shoulder, neck and back.

Greeva, Bahu , Kati Shoola

Vata

Contact lens discomfort --------------- -

Slowness in changing focus Alpa kriya laghava of netra

Vata

Discussion125


When the lakshanas of Computer Vision Syndrome are compared with dosha

predominance and lakshanas told in Ayurveda it is assumed that Computer Vision

Syndrome is a disease with Vata Pitta dosha predominance. In the present study it was

observed that the Samanya Poorvaroopa Lakshana of Netra Roga are similar with the

lakshana of Computer Vision Syndrome.So it can be assumed that the samanya

Poorvaroopa lakshana of netra roga are similar to the Poorvaroopa and also to the

Roopa of Computer Vision Syndrome.Though an exact comparision of Computer

Vision Syndrome with the existing netra roga cant be made in this study, it can be

inferred that Computer Vision Syndrome is the poorva roopa condition of netra roga

with predominance of vata pitta dosha and CVS is also an independent netra vyadhi.

Upashaya and Anupashaya

In the present study it was observed that taking break from work intermittently every

1 hour (intermittent rest), maintaining eye hygine,good night sleep,good seating

position, less glare from computer screens and sitting in a properly illuminated room

without shadows on screen and healthy nutritious food are to be considered upashaya

in CVS.

The factors exactly opposite to upashaya like ratrijagarana, alpashana, anashana,

improper lighting, and improper seating are to be considered as anupashaya in CVS.

Samprapthi

The samprapthi of Computer Vision Syndrome can be explained as follows.

Samprapti Ghataka

Dosha- Vata Pitta Pradhana Tri Dosha

Dooshya- Rasa,Rakta,Mamsa,Majja

Srotas- Netragata Sira

Srotodusti- Sanga,Atipravrutti

Udbhava sthana- Chakshu (Netra).

Vyaktha sthana-Netra

Sanchara sthana- Urdhwagata Sira

Rogamarga- Madhyama

Adhisthana- Chakshurendriya.

Discussion126


Swabhava- Chirakari

Illustration No Showing the Scheme of Samprapti of CVS

Achakshushya Nidana Sevana

(Working with computer for longer duration & following other dosha aggravating

factors )

Dosha Vruddhi and Dosha Dushti

(Nidana sevana continued further)

Dosha prakopa with predominance of Vata and Pitta Dosha

Spreading of dosha in the body through all sira and srotas

Entry of doshas into Urdhwagata Sira

Urdhwagati of Prakupita Dosha through the Urdhwagata Sira

Sthana Samshraya of Prakupita Dosha in various parts of the Netra

Poorvaroopa lakshana

Manifestation of Netra Roga (Computer Vision Syndrome)

Sadhyasadhyata

Computer Vision Syndrome is an easily curable condition i.e.,

sukhasadhya if chikitsa is started early and if nidanaparivarjana and pathya are

followed properly. But if nidana parivarjana and pathya are not followed by computer

users then Computer Vision Syndrome becomes a kricchra sadhya or yapya vyadhi.

Discussion127


Upadrava and Arishta Lakshana

In the present study during the period of intervention no upadravas or arishta

lakshana were seen.

Discussion on Netra Roga Chikitsa Sidddhanta

The management principles of Netra Roga in general consist of avoidance of

etiological factors as the first line of management. The second principle is to counter

act increased Vata and other Doshas in the poorvaroopa stage itself, because if

neglected these diseases progress rapidly and become incurable in later stages.i.e.,

a) Nidana parivarjana (Prophylactic measures)

In patients of Computer Vision Syndrome Nidanaparivarjana in total as such is

not possible and is far from practical as all of the computer workers are dependent on

the job for their livelihood.

In the present study 5 patients applied leave due to various reasons and took a break

from office work for 1 month, in them the severity of symptoms was found less

during the period of vacation.Based on this observation it can be infered that nidana

parivarjana is the best chikitsa.

b) Vaatadi dosha shamanam (Curative measures)

Vaatadi doshashama includes sthanika and sarvadehika traeatment procedures

like shamana and shodhana which include Rasayana, Aushadha, Kriyakalpa, though

the disease Computer Vision Syndrome is not mentioned in Ayurveda Samhitas based

on the principles the following Chikitsa Siddhanta can be formulated.

In an aganthu karana vyadhi like Computer Vision Syndrome netra prasadana

janana, drushtiprasadajanana drugs should be used which cause dosha shamana and

samprapthi vighatana along with vaatabhishyanda chikitsa.i.e, procedures like

Aschotana, Tarpana, Putapaka etc with netrya and snigdha vtahara drugs are

beneficial.In Netra vyadhi Chakshushya rasayana drugs are to be administrated like

Triphala as vatatapika rasayana sevana vidhi. All rasayana are beneficial in

indriyajanya vyadhi especially which are chakshushya.vatatapika chakshushya

rasayana thus administered gives strength to that particular indriya and prevent

Discussion128


diseasease due to asatmendriyartha samyoga and help in performing the daily

activities.

In the present study the patients are unable to follow nidana parivarjana as

their livelihood is dependent on the job and also lengthy and time consuming

treatment procedures like tarpana and putapaka could not be administered due to lack

of time and nature of job. So a Chakshushya rasayana yoga was selected which is very

easy to consume and also having the properties of vatadi dosha shamana, Rasayana

and Netrya.In the present study it was also observed that Computer Vision Syndrome

is associated with non ocular symptoms like pain in shoulder, neck and back due to

improper seating arrangement and poor office ergonomics. So giving only

chakshushya rasayana may not cure the disease completely but a multicentric

approach like pathya sevana,vata hara/shoola hara aushadhies,use of spectacles,mild

exercise to prevent pain in shoulder back etc and proper office ergonomics are

beneficial which can be considered under yukthivyapashraya chikitsa. If all the

mentioned principles are followed rationally Computer Vision Syndrome can be

easily cured.

DISCUSSION ON MATERIALS AND METHODS Instruments Near vision Jacquers Chart Near vision eye examination was done to find out the Acuity of near vision in patients

of CVS.

Distant vision Snellen’s Chart Distant vision eye examination was done to find out the Acuity of distant vision in

patients of CVS

Schirmers test -1 Schimmers test -1 examination was done to find out the amount of dryness in eyes of

patients suffering from CVS.As dry eyes is a common symptom complained by all

computer users this test was done to find out the amount of dryness.

