Scientific Basis for Ayurvedic Therapies -33

Scientific Basis for

Ayurvedic Therapies 

edited by

Brahmasree Lakshmi Chandra Mishra

28.7 Treatment

28.7.1 Ayurvedic Therapies

There are various medicines used in Ayurveda for the cure of raktaja krimis. Some of them

are described below.

28.7.1.1 Plant-Based Natural Oils

1. Mahamarichadi taila — This oil is also prepared from natural products. It is used in

all kinds of skin infections, such as boils, ringworm, etc. It consists of kali marich

(Piper longum), hartal, Sweta nishoth, lal chandan (Santalum sp.), nagarmotha (Cyperus

scarious), manasnil, jatamansi (Nardostachys jatamansi), daruhaldi (Berberis sp.), haldi,

indrayanmula (Citrullus colocynthis), kanermula (Nerium sp.), kuth (Saussurea lappa),

arka (Calotropis gigantea), dugdha, and vatsanabha.

2. Laghu-vis-garva taila — This oil is used in cutaneous infections. It is extracted from

Argemone mexicana Linn. (Papaveraceae), Nardostachys jatamansi DC (Valerianaceae),

TABLE 28.1

Common Names of Fungal Diseases and Corresponding Meanings

General Term Meaning

Tinea infections Dermatophytes

Tinea pedis Ringworm of foot

Tinea unguinum/onychomycosis Ringworm of the nails

Tinea corporis Ringworm of glabrous skin

Tinea imbricata Originally circinate but which become

irregular and coalescent

Tinea barbae Ringworm of the beard

Tinea favosa

Tinea cruris Severe type of chronic ringworm

Tinea capitis Ringworm of the groin

Ringworm of the scalp

Terminalia chebula Retz. (Combretaceae), Ricinus communis Linn. (Euphorbiaceae),

Plumbago zeylanica Linn. (Plumbaginaceae), Curcuma longa Linn. (Scitaminae), and

Saussurea lappa Clarke (Asteraceae).

3. Karanjadi Taila — The oil is extracted from Pongamia pinnata (Linn.) Merr. (Fabaceae).

It is useful in various kinds of skin infections, including ringworm (dermatophytes).

It consists of seeds of karanj (Pongamia pinnata), kuth, chitrakmul (Plumbago zeylanica),

chameli puspa (Jasminum sp.), and Kaner (Nerium oleander L.).

4. Ring-ring — This oil is used for ringworm infections caused by fungi. It is also

useful for other cutaneous infections.

5. Dadrughni-Vati — This tablet is prepared from chakramarda (Cassia tora Linn.). It is

used for all kinds of skin infections, ringworm, and white spots.

6. V-Gel: This gel is useful in vaginitis, vaginal candidiasis and other fungal infections

of the vagina. Each gram of V-Gel contains: extracts of triphala (4.0 mg), satapatri

(Rosa damascena Syn. R. centifolia; 3.6 mg), ela (Elettaria cardamomum; 3.6 mg), punarnava

(Boerhaavia diffusa; 3.6 mg), shaileyam (Parmelia perlata; 2.0 mg), nirgundi (Vitex

negundo; 1.6 mg), and Haridra (Curcuma longa; 1.6 mg). The drug is manufactured

by Himalayan Herbal Products Co.

7. Sankhpushpi taila — This oil includes extract and oil from the plant Evolvulus alsinoides.

It is used for ringworm, particularly for infections of scalp (Tinea capitis) in

children. It is also used to cure scabies and other cutaneous infections.

8. Tuvarakadi taila — The oil is extracted from Hydnocarpus laurifolia, a plant of tropical

origin. It is also known as chalmongra taila. The oil is used to cure all kinds of

cutaneous fungal infections. The oil is sold in the market. Upadhyay11 reported that

Trichophyton mentagrophytes was very much sensitive to essential oil of H. laurifolia.

9. Chopchinyadi churna (powder) — This powder is used for all kinds of skin infections.

28.7.1.2 Role of Different Elements

Certain elements like sulfur, mercury, and copper are used in the treatment of mycotic

infections. The metals and nonmetals are used in combination with a powdered mixture of

amla (Emblica officinalis), baheda (Terminalia belerica), and harada (Terminalia chebula) referred

to as triphala churna (powder of three fruits). The formulas that contain different compositions

of these herbs and minerals are arogyavardhini, gandhak-rasayana, and sukhshura triphala.

28.7.2 Conventional Medicine Approach

Oral administration of griseofulvin is the best treatment for dermatophytosis in general and

for Tinea pedis in particular. Earlier, the treatment depended only upon topical application

of medicines. Sometimes, results are not favorable with griseofulvin and topical therapy is

required. At present, a combination of oral administration of griseofulvin and topical antifungal

agents are the main therapies.6

In onychomycosis, topical therapy is not successful because the causal pathogen does not

respond well to griseofulvin. The patient does not feel relief even if the nail is removed

surgically because the growing nail will continuously get infected. Griseofulvin used regularly

for consecutive months gives promising results because it acts slowly. Topical application

is important in such cases. The current most effective and acceptable preparations are

imidazole ointments, such as clotrimazole, miconazole, or ketoconazole, which are fre-

quently used. Oral administration of ketoconazole is recommended in some countries but

not in Japan; the rate of hepatic disorders is too high there.

