critical analysis of netra roga nidana.pptx

Critical analysis of Netra roga

1. “CRITICAL ANALYSIS OF NIDANA OF NETRA ROGA” Dr. Shraddha Joshi Ph.D. 2 nd year Shalakya Tantra dept.

2. Why understanding Nidana is important? To assess Dosha vitiation. Helps to decide Sadhya , Asadhyata of Vyadhi . To analyse the S amprapti . For proper planning of treatment.

3. Adi bala pravrutta Due to defect in Shukra and Shonita . Kulaja Vikara (Hereditary disorder). Eg . Naktandhya (Night blindness) Albinism, etc.

4. Janma bala pravrutta These are congenital disorders caused because of Rasa and Dauhrida Apchara Kruta . Eg. Jatyandha , Microcornea / Megalocornea , Keratoconus , Congenital myopia , hypermetropia , congenital cataract, ptosis, dacryocystitis .

5. Ushna , Katu , Kshara Ahara Ati Sevana . Dosha B ala Pravrittaja Atiyoga , Ayoga, Mithyayoga of Vihara Mithyayoga - Looking into very near/very distant objects. Aayoga - Completely avoiding the vision. Atiyoga - Looking into illuminating & bright objects. Vitiation of Dosha either in Amashya / Pakvshaya .

6. Sanghata bala pravrutta These are traumatic disease due to trauma/ bite of animals/ birds. Vyala Krut : (animated injuries) Bite of insects, irritation with animal hairs. Shastra Krut : (Instrumental injuries) Stab injuries, abrasions. Probable disease: Chakshushya Vibhrama Astigmatism Injury to Avarta & Apanga marma causes Andhyatva & Drishti Upghata .

7. Kala bala pravrutta Seasonal eye diseases are produced due to change in the climatic conditions. Vyapanna Ritu : (diseases arising due to Vaikrita R itu ) Abhishyandana Av yapanna Ritu : (diseases arising due to P rakrita R itu ) Spring catarrah .

8. Daiva bala pravrutta Diseases arising due to observing bright light / Graha / Devta . These diseases are produced due to microbes. Eg . Timira , Herpes keratitis.

9. Swabhava bala pravrutta Age related degenerative changes. Akalaja : (Earlier changes due to pathology) Cataract in adult (diabetic cataract), Visual problem in children. Kalaja : (Normal changes by age) Presbyopia, senile cataract, arcus senilis , ARMD.

10. Nidana of Netra Roga उष्ण अभितप्तस्य जलः प्रवेशाद दुरेक्षणात् स्वप्न विपर्ययात् च| प्रसक्त संरोदन कोप शोक क्लेश अभिघातत् अति मैथुनात् च|| शुक्तारनालाम्लकुलत्थमाषनिषेवणाद्वेगविनिग्रहाच्च | स्वेदादथो धूमनिषेवणाच्च छर्देर्विघाताद्वमनातियोगात्  | | बाष्पग्रहात् सूक्ष्मनिरीक्षणाच्च नेत्रे विकारान् जनयन्ति  दोषाः |

11. Acharya Nidana आचार्य भावप्रकाश रजोधूमनिषेवणात् , अतिशीघ्र यानतः, ऋतु विपर्यय, शिरो अभिताप आचार्य योगरत्नाकर अतिद्रव पानम् , अतिमद्य पानम् आचार्य विदेह तीक्ष्ण अञ्जन , कीट दंश, स्पर्शादीभिः अभिहतेषु, सलिल क्रीडा, अति लङ्घन,क्रमणरूप प्रेक्षण आचार्य डल्हण आवक्शिर शयनम्, उच्चितशिर शयनं, ज्वर् अभिताप आचार्य वाग्भट पाद पीडन Other Nidana mentioned by different Acharyas

12. The Nidanas as explianed in the classics can be further grouped as follows: Aharaja Ahara Vidhi Viharaja Rutu Viparyaya Manasika Agantuja Bheshaja Nidanarthakara Sankramika

13. Aharaja Nidana Pitta Prakopaka Ahara Shukta Arnala Amla Ahara Kullatha Madhya Kshara, Tikshna , Ushna , Katu Ahara Kapha Prakopaka Ahara Masha Drava Anna Shita Ahara Guru Ahara

14. पित्तप्रकोपक आहार Ahara containing Agneya Bhavas deranges eyes. These Ahara possess: Rasa: Katu , Amla Guna : Tikshna , Vyavayi , Vishada , Sara Virya : Ushna Vipaka : Katu Result: Daha , Raga, Paka i.e. Inflammatory changes. Kumbheeka (Multiple stye ) Abhishyada (Conjunctivitis) Pilla Rogas (Inflammatory diseases)

