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Review of Ayurvedic Literatures 7

CHAPTER – II

REVIEW OF AYURVEDIC LITERATURES

EVOLUTION OF OPHTHALMOLOGY IN AYURVED:

In Vedic Period:

The task of tracing back the history of shalakya tantra has been

very difficult, as early history of it is quite obscure. The ‘Shalakins’ as a

class of specialist were developed in the course of vedic period

(8000BC)

In vedic period, Rigveda the oldest treatise of the world, there is

mentioned of the revival of the lost eye-sight by the great physicians of

that time like. Asvinikumaras22 and the lord Indra23. It stands as an

evidence of first medical Knowledge and treatment of the eye diseases

of which can record in history of human race.

Atharvaveda, is the chief source of origin of Ayurveda, gives

better advanced medical knowledge. We find in Kensutra of Ayurveda,

the description of sense organs with their proper systemic location,

specially the eye ball in the skull over the vertebrae of the neck etc.24.

Besides this we also find the description of valuable drugs, has been

applied for the improvement of eye-sight and cured the congestion of

the eye (the cardinal signs of Abhishyanda)25.

In Samhita Period:

The history of shalakya tantra appears to be as old as that of

Ayurveda. The shalakya has got priority in both of the authentic

classical treatise i.e. charaka and susruta samhita. Both these texts

established the fact that during, their times Shalakya had evolved itself

as one of the important branch of the healing art. It illustrates the fact


that Shalakya had become popular science even during pre-historic

period.

Dalhana (12th Century AD) the pioneer commentator of Susruta

Samhita defines that Shalakya is the science and art where

instruments used are chiefly rod in shape26, it belongs to the section of

head and neck disease. There were specialists of Shalakya who were

called ‘Shalakins’ and the specialists of eye diseases were known as

‘Dristivisharada’27.

Sushruta and Opthalmology:

In first century A.D. it was noted that while western Scholars

made some headway in Shalakya tantra, Indian Scholars had already

done as much or more about 1000 years back and the perfection they

had reached was for ahead of the excellence attained by the Greece –

Romans one thousand years later.

Several Ayurvedic Scholars had specialized in Shalakya tantra

and has composed many treatises where as during the same period

the Greek had not apparently developed such specialties.

Sushruta was called ‘the father of Indian surgery’ during the

vedic age which is well before the Hippocratic period and he sites

several western scholars who consider India the birth place of

medicine. According to Johnson saint, the present of modern medicine

is not Greece but India.

Sushurata knew ocular anatomy, physiology, pathology and

therapeutics of the eye. Its stated that there are 76 varieties of ocular

diseases and 51 out of them were surgical. He performed cataract

surgery followed by lensectomy and lens extraction.28 He was the first

ophthalmic surgeons who applied the snake venom and fast for the

prevention of cataract, lekhana Karma in trachoma with the leaves of

Sephalika was Susrutas’s special parasurgical contribution.


In the field of Indian ophthalmology ocular therapeutics like

Parisheka (spray), Swedana (fomentation), Anjana (collyrium or eye

ointment), Aschyotana (eye drop), tarpana and Putapaka

(chemotherapy), Sekam (eye wash) etc have been mentioned about

100 anjanas have been mentioned for treating ocular diseases, and

their number gradually increases from time to time of Susruta and

onwards. ‘Kriyakalpa’ is a special devices of application of medicine in

the eye diseases locally are unique techniques. Except Aschyotana,

these Kriyakalpas probably have no corresponding equivalent in the

modern ophthalmology. According to Susruta ordinary water is acidic

in reaction, therefore he has advocated the use of distilled water

(parisruta jala) in the treatment of abhisyanda specially for ocular

clean.

Anatomical Concept of Shuklamandala in Ayurveda:

The disease undertaken for clinical study is related to

Shuklamandala (conjunctiva), though it is classified under the

sarvagata Akshi rogas, Susruta has written everythings about the

ocular anatomy on the basis of external observation. Structurally it has

two layers. The suklamandala proper is a dense white fibrous coat and

relatively as vascular in nature. It gives the size and shape to the eye

ball. So this shuklamandala i.e. the whitish part of the eyeball is called

as the sclera.

The transparency of the eyeball is visible due to a translucent

membrane is reflected over the front part of the shuklabhaga (sclera)

except the Krishnamandala (cornea). This membrane is to be called as

Shlaismik kala (conjunctiva) in many modern Ayurvedic

ophthalmology. Sushruta, described many diseases like sirajala

(conjunctival reaction or hyperaemia), Sirapidaka (phlyctenular

conjunctivitis), Arma (pterygium), Shuktika (Bitot’s spot), pistaka

(pinguicula), Arjuna (Ecchymosis) and more practical abhishyanda


(conjunctivitis). Therefore it is presume that the concept of

shuklamandala is nothing but a union of both the sclera and

conjunctiva are keeping in Susrutas mind also. Actually the diseases of

the shlaishmik kala, though it is mentioned in several classification of

eye diseases as mentioned in Ayurveda.

Panchabhoutic involvement in shuklamandala :

The whitish part of the eyeball having predominance of jala

mahabhoota. So jala is the sthanik bhoota of shuklamandala. But the

external translucent membrane called slaismikakala is having

vascularity and so it is having predominance of Agni Bhoota.

Doshic Involvement in Shuklamandala :

Jala being the predominant bhoota, kapha is the sthanik dosha.

Moreover the though, fibrous nature also indicates kapha

predominance.

Since there is involvement of agnibhoota in the slaismikakala,

pitta is to be considered as anubandha dosha. The involvement of vata

is much less and not considerable clinically.

Dhatu’s involvement in Shuklamandala :

Because of its kapha and pitta nature Rasa, Rakta and Mamsa

are the involved dhatu.