Terbinafine is used as an antimycotic agent, which does not cause hepatic disorders. If

terbinafine is orally administered once a day, high concentrations in blood can be

achieved.7 The transfer of this drug from blood to skin is sufficient enough to be effective.8

For deep-seated mycosis, fluconazole is administered. Another drug used is amphotericin

B, a polyene-based antimycotic. It is used for the cure of fungal infections like aspergillosis,

blastomycoses, candidasis cryptococcosis, histoplasmosis, and paracoccidiodomycosis.

Fluorcytosine is used especially in Candidasis or in combination therapy. It inhibits DNA

and RNA synthesis. Terbinafine and naftifine are both allylamines used against dermatomycoses

and mucosal infections. They inhibit ergosterol biosynthesis by blocking

squalene epoxidase.

Azoles include ketoconazole, miconazole, itraconazole, and fluconazole. These are

known as imidazoles. They are used for the cure of blastomycosis, coccidiodomycosis,

histoplasmosis, and paracoccidiodomycosis and inhibit ergosterol biosynthesis by blocking

14-demethylation of lanosterol. Such infections should also be treated with systemic

antibacterial antibiotics because secondary bacterial infection may occur. During the recent

years, many antifungal agents were introduced only for topical application owing to their

toxicity. Today, a mostly broad spectrum of antifungal agents are preferred.

Increasingly, allergic reactions of the skin are observed today. One reason is the high

rate of sensitization power of these antimycotics. There are some adverse reactions such

as gastrointestinal and hepatic disorders and photo sensitivity reactions particularly by

griseofulvin and ketoconazole.6 Allergic contact dermatitis due to these new antimycotic

agents of imidazole family is rare. Another problem is the use of application.

28.8 Scientific Basis

Dadrughni-vati is a well-known antifungal agent in Ayurveda. The drug is extracted from

pawar (Cassia tora), a plant of the Fabaceae family. In Sanskrita it is known as chakramard,

meaning killer of ringworm. An antifungal phytochemical chrysophanic acid-5-anthrone

was isolated by Acharya and Chatterjee.35 Trichophyton mentagrophytes, a fungus responsible

for causing ringworm infections, can be inhibited by oil of Hydnocarpus laurifolia at 1:4

dilution, which is equal to 0.125 mg/ml dilution of miconazole nitrate, followed by seed

oil of Derris indica (Pongamia pinnata) at 1:2 dilution (0.25 mg/ml miconazole nitrate).

Epidermophyton floccosum, another causal fungus of ringworm, was reported to be the most

sensitive to oil of H. laurifolia.11

Argemone mexicana, Ricinus communis, and Plumbago zeylanica are included in Laghu-visgarva

taila (oil). All the three plants are highly antifungal. Roots of Plumbago zeylanica are

utilized by people of India and China against skin diseases.36,37 The plant extract was

found to be active against causal organisms of ringworm fungi.11 The karanjadi taila is

extracted from karanj (Pongamia pinnata). The oil was reported as high antifungal agent.29

Bakuchi taila is extracted from Psoralea corylifolia. The plant is reported to contain antimycotic

potential. It showed remarkable activity against Trichophyton mentagrophytes and

Epidermophyton floccosum.11 V-Gel has been very effective in ringworm infections, particularly

in severe vaginitis.38-40

Ayurvedic plants are currently being studied for their antidermatophyte activity to find

better treatment for skin infections. Plants are extracted either by boiling in water or by

soxhlet extraction procedures. The extracts are evaluated for their minimum inhibitory

concentration (MIC). Colony-forming units of a test fungus are determined in a sabouraud

dextrose agar medium, which is prepared and sterilized at 15 lb for 15 min. The MIC of

the plant extract is then determined in this system. The commonly used methods are a

dry-weight method, in which the actual weight of the harvested fungus is weighed at the

end of the incubation period, and the disc diffusion method, in which the effect of the

extract placed in the center of the plates is measured on the growth of the fungus by the

area of the growth.

There have been numerous studies on the plants used for antidematophyte activity. The

antifungal activity of nonvolatile constituents of higher plants has been reviewed earlier

by many workers.9–14 Many plants produce essential oils as secondary metabolites. Their

exact role in the life processes of the plant is unknown. A review of literature reveals that

a large number of essential oils were reported to possess fungitoxic activity.15–34 Most

members of the Asteraceae family are known to contain essential oils that usually have

antifungal and cytotoxic sesquiterpene lactones.

28.8.1 Why Ayurvedic Drugs for Raktaja Krimis?

Ayurvedic therapy for raktaja krimis is mostly based on essential oils and plant extracts.

These oils are very effective and are aromatic. The patient feels comfortable with this kind

of therapy. The essential oil therapy has become more important after the invasion of

secondary infections in dreaded diseases like AIDS and cancer. The risk of opportunistic

pathogens is increasing day by day in such patients because of the immunocompromising

capacity of the hosts. Generally, the secondary infections are caused by yeasts like Candida

albicans and other filamentous fungi including Alternaria, Curvularia, Phoma, and Fusarium.

