“APPLICATION OF AYURVEDA SIDDHANTA IN
THE MANAGEMENT OF COMPUTER VISION
SYNDROME”
By
Dr. K.S.DUTTA SHARMA.G, B.A.M.S.,
Dissertation submitted to the Rajiv Gandhi University of Health Sciences,
Karnataka, Bangalore.
In the partial fulfillment of the requirements for the degree of
DOCTOR OF MEDICINE (AYURVEDA)
in
AYURVEDA SIDDHANTA
Under The Guidance of
Dr.K.NASEEMA AKHTAR M.D. (Ayu) Professor,
Department of Post-Graduate Studies in Ayurveda Siddhanta, G.A.M.C., Mysore.
Co-Guide
Dr.T.R.SHANTALA PRIYADARSHINI M.S. (Ayu) Asst. Professor
Department 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
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,
GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.
DECLARATION
I hereby declare that this Dissertation “Application of Ayurveda Siddhanta
in the Management of Computer Vision Syndrome” is a bonafide and genuine
research 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 Candidate
Place: Mysore Name: Dr. K.S.Dutta Sharma.G
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,
GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.
CERTIFICATE
This is to certify that the dissertation entitled “Application of Ayurveda Siddhanta
in the Management of Computer Vision Syndrome” is a bonafide research work
done by Dr.K.S.Dutta Sharma.G in partial fulfilment of the requirement for the
degree of Doctor of Medicine (Ayurveda).
Date: Signature of the Guide
Place: Mysore Dr.K.Naseema Akthar M.D. (Ayu).,
Professor
Department of Post Graduate Studies In Ayurveda Siddhanta, Government Ayurveda Medical College,Mysore.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,
GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.
CERTIFICATE
This is to certify that the dissertation entitled “Application of Ayurveda Siddhanta
in the Management of Computer Vision Syndrome” is a bonafide research work
done by Dr.K.S.Dutta Sharma.G in partial fulfilment of the requirement for the
degree of Doctor of Medicine (Ayurveda).
Date: Signature of the Co-Guide
Place: Mysore Dr. T.R.Shantala Priyadarshini M.S. (Ayu)., Asst Professor Department of Post Graduate Studies In Ayurveda Siddhanta, Government Ayurveda Medical College,Mysore.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA
GOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.
ENDORSEMENT BY THE HOD, PRINCIPAL /
HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “APPLICATION OF
AYURVEDA SIDDHANTA IN THE MANAGEMENT OF COMPUTER
VISION SYNDROME” is a bonafide research work done by Dr.K.S.Dutta
Sharma.G under the guidance of Dr. K.Naseema Akthar Professor, Department of
Post Graduate Studies in Ayurveda siddhanta, Government Ayurveda Medical
College, Mysore.
Seal & Signature of the HOD Seal & Signature of the Principal
Dr. N.Anjaneya Murthy Dr. Ashok D.Satpute
Date: Date:
Place: Mysore Place: Mysore
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA.
DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,
GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE.
COPY RIGHT
Declaration by the Candidate
I 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 Candidate
Place : Mysore Dr. K.S.Dutta Sharma.G
© Rajiv Gandhi University of Health Sciences, Karnataka
ACKNOWLEDGEMENT
At this moment of submitting this dissertation in this Post Graduate study, my
head bows down with great humility at the feet of almighty Mother Chamundeshwari and
Lord Dhanwantari, without whose blessing, I would not have been able to attain these
stages in my life.
I express my heartfelt and profound sense of gratitude to my beloved, Professor
and HOD, Department of PG Studies in Ayurveda Siddhanta, GAMC, Mysore,
Dr.N.Anjaneya Murthy for his constant guidance, continuous supervision and help at
every stage of this study.
Words cannot express the zeal of ecstasy while depicting my deep source of
gratitude to my proficient guide Dr Naseema Akhtar.Her fruitful suggestions, optimistic
view & motherly affection showered on me during this whole period & inspired me to
accomplish this work in all aspects.