Discussion on Drug-Triphala Yashtimadhu Yoga

Discussion129


The ingredients of Triphala Yashtimadhu Yoga are Haritaki, Vibhitaki,

Amalaki and Yashtimadhu. All the above drugs were selected on the basis of their

indication in Netra roga as they are mentioned as Netrya, Swarya, Chakshushya,

Rasayana, Antistress and also as Anti inflammatory. They are useful in the preventing

and curing various types of Netra roga and they also improve vision. They are Madura

rasa pradhana, snigdha guna, sheeta virya and madhura vipaka, jeevaneeya and

tridosha shamaka in nature.Thus this drug was taken for the study based on the above

properties and also as it is directly indicated in netra roga.

Discussion on Anupana

Madhu and Ghrita are used as Anupana in the present study as per their

indication in the classics. Madhu and Ghrita are having Madhura rasa, guru snigdha

mrudu yogavahi guna,also having Rasayana karma,and Chakshushya prabhava thus

they are specially indicated in Netra roga.

All the above drugs are easily available, economical and the preparation of Choorna is

also easy.Therefore with the above intention Triphala Yashtimadhu Yoga with

anupana of Madhu and Ghrita is selected to evaluate its efficacy in netra roga like


Selection Criteria

Patients were selected by screening with the help of a detailed questionnaire,

and those fulfilling the inclusion criteria, and willing to take the treatment.As patients

of both sex work with computers the study was conducted irrespective of sex.

Patients of age group between 20-50 years were selected as subjects of age group in

the range of 20-50 years are commonly found in computer related jobs.In this study

patients having high myopia, colour-blindness, cataract, glaucoma, and with other

ocular problems were excluded as these diseases are chronic and need different and

various modalities of treatment.

Inclusion Criteria

Patients indulging in occupation of working with computers for more than 4

hours a day were taken for the study because 4 hours of computer work is considered

safe as per different studies available.Patients of either sex are taken as both male and

Discussion130


female are equally working with computers. Age group of 20-50 years was included

as people of this age group are found more in computer jobs and work for more than 4

hrs in a day.

Exclusion Criteria

Patients suffering from chronic systemic diseases, degenerative eye diseases

and severe ocular problems including high myopia and from congenital ocular

anomalies as they may interfere with the course of the study.

Diagnostic Criteria

The diagnosis of patients suffering with CVS was made based on a

questionnaire containing signs and symptoms index stated by AOA (American

optometric Association) though the individual symptoms found in CVS may mimic

other disesases,but are collectively found in CVS only.

Sampling Method

The patients were randomly selected and made in to a single group to avoid

bias.

Study Design

Present study was an observational and a single blind clinical study with pre

and post test design.This study design was taken to assess the changes in severity of

symptoms before and after drug trial to find out the clinical efficacy of drug on CVS.

Grading for subjective variables

The gradings for subjective parameters were done based on the previous

research works done in various institutes on the same subject Computer Vision

Syndrome.

Data collection

Data collection was done before treatment, after and follows up to assess the

effect of drug and pathya from before treatment to after treatment and after treatment

to follow up.

Discussion on Intervention

Discussion131


The dose of drug administered in the present study was 12 grams per day (1

karsha).In classics the Chakshushya drugs were to be taken during night.The dosage

of the drug was made 6 grams twice a day for easy administration with anupana of

Ghrita and Madhu.

Discussion on Observations

The observations were made in the patients of Computer Vision Syndrome

excluding dropouts were based on the clinical trial on 30 patients registered for the

study. The data was collected in a case sheet and were analyzed after the completion

of the study.

Dropouts

Total 40 patients got registered for the study, out of which 10 patients

discontinued the treatment after various stages. Among the dropouts 5 patients

discontinued due to personal reasons and 5 patients discontinued due to lack of time

for follow-up visits.

Availability

All the cases were reported to OPD of GAMC & H directly during the 6

months camp period.

Age

In the present clinical study it was observed that maximum numbers of

patients were in the age group between 21-30 years. The collected data indicates that

the incidence of Computer Vision Syndrome is higher in youngsters as more job

opportunities are available in computer related field for freshers.

Sex

Among 30 patients in the present study 16 patients were male and 14 patients

were female. The ratio of male and female is almost similar stating that job

opportunities are equal for both sexes in computer related jobs thus both are equally

prone to this disease.

Discussion132


Occupation

In this study it was observed that majority of the patients were software

professionals are 11 (36.66%), office clerk 8 (26.66%), accountants 4 (13.33%), call

centre employees 4 (13.33%), medical transcriptionists 2 (6.66%) and students were 1

(3.33%).The collected data indicates that the incidence of Computer Vision Syndrome

is usually more in software professionals as they have relatively more work load and

long working hours as per the demands of the employer.

Education

In the present study it was observed that maximum i.e., 24 patients (80%)

were graduates, and 6 patients (20%) are post-graduates. Due to easy employment and

attractive salaries more people are opting for computer jobs than for higher education.

It was also observed that 9 (30%) people are studying through correspondence for

higher degrees because, though these jobs pay good for freshers,career growth,

promotions and pay scale are qualification dependent.

Marital Status

Among 30 patients maximum numbers of patients were unmarried i.e. 18

(60%) and 12 (40%) patients were married.Though marital age in india is 21 as good

job and higher salary are requsite for marriage in the present society the urban Indian

marital age is nearing 30 due to good career.Though the exact relation of the disease

with marital status though could not be established in this study,the reason may be

need for good career,thats why majority of patients are unmarried.

Religion

In the present study it was observed that majority of patients were from Hindu

community i.e., 24 (80.0%) from Muslim community are 2 (6.66%) from Christian

community are 1 (3.33%) and others (Jain) are 3 (10.0%) respectively. As Indian

society is hindu dominant with more literacy rate is found in hindus suffering with


Socio Economic status

Among 30 patients maximum numbers of patients were from middle class i.e.

23 (76.7%) and 6 (20%) patients were from upper middle class and only 1 (3.33%)

Discussion133


patient was from rich class. As more Indians are from middle class.It can be

concluded that people with middle socio-economic status are the majority working in

computer jobs due to higher salary, and they also can’t do Nidanaparivarjana as their

livelihood is job related, thus they are more prone to Computer Vision Syndrome.

Locality

It was observed that out of 30 patients, majority of the patients i.e. 28 (93.3%)

patients were from urban area followed by 2 (6.66) patients from rural area.This

shows that software companies and computer firms are more in urban areas, thus

people residing and working in urban are more prone to Computer Vision Syndrome.