15. शुक्तारनालाम्ल Fermented products They have properties opposite to Oja with toxicating action. Shukta-Arnala Probable Dosha : Pitta & Rakta. Diseases: Hypertensive retinopathy, Cytomegalo virus retintis , etc. They contain histamines and so acts as vasodilators leading to allergic manifestation. Amla rasa causes “ Akshi Bhru Nikochana ” causes ciliary muscle strain and sudden voluntary actions of lids

16. कुलत्थ निषेवण Excessive use of horse gram Kullatha Laghu , Vidahi , Kashaya Rasa, Katu Vipaka , Ushna Virya . Leads to Dhatu Kshaya Tridosha Tridoshaja Netra Roga Pentosan present in kullatha can even lead to inflammatory changes.

17. अतिमद्य पानम् ( योगरत्नाकर ) Drinking excessive Alcohol Present era: many are addicted to alcohol. Toxic in nature. Lack of adequate proteins, vitamins. Alcohol causes deficiency of Vitamin B1. Methyl alcohol metabolizes very slowly & oxidizes into formic acid & formaldehydes in tissues. Probable Dosha : T ridosha Diseases: cataract, nystagmus , paralysis of eye muscles, macular degeneration, toxic amblyopia. Causes degeneration to ganglion cells, a main factor to cause toxic amblyopia.

18. Excess intake of Kshara, Teekshna , Ushna , Katu Ahara Excessive intake of Kshara, teekshna and Ushna Ahara Increases body & eyes pH Breakdown into hydroxyl ion & cation Saponifies the cell membrane. Interacts with collagen, glycosaminoglycans . Produces stromal damage. Causes epithelial defect. Causes ciliary body irritation. Excessive intake of Katu Ahara Stimulates prostaglandins (powerful vasodialators ) Inhibits aggregation of platelets. Leads to inflammatory changes. Desensitizes the neurons causing pain.

19. कफ़प्रकोपक आहार Acharya Charaka, stated that Netra will always have threat from Kapha, thus excess Kapha accumulation is to be avoided. These Ahara possess: Rasa: Madhura Guna : Guru, Snigdha , Pichilla , Virya : Sheeta Vipaka : Madhura It causes Jathragni and Dhatvagni Mandhya leading to Srotorodha and Mala Sanchaya . Result: Discharge, opacity, haziness, Shopha etc. Kaphaja Timira (cataract) Krimigranthi ( Blephritis ) Upnaha ( Dacryocystitis ) Shopha ( Peri orbital swellinng )

20. माषनिषेवण Excessive use of Black gram Masha Madhura Rasa, Madhura Vipaka , Guru, Snigdha Guna Causes Dhatu Vriddhi . Kapha Kaphaja Netra Roga It increases level of oxalates in body and decreases iron level and so increases oxidative stress and damages surrounding structures.

21. अतिद्रव पानम् ( योगरत्नाकर ) Drinking excessive liquid Present era: diet conscious. Fluid retention takes place beneath skin which causes localized swelling. Increases abdominal pressure. Increases extracellular fluid volume. Exerts pressure in arterioles. Micro circulation in eye causes occlusion & inflammatory changes.

22. Intake of cold items Lowers metabolism & alters the digestion. Nutrition absorption & excretion also gets affected. Lowers immunity Hampers the normal circulation. Abnormal nutrition leads to weakness. Probable Dosha: Kapha

23. Heavy Food intake They are rich in carbohydrates, which increases glucose level. Extra glucose level accumulates in lens. To dilute this glucose lens absorbs more fluid which changes the shape of lens.

24. Aharaja Vidhi Virrudha Ahara Asatmaya Ahara

25. विरुद्ध् आहार Dosha Utklesha Dhatu Utklesha Increases Guru, Snigdha , Pichilla Guna Deranges vasculature. Deranges permeability of vessels . Abhishyandi Srotas , Srotorodha , Netra Malsanchaya .

26. असात्मय आहार Ama Uttpatti Jathragni Mandhya Kaphaotklesha & Srotorodha Also vitiates Pittta Ama Lakshana of Netra : Raga, Shopha , Srava , Shoola , Daha which indicates inflammatory changes.