The oil provides a soothing experience after application on skin and also avoids

infections caused by opportunistic pathogens. Moreover, the drugs are relatively cheaper,

easily available, and do not have side effects; in most antifungal drugs (allopathy), such

as imidazoles, there can be side effects. These ointments are chemical based and not natural

like the essential oils used in Ayurvedic therapy.

28.9 Conclusions

The drugs of Ayurveda have a tremendous effect on human beings, as these drugs are

natural and easily available. In the case of raktaja krimis, most drugs are prescribed for

topical application because dermatophytes generally infect the dermis of the human

beings. There has been a great need to revitalize this system. Most plants used in Ayurveda

are becoming rare and some of them are threatened. Oils present in herbs need to be

evaluated in order to know their validity for topical application. The sensitivity of raktaja

krimis to many oils extracted from herbs have already been evaluated in different parts of

the world.

References

1. Rebell, G. and Taplin, D., Dermatophytes: Their Recognition and Identification, University of Miami

Press, Coral Gables, FL, 1970.

2. Currah, R.S., Taxonomy of the onygenales: arthrodermataceae, gymnoascaceae, myxotrichaceae

and onygenaceae, Mycotaxon, 24, 1, 1985.

3. Sharma, R., Chaturvedi, C., and Tiwari, P.V., Intestinal parasites: an ayurvedic approach, J.

Res. Educ. Ind. Med., 6(1–2), 27, 1987.

4. Harmsen, D., Schwinn, A., Brocker, E.B., and Frosch, M., Molecular differentiation of dermatophytic

fungi, Mycoses, 42, 67, 1999.

5. Gentles, J.C., Experimental ringworm in guinea pigs; oral treatment with griseofulvin, Nature,

182, 476, 1958.

6. Tanuma, H., Pathogenesis and treatment of hyperkeratotic tinea pedis in Japan, Mycoses, 42,

21, 1999.

7. Hay, R.J., Antifungal drugs-an introduction, J. Dermatol. Treat., 1(Suppl. 2), 1, 1990.

8. Lever, L.R., Dykes, P.J., and Finaly, A.Y., How orally administered terbinafine reaches the

stratum corneum, J. Dermatol. Treat, 1(Suppl. 2), 23, 1990.

9. Dekker, J., Antibiotics, in Fungicides: An Advance Treatise, Vol. 2, Torgeson, D.C., Ed., Academic

Press, New York, 1969, p. 580.

10. Thapliyal, P.N. and Nene, Y.L., Inhibition of plant pathogens by higher plant substances,

J. Sci. Indian Res., 26, 289, 1969.

11. Upadhyay, S.K., Studies on Ethnomedicinal Plants of Chhindwara District with Special Reference

to Search for Antimycotic Activity against Superficial Mycosis, Ph.D. thesis, Dr. H.S.

Gour University, Sagar, M.P., 1993.

12. Fawcett, C.H. and Spencer, D.M., Plant chemotherapy with natural products, Ann. Rev. Phytopathol.,

8, 403, 1970.

13. Dixit, S.N. and Tripathi, S.C., Antifungal antibiotics from higher plants, in Recent Advances in

the Biology of Micro-organisms, Bilgrami, K.S. and Vyas, K.M., Eds., Bisen Singh Mahendra Pal

Singh, Dehra Dun, India, 1970, pp. 519.

14. Mahadevan, A., Biochemical Aspects of Plant Disease Resistance. Part I. Performed Inhibitory

Substances — Prohibitins, Today and Tomorrow’s Printers and Publishers, New Delhi, India,

1982.

15. Barnes, G.L., In vitro toxicity of various fixed and essential oils of Pecan scab fungus Fusicladium

effusum, Plant. Dis. Rep., 47, 114, 1963.

16. Korta, J. and Starzyk, J., Investigation on antibiotic properties of essential oils of certain species

of umbelliferae, Acta Botinica Cravoviensia, 6, 149, 1963.

17. Maruzzella, J.C., The effect of perfume oils on the growth of phytopathogenic fungi, Plant Dis.

Rep., 47, 756, 1963.

18. Hiller, K., Antimicrobial substances in flowering plants — a review, Pharmazie, 19, 167, 1964.

19. Birch, A.J., Some natural antifungal agents, Chem. Ind., p. 1173, 1966.

20. Korbely, I. and Florian, E., Effects of essential oils on Candida albicans, Gyogyszereszet, 15, 462,

1971.

21. Garg, S.C., Antifungal activity of some essential oils, Indian J. Pharm., 36, 46, 1974.

22. Zutschi, S.K. and Mehta, S.C., Screening of some essential oils for antifungal properties, Indian

Drugs Pharm., 12, 13, 1977.

23. Goutam, M.P., Jain, P.C., and Singh, K.V., Activity of some essential oils against dermatophytes,

Indian Drugs, 17, 269, 1980.

24. Jain, P.C., Jain, C.K., and Jain, K., A note on the activity of odoriferous compound against

dermatophytes, Indian Drugs, 17(12), 397, 1980.

25. Deshmukh, S.K., Jain, P.C., and Agrawal, S.C., A note on mycotoxicity of some essential oils,

Fitoterapia, 67, 295, 1986.

