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Computer vision syndrome ss-mys

  1. 1. “APPLICATION OF AYURVEDA SIDDHANTA INTHE MANAGEMENT OF COMPUTER VISIONSYNDROME”ByDr. K.S.DUTTA SHARMA.G, B.A.M.S.,Dissertation submitted to theRajiv Gandhi University of Health Sciences,Karnataka, Bangalore.In the partial fulfillment of the requirements for the degree ofDOCTOR OF MEDICINE (AYURVEDA)inAYURVEDA SIDDHANTAUnder The Guidance ofDr.K.NASEEMA AKHTAR M.D. (Ayu)Professor,Department of Post-Graduate Studies in Ayurveda Siddhanta,G.A.M.C., Mysore.Co-GuideDr.T.R.SHANTALA PRIYADARSHINI M.S. (Ayu)Asst. ProfessorDepartment of Post-Graduate Studies in Ayurveda Siddhanta,G.A.M.C., Mysore.DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,GOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.2008
  2. 2. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.DECLARATIONI hereby declare that this Dissertation “Application of Ayurveda Siddhantain the Management of Computer Vision Syndrome” is a bonafide and genuineresearch work carried out by me under the guidance of Dr.K.Naseema Akthar,Professor, Department of Post Graduate Studies in Ayurveda Siddhanta,Government Ayurveda Medical College, Mysore.Date : Signature of the CandidatePlace: Mysore Name: Dr. K.S.Dutta Sharma.G
  3. 3. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKADEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.CERTIFICATEThis is to certify that the dissertation entitled “Application of Ayurveda Siddhantain the Management of Computer Vision Syndrome” is a bonafide research workdone by Dr.K.S.Dutta Sharma.G in partial fulfilment of the requirement for thedegree of Doctor of Medicine (Ayurveda).Date: Signature of the GuidePlace: Mysore Dr.K.Naseema Akthar M.D. (Ayu).,ProfessorDepartment of Post Graduate Studies InAyurveda Siddhanta, Government AyurvedaMedical College,Mysore.
  4. 4. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKADEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.CERTIFICATEThis is to certify that the dissertation entitled “Application of Ayurveda Siddhantain the Management of Computer Vision Syndrome” is a bonafide research workdone by Dr.K.S.Dutta Sharma.G in partial fulfilment of the requirement for thedegree of Doctor of Medicine (Ayurveda).Date: Signature of the Co-GuidePlace: Mysore Dr. T.R.Shantala Priyadarshini M.S. (Ayu).,Asst ProfessorDepartment of Post Graduate Studies InAyurveda Siddhanta, Government AyurvedaMedical College,Mysore.
  5. 5. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKADEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTAGOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.ENDORSEMENT BY THE HOD, PRINCIPAL /HEAD OF THE INSTITUTIONThis is to certify that the dissertation entitled “APPLICATION OFAYURVEDA SIDDHANTA IN THE MANAGEMENT OF COMPUTERVISION SYNDROME” is a bonafide research work done by Dr.K.S.DuttaSharma.G under the guidance of Dr. K.Naseema Akthar Professor, Department ofPost Graduate Studies in Ayurveda siddhanta, Government Ayurveda MedicalCollege, Mysore.Seal & Signature of the HOD Seal & Signature of the PrincipalDr. N.Anjaneya Murthy Dr. Ashok D.SatputeDate: Date:Place: Mysore Place: Mysore
  6. 6. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA.DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.COPY RIGHTDeclaration by the CandidateI hereby declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate this dissertation /thesis in print or electronic format for academic / research purpose.Date : Signature of the CandidatePlace : Mysore Dr. K.S.Dutta Sharma.G© Rajiv Gandhi University of Health Sciences, Karnataka
  7. 7. Dedicated to…My Loving Parents  &  Dearest  Brothers  
  8. 8. ACKNOWLEDGEMENTAt this moment of submitting this dissertation in this Post Graduate study, myhead bows down with great humility at the feet of almighty Mother Chamundeshwari andLord Dhanwantari, without whose blessing, I would not have been able to attain thesestages in my life.I express my heartfelt and profound sense of gratitude to my beloved, Professorand HOD, Department of PG Studies in Ayurveda Siddhanta, GAMC, Mysore,Dr.N.Anjaneya Murthy for his constant guidance, continuous supervision and help atevery stage of this study.Words cannot express the zeal of ecstasy while depicting my deep source ofgratitude to my proficient guide Dr Naseema Akhtar.Her fruitful suggestions, optimisticview & motherly affection showered on me during this whole period & inspired me toaccomplish this work in all aspects.Words cannot express the zeal of ecstasy while depicting my deep source ofgratitude to my proficient Co-guide Dr.T.R.Shantala Priyadarshini. Her fruitfulsuggestions, optimistic view & motherly affection showered on me during this wholeperiod of study & inspired me to accomplish this work in all aspects.I am also thankful to Dr. Ashok D. Satpute, Principal, GAMC, Mysore, for hissupport during the period of my study.I would like to place on record my heartfelt thanks and deepest sense of gratitudeto my respected teachers Dr.V.A.Chate, Dr Venkata Shivudu for their keen observationand valuable recommendations throughout the dissertation and without whom mydissertation would not have taken this shape.I would like to place on record my heartfelt thanks to Dr.Rajendra, Dr.AnandKatti, for their patient hearing during times of my frustration and for offering valuablesuggestions and inspiration from time to time during my P.G. studies.
  9. 9. I express my enormous amount of thanks to my colleague’s & fabulousclassmates, Dr.Savitha, Dr.Soubhagya, Dr.Yogesh, Dr.Vijayalakshmi, Dr.Abdul,Dr Naveen, Dr L.N.Shenoy, and Dr Savita. H, and all P.G. colleagues, who made mystay in college very joyful and educative.I convey my thanks to my junior P.G. Colleagues Dr.Pankaj, Dr.Rajesh,Dr.Annapooorani, Dr.Aparna,Dr Ranjith,Dr Kalyani,Dr Ramesh & Dr Geetha fortheir help and overall support.I remain ever thankful to physician Dr.Ramachandra Naik, internees Dr.Aravind, Dr Vinutha and all other hospital staff for their valuable support during thecourse of the study.I extend my deepest regards to Mr. Subbanna, Smt. Varalakshmi, Mr.Basavaraju & Mr.Somashekhar Librarians, GAMC, Mysore, for their generous helpduring the course of my work.At the same time, it gives me immense pleasure to remember my respectedParents and brothers with a great dedication towards them with whose blessings,inspiration and moral support; I have been able to reach this height.I personally thank Dr. Lancy D’Souza for helping in statistical analysis andinterpretation.I acknowledge thanks to all persons who have helped me directly or indirectlywith apology for my inability to identify them individually.Small things make perfection but perfection is not a small thing. I seek pardon& apologize for any errors which might be remained in the work.Date:Place: Dr. K.S.Dutta Sharma.G
  10. 10. LIST OF ABBREVIATIONA.H. Astanga HridayaA.S. Astanga SangrahaCH CharakaCD ChakradattaCS Charaka SamhitaCkp ChakrapaniMN Madhava NidanaSa.Sa Sarangdhara SamhitaSu.Sa Sushruta SamhitaVAG VagbhataAOA American Optometric AsssociationMW Monier Williams Sanskrit English DictionaryCVS Computer Vision SyndromeBP BhavaprakashaYR YogaratnakaraAK AmarakoshaVK Vaidyaka KoshaVSS Vaidyaka Shabda SindhuRN Raja NighantuMK Medini KoshaSKD Shabda Kalpa DrumaSS Statistically significantHS Highly SignificantNS Non Significant
  11. 11. ABSTRACTBackground and ObjectiveComputer Vision Syndrome is a Vikara of Chakshurendriya, occurring due toAstmendriyartha samyoga and atiyoga of Chakshurendriya. Aggravated Tridosha, Vataand Pitta Dosha, in particular, are the prime factors involved in the pathogenesis. And itvery well co-relates with that of Netra roga poorvaroopa.CVS is a multifactorial condition commonly observed in the Computer users.According to the survey conducted by ‘India Today’, the prevalence of the disease in98% of software professionals. Considering the grave nature of the disease with its higherincidence, it has been selected for the present study to find out a better cure.Though Nidanaparivarjana is much highlighted and praised in the context ofchikitsa, it is not possible always to follow especially in a disease like CVS. In thepresent study Triphala Yashtimadhu Yoga a Chakshushya Rasayana is selected in theform of choorna owing to easy palatability, so that one can perform routine activitieswithout interruption.The objective of this present study was to understand the disease based onAyurvedic concepts and to evaluate the effect of Triphala Yashtimadhu Yoga in patientsof CVS.MethodsStudy Design - A conceptual study and a single blind clinical Study.Intervention – Total 30 patients were selected randomly and assigned into a single groupand administered with Triphala Yashtimadhu Choornam in the dosage of 12 grams BD(in divided dose)Data was collected before commencement of treatment, after completion of treatment andafter follow up. The data was analyzed using contingency coefficient and other statisticaltests.