Tv watching

In the present study it was found that all the patients were having the habit of

watching TV. Watching TV for 5 hours were 1 (3.33%) for 4 hours are 4 (13.33%),,

for 3 hours are 4 (13.33%), for 2 hours are 12(40%), for 1 hour are 9 (30%),

respectively.Computer job doers also watch TV for relaxation,but for less duration

compared to professionals of other jobs but watching TV more frequently along with

computer work further aggravates the condition of Computer Vision Syndrome.

Working hours

In the present study on observing the no of working hours the minimum were

3 hrs and maximum was 16 hrs with more no of patients working for 8hrs. As per

AOA the safe number of working hours to work with a computer are 4 but in the

study the mean no of working duration is 8.5 hrs which is twice the time mentioned

by AOA. So it can be inferred that more computer working duration further

aggravates the condition of Computer Vision Syndrome.

Working duration

In the present study on observing the working duration the minimum were 3

months and maximum was 8 years with more no of patients working for 5 years.So it

can be inferred that exposure to computers for longer duration of time aggravates the

condition of Computer Vision Syndrome.

Discussion134


Working in a week

In the present study on observing the no of working days the minimum were 4

days and maximum was 7 days with more no of patients working for 6 days a

week.So it can be inferred that more computer working duration further aggravates

the condition of Computer Vision Syndrome.

Prakruti

Among 30 patients it was observed that majority of patients 15 (50%) had

Vata Pitta Prakruti followed by Pitta Kapha Prakruti in 10 patients (33.33%) and

Vatakapha Prakruti is present in 5 (16.7%) patients. It shows that Vata Pitta Prakruti

persons are more prone to this disease because working for longer hours with

computers and sitting in same posture causes Vata Pitta Prakopa and Vata Pitta

Prakruthi persons because of their parakruthi which may be an aggravating factor in

this condition.

Diet

In the present study it was found that the patients with vegetarian diet are 15

(50%) and mixed diet are 15 (50%) both are equally present. Diet Pattern and its

correlation with the incidence of the disease couldn’t be established in the present

study.

Diet pattern

In the present study it was found that the patients following vishamashana are

more i.e., 26 (86.77%) and patients following samashana were 4 (13.33%).this shows

that persons following vishamasana are more in number due to busy work schedule

and unable to take timely food.vishamashana causes vata dosha prakopa and further

causes the already sanchita dosha to prakopa avstha and may help in causing the

vyadhi.

Rasa sevana

In the present study it was found that the patients taking 4 rasa MALK are 21

(70.0%) taking 3 rasa MAL are 5 (16.66%) and taking 5 rasa MALKT are 2 (6.66%)

and taking all the 6 rasa are also 2 (6.66%).It was observed that patients taking

MALK rasa are having more symptoms. But with the available sample size no

Discussion135


conclusions can be drawn on the role of rasa sevana in causing Computer Vision

Syndrome.

Vyasana

In the present study it was found that the patients having the habit of drinking

tea were 24 (80%) habit of smoking were 7 (23.33%) drinking alcohol were 7

(23.33%) drinking coffee were 5 (16.66%) and tobacco chewing were 2 (6.66%) and

taking milk were 1 (3.33%) respectively.vyasana like smoking,tobacco chewing and

drinking alcohol further increase doshaprakopa and may aggravate the condition.

Duty

In the present study on interrogation it was found that people working in night

shifts are are complaining of discomfort with the shift, and sleep deprivation.

It can be inferred that people working in night shift were having more

discomfort compared to day shift and its an aggravating factor for Computer Vision

Syndrome as ratrijagarana causes Vata Pitta dosha prakopa.

Sleep

In the present study it was found that the patients with sound sleep are 15

(50%) and disturbed sleep are 15 (50%) both are equally present. On interrogation it

was found that people having disturbed sleep are complaining of discomfort with the

eyes.It was observed that persons with disturbed sleep are suffering more from


Treatment

Maximum number of patient i.e. 27 patients freshly reported for the study.

This clearly indicates the ignorance of the patients regarding this disease. So that until

all the symptoms of the disease get manifested they do not approach the medical

authority.

Mode of Onset

Among 30 patients all patients had gradual onset and no patient had

complained of sudden onset. Based on above observation in the present study it was

Discussion136


inferred that all the patients had gradual onset of symptoms and Computer Vision

Syndrome is said to be gradual in onset.

Sara

In the present study it was found that all the 30 (100%) patients were of

madhyama sara. With the available sample size no conclusions can be drawn on the

role of sara in causation of Computer Vision Syndrome.

Samhanana

In the present study it was found maximum number of the patients 29

(96.66%) were of madhyama samhanana. With the available sample size no

conclusions can be drawn on the role of Samhanana in causation of Computer Vision

Syndrome.

Pramana

In the present study it was found that all the 30 (100%) patients were of

madhyama Pramana. With the available sample size no conclusions can be drawn on

the role of Pramana in causation of Computer Vision Syndrome.

Satmya


(96.66%) were of madhyama satmya. With the available sample size no conclusions

can be drawn on the role of Satmya in causation of Computer Vision Syndrome.

Satwa


(96.66%) were of madhyama satva and 4 were with avara satwa. Satwa bala has a

definite role to play in causation of Computer Vision Syndrome as chinta shoka bhaya

anxiety like emotions may further aggravate due to work load associated manasika

karana and cause dosha prakopa,which may further aggravate the condition.

Agni

Among 30 patients it was observed that majority of patients 18 (60%) had

Vishamagni and 8 (26.7%) had mandagni and 4 patients (13.33%) had teekshnagni.

Discussion137


this shows that as the vyadhi is vata pitta pradhana and vishamagni may be

aggravating the comndition by vata dosha prakopa.

Vyayama


(66.66%) were doing madhyama vyayama and 10 (33.34%) were doing avara

vyayama. vyayama bala has a definite role to play in prevention of Computer Vision

Syndrome as a person can withstand from stress for longer duration with vyayama.

Desha

In the present study it was found maximum number of the patients 24 (80%)

were belonging to anupa desha.and 6 patients belong to jangala desha (20%). With the

available sample size no conclusions can be drawn on the role of Desha in the

causation of Computer Vision Syndrome.

DISCUSSION ON RESULTS

30 patients who completed the clinical trial were considered for assessing the

results. The cardinal symptoms were considered for statistical analysis and were

assessed totally 3 times, before the treatment and after 2 month of drugs trial and after

follow up. Along with the symptomatology vision tests and Schirmer test-I values

were statistically assessed by comparing pre, post tests and follow up values.

