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of Dhiman pmd


									Reprinted from J. Res. Educ. Indian Med., Oct. - Dec., 2008 pg 39-42                    ISSN 0970-7700

P.G. Dept. of Shalakya Tantra,1 R.G. Govt. P.G. Ayurveda College, Paprola, Dist. Kangra, H.P. (India)
Dept. of Shalakya Tantra, D.B. Ayurvedic College,2 Amloh - Mandi Govindgarh, Punjab (India)

             Abstract : Shushkakshipaka - an eye disease is elaborately described in Ayurvedic
        literature, which has description similar to dry eye syndrome in modern ophthalmology.
        On critical review of the literature on the subject, three physiological excrement of the eye
        i.e. Ashru (lacrimal secretions), Netradushika/Netravita (mucous secretions) and Netra-
        sneha (lipoidal secretions) are responsible for moistening, nutritive as well as cleaning
        of the eye; which constitute tear film as per modern medical science. Rasa, Meda and
        Majja Dhatus plays a major role in the regulation of these secretions. This review again
        justifies the basic fundamental of Ayurveda that excrements (Mala) are very much
        essential for the maintenance of homeostasis vis a vis the concept also gives guidelines
        for the treatment of dry eye.
            Keywords : Shushkakshipaka, Dry eye, Akshi, Ashru, Dushika, Netravita, Akshivita,
        Akshisneha, Lacrimal secretion.
Introduction                                            Shushkakshipaka as a P.G. thesis work
      Lord Sun bestowed the knowledge of                initiated authors to review the literature of
ophthalmology to the king of Videha- Rajrishi           Ayurveda regarding Tear secretion and Tear
Nimi in the welfare of suffering humanity; who          film. On critical analysis it was observed that
later mastered the science of ophthalmology             use of word Akshi and not Netra in the disease
and expounded it as Nimitantra.                         Shushkakshipaka is very specific so far as
                                                        pathogenesis is concerned which will be
      The knowledge of ophthalmology based              elaborated in forthcoming description.
on this text was reproduced in Uttaratantra             Ashrusrava, Netradushika/ Netravita or
1-19 chapters of Sushruta Samhita. Wherein a            Akshivita and Akshisneha are the secretory
comprehensive knowledge of eye and its                  products from eye which are described in
diseases including ocular therapeutics and ocular       Ayurvedic literature.
trauma has been given in a systematic and
classified manner. Acharya Vagbhatta,                   Akshi and Ashru
Bhavamishra, Sharangdhara and Madhava                           Word Akshi is derived from root word
added new advancements in this field of                 Aksha - meaning Sanhtou Vyaptou ch + kisi
science.                                                (Vachaspatyam). Ashrute Anen Ashru
                                                        Vyaptou sanghate ch. (Amarkosha). Thus
      Shushkakshipaka, a disease effecting              Akshi means the structure to which Ashru
all parts of eye has been mentioned which is            (tears) remains adhered or spread over i.e. eye
very similar to dry eye syndrome of modern              ball (Sir M. M. Willium). Thus the Ashru (tears)
ophthalmology. A pilot clinical study on                exists coherently with eye ball i.e. it is a