27. Viharaja Nidana Vata Prakopaka Vihara Durekshnat Sukshma Nirikshanat Vividha Rupa Prekshana Sakampena Atikramana Shranta Klanta Ati Shighra Yanatah Ati Maithuna Maloshna , Sankatana , Pada Pidana Swapana Viparyay Vega Vinigraha Avak Shir Shayana Ucchritta Shayana Atilanghana Bahyu Bharnam Taila Abhyanjan Varjanam Pitta Prakopaka Vihara Ushna abhitaptsya Jalah Praveshata Rajo Dhooma Nishevana Kapha Prakopaka Vihara Swapna Viparyay Abhyanjana Nithantena Chardi Vighatat

28. वातकर विहार Timira ( Hypermetropia , Accomodation problem, cataract, macular degeneration, toxic amblyopia, valsalva retinopathy). Shushkakshipaka (Dry eye) Arma ( Pterygium ). Abhishyanda (Allergic conjunctivitis, uveitis). Balasgrathita ( Pingueculae ) Ruksha & Khara Guna increases. Does Shoshana Impairs Prana vata & Vyana Vata Indriya grahana shakti altered

29. दुरेक्षणात् Looking at very distant object for a longer time Present era: Drivers, shooters, archery, working with telescopes Accomodative capacity of the lens will be destroyed. Probable Dosha: Vata Diseases: Hypermetropia

30. Present era: Working with computers, laptops, mobiles, reading, tailoring, embroidery, etc. Causes strain to ciliary muscles and lens. Probable Dosha : Vata Diseases: Dry eye syndrome, Accomodative errors. सूक्ष्मनिरीक्षण Watching minute objects for long duration

31. क्रमणरूप प्रेक्षण ( विदेह ) Continuously seeing moving objects Present era: Playing computer games, video games, traffic police, from high speed moving vehicles Strain to eye muscles specially ciliary muscles Probable Dosha : Vata Diseases: Squint, nystagmus , weakness of ocular muscles Spasm of accomodation occurs also causes difficulty in sensory perception. On starring continuously the blinking rate also will reduce, which make tear film to evaporate rapidly. All these constitutes the Atiyoga & Mithyayoga

32. श्रान्त क्लान्तः Fatigue & tiresome eyes Over usage of eyes Leads to strain on ciliary muscles and accomodation Sustained accomodative efforts Asthenopic symptoms

33. अतिशीघ्र यानतः Travelling very fast Present era: Driving in high speed, running Speed blow of air/ dust directly comes in contact with eyes. Probable Dosha : Vata Diseases: Dry eye, Netra S rava Leads to hyperplasia which encroaches cornea destroying bowmans layer and superficial tissues.

34. अति मैथुनात् Excessive indulgence in sex Leads to Dhatu Kshaya Also Shukra Dhatu Kshaya leading to purva Dhatu Kshaya Deprived nourishment to eyes Probable Dosha : Tridosha The presence of receptors in epithelial cells of lacrimal gland, meibomian gland dysfunction, tear film instability & disturbs the regulation of immune system & alters the secretory functions of lacrimal glands.

35. पाद पीडन ( वा.) Strain on foot/ sole Present era: Not wearing slippers, wearing uncomfortable foot wears, tailoring, excessive cycling. Damage to Nadis of foot which are directly connected to head. Probable Dosha : Vata Diseases: Drishti Mandhya , Timir Feet have mechanical receptors of the nervous system. These receptors are sensitive to touch, so whenever there is any sort of blow, injury to feet/soles it can affect eye also.

36. स्वप्न विपर्ययात् Abnormal sleeping habits ( Diwaswapana / Ratrijagrana ) Present era: Night shifts Sleeping late night Probable Dosha: Tridosha Divaswap : Kapha prakopa Ratrijagrana : Vata & Pitta Parkopa . Decreased oxygen supply to brain Causes loss of cognitive abilities and involuntary , spontaneous, localized quivering of ocular muscle occurs. Leads to excessive stress to ciliary muscles cause defect inn acomodation .

37. वे गविनिग्रह Suppression of Natural Urges Suppression of Vata , Vit , Jrimbha , Ashru , Kshavthu , Hikka , Kshudha all leads to Netra Rogas . Present era: During classes, in office. Probable Dosha : Tridosha The pressure exerted by controlling these urges increases pressure within the globe, causes pain. In advance stages causes vasodialation leading to haemorrhages in Shukla Mandala or Drishti Mandala.

38. अति लङ्घन ( विदेह ) Excessive fasting Present era: Excessive diet conscious Leads to Hypoglycemia Probable Dosha : Vata Diseases: Netra Shosha Decreased supply of glucose & so reduces energy production. Retinal cells will not be able to meet metabolic demands Defiecient in retinal function.

39. आवक्शिर शयनम् (डल्हण) Sleeping in head down position Present era: Sleeping on working table, bus, etc. Due to gravitational pressure there occurs compression to blood vessels . Also increase the pressure over optic nerve. Probable Dosha : Vata Diseases: Occipital neuralgia, CRVO, etc.