In the present study it is observed that Triphala yashtimadhu yoga with

anupana of madhu and ghrita along with pathya sevana and correction in work station

and usage of glasses has reduced some of the signs and symptoms of Computer

Vision Syndrome significantly.

OBJECTIVE PARAMETERS

Schirmer’s Test-I

The levels of Schirmers test-I showing raised values initially, but remained in

normal levels after the study period of 60 days and after follow up. The result

indicated statistically significant P < 0.001 was observed.This signifies that the drug

increases the moisture content of the eyes and normalizes the lacrimal secretion

Discussion138


maintaining the snigdhata of the netra, and is effective in dry and irritated eyes.This

proves the chakshushya,rasayana,netrya properties of the triphala yashtimadhu yoga.

Visual acuity Distant and Near Vision

In patients having defects in visual acuity only 1 patient has improvement of

reading in distant vision from 6/9 to 6/6 all other patients readings were stable. In

readings of near vision only 1 patient has improvement of acuity of near vision from

N13 to N14. Remaining other’s readings was stable. None of the values obtained are

showing statistical significance.

As the duration of the present study was short no conclusions can be drawn

based on the results. But improvement of 1 patient each for distant and near vision

proves the Chakshushya effect of the drugs used in the yoga and it can be inferred that

that the drug may be improving the visual acuity of the eyes and if continued for

longer duration may have a significant role to play in the management of acuity of

vision associated with Computer Vision Syndrome.

SUBJECTIVE PARAMETERS


The drug effect was statistically highly significant in patients with Dry and

irritated eyes after the completion of treatment but increased slightly during the follow

up period.Out of total 24 patients complaining dry eyes only 2 patients had no

result.Grade 3 improvement was found in 2 patients. Grade 2 improvement was found

in 5 patients and Grade 1 improvement was found in 15 patients.This proves the effect

of Chakshushya, Netrya, Tridoshashmaka, Rasayana, and Antistress, Anti

inflammatory properties of the drugs in the yoga and also having guru snigdha guna

which reduces the dryness and irritation in the eye. It suggests that the theraphy if

continued for longer duration gives better results.

Redness of Eyes

The drug effect was statistically highly significant in patients with Redness of

eyes after the completion of treatment but increased slightly during the follow up

period. Out of total 25 patients complaining red eyes only 2 patients had no

Discussion139


result.Grade 3 improvement was found in none. Grade 2 improvement was found in 8

patients and Grade 1 improvement was found in 15 patients.This proves the effect of

Chakshushya,Tridoshashmaka,Rasayana,Antistress,and Anti inflammatory properties

of the drugs in the yoga and also having guru snigdha guna and sheeta veerya they

,may be acting as vata pitta shamaka thus reducing the redness of the eyes. It suggests

that the theraphy if continued for longer duration gives better results.

Tearing of Eyes

The drug effect was statistically highly significant in patients with Tearing of

eyes after the completion of treatment and follow up. Out of total 18 patients

complaining tearing eyes only 1 patient had no result.Grade 3 improvement was found

in none. Grade 2 improvement was found in 3 patients and Grade 1 improvement was

found in 14 patients.This proves the action of tear regularization of the drug along

with Chakshushya Tridoshashmaka, Rasayana, Anti inflammatory and Antistress

properties of the drugs in the yoga.

Headache

The drug effect was statistically highly significant in patients with Headache

after the completion of treatment and follow up. Out of total 28 patients complaining

headache only 2 patients had no result.Grade 3 improvement was found in 1 patient.

Grade 2 improvement was found in 12 patients and Grade 1 improvement was found

in 13 patients. This proves the effect of Chakshushya Tridoshashmaka,

Rasayana,saumanasa janana and medhya,Antistress and Antiinflammatory properties

of the drugs in the yoga, and this yoga is also effective in reducing the headache

associated with Computer Vision Syndrome.

Burning in Eyes

The drug effect was statistically highly significant in patients with Burning in

Eyes after the completion of treatment and follow up. Out of 30 patients complaining

Burning eyes only 2 people had no result.Grade 3 improvement was found in 1

patient. Grade 2 improvement was found in 13 patients and Grade 1 improvement was

found in 14 patients.This proves the effect of Chakshushya Tridoshashmaka,

Discussion140


Rasayana, and Antistress, Anti inflammatory properties of the drugs in the yoga and

also having guru snigdha, sheeta guna.

Blurred Vision

The drug effect was statistically highly significant in patients with Blurred

Vision after the completion of treatment and follow up. Out of total 17 patients

complaining dry eyes only 3 people had no result.Grade 3 improvement was found in

1 patient. Grade 2 improvements were found in 7 patients and Grade 1 improvement

was found in 6 patients. This proves the effect of Chakshushya Tridoshashmaka,

Rasayana , and Antistress Anti inflammatory properties of the drugs in the yoga

because of which it is reducing the blurred vision arising due to excess computer

viewing.

OBSERVATIONAL PARAMETERS

Photophobia

The drug effect is statistically highly significant in patients with photophobia

after completion but increased slightly during the follow up period. Out of total 20

patients complaining Photophobia 5 people had no result after treatment meaning that

15 patients got complete relief from photophobia.This proves the effect of

Chakshushya Tridoshashmaka, Rasayana, and Antistress, Anti inflammatory

properties of the drugs in the yoga. It suggests that the theraphy if continued for

longer duration gives better results.

Contact lens discomfort

The drugs effect was non-significant in patients with contact lens discomfort

in the present study. Out of total 5 patients complaining Contact lens discomfort 4

people had no result.as contact lens discomfort is an individual specific symptom

found only in contact lens users and as lens are foreign body to the eyes the symptom

may not be relieved so all the patients are advised to shift to spectacles instead of

contact lenses.

Discussion141


Slowness in changing focus of eyes

The drugs effect was non-significant in patients with slowness in changing

focus of eyes. Out of total 12 patients complaining Slowness in changing focus of

eyes 6 people had no result after treatment. The above intervention if continued for

longer duration may have some significant effect on Slowness in changing focus of

eyes associated with Computer Vision Syndrome.

Changes in Colour perception

The drugs effect was non-significant in patients with changes in colour

perception of eyes. Only 1 patient complaining Changes in Colour perception had no

result after treatment.The above intervention if continued for longer duration may

have some significant effect in the management of Changes in Colour perception of

eyes associated with Computer Vision Syndrome.