In short when we consider the diseases of the shuklamandala,

kapha should be considered as Sthanika dosa, which creates the

inflammatory diseases of the conjunctiva, and pitta as anbandha

dosha/Rakta attract the micro-organism by their chemotactic

properties.

Physiological Function of Pitta in eye :

Pitta responsible for ranjana, prakashana, varnakara including

prabhakara i.e. ranjana, alochaka and Bhrajaka may have to be


grouped together, under a category as their function are essentially the

formation of different kinds of pigments. Viz, the pigment, in the retina

responsible for vision and colour perception; the pigments that confers

on rakta is characteristic colour and specific function and pigment of

the skin, eye and hair etc.

Physiological Function of Kapha in eye :

The eye is composed of panchamahabhootas. The most expose

part of the eye is sweta mandala (i.e. conjunctiva/sclera) and

predominance of jalamahabhoota connected to kapha dosa.

Physiologically the kapha dosa acts as a slaismika ojas (tarpaka

kapha) have a Lysozymic property and killed the micro-organism which

produces the conjunctivitis in disturbance.

Concept of Bacteriology in Ayurveda :

In discussing related to the bacteriology it is necessary for us to

take a note mentioned in Charaka that microbial population which

normally inhabit our body without causing any harm to it known as

Sahaja krimi (as like Strepto coccus and Staphylo coccus which are

resides in conjunctiva) and harmful variety known as Vaikarika. There

are twenty varities of Krimies (micro organism) in addition to the

normal one which inhibit the body, has been described.29

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(SÉGònùkÉ)


Chakrapani Dutta commenting on the ‘Normal ones referred to

by Charaka, says that these do not cause diseases.

In this connection it should be mentioned here that the

Lysozyme discovered by Alexander Fleming, about 30 years ago from

tissues was shown to oppose anti microbial property.

Lysozyme is a bacterial enzyme which act upon

Staphylococcus, Streptococcus, meningo coci and some other

organisms compare the action of sahaja krimies described in

Ayurveda). Its occurrence in the lacrimal secretion has been

demonstrated. In addition, its wide distribution in animal tissues has

also been shown. It has a mucolytic action.30

In Ayurveda, certain term like Bhuta sparsa, grahas (especially

skanda graha), oupasargika samsarga Adhidaivika and adhibhoutika

etc. are testify to the knowledge of microbiology of vedic Indian.

In Susruta Samhita Nidan 5th Chapter 33 and 34 number of

Slokas proved that the present of organisms for creating the diseases

like leprosy, pyrexia and conjunctivitis etc.

Ayurveda believes that the infectious diseases can spread

through vayu (air borne diseases), jala (water borne disease) dosha

and kala (environmental pollution diseases).

Charaka described two types of krimis (microbes) namely sahaja

(non pathogenic) and vaikarika (pathogenic). He and his follower

Vagbhata mentioned vividly their morphological characteristic habitat,

growth factor and disease caused by them.

According to Susruta the endogenous organisms like raktaja

krimis are invisible. (Microscopic) keeping in view the morphology,

pathogenecity and nomenclature of this group of krimis indicates those

micro-organism living in blood and lymphatics, such as bacteria, virus,


fungus, actinomyces, mycobacterium etc. The following figure shows

the probable co-relation with modern bacteria.31

Chart shows different Rakta Krimis (Micro-organism) as per

Ayurvedic Samhitas in comparison with Modern Bacteria

Raktaja Krimis

According to Charaka According to Susruta According to Sarangadhar

Keshada Lomada Sorasa Dantada Kushthaja

Fungi Kusthaja Dantada Snayaka (Mycobacterium Leprae) Tuberculur Microphyton Microsporum

Bacteria Streptococcus N. Gonorrhoea

Adeno Myxo Picrona Herpes Staphylo coccus Virus Virus Virus Mycobacterium leprae

Concept of Abhishyanda :

The body, according to Ayurveda, is the result of an outcome of

nutrition and the diseases, on the other hand are the result of mal or

impaired nutrition.32 The destruction occurs in between pleasure

(health) and pain (disease) arises as a result of difference between the

wholesome and unwholesome diet and regimens.33

We have seen from the foregoing that there are at least three

factors which are basic for the maintainance of promotion of health

(dhatu metabolism) or the causation of disease, decay and death. Viz.

(I) The primary substrate or menstruam provide by the parents, (II) the


nutrition and (III) Factors in the substrate which are responsible for the

conversion of foods into Dhatus, doshas and mala. These latter factors

are known together as agni. Like other kaya diseases, Akshirogas are

also formed due to derangement of Agni (Mandagni).

It is mentioned in all three samhitas that there is a general

aetiological factors which manifested the several ophthalmic disorders

in individual part of the eye ball. Abhishyanda is such a type of

disease, occurring as a general sign of other ocular diseases.

The concept of conjunctivitis exist, as Abhishaynda in Ayurvedic

literature. In netrachikitsa Vigyana (ophthalmology) this word indicates

the name of a ocular diseases, as well as a peculiar disease process.

Abhishyanda as a disease is well explained in the text book. But

abhishyanda as a disease process is not explained much. It is true that

due to abhishyandi ahara-viharas many diseases occur in both locally

and systematically (Susruta).

The word meaning of abhishyanda is oozing, flowing or trickling,

shyanda is basic word. This means to tremor or to shake. Abhi means

‘to’ or ‘towards’ so abhishyand means ‘towards shaking’. Moreover the

word Abhi means from all the angles and shyanda means discharges.