  12. 12. ResultsEffect of Triphala Yashtimadhu Choorna showed highly significant results in parameterssuch as Dry and irritated eyes, Redness of eyes, Tearing eyes, Headache, Burning in eyes,Blurred vision and Photophobia.Interpretation and ConclusionAyurvedic siddhantas are eternal and can be applied in understanding any disease.Triphala Yashtimadhu Yoga a Chakshushya Rasayana is effective in a disease caused dueto Asatmendriyartha Samyoga.Key Words Computer Vision Syndrome Netra Roga Asatmendriyartha Samyoga Triphala Yashtimadhu Yoga
  13. 13. CONTENTSPage No #Introduction 1Objectives 3Review of LiteratureHetu 4Trividha Hetu 11Netra Shareera 18Netra Roga 28Netra Roga Chikitsa 41Drug Review 48Computer Vision Syndrome 56Previous works 65Materials 66Methods 67Observation 76ResultsDiscussion 117Conclusion 143Recommendation for Future Study 144Summary 145Bibliography 147Annexure i-xii
  14. 14. LIST OF TABLESSl.No. Table Name Page No1. Showing the Synonyms of Hetu from various Sanskrit books 062. Showing the Synonyms of Hetu according to various classics 063. Showing the Asatmendriyartha samyoga of Gnanendriya 144. Showing the panchamahabhuta and its dominant parts in eye 185. Showing the chakshurendriya panchapanchaka 216. Showing the classification of Netra roga according to various acharyas 307. Showing the Netra roga nidana according to various Acharya 328. Showing the Netra roga nidana according to various commentators 339. Showing the lakshana of netra roga based on dosha predominance 3510. Showing the dosha predominace in lakshanas of CVS 3611. Netra Roga dosha predominant Lakshana in comparision to CVS 3612. Showing the comparision of CVS with various netra roga in Ayurveda 4013. Showing the pathya in netra roga 4414. Showing the apathya in netra roga 4515. Showing the rasa panchaka of drug 5316. Distribution of patients according to Age group 7617. Distribution of patients according to Sex 7618. Distribution of patients according to Occupation 7719. Distribution of patients according to Education 7720. Distribution of patients according to Marital status 7721. Distribution of patients according Socio Economic status 7722. Distribution of patients according to Religion 7823. Distribution of patients according to Locality 7824. Distribution of patients according to Diet 7825. Distribution of patients according to Diet pattern 7926. Distribution of patients according to Rasa Sevana 7927. Distribution of patients according to Sleep 7928. Distribution of patients according to Duty 8029. Distribution of patients according to Addiction 8030. Distribution of patients according to TV watching 8031. Distribution of patients according to duration of occupation 81
  15. 15. 32. Distribution of patients according to duration of working hours 8233. Distribution of patients according to working hours in a week 8234. Distribution of patients according to prakruthi 8335. Distribution of patients according to sara 8336. Distribution of patients according to samhanana 8337. Distribution of patients according to pramana 8438. Distribution of patients according to satmya 8439. Distribution of patients according to satwa 8440. Distribution of patients according to agni 8441. Distribution of patients according to vyayama shakthi 8542. Distribution of patients according to desha 8543. Distribution of patients according to chief complaints 8544. Assessment of chief complaints before treatment 8645. Showing the result on Schirmers test-I 9746. Showing the result on Distant Vision 9747. Showing the result on Near Vision 9848. Showing the result on Dry & irritated eyes 9949. Showing the result on Rednes of eyes 9950. Showing the result on tearing eyes 10051. Showing the result on Headache 10152. Showing the result on Burning eyes 10153. Showing the result on Blurred Vision 10254. Showing the result on Photophobia 10355. Showing the result on Contact lens discomfort 10356. Showing the result on Slowness in focusing 10457. Showing the result on Changes is colour perception 10558. Showing the result on Pain in Shoulder 10559. Showing the result on Pain in Neck 10560. Showing the result on Pain in back 10661. The response of the therapy for individual symptoms after treatment 10762. The response of the therapy for individual symptoms after follow up 10863. Statistical analysis of Whole treatment results 109
  16. 16. LIST OF CHARTSSl.No. Table Name Page No1. Showing the classification of Hetu 82. Showing the classification of kala 83. Showing the physiology of vision (netra roopa grahana) 224. Showing the samprapthi of Netra roga 385. Showing the Netra roga samanya chikitsa 43LIST OF PHOTOGRAPHSSl.No Particulars Page No1 Showing the Raw Drugs in Triphala Yashtimadu Yoga 542 Showing the Prepared Medicine 553 Showing the Schirmers Test Strips 714 Showing the Schirmers Test Procedure 71LIST OF GRAPHSSl.No. Particulars Page No1. Distribution of Patients According to Age 882. Distribution of Patients According to Sex 883. Distribution of Patients According to Occcupation 894. Distribution of Patients According to Educational Status 895. Distribution of Patients According to Marital Status 906. Distribution of Patients According to Socio Economic Status 907. Distribution of Patients According to Religion 918. Distribution of Patients According to Locality 919. Distribution of Patients According to Diet 9210. Distribution of Patients According to Diet Pattern 9211. Distribution of Patients According to Rasa sevana 9312. Distribution of Patients According to Nidra 9313. Distribution of Patients According to Duty 9414. Distribution of Patients According to Vyasana 9415. Distribution of Patients According to Work duration 95
  17. 17. 16. Distribution of Patients According to Agni 9517. Distribution of Patients According to Symptoms 9618. Drug effect on Schirmers test - I 11019. Drug effect on Dry Eyes 11020. Drug effect on Red Eyes 11121. Drug effect on Tearing Eyes 11122. Drug effect on Headache 11223. Drug effect on Burning Eyes 11224. Drug effect on Blurred Vision 11325. Drug effect on Photophobia 11326. Drug effect on all symptoms before after & follow up of trial 11427. Clinical improvement in Dry Eyes 11528. Clinical improvement in Red Eyes 11529. Clinical improvement in Tearing Eyes 11530. Clinical improvement in Headache 11631. Clinical improvement in Burning Eyes 11632. Clinical improvement in Blurred Vision 116
  18. 18. Introduction1Ayurveda Siddhanta & Computer Vision SyndromeINTRODUCTIONAyurveda the science of "Ayu" – deals with maintenance of health and relieffrom the disease. This can be successfully achieved only when we follow the normslaid in Ayurveda. Apart from its rich and renounced heritage, Ayurveda has a rarecharm and glory of its own. As a great healer of the suffering mankind its contributionis eminent and unique.Ayurveda has put forward Siddhantas that are eternal and can be applied tounderstand the disease in all its aspects, in its diagnosis and treatment.TrisutraSiddhanta and Panchalakshana Siddhanta are a few among those Sidddhantas that aretime tested and can be applied to understand any disease irrespective of time.With the advent of time inevitable changes in food habits, life styles,occupational challenges and environment has lead to the manifestation of newdisorders. Computer Vision Syndrome is one among such disorders occurring incomputer professionals characterized by complex eye and vision problems related tonear work which are experienced during working with computers involving bothocular and non ocular symptoms. The catastrophic effects of this disorder are lowwork performance, agony, extreme discomfort that hampers daily routine. Negligencetowards it could cost ones career resulting in Physiopsychological upset and severeeye problems.The problem is grave according to American Optometric Association with anincidence in 75% -90% of employees working with Computers and more people arelikely to suffer in the future due to rapid growth of jobs in IT sector in India. So it isthe need of the hour to find a holistic solution to this problem.In the present context I have taken Computer Vision Syndrome and madeeffort to explain it on the basis of Ayurveda Siddhanta like Hetu,trividha hetu,panchlakshana nidana and the general line of management mentioned in Ayurveda samhitasfor aganthuja netra roga. So this study is intended to study and understand “ComputerVision Syndrome” a disorder not mentioned in Ayurvedic classics based on various
  19. 19. Introduction2Ayurveda Siddhanta & Computer Vision SyndromeAyurveda Siddhanta and to find out a suitable Chikitsa Siddhanta based on the aboveobservations, from these prospects the present study has been taken.It also comprises of a clinical study to evaluate the efficacy of TriphalaYashtimadhu Yoga and its efficacy on symptoms with a time span of sixty days fortreatment and also its focus being on reliving of symptoms and management of thedisease.The first part is mainly concerned with the review of literature regardingvarious aspects of the disease such as, nirukti, bheda, paribhasha, Hetu, Trividha hetuand Nidana panchaka etc, are reviewed and elaborately discussed. The second partconsists of details of clinical trials of the effect of Triphala Yashtimadhu Yoga onComputer Vision Syndrome.It comprises of the materials and the methods used for the study, the resultsand the observations of the study and the discussion on them. A summary of the studyis provided in the last part of the dissertation with some suggestions for the futurestudies.The study has shown that Ayurveda has a significant role to play in themanagement of Computer Vision Syndrome.  
  20. 20. Objective3Ayurveda Siddhanta & Computer Vision SyndromeOBJECTIVES OF THE STUDYThe present study was undertaken with the following objectives1. To understand Trividha hetu involved in causation of Computer Vision Syndrome.2. To understand the disease based on Pancha Lakshana Nidana.3. To make an analytical study on the role of Prakruthi, and occupational influence incausation of the disorder.4. To evaluate suitable Chikitsa based on the above observations.5. To evaluate the efficacy of TriphalaYasthimadhu yoga in patients of ComputerVision Syndrome clinically.
  21. 21. Review of Literature4Ayurveda Siddhanta & Computer Vision SyndromeHETUAccording to Ayurveda a vyadhi is generally studied under the five mainheadings to understand the entire process of a disease manifestation. They are Nidana,Purvaroopa, Roopa, Upashaya and Samprapti respectively, also called as NidanaPanchaka1. Among these nidana panchaka ‘Hetu’ stands first and forms the base orroot cause for the latter stages viz, purvaroopa, roopa etc. A vyadhi is never devoid ofits hetu. Even the Karyakarana sidhantha confirms that a karya / vyadhi are not devoidof its karana / hetu2. Further it can be said that a wise treatment begins with nidanaparivarjana as told by Acharya Sushruta i.e., “Nidanaparivarjanameva chikitsa”. Thushetu plays a chief role in roga nidana and its chikitsa also.DerivationThis is a “pumling” word3Hetu = hi gatou (dhatu) 4+ Tuna pratyayaHi- to send forth, to impel, to promoteHi- hinoti, hita1. Hinoti vyapnoti karyam iti 5Hinothi- To promote furtherVyapnothi- pervading, penetrating, to spread throughoutThe word meaning of hetu is that which promotes and spreads the karya and is akarana.2. Pum hi tanu kaarane anumithi sadhane vyape phale chaIt is the pumlinga shabda with synonyms like karana, anumiti, sadhana, vyape, phale.Definition1. Seti kartavyatako rogotpaadaka heturnidaanam6The factor which causes rogotpatti by vitiating the dosha is called nidaana2. Tatra nidaanam kaaranam7Etiological factor or causative factor3. Vyadhi utpattti hetuhu nidaanamThe factor which is responsible for the disease causation or manifestation.4. Tatra hetuhu utpattikaaranamHetu is a causative factor (karana) for vyadhi.
  22. 22. Review of Literature5Ayurveda Siddhanta & Computer Vision Syndrome5. Hetus tad udbhave 8Hetu is that which gives rise to disease*In all the above context hetu = nidanam, hetu and nidanam are used as samanarthaHISTORICAL REVIEW OF HETUA) Veda kalaRogotpadaka karanas are shareeragata mala roopavisha, krimi, vata, pitta and kapha.9B) MahabharataSheeta, Ushna, and Vayu are the cause for shareerika vyadhis is found in Shantiparva16thadhyaya.C) Samhita kalaa. Brihat Trayee1. Charaka Samhita: Acharya Charaka has explained hetu in sutra sthana 1st, 11th,25th, and 28thchapter. In nidana sthana 1stchapter and in shareera sthana1st& 2ndchapter and in vimana sthana 6thchapter.2. Sushruta Samhita: Acharya Sushruta has explained hetu in sutrasthana 3rdhapter,explained it as an ‘upaya’ and karaka hetu.3. Asthang Hrudaya: Acharya Vagbhata has explained hetu in sutrasrhana 1stchapterand also under nidanapanchaka in nidanasthana 1stchapter.b. Laghu Trayee1 Madhava nidana explained in 1stchapter about hetu.2 Bhavaprakasha: Bhavamishra mentioned and described hetu in Rogaprateekaraprakarana the 7thchapter of poorvakhanda.c. Other classical texts1 Astanga Sangraha: Acharya Vagbhata described hetu in sutrasthana 1st, 22ndchapter and under nidana panchaka in nidana sthana 1stchapter.2 Yogaratnakara: Has explained that kupita malas are the nidana for all the diseases.Kupitamala here means vata, pitta and kapha.3 Gadanigraha: Gadanigrahakara explained hetu under rogagnana sadhana injwaradhikara.