Pain in shoulder

Out of total 25 patients complaining Pain in shoulder 20 people had no result

after treatment.The drugs effect was non-significant in patients with pain in shoulder.

As the symptom is due to improper seating and frequent movement in position of

hand, the trial drug having only chakshushya rasayana properties may not give

complete relief. Exercise, vatahara drugs and changing to comfortable seating position

should be tried which may give better results.

Pain in Neck

Out of total 27 patients complaining Pain in neck 24 people had no result after

treatment.The drugs effect was non-significant in patients with pain in neck.As the

symptom is due to improper seating and frequent movement in position of neck while

watching monitors,the trial drug having only chakshushya rasayana properties may

not give complete relief. Exercise, vatahara drugs and changing to comfortable seating

position should be tried which may give better results.

Pain in Back

Out of total 21 patients complaining Pain in back 19 people had no result after

treatment.The drugs effect was non-significant in patients with pain in back.As the

symptom is due to improper seating position and lack of support to spine while

Discussion142


watching monitors, the trial drug having only chakshushya rasayana properties may

not give complete relief. Exercise, vatahara drugs and changing to comfortable seating

position should be tried which may give better results.

GENERAL OBSERVATIONS

1. In the present study during the drug trial it was observed that patients have

slight difficulty in swallowing the drug because of its taste.

2. In the present study during the drug trial it was observed that 3 patients got

relieved of constipation.this may be due to anulomana property of the drug.


relieved of amlapitta.this may be due to sheetha guna, madhra rasa and

rasayana property of the drug.


sound sleep after taking the drug.this may be due to rasayana and anti stress

property of the drugs.

Conclusion144


CONCLUSION

On the basis of conceptual analysis and obseravations made in this clinical

study the following conclusions can be drawn.

The Ayurveda siddanthas are formulated, time tested and applied since

centuries to understand diseases, and to plan their management. This present study

have the following points as a befitting conclusion proving that Ayurveda siddhantas

are eternal and can be applied in understanding newer diseases like Computer Vision

Syndrome.

Asatmendriyartha samyoga Atiyoga of chakshurendriya like watching highly

luminous, fast moving flashing colours for a prolonged time have been mentioned in

classics and has been validated in understanding the aetiological factors of CVS.

All aspects of pragnaparadha play an important role in exacerbation of the

symptoms. Improper ergonomics add up to cause further vitiation.

Duration of computer work is directly proportional to the severity of

symptoms in CVS.

The Siddhanta Nidana parivarjanameva chikitsa is validated in the present

study.

If the diseases are treated in poorvaroopavastha itself they don’t become

severe.This Siddhanta is validated in CVS also.

Chakshshya yoga selected in this study has proved that they are beneficial in

diseases where nidana parivarjana is not completely possible.

145


RECOMMENDATIONS FOR FUTURE STUDY

• The same study can be conducted on larger sample with longer duration along

with yogasanas and relaxation techniques.

• The study can be done by comparing the drug along with Kriyakalpa

• The same study can be conducted with other Chaksushya and vatahara

Rasayanas.

• The study can be restricted to IPD only, as complete abstinence of nidana is

possible.

• Similar studies can be conducted to understand newer diseases and their

treatment.

Summary

145


SUMMARY

The study titled “Application of Ayurveda Siddhanta in the Management of

Computer Vision Syndrome” was selected for the study to provide an understanding

for a new disease not mentioned in Ayurvedic classics based on Ayurveda siddhantas

and to find out the role of prakruthi, and a suitable chikitsa siddhanta and the efficacy

of Triphala Yashtimadhu yoga in Computer Vision Syndrome (CVS). The work is

presented in two parts. The first part deals with the Review of Literature consisting of

Hetu,Trividha hetu,Nirukti, Paryaya, Bheda of Netra roga, Nidana Panchaka,

Sadhyasadhyata, Chikitsa, Pathyapathya and Drug Review and literature on Computer

Vision Syndrome.the second part consists of the observations,results of the clinical

trial with Triphala Yashtimadhu Yoga,discussion and conclusion.

Total 30 cases were randomly selected and were sampled into a single group,

followed by a clinical study consisting of 30 patients with a pre-post test design.

Statistical analysis was done using contingency coefficient table analysis, and

single‘t’ test.

The diagnosis was based on clinical features mentioned by AOA, American

Optometric Association.

Among 30 patients taken for the study, Dry & Irritated eyes is found in 24

patients, Redness of eyes is found in 25 patients, Tearing eyes is found in 18 patients,

Headache is found in 18 patients,Burning sensation in eyes is found in 30 patients,

Blurred Vision is found in 17 patients, Photophobia is found in 20 patients, Contact

lens discomfort is found in 5 patients, Slowness in changing focus of eyes is found in

12 patients, Changes in Colour perception is found in 1 patient, Pain in shoulder is

found in 25 patients, Pain in Neck is found in 27 patients and Pain in Back is found in

21patients respectively.

In the present study Asatmendriyartha samyoga especially chakshurendriya

atiyoga i.e., excessive watching and working with computers for longer duration

Summary

146


along with mithyahara and vihara were the most common nidanas encountered in the

patients of CVS.

All the patients were administered Triphala Yashtimadhu Yoga 12 grams a

day in divided doses with anupana of ghrita and madhu for 60 days, once in the

morning and once during bed time.

Data regarding age, sex, occupation, education, economic status, diet,

addiction etc were analysed after the study.The observations of the study also

included the etiological factors of the disease. It was observed and recorded that CVS

was prevalent in both sexes equally. Its incidence was high in the age group of 21-30

yrs; people belonging to middle socioeconomic status were more susceptible for the

disease.

The assessment of improvement was based on the above parameters

mentioned by AOA. The results revealed that a favorable response was obtained in all

30 patients (100%). The percentage of reduction in the relief of symptoms was

statistically highly significant in ocular problems like the increase in schirmers test–I

values, the reduction in the dryness of eye, redness of eye, tearing, headache, burning

eyes, blurred vision, and photophobia.No significant result was observed in Slowness

in changing focus of eyes, Changes in Colour perception, Contact lens discomfort and

in non-ocular symptoms like Neck, Back and Shoulder pain.

The conclusions derived on the basis of detailed observations are presented

under the chapter of conclusion.Future prospects of this study are highlighted as an

aid for the future research workers.