In netrachikista, we will see some basic points here. Netra is a

indriya, rupa is artha, chaksu is the Adhisthana, Agni is the dravya with

very specific indriyabudhi (Panchapanchaka). It shows that a healthy

interaction between the pitta and kapha is the basic creation for proper

functioning of netra as an indriya.34 When the agni (a basic element of

eye) is affected by the kapha, then there is diseases of the conjunctiva

(slaismikala).35

According to Vagbhatta, the eye is made up of tejas (Rakta,

pitta) bhootas, so also the sun; with proper contact with sunlight

(relates to alochaka pitta), the pitta becomes sharp (gets vision), with


improper contact it looses its sharpness (gets dull vision). One

interesting statement by Vagbata in Sangraha: the rakta as a

sandushya for producing all types of netrarogas, like Abhishyanda

etc.36 Sushruta tells that all the eye diseases have their own origin in

Abhishyanda i.e. diseases process.37

Is Abhishyanda is a contaminated disease?

Yes, it was mentioned in the Ayurvedic Samhitas like, Susruta

and Vaghata’s Astang Hridaya that Abhishyanda is a ocular anomaly

where the whole eyeball is affected (Sarbagata roga) and the

discharges occurs from all angles of the eye.

A variable amount of conjunctival discharges, hence the name

catarrhal conjunctivitis (May and worth’s text book of ophthalmology).

Vataja abhishyanda is such type of Abhishyanda where nasanaha and

frontal headache occurs with scanty discharges.38

It is, none the less, seen that Susruta and Vagbhata had

recognized a number of disease as communicable (contagious).

According to Susruta, Kustha (Obstinate type of skin disease including

leprosy), Jwara (fever), sosha (tuberculosis) and netrabhishyanda

(conjunctivitis), spread man to man due to prasanga (intimate and

frequent physical relationship), gatrasamsprasha (contact of limb as in

shaking hands) nihswasat (brathing or air brone). Sahabhoojana

(eating together from the same utensil), sahashaiyasana (sharing the

same bed) and vastra malyanulepana (wearing the same apparel,

garland of flowers and unguents).39

|ÉºÉÆMÉÉnÂùMÉÉjÉºÉÆº{É¶ÉÉæÊzÉ&·ÉÉºÉÉiºÉ½þ¦ÉÉäVÉxÉÉiÉÂ*


ºÉ½þ¶ÉªÉÉÇºÉxÉÉcÉÉÊ{É ¤ÉÛÉ¨ÉÉ±ªÉÉxÉÖ™äô{ÉxÉÉiÉÂ** EÖò¹lÉÆ V´É®úˆÉ¶ÉÉä¹É É xÉäjÉÉÊ¦É¹ªÉxnù B´É SÉ* +Éè{ÉºÉÌMÉEò®úÉäMÉÉÆ É ºÉÆGòÉ¨ÉÎxiÉ xÉ®úÉzÉ®ú¨ÉÂ**

(Su. Ni. 5/34)

Vagbhata has observed in addition that in general all diseases

are communicable.40 This comment becomes emphasized, more

particularly, due to early recognition over two thousand years ago

disease causing organisms both microscopic (Raktaja Abhyantara

Krimis) and macroscopic (Bahjya krimis).

º{É¶ÉÉæEòÉ½þÉ®ú¶ÉªªÉÉÊnùºÉä´ÉxÉÉi{ÉÉªÉ¶ÉÉä MÉnùÉ&* ºÉ´Éæ ºÉÆSÉÉÊ®úhÉÒ xÉäjÉi´ÉÎM´ÉEòÉ®úÉ Ê´É¶Éä¹ÉiÉ&**

(AH. Ni. 5/34)

Etiological factors of Abhishyanda :

The cause of Vyadhi was described as dosha-vaishaya i.e., the

impaired equilibrium of tridoshas and that this state is brought about by

Ritucharjya, asatmendriyartha-samyaga, and progyaparadha.

(Trividhahetu).


The Ritucharya have vividly described the adoptive reactions of

the human organism to changes engendered in the external

environment due to changes in successive seasons (Ritu) in terms of

chaya, Prakopa of vata, pitta and kapha, which latter, in turn are stated

to confer a state of susceptibility or predisposition to vataja, pittaja and

kaphaja type of disorders. Even so, the related chapter in these

classics have laid down Ahita aharas vihara and charya for every

seasons causes disease, due to the internal stress caused by

variations in the seasonal rhythm of the doshas.41 One such expert

from the Ayurvedic classics is a condition known as Kukkunaka

(opthalmia Neonatorum) characterized the profuse purulent ocular

discharge with redness and swelling of lids in newborn baby indicates

the excessive intake of pitta vardhaka ahara and viharas in pregnancy

period of mother.

Another example like photo conjunctivitis, pterygium etc, is also

occurs in summer season due to the excessive atop sevana (sunlight).

WHO includes that, this is due to ultraviolet rays coming from the

strong sunlight.

Prakopa or kopana is stated to be the condition in which the

dosha having increased and accumulated in its own place, being

excited by appropriate causes, spreads over to parts other than its

own.42 Vagbhata, further observes that the doshas which have attained

the stage of prakopa spread over throughout the body from the foot to

the head (supra clavicular region) i.e. all the sense organs and

produces the Abhishyanda like diseases in the eye.43

Asatmindriyartha samyoga:

Ayurveda has explained about atiyoga, hinayoga and mithya

yogas of indriya and indriyartha samyoga. Some of the occupational

diseases of eye fall under the category. In Ayurveda, according to the

Sushruta and Vagbhata ill practice of different sense organs in terms of


Atiyoga, hinayoga and mithyayoga can lead to different physio

psychological disorder of the human system, where eye takes a major

role on other sense organs. For example, the industrial workers,

drivers and swimmers are more sufferer to Abhishyanda with

Asatmindriyartha samyoga, from Ati ushnaabhitapasya, Ati

Sheegrayana (Travelling) e.g. carbon monoxide from vehicle exhausts

etc. causes conjunctivitis, Ati Raja-Sevana-dust allergies may cause

allergic conjunctivitis and polluted swimming pool water cause the

swimming pool conjunctivitis.