Words cannot express the zeal of ecstasy while depicting my deep source of
gratitude to my proficient Co-guide Dr.T.R.Shantala Priyadarshini. Her fruitful
suggestions, optimistic view & motherly affection showered on me during this whole
period of study & inspired me to accomplish this work in all aspects.
I am also thankful to Dr. Ashok D. Satpute, Principal, GAMC, Mysore, for his
support during the period of my study.
I would like to place on record my heartfelt thanks and deepest sense of gratitude
to my respected teachers Dr.V.A.Chate, Dr Venkata Shivudu for their keen observation
and valuable recommendations throughout the dissertation and without whom my
dissertation would not have taken this shape.
I would like to place on record my heartfelt thanks to Dr.Rajendra, Dr.Anand
Katti, for their patient hearing during times of my frustration and for offering valuable
suggestions and inspiration from time to time during my P.G. studies.
I express my enormous amount of thanks to my colleague’s & fabulous
classmates, 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 my
stay 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 for
their 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 the
course of the study.
I extend my deepest regards to Mr. Subbanna, Smt. Varalakshmi, Mr.
Basavaraju & Mr.Somashekhar Librarians, GAMC, Mysore, for their generous help
during the course of my work.
At the same time, it gives me immense pleasure to remember my respected
Parents 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 and
interpretation.
I acknowledge thanks to all persons who have helped me directly or indirectly
with 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
LIST OF ABBREVIATION
A.H. Astanga Hridaya
A.S. Astanga Sangraha
CH Charaka
CD Chakradatta
CS Charaka Samhita
Ckp Chakrapani
MN Madhava Nidana
Sa.Sa Sarangdhara Samhita
Su.Sa Sushruta Samhita
VAG Vagbhata
AOA American Optometric Asssociation
MW Monier Williams Sanskrit English Dictionary
CVS Computer Vision Syndrome
BP Bhavaprakasha
YR Yogaratnakara
AK Amarakosha
VK Vaidyaka Kosha
VSS Vaidyaka Shabda Sindhu
RN Raja Nighantu
MK Medini Kosha
SKD Shabda Kalpa Druma
SS Statistically significant
HS Highly Significant
NS Non Significant
ABSTRACT
Background and Objective
Computer Vision Syndrome is a Vikara of Chakshurendriya, occurring due to
Astmendriyartha samyoga and atiyoga of Chakshurendriya. Aggravated Tridosha, Vata
and Pitta Dosha, in particular, are the prime factors involved in the pathogenesis. And it
very 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 in
98% of software professionals. Considering the grave nature of the disease with its higher
incidence, it has been selected for the present study to find out a better cure.
Though Nidanaparivarjana is much highlighted and praised in the context of
chikitsa, it is not possible always to follow especially in a disease like CVS. In the
present study Triphala Yashtimadhu Yoga a Chakshushya Rasayana is selected in the
form of choorna owing to easy palatability, so that one can perform routine activities
without interruption.
The objective of this present study was to understand the disease based on
Ayurvedic concepts and to evaluate the effect of Triphala Yashtimadhu Yoga in patients
of CVS.
Methods
Study Design - A conceptual study and a single blind clinical Study.
Intervention – Total 30 patients were selected randomly and assigned into a single group
and 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 and
after follow up. The data was analyzed using contingency coefficient and other statistical
tests.
Results
Effect of Triphala Yashtimadhu Choorna showed highly significant results in parameters
such as Dry and irritated eyes, Redness of eyes, Tearing eyes, Headache, Burning in eyes,
Blurred vision and Photophobia.
Interpretation and Conclusion
Ayurvedic siddhantas are eternal and can be applied in understanding any disease.
Triphala Yashtimadhu Yoga a Chakshushya Rasayana is effective in a disease caused due
to Asatmendriyartha Samyoga.