  23. 23. Review of Literature6Ayurveda Siddhanta & Computer Vision Syndromed.Recent Ayurvedic literature1. Nidanachikitsa hastamalaka: Vd Ranajit rai desai expalained hetu under nidanapanchaka.2. Doctrines of pathology in Ayurveda: Dr K.R.Srikantha Murthy described hetu in9thchapter3. Ayurveda Vikriti Vignaan: Vd Vidyadhar shukla explained hetu in 20thchapterunder nidana panchaka.Table No.1 Synonyms of Hetu as per Sanskrit textsTypes of hetu AK VK RN MK VSS1. Hetu  - - - -2. Karana  - -  3. Nidana  - - - -4. Aadikarana  - - - -5. Anumiti - - - - 6. Sadhana - - - - 7. Vyape - - - - 8. Phale - - - - 9. Roganirnaya -  - - -10. Beejam  - - - -11. Roga Hetu - -  - -Synonyms of HetuVarious synonyms as per different classics are as follows. All of them give commonmeaning as hetu karana10Table No.2 Synonyms of Hetu as per Ayurveda CS11Ckp12AS AH13MN14BP151 Hetu      2 Nimitta      3 Aayatana      4 Karta    - - -5 Karana      6 Pratyaya      
  24. 24. Review of Literature7Ayurveda Siddhanta & Computer Vision Syndrome7 Samutthana    - - -8 Utthana - -  - - -9 Nidana   - - - 10 Yoni -   - - -11 Mukha -  - - - -12 Mula -   - - 13 Karaka - -  - - -14 Prerana -  - - - -15 Prakruthi -  - - - -16 Nibandha - - - - - Types of HetuAccording to Madukosha tika 16the hetu’s are broadly classified according to theirrole in causation of a disease.A) Dvividha hetu:1) a) Bahya b) Abhyantara2) a) Utapadaka b) VyanjakaB) Trividha hetu: 1. a) Asatmendriyartha Samyoga b) Prajnaparadhac) Parinaama.2. a) Dosha hetu b) Vyadhi hetu c) Ubhaya hetu.C) Chathurvidha hetu: a) Sannikrishta b) Viprakrusta c) Vyabhicharid) Pradhanika
  25. 25. Review of Literature8Ayurveda Siddhanta & Computer Vision SyndromeAti.Y Ayo Mit.yImportance of HetuThe Ttrisutra of Ayurveda explained in Charaka Samhita states that theknowledge of hetu, linga, aushadha is applicable to both swastha and atura. Hetu isconsidered the first among trisutra, also denoting its importance as karana for rogaand arogya. Kala, artha and karma are 3 types of hetu and its tri vikalpa i.e., atiyoga1. Sannikrishta, 2. Viprakrishta 3. Vyabhichari 4. PradhanikaHetu1.Astamendriyarthasamyoga2. Prajnaparadha3. ParinaamaDosha HetuVyadhi HetuUbhaya HetuDhiDhrtiSmrtiVibhramsha1. Bahya Hetu 2.Abhyantara Hetu 1. Vyanjaka 2. UtpadakaHetuSparsTwakhaSamavayiDushyaAsamavayiDosha dushya sammurchana(dhatu & mala)NimittaMithyahara viharaParinama (kala)Prajnaparadha (Karma)Asatmendiyartha Samyoga (Artha)GandhaGhranaRasaJihwaRupaChaksuSabdaSrotraAti.y Ayo Mith.ManasikaVachikaKayikaAti.y Ayo Mith.y Ati.y Ayo Mith.y Ati.y Ayo Mith.y
  26. 26. Review of Literature9Ayurveda Siddhanta & Computer Vision Syndromeayoga and mithyayoga are the cause for diseases and their samyagyoga (of indriyarthaprajna, and parinama) is the cause for health. So it can be understood that Roga Hetuare Atiyoga, Ayoga and Mithyayoga of Kala,Artha,Karma and Arogya Hetu aresamyagyoga of Kala,Artha,Karma.Utility of HetuHetu is helpful in knowing1. Vyadhi karana:Hetu is karana for vyadhi. So by knowing the hetu involved the vyadhi Karanaand its severity is known.2. Vyadhi vinischaya:If there is any doubt regarding the diagnosis of a disease, observation of theetiological factors leads to the confirmation of vyadhi.3. Sadhya asadhyata:Hetu is very helpful to decide the sadhyasadhyata of a vyadhi. Alpa hetu causesalpa Lakshana in a vyadhi and its sukhasaadhya lakshana.4. Upashaya anupashaya:Upashaya is opposite to hetu and anupashaya is similar to hetu.5. Chikitsa:Nidana is a synonym for hetu and nidana parivarjana is a type of chikitsa.MODERN REVIEWEtiology or Cause18Hetu word is synonymous to etiology in modern medical literature.DerivationEti-ol-o-gy or Aeti-olo-gy,Aitia - a charge, accusation, causeLogos (logy) – word of speech, treatise, discourseAitia + logos = the doctrine of causes,So the word meaning of etiology can be derived asThe discourse about the cause of a disease
  27. 27. Review of Literature10Ayurveda Siddhanta & Computer Vision SyndromeDefinitionThe study of causes specifically the cause of disease 19orThe science dealing with causes of disease 20.In modern terms there are two major classes of etiological factors1. Intrinsic or genetic2. Acquired (infectious, chemical, nutritional, physical)Knowledge or discovery of the primary cause remains the backbone on which thediagnosis can be made, a disease understood or a treatment adopted.The four aspects of a disease process that form the core of pathology are1. Etiology- cause2. Pathogenesis- the mechanism of its development.3. Morphology- the structural alterations/changes induced in cells and organs of thebody.4. Symptoms/Clinical manifestations - the functional consequences of morphologicchanges.In Ayurveda a disease is studied under 5 stages (Nidana panchaka) and inmodern it is studied in 4 stages. In both these medical systems etology/hetu is the firstand foremost factor which denotes the cause / causative factor of a disease.
  28. 28. Review of Literature11Ayurveda Siddhanta & Computer Vision SyndromeTRIVIDHA HETUINTRODUCTIONIn Ayurvedic classics it’s often stressed that trividha hetu namelyAsatmendriyartha samyoga, Prajnaparadha and Parinaama are the prime cause in thedisease origin especially of shareerika and manasika21. Though varieties of hetuclassification have been made like dvividha, trividha, chaturvidha etc but all thesehetus can be incorporated under single heading as trividha hetu. Among these trividhahetu again we can find the specific role of single hetu in different diseases, eg-Asatmendriyartha samyoga, plays an important role in indriyajanya vyadhis22.Thustrividha hetu occupy a broader place in the field of hetu.DefinitionThe hinayoga atiyoga and mithyayoga of artha, karma and kala is termed as treeniaayatanani or trividha hetu23.TypesAsatmendriyartha samyoga, prajnaparadha and parinaama are of three type’s each24HISTORICAL REVIEW OF TRIVIDHA HETUUpanishadIn Shwetashwaropnishad ‘Kaalo hi naama sarva bhutanaam aviparitanaama hetu’ ismentioned.BhagavadgeetaIn 2ndchapter indriya nigraha as the cause for sukha has been menSamhita kaalaa. Brihat TrayeeCharaka samhita1st, 11th, 20th, 25th, 28thchapters in sutrasthana. 1stchapter in nidanasthana. 1stand 2ndchapter in shareersthana explains about trividha hetu.Sushruta samhitaAcharya Sushruta has explained Asatmendriyartha samyoga, andPrajnaparadha as hetu in 61stchapter of uttaratantra, mithyayoga, ayoga and atiyogaof artha, karma as apasmara hetu and also explanation of kala is available insutrasthana 6thchapter.
  29. 29. Review of Literature12Ayurveda Siddhanta & Computer Vision SyndromeAstanga SangrahaVagbhata sutrasthana explains trividha hetu in 1st, 22ndchapters and in 1stchapter of nidanasthana.Astanga Hrudaya1stand 12ndchapter of sutrasthana, and under nidanapanchaka in nidanasthana.LaghutrayeeMadhava Nidana-1stchapter explains about trividha hetud. Recent Ayurvedic literature1. Nidanachikitsa hastamalaka: Vd Ranajit rai desai expalained hetu under nidanapanchaka.2. Doctrines of pathology in Ayurveda: Dr K.R.Srikantha Murthy described hetu in9thchapter3. Ayurveda Vikriti Vignaan: Vd Vidyadhar shukla explained hetu in 20thchapterunder nidana panchaka.Trividha Hetu Importance1. For all sorts of vedana the trividha hetu in the form of dhi, dhriti and smritivibhramsha, karma, kaala samprapti and asatmendriyartha samyoga are maincauses.252. The mithyayoga, ayoga and atiyoga of Kaala (parinaama varshadi ritu), Buddhi(prajna), Indriyartha (shabda, sparshadi, bhogya dravya guna karma) are the maincause in all type of shareerika and manasika vikaras26.3. This is again strengthened by charaka in sutrasthana stating them as ‘treeniaayatanani’ & ‘nidanatrayi’ respectively27.4. It is further declared by charaka in shareera sthana, that it is trividha hetu only viz(Astmendriyartha adi….) as main cause in the disease origin28.ASATMENDRIAYRTHA SAMYOGAIntroductionThe literal meaning of Asatmendriyartha is a state unfavourable for the indriyawith their vishaya. The word indriyartha is applied for jnanendriya only which are
  30. 30. Review of Literature13Ayurveda Siddhanta & Computer Vision Syndromefive in number viz (Shabda, Sparshadi, etc).The hina yoga, atiyoga and mithya yogaof indriyas with their respective vishyas create unfavourable situation specifically toindriyas and thereby to the body causing a disease. Among trividha hetu’s it is thenearest or immmediate cause in the disease manifestation.AsatmyaDerivation‘Asatmya’ word is formed by derived by adding two upasarga A+SA to Atma shabdathen the word Asatmya is formed. A+sa+atma = asatmyaDefinitionAsatmya – Those vishaya of indriya creating unfavorable state for body and mind29IndriyaDerivationIndriya- derived from ‘Ida’ dhatu and ‘gha’ pratyaya meaning it is the ruler of the body.DefinitionPrana is termed as Indra and its linga is indriya. So, that which gives sensoryknowledge is called indriya.ArthaVishaya or knowledge attained through a particular indriya is called artha. Indriyavishyas viz shabda, sparsha roopa rasa adi are the indriyarthas of shrotrendriya,Sparshendriya etcSamyogaDerivationIt is derived from adding Sama (upasarga) + yuj (dhatu) + gha (pratyaya)DefinitionSamyogam nama dwayorbahoonaam vaa dravyanam samhatee bhavaha. Combinationof two or more dravyas is called Samyoga.TypesDepending upon the indriya, its indriyartha and its hina, ati or mithya yoga theasatmendriyartha samyoga is classified as follows30
  31. 31. Review of Literature14Ayurveda Siddhanta & Computer Vision SyndromeTable No.3 Asatmendriyartha Samyoga of GnanendriyaIndriya IndriyaArthamAtiyoga Ayoga MithyayogaKarna ShravanamAtiShravanamAshravanam Uccha,parusha,bhishanadishravanamTwak SparshanamAtiSparshanamAsparshanam Abhighata,visha,vaatadisparshanamChakshu DarshanamAtiDarshanamAdarshanam Sookshma,atidoora,bhaswadarshanamNasa Ghranam Ati Ghranam Aghranam Putya,medhyati,teekshna,ugra,ghranamJihwa Rasanam Ati Rasanam Arasanam Apathy,vishama,arasagrahanamPARINAAMAIntroductionParinaama in general means avastha or parivartana brought by the influence ofkala. Acharya charaka had used tha word ‘kaala’ for parinaama31.since ati, hina andmithya yoga of kaala brings dosha vitiation in the shareera and causes vyadhi. Inayurveda kaala is also given importance and its explaination is found in many placesin classics.DerivationIt is derived from ‘pari’ upasarga, ‘nama’ shabda and ‘ghama’ pratyaya.Meaning of which is transformation32KaalaKa + Aa+ La = KaalaThe lakaar and akaar of kaala shabda and lakaar of lee dhatu when unites thekaala shabda occurs.Similarly, the one which destroys the entire things of the worldand assemble them together and also brings all the karya dravya to their destruction.Definition‘Sa sookshmamapi kalaam na leeyate iti’That which does not stay even for the fraction of second and is gatisheela iscalled kaala33
  32. 32. Review of Literature15Ayurveda Siddhanta & Computer Vision SyndromeTypesThough variety of classification of kaala is elaborately explained by ouracharyas 34but for the vyadhi utapatti and chikitsa purpose the entire kaala is dividedinto four in one samvtsara and again in the trividha kaala namely sheeta, ushna andvarsha are the main under which the remaining kaala is to be considered and treatmentcan be carried based on this kaala only35.Kaala ChartImportance of Parinaama1. The hina, ati or mithya yoga of any of the seasonal variation becomes a cause forvyadhi utapatti36.2. Parinaama is also understood as ‘kaala’ and since kaala is transforming the resultsof shubha ashubha karma, dharma and adharma etc.,37KaalaSamvatsara1. Visarga2. AdanaTrividha Shadvidha Dvadashavidha1. Sheeta2. Ushna3. Varsha1. Sishira2. Vasanta3. Grishma4. Varsha5. Sharat6. Hemanta1. Magha2. Phalguna3. Chaitra4. Vaishakha5. Jyesta6. Aashada7. Shravana8. Bhadrapada9. Ashwaija10. Kartika11. Margasirsha12. PushyaDvividha
  33. 33. Review of Literature16Ayurveda Siddhanta & Computer Vision Syndrome3. The kaalaja rogas are powerful in their respective kaala and hence their treatmentshould be done in advance to subdue their effect38.4. For the kaalaja swabhavika rogas like jara, mrityu, there is no treatment i.e.akalajanya jaradi conditions are treatable39.PRAJNAPARADHAIntroductionThe very literal meaning of prajna is consciousness. It is one of theimportant hetu among trividha hetu. Some commentators limit the meaning of prajnato intellect, however the definition of prajnaparadha stating as the error of dhi, dhruti,and smriti resulting ashubha karma of kaya, vacha and mana surpasses this limitationof merely intellectual error40. The word ‘karma’ is used for prajnaparadha. The wordkarma has a very wide meaning indicating the karma of kaya, vacha and manasa aswell as purvajanmakrita and sadyojanmakrita too. The word ashubha karma in thedefinition states that disturbed state of dhi, dhriti, and smriti respectively. The hina, atiand mithya yoga of such karma causes vyadhi utapatti. Thus prajnaparadha occupiesan important place in trividha hetu.DerivationIt is derived from jna (mulashabda) – jnayate iti shabda, ‘pra’ upasrga, jnayate itiartha i.e, prajna and its aparadha forming prajnaparadha41.The word prajnaparadha is a karmadhari samasa composed of two words – Prajna –To know/ understand (especially a way or mode of buddhi)Aparadha – An offencePrajnaIt is a streelinga shabda representing buddhi tattva of saraswati devi.AparadhaIt is a pumlinga shabda derived from ‘apa’ and’ radha’ dhatu..DefinitionThe ashubha karma brought about by kaya, vacha and manas in the disturbedstate of dhi, dhriti and smriti is said or defined as prajnaparadha.TypesAs per the definition it is classified into 3 types viz kayika, vachika andmanasika with again its three subtypes as hina, ati and mithyayoga respectively.