26. Singh, K.V. and Deshmukh, S.K., Volatile constituents from members of Liliaceae and spore

germination of Microsporum gypseum complexes, Fitoterapia, 55(5), 297, 1984.

27. Kishore, N. and Dwivedi, R.S., Fungitoxicity of the essential oil of Tagetes erecta L. against

Pythium aphanidermatum Fitz., the damping-off pathogen, Flavour Fragrance J., V, 6(4), 291, 1991.

28. Jain, P.C. and Agarwal, S.C., Activity of plant extract against some keratinophilic species of

Nannizzia, Indian Drugs, 13(12), 25, 1976.

29. Perrucci, S., Mancianti, F., Cioni, P.L., Flamini, G., Morelli, I., and Macchioni, G., In vitro

antibacterial activity of essential oils against some isolates of Microsporum canis and Microsporum

gypseum, Planta Med., 60, 184, 1994.

30. Mwosu, M.O. and Okafor, J.L., Preliminary studies of the antifungal activities of some medicinal

plants againts Basidiobolus and some other pathogenic fungi, Mycoses, 38 (5–6), 191, 1995.

31. Goren, N., Voerdenbag, H.J., and Johansson, B.C., Cytotoxic and antibacterial activities of

sesquiterpene lactones isolated from Tanacetum praeteritum sub sp. praeteritum, Planta Med., 62,

419, 1996.

32. Gopallakrishnan, G., Banumathi, B., and Suresh, G., Evaluation of the antifungal activity of

natural xanthones from Garcinia mangostana and their synthetic derivatives, J. Nat. Prod., 60(5),

519, 1997.

33. Calpouzos, L., Oils, in Fungicides, Vol. 2, Torgeson, D.C., Ed., Academic Press, London, 1969,

p. 367.

34. Rai, M.K., Qureshi, S., and Pandey, A.K., In vitro susceptibility of opportunistic Fusarium spp.

to essential oils, Mycoses, 42(1,2), 97, 1999.

35. Acharya, T.K. and Chatterjee, I.B., Isolation of chrysophonic acid-5-anthrone: a fungicidal

compound from Cassia tora Linn., Sci. Cult., 40(7), 316, 1974.

36. Shen-ji, P., Preliminary study of ethnobotany in Xixhuang Banna Peoples Republic of China,

J. Ethnopharmacol., 13, 223–230, 1985.

37. Sebastian, M.K. and Bhandari, M.M., Medico-ethnobotany of Mount Abu, Rajasthan, India, J.

Ethnopharmacol., 13, 121–137, 1985.

38. Kulkarni, R., Kashalikar, N., et al. Clinical evaluation of PD-959vaginal gel: an open trial, The

Antiseptic, 97, 400–401, 2000.

39. Umadevi, K. and Swarup, A., Efficacy of V-Gel (PD-959Gel) in abnormal vaginal discharge,

Asian J. Obstet. Gynecol. Pract., 3, 68, 1999.

40. Singh, R., Vaginitis. I. Evaluation of V-Gel in vaginitis and cervicitis, The Antiseptic, 98, 6, 2001.

29

Eye Diseases

Aashish S. Phadke

29.1 Introduction

One of the subspecialties of Ayurveda is

shalakyatantra,

which includes diseases of the eye,

ear, nose, and throat.

1

In this chapter, management of common eye disorders are discussed

along with available scientific information that seems to support various Ayurvedic

therapies.

29.2 Anatomy of the Eye in Ayurveda

In intrauterine development of the eye,

pitta dosa,

especially

Alochaka pitta,

is a major

contributor along with

kapha

for the development of blood vessels and related structures

of circulatory system (

Raktavaha srotasa

).

1,2

Of five basic elements, the fire element (

teja

mahabhoot

) is predominant in the formation of the eye. The differentiation of the eye starts

during the fourth month of pregnancy.

3

The description of eye development in Ayurveda

is very much similar to that known in conventional medicine at this time.

4

The eye is made

up of five orbits (

mandal

), six junctions (

sandhi

), and six coats (

patal

).

5

The orbits in sequence

are as follows: (1) orbit of eyelashes, (2) eyelids, (3) sclera and sclerotic circular margin, (4)

corneal area, (5) underneath portion of iris, and (6) pupillary zone or circular area of pupil.

The junctions include (1) junction of eye lashes with lids; (2) fornices (singular-fornix),

where bulbar conjunctiva gets attached to palpebral conjunctiva; (3) sclerocorneal junction

or limbus; (4) pupillary margin; (5) inner canthus; and (6) outer canthus.

Six coats (

patal

) are differentiated as two external and four internal. The external two

coats are the upper eyelid and lower eyelid. (Although one may not be able to replace all

ayurvedic terms with modern medical term, effort has been made to give more appropriate

parallel terms.) The first internal coat is sclera

(

tejojalashrit patal

). It is the outermost coat

and consists an aqueous humor (

tejojal

). Other important areas in this layer are the whites

of eyes

(

shwetapatal

) and the cornea (

karnika

). The second internal coat is the

choroid

(

mamsashrit patal

), a fleshy coat that has been indicated at times as

krishnapatal

. Important

structures in this coat are the choroid (

kalaka

)

,

cilliary body (

upataraka

), pupil (

tara

), and iris

(

taraka

). Medas patal is the third internal coat. Some scholars consider this as the lens

(

drishtimani

) and vitreous humor

(

sandrajala

). The fourth internal coat is the

retina

(

asthipatal

or

drishtipatal

). This coat is said to be placed midway between

krishnapatal

and

medas

patal

.