Key Words
Computer Vision Syndrome
Netra Roga
Asatmendriyartha Samyoga
Triphala Yashtimadhu Yoga
CONTENTS
Page No #
Introduction 1
Objectives 3
Review of Literature
Hetu 4
Trividha Hetu 11
Netra Shareera 18
Netra Roga 28
Netra Roga Chikitsa 41
Drug Review 48
Computer Vision Syndrome 56 Previous works 65
Materials 66
Methods 67
Observation 76
Results
Discussion 117
Conclusion 143
Recommendation for Future Study 144
Summary 145
Bibliography 147
Annexure i-xii
LIST OF TABLES
Sl.No. Table Name Page No
1. Showing the Synonyms of Hetu from various Sanskrit books 06
2. Showing the Synonyms of Hetu according to various classics 06
3. Showing the Asatmendriyartha samyoga of Gnanendriya 14
4. Showing the panchamahabhuta and its dominant parts in eye 18
5. Showing the chakshurendriya panchapanchaka 21
6. Showing the classification of Netra roga according to various acharyas 30
7. Showing the Netra roga nidana according to various Acharya 32
8. Showing the Netra roga nidana according to various commentators 33
9. Showing the lakshana of netra roga based on dosha predominance 35
10. Showing the dosha predominace in lakshanas of CVS 36
11. Netra Roga dosha predominant Lakshana in comparision to CVS 36
12. Showing the comparision of CVS with various netra roga in Ayurveda 40
13. Showing the pathya in netra roga 44
14. Showing the apathya in netra roga 45
15. Showing the rasa panchaka of drug 53
16. Distribution of patients according to Age group 76
17. Distribution of patients according to Sex 76
18. Distribution of patients according to Occupation 77
19. Distribution of patients according to Education 77
20. Distribution of patients according to Marital status 77
21. Distribution of patients according Socio Economic status 77
22. Distribution of patients according to Religion 78
23. Distribution of patients according to Locality 78
24. Distribution of patients according to Diet 78
25. Distribution of patients according to Diet pattern 79
26. Distribution of patients according to Rasa Sevana 79
27. Distribution of patients according to Sleep 79
28. Distribution of patients according to Duty 80
29. Distribution of patients according to Addiction 80
30. Distribution of patients according to TV watching 80
31. Distribution of patients according to duration of occupation 81
32. Distribution of patients according to duration of working hours 82
33. Distribution of patients according to working hours in a week 82
34. Distribution of patients according to prakruthi 83
35. Distribution of patients according to sara 83
36. Distribution of patients according to samhanana 83
37. Distribution of patients according to pramana 84
38. Distribution of patients according to satmya 84
39. Distribution of patients according to satwa 84
40. Distribution of patients according to agni 84
41. Distribution of patients according to vyayama shakthi 85
42. Distribution of patients according to desha 85
43. Distribution of patients according to chief complaints 85
44. Assessment of chief complaints before treatment 86
45. Showing the result on Schirmers test-I 97
46. Showing the result on Distant Vision 97
47. Showing the result on Near Vision 98
48. Showing the result on Dry & irritated eyes 99
49. Showing the result on Rednes of eyes 99
50. Showing the result on tearing eyes 100
51. Showing the result on Headache 101
52. Showing the result on Burning eyes 101
53. Showing the result on Blurred Vision 102
54. Showing the result on Photophobia 103
55. Showing the result on Contact lens discomfort 103
56. Showing the result on Slowness in focusing 104
57. Showing the result on Changes is colour perception 105
58. Showing the result on Pain in Shoulder 105
59. Showing the result on Pain in Neck 105
60. Showing the result on Pain in back 106
61. The response of the therapy for individual symptoms after treatment 107
62. The response of the therapy for individual symptoms after follow up 108
63. Statistical analysis of Whole treatment results 109
LIST OF CHARTS
Sl.No. Table Name Page No
1. Showing the classification of Hetu 8
2. Showing the classification of kala 8
3. Showing the physiology of vision (netra roopa grahana) 22
4. Showing the samprapthi of Netra roga 38
5. Showing the Netra roga samanya chikitsa 43