1. Reader and Head   2. Lecturer
2                                        Dhiman and Vardhan

physiological secretion. Furthermore it is stated   Ashru Secretion
that Ashru cleans the covering of eye i.e. ocular         As far as the origin of these secretions is
surface. (Tamashru Netravarnam Pramrijiya-          concerned, Acharyas have not mentioned any
Amarkosha, 2.6.92). Its consistency is clear,       specific structure from where these secretions
non viscous as evident from its synonym with        are released. Ashru remains in close contact
Netrambu (Amarkosha, 2.6.93, Ashru                  with the outermost Tejojalashrita Patala,
Netrodakam - Dalhana on Su. Ut. 55/4,               comprising of Krishna Mandal (corneal part)
Netrajala - Sh. Pu. 5/13).                          and the Sweta Mandal (sclera with conjunctival
                                                    covering) respectively (Su. Ut. 1/18). According
      By definition and derivition of word          to Acharya Vagbhatta white part gets its origin
Akshi, Vyapta Ashru remain adhered/ spread          from the essence of Kapha. This Tejojalasrita
over the eye for visual purpose (Ashrute            Patala is nourished by the Siragata Rakta
Vyapnoti Netram Darshanaye- Amarkosha,              (blood       vessels)       and     the    Rasa
2.6.92).                                            (serum and lymph) situated in Akshigolak-
      Thus “Ashru (physiological tears) are         tvaka - conjunctiva (Ni. Sa. on Su. Ut. 1.18
watery secretions which remain coherently           and Madhukosha on Ma. Ni. 59/29). Ashru
adhered or spread over the eye ball, cleanses       being watery in nature (Ni. Sa. on Su. Ut.
the ocular surface and is necessary for visual      55/4), it may be postulated that it is derived
function”.                                          from Rasa Dhatu whose Panchabhautic/
                                                    physical constitution is aquous predominant. This
      Two different conditions of hyper             hypothesis is further strengthened by the
secretion of tears are mentioned in literature of   presence of dryness and roughness of eyes as
Ayurveda. i.e. Ashruvega and Ashrusrava.            a symptom of Vataja Jwara(Ch.Ni.
                                                    1/21, As. Hr. Ni.2/16) and Vataj Pandu
Ashruvega : It has been enumerated in non -         (A. Hr. Ni. 13/11) where the principal Dushya
     suppressable urge ( Ch. Su. 7/22, Su.Ut.       is Rasa Dhatu. Achrya Sharangdhara has even
     55/12, As. Hr. Su. 4/17) that is a             mentioned the aqueous discharges from eyes
     physiological condition. Such urge of          as the Mala (excrement) of Rasa Dhatu along-
     hyper-lacrimation happens due to               with other discharges from mucosal surfaces
     excessive joy or sorrow (Su. Ut. 55/12).       of the body (Sh. Pu 5/13).
     It refers to psycological stimuli induced
     lacrimation.                                   Dynamics of Ashru
                                                          Descriptions of two structures which are
Ashrusrava : Different varieties of Ashrusrava      related with the dynamics of Ashru is available
     hyper - lacrimation have been described        in Ayurvedic literature. Acharya Sushruta has
     as a feature of many eye diseases which        described two Ashruvahini Dhamanis
     are of morbid origin of tears. In the          alongwith the description of other channels
     reference of Sravaroga/ Netranadi              concerned with sensory as well as motor
     (Ch. Dacryocystitis) disease, Acharya          functions e.g. Dhamanis pertaining to perception
     Dalhana elucidates that here the               of sound, touch, act of speech etc. (Su. Sha. 95).
     Ashrusrava refers to the vitiated doshic       Acharya Dalhana defines its function as
     condition so here the Ashrusrava refers to     ‘Ruditam Asruvahinyo Karma’ i.e. these
     the pathological stimuli induced               channels are concerned with carriage of Ashru,
     lacrimation.                                   although it is not clear whether these channels
                                 Tear Secretion - Ayurvedic Perspectives                           3

are related with secretion or excretion of Ashru.   the above description the Akshi Dushika
Another structure associated with transmigration    appears to be mainly the mucoid secretion from
of Ashru is the Ashrumarga (Su.Ut. 2/5-7)           the ocular surface which has same
refered to in the description of Sravaroga          characteristics and functions as of the mucous
present near Kaneenika Sandhi (inner                layer of tear film.
canthus). As regards their working, it is clear
from their anatomical location and description      Akshisneha
of function that these are concerned with the             Two Tarunasthi (cartilages) are present
drainage of Ashru. It referes to excretory part     in the eye lids. Asthi (oesseous tissue) being
of the lacrimal apparatus i.e lacrimal punctum      the seat of Majja Dhatu (bone marrow).
to lower end of the naso-lacrimal duct.             Cartilages are the probable structures from
                                                    where the Majja Mala (Akshisneha-lipoidal
Netradushika / Akshivita                            excrement) is excreted. Also Acharya
      Netradushika/Akshivita is other               Bhavamishra is of the opinion that Akshisneha
secretion which is an excrement from the eye        is brought in the eye by the Vyana Vayu
(Ni. Sa. Su. Ut. 18/41), and is an end product      (deriving force) through Sira (vessels) and
of Majja Dhatu (Bone marrow tissue) (Ch.            deposited there (Bh. Pr. Pu. 3/181).
Chi. 15/18., Su. Su. 46/527). While describing
the properties of these excretions; ancient                Another lipoidal tissue of the body, the
scholars state that their presence in proper        Meda Dhatu is probably also related with the
amount and properties in equilibrium with           Snehan- lubrication of eye ball; as evident from
Dhatus is necessary for Dhatu Samya and             the functions of Meda Dhatu (A. Sa. Su. 19)
Anuvartana (i.e. equilibrium of body tissues        and Medasara Purusha (Ch.Vi.8/116). In
and maintenance of integrity) of their channels     Meda- Kshaya, the luster of the eye balls is
of excretions and body as a whole (Ch.Su.           also lost (Ch. Su.17/65). These scattered
28/4, A. Hr. Su. 11/25). Their deficiency results   references regarding Akshisneha certainly
in dryness, pain, lightness and numbness in their   indicate the role of lipoidal secretions in the
respective sites. Dryness and pain (F.B.            normal functioning of eye; which refers to the
sensation, itching, burning etc.) are prevalent     lipid layer of the tear film.
symptoms in the dry eye. The symptoms arising
due to deficiency of Dushika indicates its                  Functions of Ashrudushika and
necessity and supportive functions. Hence           Akshisneha : As the Ashru-lacrimal secretions
inference can be drawn that Dushika/                are derived from Rasa Dhatu of the body and
Akshivita/ Netravita is a physiological secretion   are watery in nature its functions are similar to
which is scanty, unctuous, whitish and lubricate    that of Rasa Dhatu in the body. It cleans the
the eye ball (A. Hr. Sha. 3/63). These              ocular surface (Amarakosha, 2.6.92), restores
characters are similar to Kapha and should be       the wear and tear, provides nutrition to the
the secretion from the white area of the eye        outer tunics (Su. Su. 15/60), it also lubricates
ball (conjuctiva and sclera) which is derived       and keeps the eye wet (Su. Su. 40/5).
from Kapha (As. Sa. Sh. 5/53).
                                                          Dushika/ Akshivita (mucoid secretions)
      Whenever this excrement is vitiated by        an other physiological secretion per eye
humours or infection it turns to thick and muddy    (white area) which is scanty, unctuous and
pathological secretion (Ghana Dushika). From        whitish in colour lubricates the eye, maintain
4                                             Dhiman and Vardhan