  34. 34. Review of Literature17Ayurveda Siddhanta & Computer Vision SyndromePrajnaparadha as major cause for diseasesIt is stated in the classics that the rogotapatti of jwaradi rogas (viz. jwara,raktapitta, gulmadi…etc) are started because of dharma hrasa or adharma in dwapaarayuga. Along with it there is decline in the quality of sasya also.42The factors like lobha, abhidroha and kopa are included under adharma injanapadodhwansa adhyaya. It is mentioned in classics that for vatadi dusti andadharma the prajnaparadha is the moola yoni or karana43. This clearly indicates that, itis the prajnaparadha only in the form of adharma as the root cause in the jwaradirogas.In the manifestation of almost all the disease the trividha hetu vizasatmendriyarthadi always exists. However, prajnaparadha is the prime root in all thedisease maniefestation accompanied with asatmendriyartha samyoga and kaala. Thiscan be understood by nidanokta samprapti of diseases, which will reveal the fact thatall the diseases are caused by the stimuli of prajnaparadha associated withasatmendriyartha samyoga and parinaama.
  35. 35. Review of Literature18Ayurveda Siddhanta & Computer Vision SyndromeNETRA SHAREERAImportance of EyesOne need not emphasize the importance of the eyes as scriptures say‘Sarvendriyanaam Nayanam Pradhaanam’ “nothing in this world is as good andperfect as, unaided vision”. Eyes were greatly valued by ancient Indians and muchimportance was accorded to their protection and care.Historical reviewThe description of eye can be traced in Vedic litrature.The divine Vaidyas,Ashwini used to perform ophthalmic operations with the knowledge of anatomy. TheBrhadāranyaka Upanishad narrates about Akşhi. Chakshushopanishat is also devotedto eye care.The Uttara Tantra of sushruta samhita gives a vivid description of the eye, itsanatomical description, along with classification of its diseases and their managementis explained in detail44.Synonyms of eyeAkşi, Cakşu, Dŗşţi, Netra, Nayana and Lochana are the different synonymsused in Ayurveda Samhitas. The synonyms related to the organ of sight are Akshi,Netra, Nayana, and Lochana these words are used in anatomical sense and Netra is awidely used word for the organ of sight45-.Panchabhautika concept of NetraThe Netra, like all other organs of the body is made up of Panchamahabhutasand drushti is pancha maha bhuta prasasda bhaga.Sushruta has clearly mentioned thecontribution of Panchamahabhutas as follows46Table No 4. Panchamahabhoota dominant parts in netraMahabhoota PartPrithvi Mamsabhaga (muscular portion)Jala Shweta bhaga (white portion)Tejas (Agni) Rakta bhaga (red portion)Vayu Krishna bhaga (black portion)Akasha Ashru marga/ Srotas (tear channels)
  36. 36. Review of Literature19Ayurveda Siddhanta & Computer Vision SyndromeNetra Rachana47Situation: Siras is the uttamanga of the body. All the senses are situated in it andsupported by the head. Netra are the two among the seven external openings of theShirasShape: Acharya Sushruta in Sushruta Samhita Uttartantra has described Netra as“Suvrittam, Gostanakaram Nayana Budbudam”, which denotes the shape andconsistency of the Netra.Size: The measurements of the eyeball was described by Sushruta as 2 AngulaBahulya (anterio posteriorly) or equal to central part of ones own thumb(swangushtodara sammitam) and 2½ Angula Sarvata sardham (circumference).Parts of NetraThe anatomical parts present in eye consists of 5 Mandala, 6 Sandhi and 6Patala.The same division was adopted by Vagbhatta, Madhavakara and Bhavamishraalso.MandalaThe word Mandala is made from root ‘Mad’ + ‘Klach’ pratyaya means,covering circular areas or concentric circles. The are 5 Mandala1) Pakshma Mandala2) Vartma Mandala3) Shweta Mandala4) Krishna Mandala5) Drishti MandalaSandhiSandhis are the junctional areas between two Mandalas. The Sandhis areimportant as far as the pathogenesis of the diseases is concerned, because the diseases,of one Mandala may spread to another through these junctional areas. They are1. Pakshma – Vartma gata Sandhi2. Vartma – Shukla gata Sandhi3. Shukla – Krishna gata Sandhi4. Krishna – Drishti gata Sandhi
  37. 37. Review of Literature20Ayurveda Siddhanta & Computer Vision Syndrome5. Apanga Sandhi6. Kaneenika SandhiPatalaV.S. Apte, in his Sanskrit – English dictionary describes the meaning of Patalaas a film or coating over the eyes. According to Monier Williams, it can be consideredas a layer of the eyeball.The thickness of each Patala is 1/5th of the Drishti Mandala.There are 2Vartma Patalas and 4 Akshi Patalas. The Vartma Patalas can be considered as thelayers of the Vartma – the eyelids and palpebral conjunctivaThe four Akshi Patalas are related to the eyeball itself. 1st Patala Tejas + Jala,2nd Patala Mamsa (Pisita or Mamsashrita), 3rd Patala Medas Medoashrita, 4th PatalaAsthi –Asthyashrita.Akshi BandhanaSirā, Kandarā, Meda and Kālakāsthi aid in maintaining the position of netra.Sira & DhamaniThere are 38 Sirā which transport Vāta (8), Pitta (10), Kapha (10) and Rakta(10) in the Netra. Vāgbhata has mentioned 65 Sirā in the Netra the two Dhamani arein each eye for transmission of Roopa (visual impulses) to the mind and otherdhamani are for ashru vahana.Peshi and snayuMandala (circular) type of Peshi and Pruthu (broad) type of Snayu are found inthe eyes. They are respectively two and thirty in number.Asthi and sandhiNetra are situated in Akshi kosha surrounded by TarunasthiMarma‘Apānga’ a Sira Marma and ‘Avarta’ a Sandhi Marma are related with Netra.Any injury to these sites may result in loss or impairment of vision.
  38. 38. Review of Literature21Ayurveda Siddhanta & Computer Vision SyndromeDescription of DrishtiEtymologyDrish + ‘Ktin Karane’ pratyaya meaning there by a “tool to see”Drishti is described by Sushruta as: Masura dala matra (size of a Masura dala) Prasada of Panchamahaboota Covered by the external Patala Khadyotavisphulingabha (Sparkling like a glow worm) Shape resembles a hole (Vivirakritim) Benefited with cold thingsDrishti means vision. All the anatomical structures through which light passes toreach the retina including the optical zone of cornea, aqueous humour, lens, vitreoushumour and retina can be included in the Drishti as per many scholars.CONCEPT OF DRISHTI IN AYURVEDAVisual perception, like all other sensory phenomena, is dependent upon thestate of mind and soul. Acharya Charaka has described this process as the conjunctureof soul, mind and the sense organ with their objects. Kashyapa classifies senses intoSannikrishta Indriyas and Viprakrishta Indriyas. Eyes and ears are ViprakrishtaIndriyas, where in object need not directly fall on the senses. Eyes are developed withsufficient skills to perceive the object from a sufficiently large distance.The theory of Panchapanchaka given by Acharya Charaka depicts thephenomenon of sensory perception by enumerating the five important factors that takepart in this process. They are Indriya, Indriya Dravya, Indriya Artha, IndriyaAdhisthana and Indriya Buddhi. In case of eye, these factors are as followsTable No.5. Indriya panchapanchaka of netraIndriya ChakshuIndriya Dravya TejasIndriya Artha RupaIndriya Adhishthana Eyes (2 Netra)Indriya Buddhi Chakshurbuddhi
  39. 39. Review of Literature22Ayurveda Siddhanta & Computer Vision SyndromeImpulses from both these Akshis are collected at Chakshu47(Indriya), which isonly one in number. Further it will be analyzed at the level of Chakshurbuddhi(Indriya Buddhi) to give actual knowledge of the objects.The subtypes of Doshas likePrana Vayu and Vyana Vayu are specifically held responsible for Vata Karmas,Alochaka Pitta for Darshana and Tarpaka Kapha for Akshi Tarpana.Eyes are most important among the five Jnanendriyas. So its function can beconsidered as the function of Jnanendriya. The physiology of vision can besummarized as followsIndriyartha (Object)VataIndriyavayavaChakshurvaisheshikaAlochaka PittaIndriya Samvedaka (nerve impulse)Prana VayuBuddhi (occipital cortex)BuddhirvaisheshikaAlochaka PittaPratyakshajnana(Atma – seat of knowledge)Similar ideas are reflected in the description of two phases of Chakshurbuddhi48. Themomentary knowledge is obtained by Kshanika Chakshurbuddhi, which will befurther confirmed in the second stage by Nischayatmika Chakshurbuddhi, accordingto Chakrapanidatta.