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Annexure


ANNEXURE CLASSICAL REFERENCE

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Annexure


uÉÉiÉÉSÏlÉÉÇ mÉëiÉÏbÉÉiÉ: mÉëÉå£üÉå ÌuÉxiÉUiÉ: mÉÑlÉ: (xÉÑ E 1/25)

lÉå§É zÉÉUÏU ÌuÉ±É²rÉlaÉÑsÉ oÉÉWÒûsrÉÇ xuÉÉlaÉÑwOûÉåSU xÉÎqqÉiÉqÉç ²rÉlaÉÑsÉqÉ xÉuÉïiÉ: xÉÉkÉï ÍpÉwÉaÉlÉrÉlÉ oÉÑ Ò̄SqÉç || xÉÑuÉëÑ¨ÉÇ aÉÉåxiÉlÉÉMüÉUÇ xÉuÉïpÉÔiÉaÉÑhÉÉå°uÉÇ | mÉsÉÇ pÉÑuÉÉåAÎalÉiÉÉåU£Çü uÉÉiÉÉiÉç ¢ÑüwhÉÇ ÍxÉiÉÇ eÉsÉÉiÉç AMüÉÉzÉÉS´ÉÑqÉÉaÉÉïxcÉ eÉÉrÉliÉå lÉå§É oÉÑ Ò̄Så || (xÉÑ E 1/11)

Annexure


Annexure –II

COMPUTER VISION SYNDROME -Questionnaire

According to American optometric association, (AOA) Computer Vision Syndrome is

a complex of eye and vision problems related to near work that are experienced

during or related to computer work. In other words, you work on a computer for a

while and your eyes bother you. This survey is an effort to identify and find out

whether you are suffering from CVS. We invite you to answer the following questions

and to check out yourselves. If you find suffering from 3-4 of the symptoms and your

profession involves prolonged usage of computers, you could be suffering from


Name:

Age: Sex:

Occupation:

Phone No: Place of work:

Email: Designation:

Postal Address:

1. Primary use of computer

Data entry/ DTP

Communication internet / email

Clerical

Financial accounting

Web designing

Others

2. No of hours spent on computer per day______ since ______months/years.

3. No of days spent in a week with computer _______

4. Do you use vision corrective / protective lenses? Yes / no

If yes since____ months/years. What is their refraction and the purpose of usage?

1. Is any of your family members suffering from eye related problems?

Annexure


Yes/no. If yes, please specify?

6. Have you ever noticed any of the following symptoms during or after prolonged

usage of computer?


Blurred vision

Redness of eyes

Burning in Eyes

Tearing of eyes

Diplopia

Headache

Photophobia




Fatigue

Pain in shoulder, neck and back

7. Any other symptoms

8. You are experiencing the above symptoms since ____ weeks/months/years.

9. The above symptoms if present do they disappear after discontinuing the work

within ________ min/hrs/days.

10. Are you undergoing any treatment or techniques (yoga/exercise, etc) to prevent or

manage the above symptoms? If yes, please specify.

Place:

Date: Signature:

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA

GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. PROFORMA OF CASE SHEET FOR THE STUDY OF

“APPLICATION OF AYURVEDA SIDDHANTA IN THE MANAGEMENT OF COMPUTER VISION SYNDROME”

H.O.D : Dr.N.Anjaneya Murthy, M.D. (Ayu) Guide : Dr.Naseema Akthar, M.D. (Ayu)

Annexure


Co-Guide : Dr.T.R.Shantala Priyadarshini M.S.(Ayu) Researcher : K.S.Dutta Sharma.G

History taking Examination

SL No.: O.P.No

Name Date

Age: Sex:

Occupation:

Marital status: UM M W D

Religion: Hindu Muslim Christian Others

Socio-economic status: P LM M UM R

Education: 10 10+2 G PG

Locality: Urban / Rural

Phone No:

Email:

Postal Address:

Diagnosis:

Pradhana vedana with Avadhi Dry and irritated eyes

Blurred vision

Redness of eyes

Burning in Eyes

Tearing of eyes

Diplopia

Headache

Photophobia




Fatigue

Pain in shoulder, neck and back.

Annexure


Anubandha Vedana: (Associated complaints) Avadhi

Poorvavyadhivrittanta: (History of past illness)

Chikitsa vrittanta: (Treatment history)

Medical: Surgical:

Paarivaarika vrittanta: (Family history)

Maternal: Paternal: Siblings:

Personal history: (Vayaktika Vrittanta)

Ahara : Veg / Non-Veg regular/occasional

Rasa : Madhura / Amla / Lavana / Katu / Tikta / Kashaya

Type : Samashana / Adhayashana / Vishamashana / Anashana

Nidra : Day - regular / irregular disturbed/ sound

Night - regular / irregular disturbed/ sound

Duration :

Vyasana Habits Continuing Regular Occasional Quantity Stopped Coffee/Tea Smoking Alcohol Tobacco others Vyavasaya vrittanta:

(Occupational History):

1. Nature of work:

Primary use of computer:

Data entry/ DTP

Communication internet / email

Clerical

Financial accounting

Web designing

Others

2. Working hours:

No of hours spent on computer per day______ since ______months/years.

Annexure


3. No of days spent in a week with computer _______

4. Working conditions:

Day bright light/ dim light

Night bright light/ dim light

5. Duration of the present occupation:

Previous occupation:

6. Do you use vision corrective / protective lenses? Yes / no

If yes since____ months/years. What is their refraction and the purpose of usage?

7. Any other details

ROGI PAREEKSHA Dashavidha Pareeksha: Prakriti :Vata/Pita/Kapha/Vatapitta/Vatakapha/Kapha pitta/ Sannipata

Vikruthi : Dosha: Dushya

Sara : Pravara / Madhyama / Avara

Samhanana : Pravara / Madhyama / Avara

Pramana : Pravara / Madhyama / Avaras

Satmya :Pravara / Madhyama / Avara

Satwa :Pravara / Madhyama / Avara

Ahara shakti :Pravara / Madhyama / Avara

Vyayama shakti :Pravara / Madhyama / Avara

Vaya :Baalya /Madhyama / Vridda

Desha :Anupa / Janghala / Saadharana

Ashtasthana pareeksha

Nadi Shabda

Mutra Sparsha

Mala Druk

Jihwa Aakruthi

Srotopariksha: Ashruvaha Srotas (lachrymal gland)

