Critical analysis of Netra roga

1. “CRITICAL ANALYSISOF NIDANA OF NETRAROGA”
Dr. Shraddha Joshi
Ph.D. 2nd year
Shalakya Tantra dept.

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

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

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

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

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

7. Kalabala
pravrutta
• Seasonal eye diseases are produced
due to change in the climatic
conditions.
• Vyapanna Ritu:
(diseases arising
due to Vaikrita Ritu)
• Abhishyandana
• Avyapanna Ritu:
(diseases arising due
to Prakrita Ritu)
• Spring catarrah.

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

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

10. Nidana of Netra Roga
उष्ण अभितप्तस्य जलः प्रवेशाद दुरेक्षणात् स्वप्न ववपरययययात् |
प्रसक्त संरोदन कोपर शोक क्लेश अभिघातत् अतत मैथुनात् ||
शुक्तारनालाम्लक
ु लत्थमाषतनषेवणाद्वेगववतनग्रहाच् |
स्वेदादथो धूमतनषेवणाच् छदेववययघाताद्वमनाततयोगात् ||
बाष्परग्रहात् सूक्ष्मतनरीक्षणाच् नेत्रे ववकारान् जनयन्तत दोषाः|

11. Acharya Nidana
आ ाययय िावप्रकाश रजोधूमतनषेवणात् , अततशीघ्र यानतः, ऋतु
ववपरयययय, भशरो अभितापर
आ ाययय योगरत्नाकर अततद्रव परानम् , अततमद्य परानम्
आ ाययय ववदेह तीक्ष्ण अञ्जन , कीटदंश, स्परशाययदीभिः अभिहतेषु,
सभलल क्रीडा, अतत लङ्घन,क्रमणरूपर प्रेक्षण
आ ाययय डल्हण आवन्क्शर शयनम्, उन्च् तभशर शयनं, ज्वर्
अभितापर
आ ाययय वाग्िट पराद परीडन
Other Nidanamentionedby different Acharyas

12. The Nidanas as explianedin the classicscan be further groupedas follows:
1. Aharaja
2. AharaVidhi
3. Viharaja
4. RutuViparyaya
5. Manasika
6. Agantuja
7. Bheshaja
8. Nidanarthakara
9. Sankramika

13. Aharaja Nidana
PittaPrakopaka
Ahara
• ShuktaArnala
• AmlaAhara
• Kullatha
• Madhya
• Kshara,Tikshna,Ushna,KatuAhara
KaphaPrakopaka
Ahara
• Masha
• DravaAnna
• ShitaAhara
• GuruAhara

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

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

16. क
ु लत्थ तनषेवण
Excessive use of horse gram
Kullatha
• Laghu,Vidahi,KashayaRasa,KatuVipaka,UshnaVirya.
• Leadsto DhatuKshaya
• Tridosha
• TridoshajaNetraRoga
Pentosan present in kullatha can even lead to
inflammatory changes.

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

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

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

20. माषतनषेवण
Excessive use of Black gram
Masha
• MadhuraRasa, Madhura Vipaka, Guru, SnigdhaGuna
• CausesDhatuVriddhi.
• Kapha
• KaphajaNetraRoga
It increases level of oxalates in body and
decreases iron level and so increases
oxidative stress and damages surrounding
structures.

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

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

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

24. Aharaja Vidhi
• VirrudhaAhara
• AsatmayaAhara

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

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

27. Viharaja Nidana
VataPrakopaka Vihara • Durekshnat
• SukshmaNirikshanat
• Vividha RupaPrekshana
• SakampenaAtikramana
• Shranta Klanta
• AtiShighraYanatah
• AtiMaithuna
• Maloshna,Sankatana,Pada Pidana
• SwapanaViparyay
• VegaVinigraha
• AvakShir Shayana
• UcchrittaShayana
• Atilanghana
• Bahyu Bharnam
• TailaAbhyanjan Varjanam
Pitta Prakopaka Vihara
• Ushnaabhitaptsya Jalah Praveshata
• Rajo DhoomaNishevana
KaphaPrakopaka Vihara
• SwapnaViparyay
• AbhyanjanaNithantena
• ChardiVighatat

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

52. Mansika Nidana
• Prasakta Sanrodanam
• Bhaya
• Shoka
• Klesha
• Kopa

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

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

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

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

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

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

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

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

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

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

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

64. Bheshaja
• Atiswedana
• Vamana Atiyogata
• Anjana

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

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

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

68. Nidanarthkara
• Jwarotpata
• Granthi
• Meha

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

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

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

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

73. Aupsargika Roga
The Nidanas stated are:
प्रसंगात् (get together)
गात्र संस्पर्ााद् (Touching the skin)
न िःश्वसाद् (Contact with exhaled air)
सह भोज ाद् (Eating together)
सह्र्य्या अस ात् (Sleeping and Sitting together)
वस्त्रमाल्य अ ुलेप ात् (Sharing clothes, garlands & cosmetics)