40. उच्चितशिर शयनं (डल्हण ) Sleeping with head elevated Present era: Use of high pillows, sleeping on sofa, etc. Decreased blood circulation to head & so hampers metabolism to eyes. Probable Dosha : Vata Diseases: Vataja Netra Roga , Optic atrophy

41. बाहु भारनम् Carrying heavy loads over head Increases Intrathoracic pressure (against closed glottis) Rupture of Retinal capillaries

42. तैल वर्जन Not using oil properly Increases Ruksha , Khara , Sukshma Guna .

43. बाष्पग्रहात्  Suppressing tears during grief Suppressing the tears. Vitiated Vayu obstructs the Doshas Probable Dosha : Kapha & Vata Diseases of Ashruvaha Srotas Further causes instability of tear film, dryness of ocular surface.

44. पित्तकर विहार Abhishyanda (Conjunctivitis) Adhimantha (Glaucoma) Pitta Vidagdha Drishti (Day blindness) Dhumadarshi (Haziness of vision) Serves Achakshushya Rakta Dushti Syanda Srotas Increases Tikshna & sara guna of Pitta Rakta Dushti Syanda Srotas Disturbs tejo guna Indriya grahan daurbalya

45. “ उष्ण अभितप्तस्य जलः प्रवेशाद ” Immersing in cold water immediately after getting exposed to heat/sun Present era: Bathing/drinking cold water Entering into AC compartment soon after exposure to heat/sun . Tissue integrity will be spoiled Probable Dosha: Pitta. Circulatory disturbances occurs

46. रजोधूमनिषेवणात् Exposure to dust & smoke Present era: While walking, driving, addicted to smoking Causes oxidative stress Probable Dosha : Vata Oxidative damage evokes. Ocular injury may occur. Potent irritant Causes infection to conjunctiva & sclera Immediate hypersensitivity reaction mediated by IgE & mast cell activation.

47. कफ़कर विहार Dosha Utklesha Interacts with Rakta & Pitta Syanda srotas Abhishyanda (Conjunctivitis) Sleshma Vidagdha Drishti ( Night blindness) Pothaki (Trachoma).

48. स्वप्न विपर्ययात् Abnormal sleeping habits ( Diwaswapana / Ratrijagrana ) Present era: Night shifts Sleeping late night Divaswap : Kapha prakopa Ratrijagrana : Vata & Pitta Parkopa . Probable Dosha: Tridosha Fluid in eye fails to drain properly, making it susceptible for nerve damage.

49. अभ्यञ्जन नित्हन्ते Excessive oil massage Increases Snigdha , Pichilla , Guru Guna & Dosha Utklesha .

50.   छर्देर्विघात Suppressing urge of vomiting Suppressing the urge of vomit. Causes strain to eye & Akshi Kandu Probable Dosha : Vata Diseases: Eye lesions, Arjuna (Sub- conjunctival hammeorrhages .

51. Consuming Ushna Drvyas in U shna R itu causes Pitta Prakopa . Consuming Shita Drvyas in Shita Ritu - Kapha Prakopa . i.e. not following R itucharya Seasonal eye changes are produced due to change in the climatic conditions. The conjunctiva of eye is more sensitive than skin. Ritu Viparyay (Seasonal variation) In warm climate, there will be hyperplasia of epithelium & sub epithelium of conjunctiva. Cold climate can constrict the blood vessels and can even restrict the normal metabolism of cornea. Cann be painful & may affect visual clarity & may also lead to dryness of eyes.

52. Mansika Nidana Prasakta Sanrodanam Bhaya Shoka Klesha Kopa

53. प्रसक्त संरोदन Continuous weeping for longer duration Causes excessive stimulation to lacrimal gland by which the gland secrets more fluid that washes away nutrients and bacterio static effect of conjunctival sac. Probable Dosha: vata Diseases: Xerosis and diseases of lacrimal apparatus. Conjunctival sac & lacimal apparatus looses the stamina against diseases.