the integrity of ocular surface, prevents dryness              Krishandass Academy, Varanasi (1990).
and other symptoms. Being secreted from                  3.    Sushruta Samhita: with Dalhana commentary,
Kapha domonant structure of the eye it exhibits                Vaidya Jadavji Trikamji Acharya,
preventive (Bala) activity too. Akshisneha                     Chaukhambha Orientalia, Varanasi (1980).
(lipoidal secretions) also lubricate the ocular          4.    Charaka Samhita: with Chakrapani
surface and prevent the drying property of Vayu                commentary, Vaidya Jadavji Trikamji Acharya,
(evaporation) and thus maintain the luster of                  Chaukhambha Orientalia, Varanasi (2005).
the eye ball.                                            5.    Ashtang Sangraha: Late Dr. V.V. Pandit Rao
                                                               and Vaidya Ayodya Pandya. Kendriya
Conclusion                                                     Ayurved and Siddha Anusandhan Parisad,
       Ashru - lacrimal secretion, Dushika-                    New Delhi (1988).
mucus secretion and Akshisneha- lipoidal                 6.    Ashtang Hridya: with Arun Dutta
secretion are three different physiological                    commentary, Chaukhambha Surbharti
excrements which are liberated at and remain                   Prakashan, Varanasi (2002).
adhered to ocular surface. Ashru is derived              7.    Bhavaprakash: Sri Brahmasankara Mishra
from Rasa Dhatu, Dushika is derived from                       and Sri Rupalalji Vaidya, Chaukhambha
Rasa and Kapha where as Akshisneha is the                      Sanskrita Sansthan, Varanasi (2004).
excrement of Meda and Majja Dhatu.                       8.    Madhava Nidana: with Madhukosha
                                                               commentary by Acharya Yadava Sharma,
      These are lubricating, nutritive and                     Chaukhambha Orientalia, Varanasi (1986).
preventive in function and act like the Tear             9.    Sharangadhara Samhita: Pandit Parasuram
film. Ashru - lacrimal secretions are of three                 Sastri      Vidyasagar,      Chaukhambha
types i.e., Vyapta Ashru (physiological tears),                Orientalia, Varanasi (1986).
Ashruvega (psychogenic lacrimation) and                  10.   Williums M. Monier: A Dictionary English
Ashrusrava (pathological lacrimation).                         and Sanskrit, Motilal Banarasidas, Delhi
                    References                           11.   Prabhakar Vardhan: A clinical study on the
1.        Amarkosha: Pt. Hargovinda Shastri,                   effect of Keshanjana and Parisheka in the
          Chaukhambha Sanskrit Sansthan, Varanasi              management of Shushkashipaka w.s.r. Dry
          (1982).                                              Eye, P.G. Thesis, Shalkya Department GAC
2.        Vachaspatyam: Sri Tarkanath Tarkavachaspati,         Paprola, H. P. (2004).

Address for correspondence: Dr. K.S. Dhiman, “Gurukripa”, Khatrehar, V.P.O. Paprola-176115 Dist. Kangra,
Himachal Pradesh (India). E-mail:

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