Some scholars consider this coat as the pupil (

drihti

), whereas others consider it as the entire

retina.

6

29.3 Etiology of Eye Disorders

Etiological factors of eye disorders discussed in Ayurveda

7,8

are the following:

1. Constant exposure to cold water

2. Exposure to cold immediately after exposure to heat

3. Constant watching of distant objects

4. Alteration in sleep pattern

5. Tensions

6. Excessive exercise

7. Crying

8. Anger

9. Trauma

10. Consuming sour preparations in excess

11. Controlling essential urges

12. Increased amount of sudation

13. Exposure to gases or fumes, e.g., pollutant on roadways or from industries

14. Purification measures (

panchakarma

[e.g., induced emesis

in excess])

15. Observing microscopic objects for long periods

In traumatic eye disorders, the traumatic lesion causes vitiation of

dosas

in the eye.

29.4 Pathogenesis of Eye Disorders

Vitiated

dosas

move upward to the eyes, invade various channels, and lead to malfunctioning

of various substructures of the eye. The vitiated

dosas

, especially the

pita

dosa

,

propagate through the channels or vessels (

srotasa

) toward the head region. They enter

various parts of the eye such as the lids, junction, sclera, iris, choroids, cilliary body, pupil,

and retina and cause a variety of eye diseases.

9,10

29.5 Clinical Features of Eye Disorders

The general symptoms of eye disorders

11

are the following:

1. Eyes with muddy discharge

2. Hazy cornea or sclera

3. Congestion of eye

4. Sticking of lids due to eye discharge (due to

kapha

)

5. Heaviness of the lids or eyes (due to

kapha

)

6. Burning sensation or hot feeling of eyes (due to

pitta

)

7. Pricking pain in eyes (due to

vata

)

8. Hyperemia of eyes (in

rakta

predominance)

9. Foreign body sensation

10. Pain in lids

11. Visual disturbances

12. Difficulty in eye movement

13. Difficulty in closing or opening of eye

14. Impaired visual perception

29.6 Classification of Eye Disorders

Ayurvedic texts describe 76 to 96 ocular diseases and have several systems of classification,

namely, based on vitiated

dosas

(67), therapeutic management (76), or anatomical structure

based (76).

12–15

The structure-based classification closely resembles the classification mentioned

in conventional medicine. The diseases are also characterized based on prognosis:

curable, difficult to cure, and incurable. An attempt is made to translate Ayurvedic names

of eye disorders, but Ayurvedic scholars of eye diseases may disagree on some of the

translations.

29.7 Symptoms, Etiology, Pathology, and Management of Eye Disorders

The management of some of the eye disorders in Ayurvedic texts is very similar to

contemporary modern ophthalmology. Only six diseases are selected as examples of

Ayurvedic management in this chapter: (1) conjunctivitis (

abhishyanda

), (2) glaucoma (

adhimantha

), (3) trichiasis (

pakshmakopa

), (4) chalazion (

utsangini

and

lagan

), (5) cataract (

kaphaja

linganash

), and (6) miscellaneous diseases (

Drishtigata vyadhi

). Formulations used in the

29.7.1 Conjunctivitis (

Abhishyanda

)

According to Ayurvedic texts, conjunctivitis (

abhishyanda

or

syandam

) refers to a condition

in which there mainly exists a congestion in general of all channels situated above the

level of clavicle (collar bone) and specifically that of the eye.

15,16

According to modern

ophthalmology, inflammation of conjunctiva characterized by redness of the eye and

conjunctival discharge is known as conjunctivitis.

17

According to Ayurvedic texts, it is

considered to be one of the major causes for eye disorders. If not treated, in time it can

lead to other severe ocular disorders similar to those known in conventional medicine.

18,19

management of eye diseases are given in Table 29.1.

29.7.1.1 Symptoms

The common symptoms of conjunctivitis are muddiness of eyes, inflammation of eyes,

epiphora or discharge, itching of eyes, heaviness of the eyes, pain in the eyes, burring of

the eyes, and congestion of eyes.

20,21

Ayurvedic scholars defined this disease as an infectious

disease (

aupasargika roga

)

22

and classified it into four types of

conjunctivitis:

vataja

abhishyanda, pittaja abhishyanda, kaphaja abhishyanda,

and

raktaja abhishyanda

. Descriptions

of each are listed below.

23

1. Subacute catarrhal conjunctivitis and catarrhal conjunctivitis (

vataja

) — Symptoms

include pricking pain in the eye, stiffness of the appendages of eye (e.g., lids),

horripilation, foreign body sensation, roughness, headache, dryness in eye, cool

lacrimation, and slight oedema of eye. These symptoms are relieved with oleation

and heat treatment.