54. कोप शोक Excessive anger and grief (They are M ansika Dharniya Vega) Probable Dosha: Pitta & vata Diseases: Subconjunctival hameorrhage , Vataja Vikara . During anxiety attacks Body gets a rush of Adrenaline Pupil gets dialated Blurred vision occurs as a reaction to unnecessary extra light

55. क्लेश Excessive Stress Probable Dosha: V ata Diseases: Vataja Netra Rogas Stress, suffering pain, trouble Frequent changes in endocrine, immune autonomic nervous and cardiovascular system Fundamentally influenced by brain func . & neurotransmitters Impact on eyes

56. भय Fear is reinforcement of a safety signal, which is autonomic neuro endocrine action. Causes muscle twitching, increases heart rate, leads to sudden dilation of pupil

57. Agantuja Nidana Abhighata Salila Kreeda Keetamakshika Sparshadibhi Chandragrahana , Nakshtra kramana Divakara Agni Tejasa , Ratnanam Vilokana

58. अभिघातत् Trauma to eyes Minute irritating injuries or contusion injuries or perforating injuries cause a great loss to the eye. No proper care Blindness Present era: Chemical injuries, occupational hazards, accidents. Probable Dosha : Tridosha Diseases: Corneal abrasion, Corneal erosion, Periorbital abcess , etc.

59. कीटदंश ( विदेह ) Insect bite Causes Injury May release toxins Acts as foreign body Probable Dosha : Tridosha Diseases: Pain, Burning, Swelling

60. स्पर्शादीभिः अभिहतेषु ( विदेह ) Contact with toxic materials Present era: Accidental contact with paint, perfumes, deos , detergents, soaps, lab materials, etc. Causes local tissue damage Probable Dosha : Tridosha Diseases: can worsen from irritation to blindness.

61. सलिल क्रीडा ( विदेह ) Water sports Present era: Not wearing swimming goggles during swimming or water games. Entry of contaminated water into eyes. Probable Dosha : Tridosha Diseases: burning sensation to eyes, corneal abrasions, conjunctivitis, ulcerative keratitis, etc.

62. चन्द्रग्रह, नक्षत्र क्रमण Visualizing Lunar eclipse It will lead to ciliary muscles strain in eyes. The penetrating & high illuminating rays can lead to retinal damage.

63. दिवाकर अग्नि तेजस, रत्नानां विलोकन By the glare of sun & by visualizing the precious stone Retinal damage occurs due to photo-chemicals rather than thermal injury. By sun gazing, ( though there is 4 degree celcius increase in temp insufficient to photo coagulate) the light promotes oxidation, chemical reactions occur in exposed tissues with unbonded molecules. The duration of exposure is necessary to cause injury & it varies with intensity of light.

64. Bheshaja Atiswedana Vamana Atiyogata Anjana

65. स्वेद Excessive sudation to eye Only Mridu Swedana is advised in Netra Rogas . In diseases like Timira, Swedana is contraindicated. Present era: Working in coal mines, cooking, bakers. Probable Dosha : Pitta & Rakta Diseases: Pittaja Abhishyanda , Dry eye. The vasculature will be altered leading to dilatations of vessels leads to Pitta Prakopa Netra rogas .

66. वमन अतियोगात् Excessive Vamana therapy Causes “ Akshir vyavruthi ” ( Protusion of eyeball) Probable Dosha : Vata Vriddhi , Kapha & Pitta Kshaya Diseases: Retinal detachment, Viterous prolapse, Arjuna (Sub- conjunctival hammeorrhages . Ati Vamana causes Vata Prakopa . Upward pressure exerted during Vamana causes the fragile vessels of eyes to rupture & bleed.

67. तीक्ष्ण अञ्जन ( विदेह ) Applying teekshnanjana to patients who are already tired due to wind, sun,etc . Local irritation, excessive lacrimation, conjunctiva damage, cornea, etc. Probable Dosha : Tridosha Diseases: Sirajala , Siraharsha , etc.

68. Nidanarthkara Jwarotpata Granthi Meha

69. शिरो अभिताप Exposure of head to excessive heat Present era: Engineers, Constructors, Coolies, Traffic police. Probable Dosha : Vata & Pitta Prakopa . Diseases: Photokeratitis “ Deha Indriya Manastapa ” “ Indriya Tapina Timiradaya ” (Ch. Chi. 3) Santapa is a cardinal feature of Jwara so it affects eye also.

70. ज्वर् अभिताप (डल्हण ) High fever Due to high fever Along with head temp. of eye lso increases Probable Dosha : Pitta Diseases: Peri -orbital swelling, conjunctivitis in hay fever, etc.

71. ग्रन्थि Glandular disorders have impact on eyes like swelling around the eyes in hypothyroidism.

72. मेह As a complication of diabetes, eyes can also be affected. Diabetes mellitus leading to diabetic retinopathy.

73. Aupsargika R oga The Nidanas stated are: प्रसंगात् (get together) गात्र संस्पर्शाद् (Touching the skin) निःश्वसाद् (Contact with exhaled air) सह भोजनाद् (Eating together) सह्शय्या असनात् (Sleeping and Sitting together) वस्त्रमाल्य अनुलेपनात् (Sharing clothes, garlands & cosmetics)