Prajna aparadha:

According to Charaka in Shareera Sthanam Prajna Apardha is

“dhi dhruti smriti vibhrastaha karma yat kurutha ashubam

prajnaparadha tam vidyat sarva dosha prakoanam”

Dhi, dhruti and smritis are not in a function then transgressing

willfully, contradicting our own mind, will, mental stress we do some

action driven by pleasure seeking attitude even though we are aware

of its effects or sometimes unaware of its effects is known as prajna

aparadha.

� Direct injuries to eye is prajna apardh

� Exposing to hazardous chemicals, inflammable materials,

crackers etc.

� Polluting the atmosphere and improper waste disposal is also

prajna apardha.

� Choosing the job where eye strain occurs is prajna apardha.

Briefly, all types of Abhishyanda are due to prajna apardha. All

causes of Abhishyanda could be brought under the prajna apardha.

Doshic Involvement in various eye diseases :

The dosha which are vitiated (become abnormal undergo either

vridhi and kshaya) causes vitiation of Rasa and other dhatus (tissues)


next, both of them (dosha-dhatu samuurchanat) together vitiate the

malas (where from the organisms are grown up) which in turn vitiate

the channels (srotos) and spread all over the body and produces the

disease, even in eye also.44

Role of Pitta Prakopa Ahara-vihara in eye disease :

Ingestation of food predominantely katu, amla, lavan, tikshna,

ushna virya laghu, bidahi, tila-taila, tila paniyaka, kulattha, sarshapa

atasi flesh of godha, curd, whey, kurchika, amalaphala, katuwara,

vidagdhajirna (leading to formentative changes) affect the pitta dosa

(pittanusari) which affect the Rakta dhatu and produces the eye

diseases like dhatu and produces the eye disease like abhishyanda,

Adhimantha etc.

The regimen like mental anger, grief fear, fright, indulgence of

excessive exposure to the sun, working in the industrial factories etc.

causes vitiation of pitta and the dosa causes the muco-purulent type of

conjunctivitis.

When the pitta is vitiated by the above achakshushya nidana,

then it affects the rakta dhatus (doshadushya samurthana) and

produces and abhishyanda samprapti with an inclination towards netra

result manifestation of various eye dieases and affects the whole eye

parts like lids, conjunctiva, cornear, retina etc.

Role of Kapha Prakopaka Ahara-vihara in eye diseases :

Ingestion of food substances essentially guru, slimy, amala and

lavana rasa, substances which increase the secretion of kapha, food

grains such as yavaka, hayanaka, nishatha, masha, maha-masha,

godhuma tila rice curd, milk, payasa, preparation of cane-sugar flesh of

beats and birds of aquatic habits, lard, bullus and lotus stems,

kasheruka, sringataka, madhuraphala, food consisting of unwhole

some substances like cold drinks etc. cause the vitiation of kapha.


Day-sleep, lazy and sedentary habits, eating before the

digestion of food consumed previously vitiate the kapha dosa and this

dosa affect the pitta and rakta produces the eye diseases.45

Role of Rakta dosha in eye diseases :

In Aharas- frequent meals, repeated use of food composed of

substance possessing shita virjya, liquid, guru, snigdha, eating before

the digestion of previous food, and the viharas like day-sleep, anger,

exposure to the glare of the sun as fire etc. are the causes of eye

disorders.

Dosas involvement in the process of conjunctival inflammation :

Susruta has described it as an inflammatory process, which may

lead on to suppuration and ulceration. In this view, whatever may be

the nature of the exciting causes of acute and chronic inflammatory

states: these are many and they include abhighata (trauma), visha

(poisons and toxic substances), bhutas (other living forms which

invade the body either to parasite as to kill. e.g. bacteria) Violent

environmental disturbances, atmosphere or materological etc. the

factors which undergo morbid changes and react to produce

inflammatory states are the three dosas. The pain in any inflammatory

state is ascribed to Vata, the process of suppuration to pitta and the

material of the pus to kapha.

´ÉÉiÉÉ½þxiÉä xÉÉÎºiÉ °üVÉÉ, xÉ{ÉÉEò&

Ê{ÉkÉÉ ½þxiÉä xÉÉÎºiÉ Eò¡òcÉ {ÉÚªÉ&*46 The commentary of Dalhana on this reference apart, scientific

researches undertaken in modern times, relating to the origin of pus

will be more to the point. Puya or pus may be described as a thick

yellow fluid consisting of liquefied tissue, the fluid of inflammatory

executed and containing polymorpho nuclear leucocytes known here

as pus cells, and living and dead bacteria. Formation of Puya (pus) is

directly correlated to septic inflammatory process which represents, on


the one hand, the virulence or the destructive power of the involving

bacteria and the resistance or destructive power of the invading

bacteria is pronounced, then paralyse the leucocytes with their toxins.

They thus invade the blood stream (Rakta). Set up septicemia and

spread throughout the body leads to fatal results as in the case of

streptococcal infections. It would thus appear that the protoplasm of

tissue cells and leucocytes are essentially, shlaismic both in respect of

their gunas (properties) and karma (function).

Pathogenesis of Abhishyanda :

The samprapti (pathogenesis) is the process which occurs in the

body in between Nidana Sevana and the stage of Rupa of the

diseases. The knowledge of the disease process is important from the

treatment view point, because without proper knowledge of

“Anshaansha kalpana” of Dosha, one cannot get success in the

treatment, hence the knowledge of samprapti is essential to cure the

disease.