24

2. Acute catarrhal conjunctivitis (

pittaja

) — Symptoms include burning sensation of

the eye, suppuration or pus formation, feeling of smokiness, blackish lids, chemosis,

edematous lids, aggregation of exudates within the eye, and a feeling of

extreme heat. These conditions are relieved with cool therapies.

25

3. Catarrhal conjunctivitis or purulent conjunctivitis or mucopurulent conjunctivitis

(

kaphaja

) — Symptoms include heaviness in and around eyes, swelling of the eyes,

itching of eyes, sticking of the lids due to purulent or mucopurulent discharge,

feeling drowsy, and loss of taste. These conditions are relieved with hot therapies.

26

4. Acute mucopurulent conjunctivitis (

raktaja

) — Symptoms include red lacrimation

along with a pus or blood-stained discharge, red eye, or the entire eye appears to

be red with red capillaries. Symptomatology is similar to the

pittaja

type.

27

TABLE 29.1

Formulations Used in the Management of Eye Diseases

Formula Name Text Reference Manufacturer

a

Triphala ghrita Siddha yoga sangraha

Sahasrayogam

BAB, AVS

Mahatriphala ghrita Siddha yoga sangraha

Sahasrayogam

AVP

Shatavaryadi ghrita Bharat bhaishajya ratnakara

AVP, AVS

Saptamruta yoga Siddha yoga sangraha

BAB

Punarnavashtak kwatha Sharangdhara samhita

BAB, ZP, SP

Rasanjana Sharangdhara samhita Classic formula manufacturers

Paradanaga rasanjana Netra roga vidnyana Classic formula manufacturers

Punarnavanjana Netra roga vidnyana Classic formula manufacturers

Netrashani rasa Netra roga vidnyana Classic formula manufacturers

Marichyadi yoga Yoga ratnakara Classic formula manufacturers

Nibapatranetrabindu Dravyaguna vidnyana Classic formula manufacturers

I-tone eyedrops Patented and proprietary drug DP

Ophthacre eyedrops Patented and proprietary drug HDC

aAVP = Arya Vaidya Pharmacy, Coimbtore, India; AVS = Arya Vaidya Sala, Kottakal, Kerala, India; BAB =

Baidyanatha Ayurveda Bhavana, Nagpur, India; DP = Dey’s Pharmaceuticals, Calcutta, India; HDC =

Himalaya Drug Company, Banglore, India; SP = Sandu Pharmaceuticals, Mumbai, India; ZP = Zandu

Pharmaceuticals, Mumbai, India.

29.7.1.2 Treatment

Patients should be protected from external factors like fumes, dust, bright sunlight, etc.

Treatment of conjunctivitis is done in two phases; one is specific for a chronic condition

(amavastha) and the other is specific for acute condition phase (teevravastha).28,29 In the

chronic phase, the therapy is directed toward toxic waste materials in the body, which can

continue up to 4 to 5 days with the same preliminary practices before advising panchakarma

procedures such as fasting (langhan), sudation therapy (swedan), applying a layer of thin

medicament paste on the lid of the affected eye (pralepa), and eating bitter foods to cause

elimination of toxic materials into the gut. During this treatment, patients are asked to

avoid heavy meals, bathing, intake of decoction, and eye ointment and liners.

After treating the chronic phase (samavastha), the patient is given treatment in the

phase after the toxic materials are eliminated (niramavastha). The treatment includes two

aspects: (1) local therapy and (2) general therapy. Certain local therapeutic modalities

used in niramavastha are tarpana, putapaka, parisheka, eyedrops (ashchyotana), eye powder

(anjanna), medicated smoking (dhoomra), and nasal drops (shirobasti, nasya). Drugs used

for treatment of conjunctivitis according to vitiated dosa, particularly in the form of

eyedrops, are described here. In general therapy, one has to undergo panchakarma therapy

to eliminate the vitiated dosa from the gut and body and its further aggregation and

bring them to equilibrium. The specific procedures of general therapy are given only if

necessary. The following decoctions are cleaned and filtered through a very fine filter

and used as eyedrops.

29.7.1.2.1 Vataja Type

1. Brihat panchamool or brihati (Solonum indicum), erand (Ricinus communis), and shigru

(Moringa olifera) in decoction form

2. Nimbapatra (Azadirrhacta indica) and lodhra (Symplcos racemosus)

3. Saindhav (salt), pippali (Piper longum), wala (Andropogan vetiveria), and yashtimadhu

(Glycerrhyza glabra) processed with medicated milk (siddha dugdha)

29.7.1.2.2 Pittaja Type

1. Kamal (Nymphea spp.), neelakamal (Nymphea spp.), amalki (Phyllanthus embelicus),

kantakari (Solanum xanthocarpum), brihati (Solanum indicum), dashmool, shatavari

(Asparagus racemosus), talispatra (Abies webbiana), and manjishtha (Rubia cordifolia)

in decoction form

2. Chandan (Santalinum album), manjishtha (Rubia cordifilia), yashtimadhu (Glycerrhyza

glabra), lodhra (Symplocos racemosus), surarnagarik, and honey; used in painful

conditions of the eye

29.7.1.2.3 Kaphaja Type

1. Decoction of roots and bark of bilva (Aegel marmelos), kantakari (Solanum xanthocarpum),

and aragvadha (Cassia fistula)

2. Decoction of shunthi (Zinziber officinalis), triphala (mixture of fruits of three

myrobalans, neem (Azadiracta indica), vasa (Adhatoda vasika), and lodhra (Symplocos

racemosus)

29.7.1.2.4 Raktaja Type

A decoction for treating this type includes eyedrops made up of stree stanya (breast milk),

mixture of musta (Cyperus rotandus) and jyeshthamadhu (Glycirrhiza glabza) in rain water, and

lodhra (Symplocos racemosus) in dehydrated butter from cow’s milk (ghee). This is all mixed

with water along with triphala and sugar.