  40. 40. Review of Literature23Ayurveda Siddhanta & Computer Vision SyndromeANATOMY OF EYEIntroductionEven though the eye is small, it serves a very important function i.e. sense ofsight. Vision is arguably the most useful of the five senses and is one of the primarymeans to gather information from the surroundings. Eye is often compared to acamera. Two eye balls are situated in the two bony orbits of the norma-frontallis ofthe skull49and protected by eye lids and eye lashes. Each eye ball is a cystic structurekept distended by the pressure inside it. Each of them gathers light and thentransforms that light into a “picture”.Dimensions of an adult eye ballAntero-posterior diameter 24mmLateral diameter 23.5mmVertical diameter 23mmCircumference 75mmVolume 6.5mlWeight 7gmsCoats of the eye ballThe eye ball comprises of three coats1) The outer fibrous tunic = sclera and cornea2) The middle vascular tunic = iris, ciliary body and choroids3) The inner nervous tunic = retinaInterior of the eyeball has the following structures1) Aqueous humor2) Lens3) VitreousThe accessory structures are1) Eyebrows2) Eyelids and eyelashes3) Lacrimal apparatus
  41. 41. Review of Literature24Ayurveda Siddhanta & Computer Vision SyndromeScleraThe sclera forms posterior 5/6 of the eye ball. It has received its name from itsextreme dense fibrous tissue which is hard and maintains the shape of eyeball. Itsexternal surface is white in colour.CorneaThe cornea is a transparent anterior one-sixth of the fibrous coat of the eyeball.It is almost circular in outline.It is convex anteriorly and projects like a dome in frontof the sclera. The cornea is dense and of uniform in thickness throughout; its posteriorsurface is perfectly circular in outline, and exceeds the anterior surface slightly indiameter. its separated from iris by the aqueous humour in the anterior chamber.IrisThe iris has received its name from its various colors in different individuals.It is a thin, circular, contractile disk, suspended in the aqueous humor between thecornea and lens, and perforated a little to the nasal side of its center by a circularaperture, the pupil. On its periphery it is continuous with the ciliary body, and is alsoconnected with the posterior elastic lamina of the cornea by means of the pectinateligament; its surfaces are flattened, and look forward and backward, the anteriortoward the cornea, the posterior toward the ciliary processes and lens. The iris dividesthe space between the lens and the cornea into an anterior and a posterior chamber.RetinaThe Retina is soft, semitransparent, having a purple tint in the fresh state,owing to the presence of a coloring material named rhodopsin or visual purple; but itsoon becomes clouded, opaque, and bleached when exposed to sunlight. Exactly inthe center of the posterior part of the retina, corresponding to the axis of the eye, is anoval yellowish area, the macula lutea; in the macula is a central depression in thefovea centralis. At the fovea centralis the retina is exceedingly thin, and the dark colorof the choroid is distinctly seen through it. About 3 mm to the nasal side of the maculalutea is the entrance of the optic nerve (optic disk), the circumference of which isslightly raised to form an eminence (colliculus nervi optici) the arteria centralis retinæpierces the center of the disk.
  42. 42. Review of Literature25Ayurveda Siddhanta & Computer Vision SyndromeThis is the only part of the surface of the retina which is insensitive to light, and it istermed the blind spot.Aqueous humorThe aqueous humor fills the anterior and posterior chambers of the eyeball. Itis small in quantity, has an alkaline reaction, and consists mainly of water, less thanone fiftieth of its weight being solid matter, chiefly chloride of sodium.Crystalline lensThe lens is made up of soft cortical substance and a firm, central part, thenucleus.The crystalline lens, enclosed in its capsule, is situated immediately behindthe iris, in front of the vitreous body, and encircled by the ciliary processes, whichslightly overlap its margin. The lens is a transparent, biconvex body, the convexity ofits anterior being less than that of its posterior surface.EyebrowsEye brows are two arched eminences of integument, which surmount theupper circumference of the orbits, and support numerous short, thick hairs, directedobliquely on the surface.EyelidsEyelids are two thin, movable folds, placed in front of the eye, protecting itfrom injury by their closure. The upper eyelid is the larger, and the more movable ofthe two, and is furnished with an elevator muscle, the Levator palpebrae superioris.EyelashesEyelashes are attached to the free edges of the eyelids; they are short, thick,curved hairs, arranged in a double or triple row: those of the upper eyelid, morenumerous and longer than those of the lower, curve upward; those of the lower eyelidcurve downward, so that they do not interlace in closing the lids.Lacrimal apparatusLacrimal apparatus consists of the lacrimal glands, which secretes the tearsand convey the fluid to the surface of the eye, and its excretory ducts, the lacrimal
  43. 43. Review of Literature26Ayurveda Siddhanta & Computer Vision Syndromeducts, the lacrimal sac, and the nasolacrimal duct by which the fluid is conveyed intothe cavity of the nose.Physiology of visionIn some ways the eye is like a camera. Its optical elements focus the image ofobjects on a light sensitive film- the Retina, while ensuring the correct amount of lightmakes the proper exposure. In order to achieve clear vision, light reflected fromobjects within the visual field is focused to the retina of both eyes. The processesinvolved in producing a clear image are –a) Refraction of the light rays by the lens and camerab) Accommodation of the eyes to lightThe retina is the photosensitive part of the eye. The light sensitive cells are therods and cones. When light falls upon the retina, it acts as a stimulus to the rods andcones, which serve as the sensory nerves endings. An image focused on the retinastimulates photo receptors, which transduce the light stimulus into receptor potentialand pass the information on to bipolar cells. Bipolar cells, in turn communicateganglion cells, which project their axons to the lateral geniculate body of thethalamus. From the thalamus, fibers carrying visual nerve impulses extend to theprimary visual center in the occipital lobe.In the outer segment of the photoreceptors,the transduction of light into electrical signals takes place. The first step in thisprocess is absorption of light by rhodopsin/iodopsin (photopigments). These photopigments have two parts -i) A glycoprotein - Opsinii) Derivative of Vitamin A - RetinalVitamin A derivates are formed from the carotenoids. Photopigments arecoloured proteins in outer segment membranes that undergo structural changes uponlight absorption. They initiate the events that lead to production of a receptorpotential. The single type of photopigment in rods is called rhodopsin. A conecontains one of the three different kinds of photopigments, thus there are three typesof cones. Retinal is the light absorbing portion of all visual photopigments. In thehuman retina, there are four different opsins, one for each cone photopigment and onefor rhodopsin. Small variations in the amino acid sequences of the different opsinspermit the rods and cones to absorb different colours of incoming light. Rhodopsin
  44. 44. Review of Literature27Ayurveda Siddhanta & Computer Vision Syndromeabsorbs blue to green light most effectively whereas the three cone photo pigmentsmost effectively absorb blue, green or yellow to red light. Retinal exists in two forms.a) Cis b) Trans.In darkness, it has a bent shape called cis – retinal. When it absorbs light itstraightens out to a shape called Trans-retinal forming Cis Trans Isomerisation cis toTran’s conversion is called isomerisation and it is the first step in transduction.Forming of a visual image begins with isomerisation of particular photopigments incertain rods and cones.After this process, several unstable substances form and disappear. In about a minute,transretinal completely separates from the opsin. In darkness, an enyme called retinalisomerase can reconvert Trans to cis – retinal, which then binds to opsin and reformsa functional photopigment. This is called regeneration.This process is contributed bylarge storage of vitamin A by pigment epithelium.
  45. 45. Review of Literature28Ayurveda Siddhanta & Computer Vision SyndromeNETRA ROGAThe diseases occurring in various parts of the Netra are termed as Netra rogaHistorical review of netra roga1. Veda kaalaa) In Yajurveda Taittareeya sakha explanation of drushti prapti is mentioned50.b) In Atharvana veda explanation is available about Andhatwa nivarana andimportance of drushti.2. Upanishad & Purana kalaa) In Garuda purana explanation of netra roga is availableb) In Koushika sutra netra roga lakshana and chikitsa are explained.c) In Ramayana darkness in forest is denoted by thr word “timira” which is also anetra roga51.3. Darshana kaalaa) In vedantha darshana anitya type of netra drushti and timira are explained.b) In bouddha darshana symptoms of timira and other eye diseases are mentioned52.4. Samhita kaalaBruhatrayeea) Acharya charaka mentioned netra rogas in trimarmeeya chikitsa adhyaya ofchikitsa sthana.b) Acharya sushruta explained netra roga and their chikitsa in detail in uttaratantra.c) Acharya vagbhata explained netra roga and their chikitsa in detail in uttarasthana.Laghutrayeea) Madhavakara in Madhavanidana explained nidana and lakshana of netra rogas inNetraroganidana adhyaya.b) Bhavamishra in Bhavaprakasha explained netra roga and their chikitsa in detailunder Netrarogaadhikara.c) Sarangadhara explained netra roga and their chikitsa in detail in uttarakhanda.
  46. 46. Review of Literature29Ayurveda Siddhanta & Computer Vision SyndromeOther classical textsa) Harita Samhita explained Netra roga and their chikitsa in netra roga chikitsaadhyaya.b) Yogaratnaka explained Netra roga and their Chikitsac) Chakradatta also explained Netra roga and their Chikitsa under chikitsaprakarana.Recent booksa) Dr Vishwanath Dwivedi in ‘Nimi tanthra’ book explained Netra roga and theirChikitsab) Dr Ravindra Chandra Choudary in ‘Shalakya Vignana’ text book explained Netraroga and their Chikitsac) Dr D.Lakshman Acharya in ‘Shalakya Tantra’ text book explained Netra roga andtheir Chikitsad) Dr P.K.Shantakumari in text book ‘Opthalmology in Ayurveda’ explained Netraroga and their ChikitsaClassification of Netra RogaAyurveda Samhitas have classified the diseases according to nature ofoccurrence and the site of occurrence. The netra roga also can be classified asfollowsNature of Occurrence531. Aadi Bala Pravrutta- Includes hereditary disorders acquired from mother andfather.2. Janma Bala Pravrutta- Includes Congenital abnormalities3. Dosha Bala Pravrutta- Eye Problems caused by Dosha vitiation.4. Sanghatha Bala Pravrutta. – Abhighata janya netra roga due to factors likebhoutikaabhighata,yantrika,abhighata,rasayanika,abhighata,keetanu,suryavalokana,agni,aatapa,atiyoga,ayoga and mithyayoga of drushti, seeing very bright light etc,.5. Kala Bala Pravrutta- Netra roga caused due to seasonal changes.6. Daiva Bala Pravrutta Netra roga caused due to natural calamities, accidents etc.7. Swabhava bala pravrutta – Netra roga due to Senile or age related changes.
  47. 47. Review of Literature30Ayurveda Siddhanta & Computer Vision SyndromeTable No. 6 Netra Rogā according to different Āchārya 54-59Su.Sa AS AH MN YR BP SA KTSandhigata Rogās 09 09 09 09 09 09 09 09Varthmagata Rogās 21 24 24 21 21 21 24 27Śhuklagata Rogās 11 13 13 11 11 11 13 13Kŗişhņagata Rogās 04 05 05 04 04 04 05 06Sarvagata Rogās 17 16 16 17 17 17 16 16Pakşhmagata Rogās - - - 02 02 02 - -Dŗşhtigata rogās 12 27 27 12 12 12 27 25Bahyaja 02 - - 02 - 02 - -Total 76 94 94 78 78 78 94 96NIDANA OF NETRA ROGA60 -63After discussing the definition derivations and classification of the netra rogait is very essential to concentrate on etiological factors that are responsible for thecausation of the disease.Nidana is one of the five factors of diagnosis of any disease called as nidanapanchaka. It is the factor which is the cause of any diseases. It is also that factor whichdirects us towards a diagnosis of disease.Nidana is classified into different groups in Ayurvedic classics on differentbasis. Some of them are in relation to the time taken in causing a disease and some areon the basis of their diagnostic significance.In this chapter the causative factor ofnetra roga will be dealt for the study of netra roga process.Nidana is categorized broadly into two main divisions:1) General causative factor (samanya nidana)2) Specific causative factor (vishesha nidana)General etiological factors are responsible for the manifestation of all varietiesof where as the specific etiological factors are responsible for the specific variety ofnetra roga.The Nidana Panchaka consists of Nidana, Purvaroopa, Lakshana, Upashaya
  48. 48. Review of Literature31Ayurveda Siddhanta & Computer Vision Syndromeand Samprapti which help to understand the disease in detail.The Nidana Panchaka ofNetra Roga is explained below.Acharya Charaka in sutrasthana 18 chapter Trishotheeya adhyaya says that it’snot necessary to name all the diseases and it’s not possible also to name them.anintelligent physician should diagonise the disease, basing on dosha because the sametridosha getting prakopa due to various factors gets lodged in various parts of shareeraand causes various diseases. Thus this Siddhanta of Acharya Charaka is valid inunderstanding new diseases like CVS which though not mentioned in AyurvedaSamhitas can be understood by applying panchlakshana nidana as follows.