Maximum stress has been given by all the Acharyas on the

stage of Pathogenesis as it helps in the presentation of the disease if

identified earlier.

Sushruta further says that a clear idea about the knowledge of

these stages (kriya kala) can help to check the diseases from going

into further stages.

Sanchaya :

The equilibrium is disturbed by etiological factors

(Achakshushya Ahara vihara) also involving the Jatharagni and

reducing it to a stage of Agnimandya.

Kapha dosa is stated to have accumulated and stagnated in its

own place (conjunctiva) instead of freely circulating as in its normal

avastha or state.

(ºÉÆ¾þÊiÉ¯ û{ÉÉ ´ÉÞÊrù¸ÉªÉ& Dalhana)


Prokopa :

When the provocative factors are allowed to act further, the

previously accumulated dosha get irritated, as a result they undergo

the stage of meeting and in turn, ready to leave their original places.

Nothing specifically for Abhishyanda has been mentioned by the great

sages, but a co-relation at the prakopa stage can be given a swelling,

burning sensation irritation and redness of the slaismika kala

(conjunctiva) indicate the stage of inflammation.

Prasara :

In case the provocative factors are still allowed to continue to

irritate the Doshas, a stage of prasara ensures. Once again our ancient

scholars left, it to the intelligence of the vaidya to discover the

symptomatology at this stage. A probable correlation is the presence of

purulent and mucopurulent discharge on provocation. It can be easily

understood from the fact that Acharyas have said that Rasa, rakta and

Mamsa (dhatu involved in suklamandala) dushti takes place at this

stage.

In this stage both bulbar and palpebral conjunctiva get friable

which is an indication of advance stage of hyperaemia in acute

inflammation.

Sthana Samsraya :

This is the stage where the disseminated doshas get their

localization in tissue or an organ where the defense mechanism is

weak in this stage the doshas after getting their entry in the individual

cell of the tissue or the organ affect the near normal function of that

particular tissue/organ apparently. Though the actual clinical

symptomatology of the particular disease has yet to be manifested,

considerable stress have been given to this stage of shat kriyakala as

the “Purvarupa” i.e. prodromal symptoms have appeared giving the

direct indication of the disease itself but yet to cause its much harmful


effect at the local level as well as at systemic level. A disease identified

at this stage can be cured much easily. A clear cut co-relation of the

prodromal symptoms given in Ayurveda can not be made out the

patho-physiology of their recent counterpart. An attempt has been

made out which is as follows :

Showing the stages of inflammation in relation to purvaroopa of

Abhishyanda

purvaroop of Abhishyanda

given by Sushruta

Prodromal symptomatology by

recent text

Abila

Sangravamashru

Kandu

Toda

Pradaha

Raga

Urju

Turbidity

Swelling

Itching

Dolor

Color Stage of

Rubar Inflammation

Tumour

iÉjÉÊ´É™Æô ºÉºÉÆ®ú¦É¨É¸ÉÖ EòxnÖù{É½äþ½þ´ÉiÉÂ*

MÉ¯ û¹ÉÉ iÉÉänù ®úÉMÉÉ½þÉäVÉÖÇŸõ SÉÉ´ªÉHò ™ôIÉhÉè** (Susruta)

Vyakta :

When causative doshas get excessive accumulation and

thereby cause significant changes to the tissue of the organ, the

disease shows definite clinical manifestation and symptom complex. It

is this stage where the differentiation of symptom complex is possible

with doshika classification. in this stage Abhishyanda will represent the


signs and symptoms which are very much similar to the various types

of conjunctivitis (e.g. bacterial, viral, fungal etc.)

Showing a comparison of clinical features in between

Abhishyanda and Bacterial Conjunctivitis

Clinical features of

Abhishyanda

Clinical features of

Conjunctivitis

Ocular signs in Abhishyanda

Pitta and kapha sravas

Sopha

Lalima

Ocular sign in bacterial

conjunctivitis

Mucopurulent discharges

Swelling

Redness

Ocular symptoms in Abhishyanda

Pradaha

Jalasrava

Kandu

Burning sensation

Tearing

Itching

Bheda :

This is the stage which gives the idea about the process of

doshika vitiation either coming to an end, to chronicity or may spread

to distant part of the body. In other words it is this stage of Bheda only

where an idea of complication as well as prognosis of the disease can

be understood, eg. Adhimanthya is a complication of Abhishyanda as

per ancient scholars.

Samprapti Ghataka :


Nidana Kapha, pitta, prakopaka Nidana

Dosha Kapha, Pitta, Rakta

Dushya Rasa, Rakta, Mamsa

Srotas Rasavaha, Raktabaha, Mamsavaha

Srotas dusti Sanga, Atipravriti, Siragranthi and

Vimarga Gaman

Agni Jatharagni, Manda, Dhatuwagni,

Manda

Dosha marga Slaismik Kala

Roga Marga Bahya

Udbhava sthana Amashya

Adhisthana Shuklamandala

Pratyatma Lakshana Pitta srava, jala srava, Puyasrava and

Sirajala (hyperaemia)

Chart shows the Aetio-pathogenesis of Abhishyanda followed by

Satkriyakala of Susruta

NIDANA SEVANA

Aharajanya Nidana Viharajanya Nidana

Kapha Prokopa Agnimandya Pitta prokopa Agantuja iatrogenic Lack of ocular Factors hygiene Kapha Dusti Rakta Dusti

(Sanchaya)


Ama formation Attracks the organisms

Provacation due to continuous

Nidana sevana Direct injury to Salismik kala

(Achaya Praakopa)

Rakta/Pitta dusti occurs

(Prokopa)

Dusita Rakta pitta interacts Provacation of Doshas Discharge occur

with dusita kapha (Prasara)

Ascend of Dosas to Urdhwajatru

(Sthana Samsraya)

Localization in Abhishyanda sthita rasa rakta & mamsa

(Vyaktavastha) Production of prodromal sign /symptoms (Discharge, hyperaemia, pain etc.)