LIST OF PHOTOGRAPHS
Sl.No Particulars Page No
1 Showing the Raw Drugs in Triphala Yashtimadu Yoga 54
2 Showing the Prepared Medicine 55
3 Showing the Schirmers Test Strips 71
4 Showing the Schirmers Test Procedure 71
LIST OF GRAPHS
Sl.No. Particulars Page No
1. Distribution of Patients According to Age 88
2. Distribution of Patients According to Sex 88
3. Distribution of Patients According to Occcupation 89
4. Distribution of Patients According to Educational Status 89
5. Distribution of Patients According to Marital Status 90
6. Distribution of Patients According to Socio Economic Status 90
7. Distribution of Patients According to Religion 91
8. Distribution of Patients According to Locality 91
9. Distribution of Patients According to Diet 92
10. Distribution of Patients According to Diet Pattern 92
11. Distribution of Patients According to Rasa sevana 93
12. Distribution of Patients According to Nidra 93
13. Distribution of Patients According to Duty 94
14. Distribution of Patients According to Vyasana 94
15. Distribution of Patients According to Work duration 95
16. Distribution of Patients According to Agni 95
17. Distribution of Patients According to Symptoms 96
18. Drug effect on Schirmers test - I 110
19. Drug effect on Dry Eyes 110
20. Drug effect on Red Eyes 111
21. Drug effect on Tearing Eyes 111
22. Drug effect on Headache 112
23. Drug effect on Burning Eyes 112
24. Drug effect on Blurred Vision 113
25. Drug effect on Photophobia 113
26. Drug effect on all symptoms before after & follow up of trial 114
27. Clinical improvement in Dry Eyes 115
28. Clinical improvement in Red Eyes 115
29. Clinical improvement in Tearing Eyes 115
30. Clinical improvement in Headache 116
31. Clinical improvement in Burning Eyes 116
32. Clinical improvement in Blurred Vision 116
Introduction1
Ayurveda Siddhanta & Computer Vision Syndrome
INTRODUCTION
Ayurveda the science of "Ayu" – deals with maintenance of health and relief
from the disease. This can be successfully achieved only when we follow the norms
laid in Ayurveda. Apart from its rich and renounced heritage, Ayurveda has a rare
charm and glory of its own. As a great healer of the suffering mankind its contribution
is eminent and unique.
Ayurveda has put forward Siddhantas that are eternal and can be applied to
understand the disease in all its aspects, in its diagnosis and treatment.Trisutra
Siddhanta and Panchalakshana Siddhanta are a few among those Sidddhantas that are
time 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 new
disorders. Computer Vision Syndrome is one among such disorders occurring in
computer professionals characterized by complex eye and vision problems related to
near work which are experienced during working with computers involving both
ocular and non ocular symptoms. The catastrophic effects of this disorder are low
work performance, agony, extreme discomfort that hampers daily routine. Negligence
towards it could cost ones career resulting in Physiopsychological upset and severe
eye problems.
The problem is grave according to American Optometric Association with an
incidence in 75% -90% of employees working with Computers and more people are
likely to suffer in the future due to rapid growth of jobs in IT sector in India. So it is
the need of the hour to find a holistic solution to this problem.
In the present context I have taken Computer Vision Syndrome and made
effort to explain it on the basis of Ayurveda Siddhanta like Hetu,trividha hetu,panch
lakshana nidana and the general line of management mentioned in Ayurveda samhitas
for aganthuja netra roga. So this study is intended to study and understand “Computer
Vision Syndrome” a disorder not mentioned in Ayurvedic classics based on various
Introduction2
Ayurveda Siddhanta & Computer Vision Syndrome
Ayurveda Siddhanta and to find out a suitable Chikitsa Siddhanta based on the above
observations, from these prospects the present study has been taken.
It also comprises of a clinical study to evaluate the efficacy of Triphala
Yashtimadhu Yoga and its efficacy on symptoms with a time span of sixty days for
treatment and also its focus being on reliving of symptoms and management of the
disease.