A great difference does not exist with regard to the current Ayurvedic therapy and that

of traditional practice (textual therapy). However certain formulations cannot be prepared

today because of the unavailability of certain ingredients or because of difficulties in proper

identification of certain ingredients. Many Ayurvedic physicians use Ayurvedic commercial

eyedrops in the treatment of conjunctivitis such as Ophthacare Eyedrops (Himalaya Drug

Company, Banglore, India) or Itone Eyedrops (Dey’s Pharmaceutical, Calcutta, India). These

products are made under sterile conditions instead of having the companies make their

own.

In contemporary ophthalmology, there are various approaches to treating different types

of conjunctivitis. Basically, usage of antimicrobial preparations and antiallergics have a

major role in the treatment of conjunctivitis.

Ayurveda is especially useful when patients have nonspecific conjunctivitis or have

resistance to existing antibiotic preparations. With these types of patients, the use of

Ayurvedic therapy either alone or as an adjuvant therapy is useful.

29.7.2 Glaucoma (Adhimantha)

According to Ayurvedic texts, glaucoma (adhimantha) is an ocular disorder characterized

by pain in the eye with a particularly churning or throbbing type of pain. The pain is very

severe as if the eye is being scooped out, crushed, or churned.30,31 According to modern

ophthalmology, glaucoma is a symptomatic condition where there is pain in the eye because

of increase in the intraocular pressure of the eyeball. Glaucoma is a condition of the eye in

which the ocular tension is raised above the normal. The tension becomes high because of

the faulty drainage of the aqueous humor. The tension of the eye is variable in health and

is usually between 16 to 23 mmHg measured by the Schiotz tonometer.32

29.7.2.1 Etiology

According to Ayurveda, if a case of conjunctivitis (abhishyanda) is not treated in time, it

may lead to glaucoma (adhimantha).33

29.7.2.2 Classification of Glaucoma

According to Ayurveda, glaucoma can be classified into four types (dosa-based classification):

vataja, pittaja, kaphaja, and raktaja adhimantha.34 As per modern contemporary ophthalmology,

there are various approaches of classification of glaucoma. Examples include

primary and secondary glaucoma, acquired and congenital glaucoma, acute and chronic

glaucoma, and open-angle and angle-closure glaucoma.35

29.7.2.3 Symptoms

29.7.2.3.1 Vataja Type

With vataja type of glaucoma,36 there is a severe feeling of pain at the eyebrows, temple

region, and in the half portion of the head (of the side of an affected eye). There is

congestion, muddiness of cornea, tinnitus, and vertigo.

29.7.2.3.2 Pittaja Type

Symptoms of the pittaja type of glaucoma37 include severe pain in the eyes as if they were

being burnt by fire or a caustic chemical (kshara). The eyes have red capillary network

throughout and are liver-colored. They are watery with edematous lids, and there is a

burning sensation at the head region. The patient is often unconscious.

29.7.2.3.3 Kaphaja Type

With the kaphaja type of glaucoma,38 the eyes are heavy, with secretion, edema, echimosis,

excessive lacrimation, cold and sticky discharge, hypersensitivity, and headache. The

patient sees things as smoky, dirty, and imperfect (suggestive of halos). Other symptoms

include a sunken cornea and bulged sclera (suggestive of shallow angle of anterior chamber).

29.7.2.3.4 Raktaja Adhimantha Type

Symptoms of the raktaja adhimantha type of glaucoma39 include severe pain in the eyes

with tenderness, blood-stained discharge, redness, and ciliary congestion. The patient

visualizes colors and flames.

29.7.2.4 Prognosis

If not treated in time, there is a possibility of blindness. According to ancient Ayurvedic

texts, one may lose sight within 7 days in the kaphaj type, 6 days in vataj, 5 days in raktaj

adhimantha, and 3 days or sudden loss (tatkal) in the pittaj type.40 It is also the understanding

in modern ophthalmology that if the glaucoma is not treated properly or remains

untreated, irreversible loss of visual field may occur, which can lead to blindness.

29.7.2.5 Treatment

Ayurveda has two lines of treatment for glaucoma: general and specific.41–43

29.7.2.5.1 General Line of Treatment

The patient is advised to rest the affected eye and is given sudation, proper diet, and

induced medicated purgation at the period of exacerbation of the disease. The patient

should avoid intake of liquors and excess sleep. Detoxification methods (panchakarma) such

as the oleation, sudation, and induced medicated purgation or enema are advised to

eliminate vitiated dosas that are responsible for the problem. Another unique technique

advised traditionally is bloodletting, where leeches are applied around the temporal region.