(Bhedavastha) ABHISHYANDA

Another physio-pathological consideration in Different

Abhishyanda as per Charaka concern :

In Ayurveda, the physioanatomical constituents of the human

body depends upon the tridosa, saptadhatu and the 13 types of Agnis.

These constituent perform the bio-chemistry (i.e. metabolisms) of our

body for which we get the immunity and to fight against the diseases.

There is a slaismika oja mentioned in samhitas and spreaded all over

the body elements which protects the body from all exogenous

organisms as like Lysozymes found in the conjunctiva.

Samhita granthas have treated agnimanya (both at the level of

Jatharagni and dhatwagni as conductive to srotakhavaiguna, agnidusti

being followed by srotadusti. In addition, agnimandya or agnidusti, at

the level of dhatwagni paka (intermediary metabolism) is between


amadosha and tridosha (vata, pitta and kapha), resulting in what may

be described as metabolic histo-toxic anoxia (malas).

Thus, all the pathological lesions acute and chronic in this view,

have their beginning at the level of srotamsi. It is of the fact that the

conjunctiva is composed of dosha (sthanikdosa kapha and anubandha

dosa – pitta) and the dhatus like Rasa, Rakta and Mamsa. When these

component of the conjunctiva are vitiated by the Exogenous and

endogenous causes → result srota dusti. The characteristic features of

the srotadusti, according to Charaka47 are atipravritti → amount of

increased permeability, resulting in the leakage (discharges from the

conjunctiva), the retention of fluids and material present in the (Sanga)

→ results chemosis in conjunctiva, siragranthi (dilalation of sira/veins

→ leads to congestion of the conjunctiva and lastly the vimarga

gamana i.e. the fluid moves through collateral vessels or back

pressure leading to oedema on the lids. In this manner the

inflammation of the conjunctiva is occurs and it is called as

conjunctivitis.

Chart shows the pathogenesis of Abhishyanda (Conjunctivitis)

according to Charaka

Due to Ahita Aharas (Unwholesome diet)

Agnimandya

Agnidushti

Decreases Decreases Dhatuagni Paka Bhootagni paka


Produces

Ama Dosha Dustatridosha

Forms

Metabolic Histo-toxin (Malas)

Srotadushti Lakshana (Cha. Vi. 5 : 24)

Atipravritti Sanga (Fluid Retention) Siragranthi Viomarga Gamana

Discharges from Chemasis of Dilatation of Edema of Srotamsi of conjunctiva conjunctival lids Conjunctiva (Conjunctival edema) vessels

Conjunctival congestion

Cardinal signs of conjunctivitis

Classification of Abhishyanda:

There are four types of Abhishyanda (viz., vataja, pittaja,

kaphaja and Raktaja) according to Vagbhata and Susruta. The tables

shows the classification of Abhisanda in relation with modern concept.

Chart the classification of Abhishyanda with probable modern

terminology

Abhishyanda

Vataja Abhishyanda (Simple bacterical

conjunctivitis)

Pittaja Abhishyanda (Mucopurulent conjunctivitis

Staphylococcus origin & Streptococcus

origin


SIGN AND SYMPTOMS OF DIFFERENT ABHISHYANDA :

Clinical consideration of Vataja Abhishyanda:

In Abhishyanda arising from (aggravation of) vata, there will be

distension of the nose (Nasa-Naha), slight swelling, pricking, pulsating

and puncturing type of pain in the temporal region, eye, eyebrows,

forehead and mouth excretion from the eye is dry, small in quantity

tear cold and less in quantity, unsteady pain difficulty in opening and

closing the lids, feeling as through worms are crawling inside

(Grittiness), the eye appears as bloated (increases in size) feels as

through filled with small pains, there is relief (of distress) by oily and

warm comforts this is Abhishyanda48.

In Abhishyanda produce by vata, the eye has constant pricking

pain, less of movement, horripilations, friction and roughness of the

body, headache, eye is dry and tears cold.49

Clinical consideration of Pittaja Abhishyanda:

Burning sensation, feeling as though smoke is coming out,

swelling, blue colour over the lid moistness inside, tears yellow and

warm, redness and objects appearing yellow, eye having ulcer as

Neurogenic cause

Raktaja abhishyanda

(Mucopurulent conjunctivitis/haemorrhagic

conjunctivitis)

Bacterial & Viral origin

Kaphaja Abhishyanda (All types of Allergic

conjunctivitis)

Exogenous/Endogenous causes

Leads to infection forms the purulent conjunctivitis

Kukkuna (Ophthalmia neonatorum)


though caused by alkalies – these are the symptoms of Abhishyanda

of pitta origin.50 By pitta there will be burning sensation, quick

ulceration, desire for cold comforts feelings of hot fumes coming out,

increase of tear, tears being warm and yellow colour of the eyes are

the features.51

Clinical consideration of Kaphaja Abhishyanda:

In abhishyanda of kapha origin, there is lassitude (loss of

movement of the eye), severe swelling itching, sleep, lack of desire for

food, the excretion from the eye is thick, unctuous, copious, white and

slimy, similarly also the tear.52

The person has desire for warm comforts, feels heaviness,

swelling of the eye, itching and thickening, white colour feeling of

severe cold and frequent slimy exudation are the features.53

Clinical consideration of Raktaja Abhishyanda:

In abhishyanda due to aggravation of rakta the tears are red,

redness appears, red colour of the excretion, seeing of red coloured

ring and the symptoms of pittaja abhishyanda will be found.