The first part is mainly concerned with the review of literature regarding
various aspects of the disease such as, nirukti, bheda, paribhasha, Hetu, Trividha hetu
and Nidana panchaka etc, are reviewed and elaborately discussed. The second part
consists of details of clinical trials of the effect of Triphala Yashtimadhu Yoga on
Computer Vision Syndrome.
It comprises of the materials and the methods used for the study, the results
and the observations of the study and the discussion on them. A summary of the study
is provided in the last part of the dissertation with some suggestions for the future
studies.The study has shown that Ayurveda has a significant role to play in the
management of Computer Vision Syndrome.
Objective3
Ayurveda Siddhanta & Computer Vision Syndrome
OBJECTIVES OF THE STUDY
The present study was undertaken with the following objectives
1. 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 in
causation of the disorder.
4. To evaluate suitable Chikitsa based on the above observations.
5. To evaluate the efficacy of TriphalaYasthimadhu yoga in patients of Computer
Vision Syndrome clinically.
Review of Literature4
Ayurveda Siddhanta & Computer Vision Syndrome
HETU
According to Ayurveda a vyadhi is generally studied under the five main
headings to understand the entire process of a disease manifestation. They are Nidana,
Purvaroopa, Roopa, Upashaya and Samprapti respectively, also called as Nidana
Panchaka1. Among these nidana panchaka ‘Hetu’ stands first and forms the base or
root cause for the latter stages viz, purvaroopa, roopa etc. A vyadhi is never devoid of
its hetu. Even the Karyakarana sidhantha confirms that a karya / vyadhi are not devoid
of its karana / hetu2. Further it can be said that a wise treatment begins with nidana
parivarjana as told by Acharya Sushruta i.e., “Nidanaparivarjanameva chikitsa”. Thus
hetu plays a chief role in roga nidana and its chikitsa also.
Derivation
This is a “pumling” word3
Hetu = hi gatou (dhatu) 4 + Tuna pratyaya
Hi- to send forth, to impel, to promote
Hi- hinoti, hita
1. Hinoti vyapnoti karyam iti 5
Hinothi- To promote further
Vyapnothi- pervading, penetrating, to spread throughout
The word meaning of hetu is that which promotes and spreads the karya and is a
karana.
2. Pum hi tanu kaarane anumithi sadhane vyape phale cha
It is the pumlinga shabda with synonyms like karana, anumiti, sadhana, vyape, phale.
Definition
1. Seti kartavyatako rogotpaadaka heturnidaanam6
The factor which causes rogotpatti by vitiating the dosha is called nidaana
2. Tatra nidaanam kaaranam7
Etiological factor or causative factor
3. Vyadhi utpattti hetuhu nidaanam The factor which is responsible for the disease causation or manifestation.
4. Tatra hetuhu utpattikaaranam Hetu is a causative factor (karana) for vyadhi.
Review of Literature5
Ayurveda Siddhanta & Computer Vision Syndrome
5. Hetus tad udbhave 8
Hetu is that which gives rise to disease
*In all the above context hetu = nidanam, hetu and nidanam are used as samanartha
HISTORICAL REVIEW OF HETU
A) Veda kala
Rogotpadaka karanas are shareeragata mala roopavisha, krimi, vata, pitta and kapha.9
B) Mahabharata
Sheeta, Ushna, and Vayu are the cause for shareerika vyadhis is found in Shantiparva
16th adhyaya.
C) Samhita kala
a. Brihat Trayee
1. Charaka Samhita: Acharya Charaka has explained hetu in sutra sthana 1st, 11th,
25th, and 28th chapter. In nidana sthana 1st chapter and in shareera sthana1st & 2nd
chapter and in vimana sthana 6th chapter.
2. Sushruta Samhita: Acharya Sushruta has explained hetu in sutrasthana 3rd hapter,
explained it as an ‘upaya’ and karaka hetu.