  49. 49. Review of Literature32Ayurveda Siddhanta & Computer Vision SyndromeTable No. 7 Netraroga NidanaNo Etiological factors of NetraRogaSu.Sa MN BP YR1. Ushna Abhitaptasya JalaPravesha   2. Doorekshana    3. Swapna Viparyaya    4. Prasakta Samrodana    5. Kopa    6. Shoka -   7. Klesha    8. Shiro Abhighata    9. Atimaithuna    10. Shukta Aranala    11. Amla    12. Kulattha    13. Masha Atinishevana    14. Vega vinigraha    15. Ati Swedana    16. Ati Dhooma Nishewana    17. Rajo nishevana    18. Chardi vighata    19. Vamanaatiyoga    20. Bhashpanigrahat    21. Sookshma nireekshanat    22. Ati vega yaanaat - -  -23. Rutu viparyaya -   24. Atidravapana -   25. Atimadyapana -   26. Upasarga   - 
  50. 50. Review of Literature33Ayurveda Siddhanta & Computer Vision SyndromeAcharya Dalhana while commenting on uttaratanthra 19thchapter ‘Nayanabhighatapratishedha adhyaya’ has mentioned about Abhighata nidana causing netra roga byamoortha dravyas like vata,atapa,dhooma,raja,keeta, makshika, mashaka,“Ahita ashanaat, Bhrusha bhasva chala sookshma veekshanaatcha”.According to Acharya Nimi Nidana for netra roga are ahita aahara and visual contactwith excessively sparkling, fast moving and minute objects.Pujyapada Muni in Netra Prakashika gives the following nidanas wrong wayof oil bath -either in excess or less, witch craft, drug addiction, weight lifting ,staringat luminous objects like sun,jwala-nireekshana etc cause netra roga.Table No. 8 Netra roga Nidana according to CommentatorsCkp DalAvakshira shayya - +Shiro ucchitha - +Kshara sevana - +Darshana ayoga + +Darshana atiyoga + +Darshana mithya yoga + +Bhasavarna + +Upasarga - +Acharya Chakrapani73while commenting on Matrashitiya adhyaya of CharakaSamhita sutrasthana in the context of guru and laghu aahara and its relation to agnisays that “the eye is the seat of tejas. Perception of vision occurs due to the union ofthe eye with tejas. The same tejas if excess causes loss of vision or impairs thevision”.
  51. 51. Review of Literature34Ayurveda Siddhanta & Computer Vision SyndromePOORVAROOPAThe feebly manifested symptoms which are produced during the processes ofsthana samshaya avastha of kriya kala in the manifestation of disease process areknown as poorva rupas65.Poorvaroopa are that group of signs and symptoms appearing in milder formand indicative of forth coming disease.The description of prodromal symptoms of netra roga was not given separatelyin all Ayurvedic texts but only Acharya Sushruta had mentioned them in uttaratanthra.Poorvaroopa of Netra roga are explained in general for all eye diseases and are asfollows. All these lakshana are alpa vyaktha in the poorva roopavastha of netra roga.So the general poorva rupas explained in the context of netra roga are considered here.1. Avila2. Samrambha3. Ashru4. Kandu5. Upadeha6. Guru7. Oosha8. Toda9. Ragayuktam10. Sashoolam vartma-kosheshu11. ShukapurnabhamAcharya Dalhana commenting on this state’s another version i.e.,kandupoornopadehavat (excess Itching) is present instead of ashrupoornopadehavat(excess lacrimation) and sa shoolam as ishat shoolam i.e., mild pain are present in thisstage. Purva roopa has not been specifically mentioned by Acharya Charaka andVagbhata and it is implied that the lakshnas in lesser intensity are to be considered aspoorva roopa of netra rogas.
  52. 52. Review of Literature35Ayurveda Siddhanta & Computer Vision SyndromeROOPAThe stage of disease manifestation where the signs and symptoms areexhibited clearly is the vyakthavasta and such a group of clinical features is called asroopaor lakshana of the disease.This roopa can be very specific to a disease and indicative of the underlyingpathology. This can be subjective or objective however, it becomes the main aid indiagnosis due to clear cut manifestation of disease at this stage.Generally rupa are classified into samanya and vishista rupas. Under samanyaRoopa/Lakshanas the following Lakshanas can be considered based on doshapredominance according to Acharya Charaka66.Table No.9 Dosha predominant lakshana in netra rogaVata Pitta KaphaAlparaga Daha ShuklopadehaUpadeha Atiruja Bahu picchila ashruToda Raga GurutaBheda Peetopadeha KanduROOPA wsr TO CVSSigns and symptoms of Computer Vision Syndrome and the probable dosha vitiationinvolved in it is being considered based on the signs and symptoms as follows. Thesigns & symptoms of CVS can vary but mostly include Eye Irritation (Dry Eyes, Itchy Eyes, Irritated Eyes) Red Eyes Blurred Vision (Distance Or Near), Headaches Light Sensitivity, Double Vision Backache Neck Ache Muscle Fatigue
  53. 53. Review of Literature36Ayurveda Siddhanta & Computer Vision Syndrome Eye Strain Difficulty Refocusing the Eyes.Table No.10 CVS symptoms and their dosha involvementThe lakshana of netra roga based on dosha predominance wsr to CVS is comparedhere.Table No.11 Netra Roga Lakshana in comparision to CVSVata Lakshana CVSAlparaga Redness Upadeha Excessive secretions of eye / stickiness Toda Mild pain (pricking) Bheda Tearing pain Pitta LakshanaSymptoms Ayurvedic terms Dosha vitiationDry and irritated eyes Visushka Netra /Rooksha NetraVataEye Strain Netra Klama VataBlurred vision Avila Darshanam PittaRed Eyes Netra Raaga PittaBurning Eyes Netra Daha PittaExcessive lacrimation Ashru Bahulata VataDouble vision Dwidha pashyati (Mithyadarshana)VataDifficulty in focusing Roopa darshana asahyata(heena tarpita lakshana)VataChange in colour perception Vikruta varna patavam Vata / PittaPhotophobia Prakasha Asahyatva Vata / PittaHeadache Sirashoola Vata/PittaPain in shoulder, neck and back. Greeva, Bahu ,Kati ShoolaVataContact lens discomfort --------------- -Slowness in changing focus Alpa kriya laghava ofnetraVata
  54. 54. Review of Literature37Ayurveda Siddhanta & Computer Vision SyndromeDaha Burning sensation Atiruja Excessive pain Raga Redness Peetopadeha Yellow discoloration -Kapha LakshanaShuklopadeha White discoloration -Bahu picchila ashru Excess sticky secretions in eyes -Guruta Heaviness Kandu Itching UPASHAYAUpashaya-Anupashaya67The Ahara-Vihara-Aushadha, which helps to relieve disease symptoms, iscalled as Upashaya and that which cause aggravation of the symptoms is calledAnupashaya.In the context of netra roga direct reference is available about Upashaya& Anupashaya. Hence, all those factors mentioned under anupashaya along withapathyas and nidana can be considered as Anupashaya and in Upashaya those factorswhich relieve symptoms of Netra roga, can be included. Upashaya and Anupashayafor netra roga will be discussed in detail under netra roga pathyapathya and samanyachikitsa.SAMPARPTHIAfter discussing nidana it is very essential to consider samprapti of the diseaseproper. Samprapti is that, which explains disease process starting from dosha dusti,their spread and the manifestation of the disease. Thus complete knowledge ofsamprapti is very essential in planning the successful treatment.The samanyasamprapthi of netra roga according to various Acharyas is as follows.
  55. 55. Review of Literature38Ayurveda Siddhanta & Computer Vision SyndromeCharaka68Charaka considers netraroga under trimarmeeya rogas and its samprapthi isexplained as the dusta vayu reaches the indriyas and manifests loss of function of thatsense organ (loss of vision if it’s the eye,etc) .In the same sloka he says that if dushtavayu gets inside the sira it manifests as mild pain, (mandaruk) oedema, (shofa) driesup, (Shusyathi) excessive pulsation, (Spandathe) loss of sensation, (supathata)constriction or decrease in size (tanvyo means thinning),dilatation or increase in size(mahatyo means to become bigger ) of the sira.Sushruta69The doshas are vitiated due to achakshushya nidana and enter the urdhwagatasiras, lodge in the various parts of the eye and manifest as netrarogas.Commenting onthe above Dalhana says "the siras referred here are the netragata siras, the termNetrabhaga means the different structures of the eye, and according to some it meansnetraraaji i.e., the capillaries supplying the eye.Vagbhata70The doshas getting vitiated by achakshushya nidana as mentioned in sarvaroganidana with predominance of pitta dosha enter the urdwagata siras, and lodging indifferent parts of the eye manifest the netrarogasIllustration Showing the Scheme of Samprapti in Netra RogaAchakshushya Nidana SevanaDosha Vruddhi and Dosha Dushti(Nidana sevana continued)Dosha prakopa with predominance of Vata and Pitta DoshaSpreading of dosha in the body through all sira and srotasEntry of doshas into Urdhwagata Sira
  56. 56. Review of Literature39Ayurveda Siddhanta & Computer Vision SyndromeUrdhwagati of Prakupita Dosha through the Urdhwagata SiraSthana Samshraya of Prakupita Dosha in various parts of the NetraPoorvaroopa lakshanaManifestation of Netra RogaSamprapti Ghataka Dosha- Vata Pitta Pradhana Tri Dosha Dooshya- Rasa,Rakta,Mamsa,Medas Srotas- Netragata Sira Srotodusti- Sanga,Atipravrutti Udbhava sthana- Chakshu (Netra) Vyaktha sthana-Netra Sanchara sthana- Urdhwagata Sira Rogamarga- Madhyama Adhisthana- Chakshurendriya Swabhava- ChirakariVYAVACCHEDAKA NIDANABefore confirming the diagnosis of CVS, it has to be differentiated from otherdiseases which mimic netra roga with some specific symptoms. For this one shouldtake proper examinations as well as investigations in order to differentiate it fromother diseases which have similar specific symptoms mentioned in Ayurveda Samhita.For this the following disorders can be considered.
  57. 57. Review of Literature40Ayurveda Siddhanta & Computer Vision SyndromeTable 13.Comparision of CVS with Netra Roga mentioned by various AcharyasThe lakshanas of CVS resemble the lakshana of the diseases mentioned inAyurveda, as above but a detailed examination and interrogation is necessary to ruleout the above said diseases.CVS is not a very severe disease, compared to the diseasestaken for Vyavacchedaka nidana and CVS is also always associated with patientsworking with computers.these diseases may occur along with CVS and make thecondition severe and worse but CVS cannot be compared as such with any of theses.SADHYASADHYATABefore going to start the chikitsa of a particular disease one should know aboutthe sadhyasadhyata of a disease, i.e. According to prabhava, the diseases are classifiedas Sadhya and Asadhya. Sadhya is subdivided as sukha sadhya and krichra sadhya,asadhya is subdivided as yapya and pratyakheya.CVS is an easily curable condition i.e., sukhasadhya if chikitsa is started earlyand if nidanaparivarjana and pathya are followed properly. But if nidana parivarjanaand pathy are not followed by computer user’s then CVS becomes a kricchra sadhyaor yapya vyadhi.UPADRAVAIn Ayurveda, Acharyas has not described the Upadrava separately forindividual netra roga but mentioned that if netraroga are left untreated they becomechronic and lead to complications like timiraName of disease Charaka Sushruta As Ah MnVatabhishyanda -    Sushkaakshipaka -    Asopha -    Sasopha -    Sirotpata -    
  58. 58. Review of Literature41Ayurveda Siddhanta & Computer Vision SyndromeNETRA ROGA CHIKITSA“Yaabhihi kriyaabhihi jaayanthe shareere dhatava samaahSa chikitsa vikaaranaam karma tat bhishaja smrutham” (Ch .su.16/34)Chikitsa is that procedure/entity which brings the bodily components to a state ofnormalcy. In general, Chikitsa for any roga is told asSamshodhanam Samshamanam nidaanasya cha varjanametavatbhishajaa karyam roge roge yatha vidhihi (Ch-vi 7/30)The management principles of Netra Roga in general consist of avoidance ofetiological factors as the first line of management. The second principle is to counteract increased Vata and other Doshas in the poorvaroopa stage itself, because ifneglected these diseases progress rapidly and become incurable in later stages.Management of netra roga can be broadly classified into71a) Nidana parivarjana (Prophylactic measures)It is the first line of treatment of any disease and it is most important line oftreatment for Netra roga also.It indicates that the root of Samprapti process is nidanaand it must be avoided for best management of the disease. In netra roga the factorswhich are mentioned as Nidana of the disease should be avoided.Nidana parivarjanamincludes avoiding by all means the etiological factors leading to aggravation of dosha,vyadhi and apathya.b) Vaatadi dosha shamanam (Curative measures)Vaatadi dosha shamanam includes treating the aggravated doshas involved incausing Netra roga by shamana and shodhana.AushadhaIn Nayanabhighata pratishedha adhyaya Acharya Dalhana says thatpittaabhishyanda, raktaabhishyanda and vataabhishyanda chikitsa is to be followed inabhighataja netra rogas with drugs having drushti prasaadana properties, like Nasya,Aalepa, snigdha dravya which are drushtiprasaadajanana should be used.