In that produced by rakta tears are coppery in colour, eye is red

has bright red lines will over; the symptoms of aggravation of pitta will

be present in the both.54

Sch

olar

s

Typ

e of

Abh

ishy

anda

Signs and Symptoms of Abhishyanda

Ocu

lar

pain

F/B

Sen

satio

n

Fill

ing

of d

ryne

ss

Coo

l dis

char

ge

Sea

nty

disc

harg

e

Mat

ting

eye

lash

es

Nas

al o

bstr

uctio

n

Oed

ema

on L

ids

Bur

ing

sens

atio

n

Pur

ulen

t dis

char

ge

(kap

ha s

rava

)

Mue

copu

rule

nt

(puy

asra

va)

Con

gest

ion

Itchi

ng s

ensa

tion

Con

junc

tival

inje

ctio

n

Jala

srav

a (T

earin

g)

Acc

ordi

ng to

S

ushr

uta

Vataja + +++ ++ ++ +++ + + - - - - - - + ++

Pittaja - + - - - + - + ++++ + +++ ++ - ++ +++

Kaphaja - - - - - + - +++ - ++ - ++ +++ + +++

Raktaja - + - - - + - + + - +++ + + +++ ++


Acc

ordi

ng to

V

agbh

ata

Vataja ++ + ++ + + - +++ + - - - - - + +

Pittaja + ++ - - - +++ - + ++++ - +++ +++ - + +++

Kaphaja - - - + - + - +++ - +++ - + +++ + ++

Raktaja + + - - - + - + +++ - ++ +++ + ++

++

++

KUKKUNAKA (Opthalmia Neonatoram) :

According to Vagbhata Kukkunaka is a severe types of ocular

disease occurs in newborn during the time of Dentition. This disease is

caused by the vitiation of kapha dosha in lactating mother’s milk and

the disease is spreaded to the newborn due to intake of mother’s milk.

EÖòEÖòhÉEò& Ê¶É¶ÉÉä®äú´É nùxiÉÉäi{ÉÊiÉ ÊxÉÊ¨ÉkÉVÉ&

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ºÉ´Éi¨ÉÇ ¶ÉÖ™ô {ÉèÊUô±ªÉ EòhÉÇxÉÉºÉÊIÉnÇùxÉ&**

(Vagbhatta)

Acharya Susruta has mentioned this type of disease under the

chapter of 19.

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xÉÉÊºÉEòÉÆ {ÉÊ®ú¨ÉÞnùxÉÉÊiÉ EòhÉÇ ´ÉÉÆUôÊiÉ nù&ÊJÉiÉ&


™ô™ôÉ]õ ¨ÉÊIÉEÖÆò]õSÉ, xÉÉºÉÉÆ SÉ {ÉÊiÉ ¨É½ÇþÊiÉ*

xÉäjÉ Eò¨bÚ÷ªÉiÉä%¦ÉÒIhÉÆ {ÉÉÊhÉxÉÉ SÉÉ{ªÉiÉÒJÉ™Öô*

ºÉ |ÉEòÉ¶ÉÆ xÉ ºÉ½þiÉä, +IÉÖSÉÉºªÉ |É´ÉiÉÇiÉä*

´Éi¨ÉÇxÉÒ ·ÉªÉlÉÖ ÉÉºªÉ, VÉÉIÉÒªÉÉxiÉÆ EÚòEÚòhÉEò¨ÉÂ**

(Jibakatantra)

When the baby is affected by the Kukunaka disease then the

baby touch the nose, forehead, ormita and rubbing the ear

continuously. These is the following signs & symptoms the found.

Aetiopathogenesis (Nidana and Samprapti) :

When the Ahita ahara and viharas affects the sharirik kapha

dosha, then it gets accumulated in their own place. After that the kapha

dosa vitiated by the pitta.

The Sharirik kapha dosa gets vitiated by the kapha vardhaka

ahara and viharas, and accumulated in the breast milk of a lactating

mother. When the newborn consumes his vitiated milk then the eyes of

the child affected by the Kukkunaka, a serious type of ocular anomaly

compared with opthalmia neonatorum in modern medical science.


Chart showing the samprapti of Kukkunaka

Signs and Symptoms of Kukkunaka:

Neonatal are the victims of Kukkunaka. With painful marked

swelling of the lids. There is profuse purulent discharge and melting of

the eye lashes with photo phobia. The neonate often rubs its ear nose

and eyes.55

According to Jibaka, the following are the signs and symptoms

of Kukkunaka:

Vitiated Kapha dosa

Mandagni

Dhatu Dusti Dosha dusti

Dhatu Kshaya

Vata dosa

Pain Occurs

Srota dusti

Ati prabriti

Sotha

Oedematus lid

Purulent discharges

Sanga

Dilatation of lid vessels

Redness of the lids

Sticky yellowish discharge

Melting of eye lashes

Produce

Kukkunaka


It spread to the neonatal eyes followed by the consumption of

vitiated breast milk of a lactating mother.

The affected child may rubs the nose, lalata, akshikota, ear and

eyes with hands.

Both the lids are oedematous results the closing of eyes,

photophobia purulent discharge, ocular itching, burning sensation are

the main symptoms of kukkunaka. (Jibaka Tantra).

Treatment of Kukkunaka56

In Kukkunaka, the nursing mother should made to consume

medicated ghee prepared with khadira, srestha and leaves of nimbi;

then emesis therapy administered using krsnayasti, sarsapa and

saindhava and purgation therapy with the decoction of haritaki, pippali

and draksha. Her breasts should be smeared with paste of musta.