Annexure


Local examination

1. Head and face

2. Lids and eyelashes

3. Conjunctiva and Sclera

4. Cornea Iris and anterior chamber

5. Lens and pupil

Netra Pareeksha Mandala

1. Pakshma

2. Varthma

3. Shukla

4. Krishna

5. Drishti

Sandhi

1. Pakshma Varthmagata

2. Varthma Shuklagata

3. Shukla Krishnagata

4. Krishna Drishtigata

5. Kaneena

6. Apanga

Interpretation

Vikrutitah Pareeksha: Nidana: Aahara: Vihara: Manasika: Poorvaroopa: Roopa: Upashaya: Rest Sleep Dark room taking a break

Annexure


Anupashaya Bright light Tension Seating position Noise Strenuous work Sleeplessness Sampraptighataka Dosha : Dushya: Agni : Koshta : Ama : Srotas : Srotodusti prakara: Udbhava sthana : Sanchara sthana : Vyakta sthana : Adhisthana : Rogamarga : Samprapti : Vyadhivinischaya :

Chikitsa Shamanoushadhi: Dose: Kala: Anupana: Date of commencement: Pathya: Date of completion: Apathya:

Observation & Assessment

Objective parameters

Dryness of the eye - Present/ absent

Schirmers test I

Right eye BT AT FU

Left eye

Annexure


Acuity of Vision Distant and Near

Without Glasses

BT AT FU

NV DV NV DV NV DV Both eyes Right eye Left eye

Subjective parameters

Symptoms BT AT FU 1. Irritation in eyes 2. Redness of eyes 3. Tearing in eyes 4. Headache 5. Burning in eyes 6. Blurred vision 7. Diplopia

Observational parameters

Symptoms BT AT FU Present/ Absent P A P A P A

1. Photophobia 2. Contact lens

discomfort

3. Slowness in changing focus of eyes

4. Changes in colour perception

5. Pain in shoulder 6. Pain in Neck 7. Pain in Back

Result: Signature of HOD:

Signature of Researcher:

Signature of Co Guide:

Signature of Guide:

MASTER CHART

CASE NO

AGE SEX OCC REL E.S M.S SES LOC

AAHARA

PRAKRUTI

SARA SAMHANANA

PRAMANA

SATMYA

SATWA AGNI

VYAYAMA

DESHA

1. 23 F CC MU PG UM UMC UR MI PK M M M M M Ma M A 2. 26 F ST HI PG UM UMC UR MI VP M M M M M Vi M J 3. 22 M SW HI G UM UMC UR VE VP M M M M M Te M A 4. 29 F A HI G M MC UR MI VP M M M M M Ma M A 5. 31 F A HI G M MC UR MI VK M M M M M Vi M A 6. 40 F CL HI G M MC UR MI PK M M M M M Ma M A 7. 50 M A HI G M MC UR MI PK M M M M M Vi M A 8. 27 M A MU G M MC UR MI VP M M M M M Vi M A 9. 24 F CC CI G UM MC UR MI VK M M M M M Vi M A 10. 39 F CL HI G M MC UR VE PK M M M M M Ma M A 11. 24 M CC HI G UM MC UR VE VP M M M M M Vi M A 12. 23 M CL HI G UM MC RU MI VK M M M M M Vi M A 13. 30 M SW HI PG M RIC UR VE VP M M M M M Te M J 14. 49 M MT HI G M UMC UR MI PK M M M M M Ma M J 15. 50 M CL JA G M MC UR VE PK M M M M M Te M A 16. 28 F CL JA G UM MC UR VE VP M M M M M Vi M A 17. 26 F SW JA G UM MC UR VE PK M M M M M Vi M A 18. 49 M CC HI G M MC UR MI PK M M M M M Vi M A 19. 21 F SW HI G UM UMC UR MI VP M M M M M Vi M J 20. 21 M SW HI G UM MC UR VE VP M M M M M Vi M J 21. 28 F SW HI PG UM MC UR VE PK M M M A A Vi M A 22. 25 F SW HI G UM MC UR MI VP M M M M M Ma M A 23. 25 F CL HI G UM MC UR MI VK M M M M M Vi M A 24. 21 M CL HI G UM MC RU MI VP M M M M M Ma M A 25. 23 F SW HI G UM MC UR VE PK M M M M M Vi M A 26. 26 M SW HI G UM MC UR VE VP M M M M M Te M J 27. 49 M CL HI G M MC UR VE VP M M M M A Vi A A 28. 26 M SW HI G UM MC UR VE VP M A M M M Vi A A 29. 49 M MT HI PG M UMC UR VE VK M M M M A Ma M A 30. 26 M SW HI PG UM MC UR VE VP M M M M A Vi M

A

BEFORE TREATMENT AFTER TREATMENT FOLLOW UP

ST DE RE TE HE BU BL DI ST DE RE TE HE BU BL DI ST DE RE TE HE BU BL DI

1. 20 I2 R2 T1 H2 BU3 BL1 DI 0 20 I1 R0 T0 H0 BU1 BL0 DI 0 20 I1 R0 T0 H0 BU1 BL0 DI 0 2. 22 I2 R3 T2 H2 BU3 BL0 DI 0 23 I1 R1 T0 H0 BU2 BL0 DI 0 23 I1 R1 T0 H0 BU2 BL0 DI 0 3. 20 I0 R2 T0 H2 BU2 BL1 DI 0 21 I0 R1 T0 H1 BU1 BL0 DI 0 21 I0 R1 T0 H1 BU1 BL0 DI 0 4. 22 I2 R2 T2 H2 BU2 BL0 DI 0 23 I0 R0 T1 H2 BU1 BL0 DI 0 23 I0 R1 T1 H2 BU1 BL0 DI 0 5. 21 I2 R2 T2 H2 BU2 BL0 DI 0 21 I1 R1 T1 H2 BU0 BL0 DI 0 21 I1 R1 T1 H2 BU0 BL0 DI 0 6. 18 I2 R3 T2 H2 BU2 BL2 DI 0 19 I1 R1 T1 H0 BU0 BL0 DI 0 19 I1 R1 T1 H0 BU0 BL0 DI 0 7. 19 I2 R0 T0 H2 BU2 BL2 DI 0 20 I1 R0 T0 H1 BU0 BL1 DI 0 20 I1 R0 T0 H1 BU0 BL1 DI 0 8. 23 I0 R1 T1 H2 BU2 BL0 DI 0 23 I0 R0 T0 H0 BU1 BL0 DI 0 23 I0 R0 T0 H0 BU1 BL0 DI 0 9. 21 I2 R0 T0 H2 BU2 BL2 DI 0 21 I0 R0 T0 H0 BU0 BL1 DI 0 21 I0 R0 T0 H0 BU0 BL1 DI 0