3. Asthang Hrudaya: Acharya Vagbhata has explained hetu in sutrasrhana 1st chapter
and also under nidanapanchaka in nidanasthana 1st chapter.
b. Laghu Trayee
1 Madhava nidana explained in 1st chapter about hetu.
2 Bhavaprakasha: Bhavamishra mentioned and described hetu in Rogaprateekara
prakarana the 7th chapter of poorvakhanda.
c. Other classical texts
1 Astanga Sangraha: Acharya Vagbhata described hetu in sutrasthana 1st, 22nd
chapter and under nidana panchaka in nidana sthana 1st chapter.
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 in
jwaradhikara.
Review of Literature6
Ayurveda Siddhanta & Computer Vision Syndrome
d.Recent Ayurvedic literature
1. Nidanachikitsa hastamalaka: Vd Ranajit rai desai expalained hetu under nidana
panchaka.
2. Doctrines of pathology in Ayurveda: Dr K.R.Srikantha Murthy described hetu in
9th chapter
3. Ayurveda Vikriti Vignaan: Vd Vidyadhar shukla explained hetu in 20th chapter
under nidana panchaka.
Table No.1 Synonyms of Hetu as per Sanskrit texts
Types of hetu AK VK RN MK VSS 1. Hetu - - - - 2. Karana - - 3. Nidana - - - - 4. Aadikarana - - - - 5. Anumiti - - - - 6. Sadhana - - - - 7. Vyape - - - - 8. Phale - - - - 9. Roganirnaya - - - - 10. Beejam - - - - 11. Roga Hetu - - - -
Synonyms of Hetu
Various synonyms as per different classics are as follows. All of them give common
meaning as hetu \ karana10
Table No.2 Synonyms of Hetu as per Ayurveda Samhita
Sl.no CS11 Ckp12 AS AH13 MN14 BP15
1 Hetu
2 Nimitta
3 Aayatana
4 Karta - - -
5 Karana
6 Pratyaya
Review of Literature7
Ayurveda Siddhanta & Computer Vision Syndrome
7 Samutthana - - -
8 Utthana - - - - -
9 Nidana - - -
10 Yoni - - - -
11 Mukha - - - - -
12 Mula - - -
13 Karaka - - - - -
14 Prerana - - - - -
15 Prakruthi - - - - -
16 Nibandha - - - - -
Types of Hetu
According to Madukosha tika 16 the hetu’s are broadly classified according to their
role in causation of a disease.
A) Dvividha hetu:
1) a) Bahya b) Abhyantara
2) a) Utapadaka b) Vyanjaka
B) Trividha hetu: 1. a) Asatmendriyartha Samyoga b) Prajnaparadha
c) Parinaama.
2. a) Dosha hetu b) Vyadhi hetu c) Ubhaya hetu.
C) Chathurvidha hetu: a) Sannikrishta b) Viprakrusta c) Vyabhichari
d) Pradhanika
Review of Literature8
Ayurveda Siddhanta & Computer Vision Syndrome
Ati.Y Ayo Mit.y
Importance of Hetu
The Ttrisutra of Ayurveda explained in Charaka Samhita states that the
knowledge of hetu, linga, aushadha is applicable to both swastha and atura. Hetu is
considered the first among trisutra, also denoting its importance as karana for roga
and arogya. Kala, artha and karma are 3 types of hetu and its tri vikalpa i.e., atiyoga
1. Sannikrishta, 2. Viprakrishta 3. Vyabhichari 4. Pradhanika
Hetu
1. Astamendriyartha samyoga
2. Prajnaparadha 3. Parinaama
Dosha Hetu Vyadhi Hetu Ubhaya Hetu
Dhi Dhrti Smrti
Vibhramsha 1. Bahya Hetu 2.Abhyantara Hetu 1. Vyanjaka 2. Utpadaka
Hetu
Spars Twakha
Samavayi Dushya
AsamavayiDosha dushya sammurchana
(dhatu & mala)
Nimitta
Mithyahara vihara
Parinama (kala)Prajnaparadha (Karma)Asatmendiyartha Samyoga (Artha)
Gandha Ghrana
Rasa Jihwa
Rupa Chaksu
Sabda Srotra
Ati.y Ayo Mith.