After purification she should be made to drink the decoction of Triphala

potala, musta, guduchi.

The eye lid of the child should be scraped or blow taken out by

applying the leech; after that it should be bathed with the decoction of

Amlaki, asmantaka and leaves of Jambu.

Children are consuming milk and ghee (as food) they generally

get affected by diseases caused by kapha, hence in all disease emesis

therapy should be administered first.

Pilla Roga:

It is a chronic condition where lusterless, dull, clouded or

dirtyness of the eye is occurs. Here the 18 types of ocular anomalis as

mentioned by the Vagbhatta.57 out of them Abhishyanda comes under


the Sarbagata netrarogas and possess a chronic stage compared with

chronic conjunctivitis.

Principles of Treatment of different Abhishyanda :

Vataja Abhishyanda :

1. (a) Nidana parivarjanam

(b) Rest

(c) Sheetopachar (1-4 days)

(d) Ushnopachar (in niram stage)

2. In sama dosha 4 days langhana etc.

3. Ghrita, Kashayarasa, guruahara, anjana and snana are rissedha

in samaja.

After Ama Pachana –

I. Sneha panam (ghrita pana)

II. Mridu sweda

III. Rakta mokshana (at upanasika, lalata and apanga)

IV. Sneha virechana

V. Sneha tarpanas

VI. Sneha putapaka

VII. Sneha dhooma

VIII. Sneha nasya

IX. Aschyotana

X. Sneha pariseka

XI. Sirovasti

XII. Pradeha

XIII. Abhyanga

XIV. Sneha anjana

Snehana :

(i) Intake of ghee after meal

(ii) Intake of medicated milk and ghee prepared with Triphala


(iii) Intake of medicated milk & ghee prepared with the

dashamoola

Mridu sweda :

Seka with any of the following :

1. Anupa mamsa

2. Singdha dravyas + mamsa + Dadima phala rasa + Amlakiphala

rasa

3. Amla dravas like kanji

4. Aranda moola-patra + twacha Siddha dugdha – useful in seka

nasya.

Ashchyotana Yoga :

1. With decoction of Eranda and Shigru and Triphala

2. With decoction of Nimba patra and Lodhra.

Pindika

Hot pindika (poultice) is prepared with erandapatra mole and twacha.

Anjana

With the following remedies

1. Yastimadhu, haridra, haritaki, mixed with Ajaksheera.

2. Swarna gyrika 1, pippali 4 parts, shunti & parts should grind with

Aja ksheera to prepared varti

3. Madhu, saindhava lavan, swarna gyrika, grinded well and has to

use as anjana.

Bidalaka

1. Haritaki fry in ghrita and has to apply to the eye lids.


2. Lodhrs fry in ghrita and has to paste to the eye lids.

3. Saindhavalavan, Daru haridra, gyrika, haritaki and rasanjan has

to paste to the eye lid.

Treatment principle of Pittaja Abhishyanda :

Pittaja Abhishyanda may leads to blindness if it is not treated

properly.

Pitta sodhana chikitsa :

For this the following steps should bee adopted

• Virechanam for kayasodhana

• Raktamokshanm for raktasodhana

• Nasya, gandoosha, kabala etc. for sirosodhanam. After

sodhana, samana chikitsa can be done.

Specific ophthalmic medications. Like Netraseka, Ashyotana

vidalaka and pindi, all the procedures should be conducted with pitta

samana and ropana drugs.

Netraseka : Chandana, Nimba patra, Yastimadhu, Rasanjan

saindhava lavan grind with water and should be use as seka with

honey.

Ashchyotana Yogas : Nimba patra kalka has to paste with Lodhra

and heated. The powder stanya, after filtration should use for

Aschyotana.

Triphala decoction is very effective for pittaja Abhishyanda.

Amalaki, Haritaki can be used by dipping the in water and used

like above.

Pindi : Amlaki is use for pindi karna.

Bidalaka : Chandana sariba, manjistha, tagar, lodhra can be applied

to the eye lids.


Anjana :

1. Trivroth or yastimadhu + Madhu + Sharkara in Rasakriya

anjana.

2. Talisapatra, Ela, Gyrika, musta + stanya or cow milk as choorna

anjan.

3. Triyochanadi anjana used for Anjana karma.

Treatment principle of Kaphaja Abhishyanda

1. General principles and siravyadana the sweda, Avapeedana

nasya, Dhoomrapana seka, pralepa, kavalagraha, raksha

aschyotana, ruksha putapaka, tiktaghrita (Kaphahara).

2. Langhana, swedana nasya, teekshna pradhana nasya,

teekshna upanaha, ruksha virechana (Yoga Ratnakara)

3. Raktamokshana is very effective in srotadusti

4. Anjana with kapha samaka drugs is effective

Aschyotana – Triphala kasaya should be poured in to effected eyes

for curing the Abhishyanda disease.

Bidalaka – Rasanjana, Sunthi, Haritaki etc. are used for lepana karma.

Anjana

1. Triphala, Trikatu, Haridra, Vidanga etc. makes varti as anjana

karma.

2. Haritaki, Haridra, Yastimadhu as varti for anjana.

Treatment principle of Raktaja Abhishyanda :

(A) Antah Sodhana

Snehana with Kaumba ghrita 100 years old ghee

Siramokshana

Mamsa rasa bhojana

Virechana

Siravirechana


(B) Sthanik upachara

Pradeha

Parisheka

Nasya

Dhooma

Aschyotana

Abhoyanga

Tarpana

Anjana

Jalaukavacharana

Seka Karma (Washing) :

Triphala, Lodhra, Yastimadhu, Musta grind with cool water and

used for seka karma.

Ashyotana Karma :

Triphala kasaya applied as Ashyotana karma.

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