This technique is not currently popular. The patient is advised to take meat soups with

ghee, oils, fats, and bone marrows and processed milk medicated with drugs such as

meshashringi (Gymnea sylvestris) and ajamoda (Carum roxburghianum). The patient is given

triphala ghee orally after food. During the acute pain phase, the patient is given kapitha

medicated milk or brihat panchamool siddha ghee or milk.

29.7.2.5.2 Specific Line of Treatment

Many physicians prescribe specific formulations such as punarnavashtaka kwatha, chandraprabha

vati, laghu malini vasanta rasa, mahatriphala ghrita, saptamruta loha, and many other

Ayurvedic medicines orally for treatment, and certain medicaments are applied locally as

ophthalmic preparation (anjanas). The following ophthalmic preparations are applied

gently on palpebral conjunctiva: parad nag rasanjana and punarnava anjana.

29.7.2.5.3 Cauterization (Agnikarma)

Cauterization is done only when there is no relief from other recommended medication.

Cauterization is a form of heat therapy. Heat is applied by a special hot metal rod placed

in-between the eyebrows or at the lateral ends of the eyebrows. This procedure is currently

not practiced.

Ghee is applied to these spots, and the wound is then treated with a paste made of 125

mg of common salt and ten leaves of neem (Azadirrhacta indica). If a patient comes with

a higher degree of intraocular pressure (IOP), the first line of therapy recommended to

Ayurvedic eye departments is surgical procedures (antiglaucoma surgeries [AGS]). For

fresh cases with mild to moderate increase in the IOP, Ayurvedic physicians provide

Ayurvedic therapy.

In conventional ophthalmology, the treatment of glaucoma includes the use of diuretics,

meotic agents (e.g., pilocarpine), and the latest antiglaucoma drugs (e.g., Timolol maleate)

as a conservative therapy. Treatment can also include various surgical procedures (AGS)

such as iridectomy, cyclodiathermy, and trabeculectomy.44

29.7.3 Trichiasis and Entropion (Pakshmakopa and Antarvyavartana)

29.7.3.1 Pathogenesis

Vata, pitta, and kapha in their aggravated stages cause dryness and pointed eyelashes. The

involvement of vata causes the eyelashes to turn inside, touching the sclera and cornea

and giving rise to friction and irritation of these surfaces.45 Trichiasis involves inversion

of a varying numbers of eyelashes, so that they rub against the cornea (eyelid margins

are in the normal position). The misdirected eyelashes cause mechanical irritation and

injury to the cornea, with pain, lacrimation, photophobia, and ulceration.46

29.7.3.2 Treatment

Ayurveda recommends removal of the defective eyelashes.47 Again, there is a similarity

in the Ayurvedic treatment with the modern therapeutic approach of removing the eye

lashes with the epilation forcep.48 The contraction of the lid may also cause the above

problem. In modern ophthalmology, this can be compared with trichiasis and entropion,

respectively. Surgical procedures for trichiasis (pakshmakopa) and entropion (pakshmasankocha

or antarvyavartana) discussed by various Aayurvedic scholars are similar to

those of the modern surgical procedure of tarsorrhaphy.49 In practice, Ayurvedic physicians

apply certain pastes on eyelashes or use epilation forceps to epilate the hair follicle of eye

lashes. In case of entropion or ectropion, modern surgery usually is recommended.

29.7.4 Chalazion (Utsangini and Lagan) (Internal Hordeolum, Tarsal Cyst, and

Meibomian Cyst)

This consists of a swelling of the meibomian gland following an obstruction of its duct

accompanied by chronic inflammation in the surrounding tarsus. More than one chalazion

may occur at the same time.50

29.7.4.1 Pathogenesis

According to Ayurveda, this condition is due to vitiation of all the three dosas (tridohadushti)

and vitiation of the blood (raktadushti).51

29.7.4.2 Symptoms

The signs and symptoms are itching and pain. In addition, when the eye is opened there

is discharge similar to egg yolk.52

29.7.4.3 Treatment

The recommended treatment in both conventional medicine and Ayurveda is surgery. The

Ayurvedic practitioner uses the paste of herbal ingredients such as hirakasis, trikatu, rasanjana,

and saindhava mixed with honey to heal the wound.53

29.7.5 Cataract (Kaphaja Linganasha)

Cataract is a well-identified and characterized eye disorder in Ayurveda. Linganash is a

term derived from two words: linga (funtion) and nash (destruction). When there is destruction

of the function of the eye, the lens becomes opaque and is known as linganasha.54

Opacification (formation of opacities) in the crystalline lens is known as cataract.55 Ayurveda

recognizes three stages of cataract: initial blurred vision stage or refractive error (timir),

immature cataract (kacha), and cataract (kaphaja linganasha). These stages are not recognized

contemporary medicine. Ayurvedic physicians refer these patients to conventional-medicine

doctors for the latest procedures, such as intraocular lens implantations, which are far

superior and effective to deal with this condition.

 

Om Tat Sat

                                                        

(Continued...) 

(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)