  59. 59. Review of Literature42Ayurveda Siddhanta & Computer Vision SyndromeTriphala is said to be drug of choice in case of Netra Roga with various Anupana.Based on the involvement of Doşās. This drug is Cakşuşya, Rasāyana along withDeepana, Pācana properties. A number of herbal and animal drugs like madhu, ghrita,yashtimadhu etc are mentioned as Chakshushya in the Samhitas and Nighantus whereas many mineral drugs are described in the text books of Rasashastra, which can beused in treating various netra roga.Kriyakalpa72Sushruta has recommended ‘Kriyakalpa’ for the management of netra roga, alongwith other types of treatment. They can be advocated in almost all eye diseases and itcomprises of Tarpana, Putapaka, Anjana, Aschyotana and Seka.Later scholars likebhavaprakasha have advocated the use of Swarasa and Arka for local use in Netraroga.Shastra karmaThe shalya treatment of Netra roga begins with shastra karma including chedanaetc procedures to relieve Rakta and mamsa dushti.PanchakarmaPanchakarma is indicated for sarva deha gata dosha shodhana, A number ofnasya, vamana and vasti yoga are also described for Netra Roga based on the dosha.Pathyaapathya73Pathysevana plays a major role both in prevention and cure of netra roga.According to Sushruta, the person who is having the habit of regularly taking oldGhrita prepared from Shatavari or Amalaki, Yava cooked with sufficient quantity ofGhrita and the decoction of Triphala etc, by taking these ane has no reason to fearfrom even the severest form of Netra Roga.The cooked vegetables of Jivanti, Sunishannaka, Tanduliya, good quantity ofVastuka, Moolakapotika and jangala mamsa are beneficial for eyesight. Patola,Karkotaka, Karavellaka, Vartaka, Tarkari, Karira fruits, Shigru and Aartagala etc,. allthese vegetables cooked with Ghrita also promote eyesight. Acharya Vangasenasupports the same views.
  60. 60. Review of Literature43Ayurveda Siddhanta & Computer Vision SyndromeAcharya Bhavaprakasha has mentioned that use of certain procedures like Lepa,Abhyanjana, Sechana, Dhavana, etc. in the sole of foot are beneficial for theimprovement of eyesightAştāňga Hŗdaya advocates Raktamokşaņa, Virecana, purity of mind, relaxation,Anjana, Nasya, meat of birds, oil. (A. S. Ut. 13/99-100). Pādābhyanga andPādarakşādhāraņa, Śitodaka Parişeka, Śitodaka Snāna, Śitodaka Gandūşadhāraņa,Dakşiņamāruta,keeping palmar region of the hands to the eyes are stated for therejuvenation of the eye sight74.The Chakshushya regimen mentioned in the classics is be useful in controllingthe progress of the disease. A combination of the above said drugs, in the form of oralsupplement, and kriyakalpas will play a definite role in the management of netra roga.NETRA ROGA SAMANYA CHIKITSĀNidana Parivarjana Dosha Shamana (Shodhana/Shamana)Sthanika SarvadehikaAushadha Shastra PanchakarmaAushadha Kriya KalpaTriphala Seka Chedana Snehana PathyapathyaYashtimadhu Āścyotana Bhedana Swedana VishramaSaptamritaloha Pindi Lekhana VamanaEtc.drugs Bidālaka Vyadhana VirecanaTarpana Raktamoksana BastiPutapāka Kshara karma NasyaAnjana AgnikarmaNetra vyayama Jalukavacharana
  61. 61. Review of Literature44Ayurveda Siddhanta & Computer Vision SyndromeThe samanya chikitsa of netra roga are mentioned above but to plan a chikitsaSiddhanta for a disease not mentioned in samhita the following points are to beconsidered. CVS is a netra roga caused due to Nija and Aganthu karana janya doshaprakopa. Nidana parivarjana is the first line of treatment in all aganthuja rogas. Vataadi dosha shamana is the second line of treatment for the prakupita doshacausing specific lakshana in this particular vyadhi. In Nayanaabhighata Pratishedha adhyaya Acharya Sushruta mentioned netraprasadana janana, drushtiprasadajanana drugs should be used along withvaatabhishyanda chikitsa.i.e. procedures like aschotana ,tarpana putapaka andRasayana.PATHYA APATHYAPracticing appropriate Pathya-Apathya along with the treatment of disease isone of the unique characteristics of Ayurvedic science. Classical texts emphasize thatsuccess or failure of the treatment depends to a large extent on the practice of Pathyaand Apathya. The food articles, drugs and regimens which do not affect the body andmind adversely are regarded as Pathya and in the same way which adversely affectsthe body are considered to be Apathya75.By following the Pathya and avoiding apathya mentioned in the Ayurvedicclassics one can maintain his healthy vision and prevent it from many diseases.Table 14.Pathya in Netra RogaAahara Su.Sa AH YR CDYava    Godhuma -   Sali -   Shastika -   Mudga -   Kodrava -   Saindhava -   Sharkara -   
  62. 62. Review of Literature45Ayurveda Siddhanta & Computer Vision SyndromeVarsha jala - -  -AushadhaTriphala    Amalaki    Punarnava -   Dadima -   Yashtimadhu    Shatavari -   Karavellaka -   Kustumburu -   Patola -   Draksha -   Lodhra -   Godugdha    Goghruta    Jangala mamsa    KarmaShirobhyanga    Padabhyanga    Netra aschotana    Chatra dharana    Padatra dharana    ManasikaManasika santulana    Sattwa pradhana    Table 15.Apathya in Netra RogaAahara Su.Sa AH YR CDPathrashaka    Pinyaka -   Dadhi -   Matsya -   
  63. 63. Review of Literature46Ayurveda Siddhanta & Computer Vision SyndromeAmla sura    Atiyoga of Lavana    Teekshna -   Katu -   Ushna -   Guru    Atyamla -   Vidahi -   ViharaKshudha & other vegadharana   Abhighata    Suryavalokana    Diwaswapna    Ratrijagarana    Rukshata atisevana    Utkatasana    Bhashpa sevana    Dhooma sevana    ManasikaChinta    Shoka    Bhaya    Krodha    KriyaAtivamana    Ati virechana    Ati nasya    Mithya yoga of netrakriyakalpa   “Ahita ashanaat sada nivrutti,Bhrusha bhasva chala sookshma veekshanaatcha”
  64. 64. Review of Literature47Ayurveda Siddhanta & Computer Vision SyndromeAccording to Acharya Nimi76apathya for netra roga are ahita aahara and visualcontact with excessively sparkling, fast moving and minute objects.By judiciouslyapplying the above said principles netra roga can be prevented and treated.
  65. 65. Review of Literature48Ayurveda Siddhanta & Computer Vision SyndromeDRUG REVIEWDRUG REVIEW OF TRIPHALA YASHTIMADHU YOGAAcharya Vagbhata recomends Triphala mixed with honey and ghee to be takenin the night to improve visual acuity77.Amalaki and yasthimadhu pacifies pitta and alleviates defects of visionaccording to Vangasena78.Nimi opines that taking Triphala and Yasthimadhu churna with ghee and honeyat night, consuming wholesome diet and amalaki water helps one attain excellentvision79.HARITAKI80Name HaritakiBotanical name Terminalia chebula retzFamily CombretaceaeSynonyms Abhaya,Amrutha,Pathya,Putana,Jaya,Avyatha,Haimavathi,Kayastha,Vayastha,Siva,Chetaki,Pranadaa,Jivanthi,Rohini,Vijaya,ShreyasiRasa Pancharasa (Lavana Varjita)Guna Laghu RukshaVirya UshnaVipaka MadhuraPrabhava Tridoshaghna,Deeepana,Prajasthapana,Medhya,Chakshushya,Hrudya,Anulomana,RasayanaParts used Phala, PhalamajjaGana Charaka-Jwaraghna,Arśoghna,Kāsaghna,Kustaghna,PrajāsthāpanaSuśhruta-Āmalakyādi, Parushakādi, Triphalā
  66. 66. Review of Literature49Ayurveda Siddhanta & Computer Vision SyndromeVāgbhata-ParushakādiChemical composition Fruit:Anthraquinone,Glycosides, ChebulicAcid, TannicAcid, Terchebin, Vit-CFruitkernel:Arachidic acid,Oleic acid, Palmitic acid, Behenic acid& Stearic acidFlower: Chebulin.Pharmacological activityAntimicrobial, Antifungal, Antibacterial, Antistress,Antispasmodic,Hypotensive,Antihepatitis B virus activity, Inhibitory activity againstHIV-1Protease.VIBHITAKI81Name VibhitakiBotanical Name Terminalia bellerica roxbFamily CombretaceaeSynonyms Akshaphala,Karshaphala,Kalidruma,Bhootavasa,Kaliyugalaya,TrilingaRasa KashayaGuna Laghu RukshaVirya UshnaVipaka MadhuraPrabhava TridoshaharaKarma Keshya,Krimihara,Vatahara,ChakshushyaParts Used Phala, PhalamajjaGana Charaka-Jwarahara, Kāsahara, VirechanopagaSuśhruta-Mustādi, TriphalāVāgbhata-MustādiChemical Composition Fruit:Fructose,Galactose,Mannitol,Glucose,Rhamnose,B-SitosterolPharmacological activityAntihistaminic, purgative, antifungal, blood pressure dipressent, activity against viralhepatitis and vitiligo, bronchodialator, antispasmodic, CNS stimulant.