10. 26 I3 R3 T0 H3 BU3 BL2 DI 0 28 I2 R2 T0 H2 BU2 BL2 DI 0 28 I2 R2 T0 H2 BU2 BL2 DI 0 11. 18 I2 R2 T2 H2 BU2 BL2 DI 0 18 I1 R1 T1 H1 BU0 BL0 DI 0 18 I1 R1 T1 H1 BU0 BL0 DI 0 12. 21 I2 R2 T2 H3 BU3 BL0 DI 0 21 I1 R1 T1 H2 BU2 BL0 DI 0 21 I1 R1 T1 H2 BU2 BL0 DI 0 13. 25 I2 R2 T0 H2 BU2 BL0 DI 0 26 I0 R0 T0 H0 BU0 BL0 DI 0 26 I1 R1 T0 H1 BU1 BL0 DI 0 14. 23 I0 R2 T2 H0 BU3 BL3 DI 0 25 I0 R1 T1 H0 BU1 BL1 DI 0 25 I0 R1 T1 H0 BU1 BL1 DI 0 15. 28 I2 R2 T0 H3 BU2 BL2 DI 0 29 I1 R0 T0 H1 BU1 BL0 DI 0 29 I1 R0 T0 H1 BU1 BL0 DI 0 16. 20 I3 R2 T2 H2 BU2 BL1 DI 0 20 I1 R1 T1 H1 BU1 BL0 DI 0 20 I1 R1 T0 H0 BU1 BL0 DI 0 17. 28 I0 R2 T2 H3 BU3 BL0 DI 0 29 I0 R1 T1 H1 BU1 BL0 DI 0 29 I0 R1 T1 H1 BU1 BL0 DI 0 18. 18 I2 R2 T0 H3 BU2 BL2 DI 0 19 I2 R2 T0 H2 BU2 BL2 DI 0 19 I2 R2 T0 H2 BU2 BL2 DI 0 19. 25 I3 R2 T1 H2 BU1 BL1 DI 0 25 I0 R0 T0 H0 BU0 BL0 DI 0 25 I0 R0 T0 H0 BU0 BL0 DI 0 20. 25 I2 R2 T1 H3 BU2 BL0 DI 0 26 I1 R1 T0 H1 BU0 BL0 DI 0 26 I1 R1 T0 H0 BU0 BL0 DI 0 21. 24 I3 R2 T0 H3 BU3 BL3 DI 0 26 I0 R0 T0 H2 BU1 BL0 DI 0 26 I0 R0 T0 H2 BU1 BL0 DI 0 22. 25 I2 R2 T2 H2 BU3 BL2 DI 0 26 I0 R0 T1 H0 BU0 BL0 DI 0 26 I0 R0 T1 H0 BU0 BL0 DI 0 23. 24 I2 R2 T0 H2 BU2 BL0 DI 0 24 I1 R1 T0 H1 BU1 BL0 DI 0 24 I1 R1 T0 H1 BU1 BL0 DI 0 24. 20 I3 R3 T2 H2 BU3 BL3 DI 0 20 I3 R3 T2 H1 BU3 BL3 DI 0 20 I3 R3 T2 H1 BU3 BL3 DI 0 25. 20 I0 R0 T0 H1 BU1 BL2 DI 0 20 I0 R0 T0 H0 BU0 BL0 DI 0 20 I0 R0 T0 H0 BU0 BL0 DI 0 26. 19 I0 R2 T2 H0 BU2 BL0 DI 0 20 I0 R1 T1 H0 BU1 BL0 DI 0 20 I0 R1 T1 H0 BU0 BL0 DI 0 27. 19 I3 R0 T0 H2 BU2 BL2 DI 0 19 I1 R0 T0 H1 BU1 BL0 DI 0 19 I1 R0 T0 H1 BU1 BL0 DI 0 28. 20 I1 R2 T1 H2 BU2 BL0 DI 0 20 I0 R0 T0 H0 BU0 BL0 DI 0 20 I0 R0 T0 H0 BU0 BL0 DI 0 29. 20 I2 R2 T0 H2 BU2 BL0 DI 0 21 I1 R1 T0 H1 BU0 BL0 DI 0 21 I1 R1 T0 H1 BU0 BL0 DI 0 30. 22 I2 R0 T2 H2 BU2 BL0 DI 0 22 I1 R0 T0 H0 BU1 BL0 DI 0 22 I1 R0 T0 H0 BU1 BL0 DI 0

Sex

Male – M

Female –F

Age – Ag

Religion – R

Hindu – HI

Muslim – MU

Christian – CI

Other (Jain)– JA

Marital Status – M.S.

Unmarried – UM

Married – M

Socio Economical

Status – SES

Middle Class ‐MC

Upper Middle Class UMC

Rich – RI

Locality – L

Urban – UR

Rural – RU

Diet – D

Vegetarian – VE

Mixed – MI

Occupation – OCC

Student –ST

Cll Centre‐CC

Software‐SW

Accountant‐A

Clerk –CL

Medical Transcription –MT

Education – E.D.

Graduated – G

Post Graduated – PG

Ashana – AS.

Samashana – SA

Anashana – AN

Adhyashana – AD

Vishamashana – VI

Vihara – VI

Shramaja – 1

Ashramaja – 2

Appetite – AP

Avara – 1

Madhyama – 2

Pravara – 3

Results

BT-Before Treatment

AT- After Treatment

FU-Follow Up

Prakruthi‐ PRAK

VataPitta – VP

VataKapha – VK

PittaKapha – PK

Sara‐SARA

Madhyama‐M

Avara‐A

Samhanana‐ SAM

Madhyama‐M

Avara‐A

Pramana‐PRAMA

Madhyama‐M

Avara‐A

Satmya‐ SATM

Madhyama‐M

Avara‐A

Sattva‐ SAT

Madhyama‐M

Avara‐A

Agni‐ AG

Manda –Ma

Vishama Vi

Teekshna –Te

Vyayama‐VYAYA

Madhyama‐M

Avara‐A

Key to master chart

computer vision syndrome ss-mys

Education

motherly affection

ayurveda vikriti

rajiv gandhi

chaukambha

ayurveda siddhanta

computer vision

vision syndrome

vaidya lakshmipati