  67. 67. Review of Literature50Ayurveda Siddhanta & Computer Vision SyndromeAMALAKI82Name AmalakiBotanical Name Emblica officinalisFamily EuphorbiaceaeSynonyms Abhaya,Amruthaphala,Dhatri,Vayastha,Sitaphala,Tishyaphala,Sriphala,Vrishya,Vayasya.Rasa Amlapradhana PancharasaGuna Snigdha,Sitavirya SitaVipaka MadhuraDoshaghnata TridoshaharaKarma Vayasthapana,Rasayana,Vrishya,Chakshushya,pramehahara,raktapittaharaParts used PhalamajjaGana Charaka-Jwaragna,Kāsagna,Virechanopaga,Kustagna, VayasthāpanaSuśhruta - Amalakyadi, Parushakādi, TriphalāVāgbhata – ParushakadiChemical Composition Vit-C, Phyllembin, Linolic acid, Indole Aceticacid,Axyubrin,Corialgin,Trigaloyl Glucose.Elagic acid, and saltsPharmacological activityAntimicrobial, anti fungal, anti inflammatory, anti bacterial, anti ulcer, spasmolytic,mild CNS depressant, hypolipidemic, antiatherosclerotic, antimutagenic, antioxidant,and immunomodulator.YASHTIMADHU83Name YashtimadhuBotanical Name Glycyrrhiza Glabra
  68. 68. Review of Literature51Ayurveda Siddhanta & Computer Vision SyndromeFamily FabaceaeSynonyms Klitaka,Madhuka,Madhuyashti,MadhulikaRasa MadhuraGuna Guru,SnigdhaVirya SitaVipaka MadhuraDoshaghnata Kaphavata Shamaka, TridoshaharaKarma Netrya,Swarya,Rasayana,Vrishya,ChakshushyaParts used RootChemical composition Glycyrrhizine, Glycyrrhizic acid,Iso Neo Liquirtin, Liquirtinogen, Glabrin,Licoridin,GHRITA84Name GhritaZoological Name Bos taurusFamily HerbivoraSynonyms jeevaneeya, pavithra, navaneetha,Sarpi, adhara, aajya, havi, amrutahvaRasa MadhuraGuna Guru, Snigdha, mrudu, yogavahiVirya SitaVipaka MadhuraDoshaghnata Pitta vata Shamaka, Tridoshashamaka,rasayanaKarma Rasayanaparam,chakshushya,jeevaneeya,Buddhi, smruthivardhakaChemical composition 5gms of ghee contains vit-A 165 I.U,vit -D 25 I.U.Copper- 0.075%MADHU85Name MadhuZoological Name APISFamily Orthropoda
  69. 69. Review of Literature52Ayurveda Siddhanta & Computer Vision SyndromeSynonyms Makshika,Kshaudra,Madhvika,Sharadam,Varati,Bhringavantham,Pushparasodbhavam,Kusumasavam,Pushparasam.Rasa Madhura, kashaya anurasaGuna Sheeta,Laghu,RukshaVirya Sita (Ch) Ushna (Su,Bp)Vipaka Katu (A.S)Doshaghnata Tridoshashmaka,mainly Kapha shamaka.Karma Chakshushya, chhedi,vishaharavatalaUses Indicated in netra roga,krimi,medovikara,shwasa,hikka,atisara and is yogavahi.Chemical composition Glucose- 84.9% Sucrose-2.69%Alkaloids-0.12% water-10.03%Sp.gravity-1.36 nitrogen-1.29% The above table shows that the compound drug possesses predominance ofMadhura, Kashaya rasa, Guru Snigdha guna, Sheeta virya, Madhura vipaka. Madhura rasa is told as Shadindriya prasadaka by Acharya Charaka. All the drugs are having Chakshushya,Rasayana,Netrya,karma.Hence acts as Vatapitta Shamaka by virtue of its Rasa, Guna Vipaka Virya and DoshaKarmata,and by combination they act as Chakshushya,Rasyana and Tridosha shamaka
  70. 70. Review of Literature53Ayurveda Siddhanta & Computer Vision SyndromeTable No.16 Rasa panchaka of Drugs in Triphala Yashtimadhu YogaRasa Guna Virya Vipaka DoshaKarmaDrugNameM A L K T KSLAGURUSUU S M A K V P KHaritaki + + - + + + + - + - + - + - - + + +Vibhitaki - - - - - + + - + - + - + - - + + +Amalaki + + - + + + - + - + - + + - - + + -Yashtimadhu+ - - - - - - + - + - + + - - + + -Madhu + - - - - + - + + - + + - - + - - +Ghrita + - - - - - - + - + - + + - - + + -
  71. 71. Review of Literature54Ayurveda Siddhanta & Computer Vision SyndromeFIGURES SHOWING THE DRUGS IN TRIPHALA YASHTIMADHU YOGAHaritaki AamalakiVibhitaki Yashtimadhu
  72. 72. Review of Literature55Ayurveda Siddhanta & Computer Vision SyndromeTriphala Yashtimadhu YogaTriphala Choorna Yashtimadhu ChoornaGhrita Madhu
  73. 73. Review of Literature56Ayurveda Siddhanta & Computer Vision SyndromeCOMPUTER VISION SYNDROME (CVS)As we entered the 21st century, the growing use of computers be at home oroffice, brings with it an increase in health risks, especially sense organs, more so theeyes.A WHO press release (1998) mentions that glare and reflections from VDTdisplays are a source of eyestrain and headache. Surveys of computer workers revealthat vision related problems are most frequently reported health problems, occurringin over 70 percent of computer workers. The pain and discomfort associated with theproblem can affect workplace performance and domestic activities also. With a fewpreventative measures, however, the symptoms associated with CVS can be easilyavoided86.Definition of CVSThe American Optometric Association (AOA) defines Computer VisionSyndrome as “The complex of eye and vision problems related to near work whichare experienced during or related to computer use” CVS is a temporary conditionresulting from focusing the eyes on a computer display for protracted, uninterruptedperiod of time87.IncidenceMost studies indicate that computer operators, who view their Video DisplayTerminals (VDTs), report more eye-related problems than non-VDT office workers.A number of investigators have reported that visual symptoms occur in 75-90% ofVDT workers. In contrast to the popular conception regarding carpal tunnelsyndrome, a study released by NIOSH (National Institute of Social Health USA)showed that only 22% of VDT workers have musculoskeletal disorders89.A survey of optometrists in USA indicated that 10 million eye examinationsare annually done primarily because of visual problems at VDTs. This studydelineated the series of symptoms which eventually called as CVS. The causes forthese visual symptoms are a combination of individual visual problems, poorworkplace conditions and improper work habits. The above mentioned survey alsoconcluded that two-thirds of the complaints were related to vision problems whileone-third was due to environmental factors. Many people have marginal vision
  74. 74. Review of Literature57Ayurveda Siddhanta & Computer Vision Syndromedisorders which do not cause symptoms when performing less demanding visualtasks. However, it has also been shown that VDT users also have a higher incidenceof complaints than non-VDT users in the same environment.Etiology of CVSThe main causes of CVS include an unsuitable environment and the improperuse of eyeglasses or contact lenses along with that working at a computer is morevisually demanding than doing other standard office work such as reading printeddocuments etc., aspects of the design of the computer video display such as screenresolution and contrast, image refresh rates and flicker, and screen glare, as well asworking distances and angles all may contribute to worker symptoms.In order to accomplish specific computer related tasks, frequent eyemovements from work document to the computer screen, or from the screen to thekeyboard and back again, are performed. In addition, as the object being viewedchanges, so does the need for a change in eye focusing to maintain a clear image.These changes occur repeatedly during computer use. The flexibility of the lenswithin the eye and weakening of the ciliary muscle gradually decreases with age(onset of presbyopia) which affects most people after age 40. The normal blink rate inhuman eyes is 16-20 per minute. Studies have shown the blink rate decreases to aslow as 6-8 blinks/minute for persons working on the computer screen. This leads todry eyes.Additionally, the near focusing effort required for such long hours puts strainon ciliary muscles of the eye. This induces symptoms of asthenopia and leads to afeeling of tiredness in the eyes after long hours of work. Some patients present withinability to properly focus on near objects after a short duration. This can be seen inpeople aged around 30-40 yrs of age, leading to a decrease in the accommodative andfocusing mechanisms of the eye. This can be a setting in due to early presbyopia.Signs & symptoms of CVSThe signs & symptoms of CVS can vary but mostly include Eye Irritation (Dry Eyes, Itchy Eyes, Irritated Eyes) Red Eyes Blurred Vision (Distance Or Near), Headaches
  75. 75. Review of Literature58Ayurveda Siddhanta & Computer Vision Syndrome Light Sensitivity, Double Vision Backache Neck Ache Muscle Fatigue Eye Strain, Difficulty Refocusing the Eyes.Symptoms and their manifestationDry and irritated eyesDry and irritated eye is one among the most common problem of Computerand VDT users. It is also termed as VDTS Video Display Terminal Syndrome.Thefrontal surface of the eye is covered with a tissue consisting of lacrimal glands whichsecrete the tears. These tears cover the eye surface and maintain moisture for thenormal functioning of the eye. They also help to maintain the proper oxygen balanceof the external eye structures and maintain optical properties of the visual system.The normal tear layer is cleaned off and refreshed by the blinking action of theeyelids.The blink reflex is one of the fastest reflexes in the body. However, these blinkrate varies with different activities faster when we are very active, slower when we aresteady or concentrating. Research has shown that the blink rate of VDT workersdropped very significantly during work at a Computer/VDT compared to before andafter work. Possible explanations for the decreased blink rate include concentration onthe task or a relatively limited range of eye movements. The size of the eye opening isrelated to the direction of gaze- as we gaze higher, the eyes open wider. The amountof evaporation roughly relates to eye opening, the higher gaze angle when viewing aVDT screen results in faster tear loss and reduced percentage of blinks which result indry eyes leading to irritation.Red eyesEyes appear red because of the excess flow of blood to the capillaries in theeye.Sometimes it may be also due to soreness in the eye. This may be due to pooroffice ergonomics and unclean environment.
  76. 76. Review of Literature59Ayurveda Siddhanta & Computer Vision SyndromeHeadacheHeadache is one of the ‘discomfort’ symptoms of CVS and is the primaryreason, for which most people seek an eye examination. Visual headaches occur morefrequently, often occur toward the front of the head, occur most often toward themiddle or end of the day, and can occur on one side of the head more than theother.VDT workers most likely get tension-type headaches. These can be precipitatedby many forms of stress, including anxiety and depression; numerous eye conditions,including astigmatism and hyperopia; improper workplace conditions, including glare,poor lighting, and improper workstation setup are the predisposing factors.Burning eyesBlinking is very essential to maintain the moisture of the eye surface. Whenthe blinking rate slows down due to continuous viewing the eyes become dry andcause burning sensation.Blurred visionThe ability of the eye to change its focal power is called accommodation andvaries due to many factors. An image that is not focused accurately will appearblurred.Blurred vision symptoms can result from refractive error (e.g., hyperopia,myopia, and astigmatism), improper prescription lenses, presbyopia (age-relatedfocusing problem) or other focusing disorders. Considering the working environment,blurred images can also arise from a dirty screen, poor viewing angle, reflected glareor a poor quality or defective monitor. All of these factors should be considered whenthis symptom occurs.Double visionDouble vision is a very uncomfortable and unacceptable condition for the visualsystem. Double vision is a serious symptom and can be caused by several factors. Acomplete eye examination is indicated if this symptom persists.Photophobia / glare sensitivityThe eyes are designed to be stimulated by the light and to control the amountof light entering the eyeball. Lighting conditions in office environment are foreign tothe natural lighting and can cause an adverse reaction to light. The largest single
  77. 77. Review of Literature60Ayurveda Siddhanta & Computer Vision Syndromefactor in the workplace is glare which is mostly caused by large disparities inbrightness in the field of view. It is much desirable to eliminate bright sources of lightfrom the field of view and strive to obtain a relatively even distribution of luminance.A person is at greater risk to experience discomfort glare when the source is brighterand when it is closer to the point of attention.Neck, shoulder and back acheIt is often heard in medical circles that ‘the eyes lead the body’. Nature hasdesigned our visual system to be so dominant that we will alter our body posture toaccommodate any deficiency in the way we see. In many office situations the visionof a worker is compromised and they must adapt their posture to ease the strain on thevisual system. Uncomfortable seating arrangements and continuous, working withcomputers for longer duration in the same posture causes pain in shoulder, neck andback.Contact lens discomfortThis is commonly found in regular Contact lens users. Computer viewingresults in decreasing blinking rates to one third of normal, while the straight-aheadgaze needed to look at a screen exposes to more air. Combined, this causes the eye todry out and become itchy much faster than usual.If frequent blinking is not enough toeliminate the dryness and itching, an ophthalmologist prescribed eye drops madeespecially for contact lenses can be used.Changes in colour perceptionChanges in colour perception results from long working hours,long standingeye pathologies and flickering colours resolution of VDT screen.FatigueIt is a general symptom of tiredness because of improper work stationconditions.It can also occur due to mental tension, work overload or long workinghours.EyestrainEyestrain is one of those vague terms that have different meanings. The termeye care professionals use for eyestrain is asthenopia (AS-then-OH-pee-ah),.