Manasika VachikaKayika
Ati.y Ayo Mith.y Ati.y Ayo Mith.y Ati.y Ayo Mith.y
Review of Literature9
Ayurveda Siddhanta & Computer Vision Syndrome
ayoga and mithyayoga are the cause for diseases and their samyagyoga (of indriyartha
prajna, and parinama) is the cause for health. So it can be understood that Roga Hetu
are Atiyoga, Ayoga and Mithyayoga of Kala,Artha,Karma and Arogya Hetu are
samyagyoga of Kala,Artha,Karma.
Utility of Hetu
Hetu is helpful in knowing
1. Vyadhi karana:
Hetu is karana for vyadhi. So by knowing the hetu involved the vyadhi Karana
and its severity is known.
2. Vyadhi vinischaya:
If there is any doubt regarding the diagnosis of a disease, observation of the
etiological factors leads to the confirmation of vyadhi.
3. Sadhya asadhyata:
Hetu is very helpful to decide the sadhyasadhyata of a vyadhi. Alpa hetu causes
alpa 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 REVIEW
Etiology or Cause18
Hetu word is synonymous to etiology in modern medical literature.
Derivation
Eti-ol-o-gy or Aeti-olo-gy,
Aitia - a charge, accusation, cause
Logos (logy) – word of speech, treatise, discourse
Aitia + logos = the doctrine of causes,
So the word meaning of etiology can be derived as
The discourse about the cause of a disease
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Definition
The study of causes specifically the cause of disease 19
or
The science dealing with causes of disease 20.
In modern terms there are two major classes of etiological factors
1. Intrinsic or genetic
2. Acquired (infectious, chemical, nutritional, physical)
Knowledge or discovery of the primary cause remains the backbone on which the
diagnosis can be made, a disease understood or a treatment adopted.
The four aspects of a disease process that form the core of pathology are
1. Etiology- cause
2. Pathogenesis- the mechanism of its development.
3. Morphology- the structural alterations/changes induced in cells and organs of the
body.
4. Symptoms/Clinical manifestations - the functional consequences of morphologic
changes.
In Ayurveda a disease is studied under 5 stages (Nidana panchaka) and in
modern it is studied in 4 stages. In both these medical systems etology/hetu is the first
and foremost factor which denotes the cause / causative factor of a disease.
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TRIVIDHA HETU
INTRODUCTION
In Ayurvedic classics it’s often stressed that trividha hetu namely
Asatmendriyartha samyoga, Prajnaparadha and Parinaama are the prime cause in the
disease origin especially of shareerika and manasika21. Though varieties of hetu
classification have been made like dvividha, trividha, chaturvidha etc but all these
hetus can be incorporated under single heading as trividha hetu. Among these trividha
hetu again we can find the specific role of single hetu in different diseases, eg-
Asatmendriyartha samyoga, plays an important role in indriyajanya vyadhis22.Thus
trividha hetu occupy a broader place in the field of hetu.
Definition
The hinayoga atiyoga and mithyayoga of artha, karma and kala is termed as treeni
aayatanani or trividha hetu23.
Types
Asatmendriyartha samyoga, prajnaparadha and parinaama are of three type’s each24
HISTORICAL REVIEW OF TRIVIDHA HETU
Upanishad
In Shwetashwaropnishad ‘Kaalo hi naama sarva bhutanaam aviparitanaama hetu’ is
mentioned.
Bhagavadgeeta
In 2nd chapter indriya nigraha as the cause for sukha has been men
Samhita kaala
a. Brihat Trayee
Charaka samhita
1st, 11th, 20th, 25th, 28th chapters in sutrasthana. 1st chapter in nidanasthana. 1st
and 2nd chapter in shareersthana explains about trividha hetu.
Sushruta samhita
Acharya Sushruta has explained Asatmendriyartha samyoga, and
Prajnaparadha as hetu in 61st chapter of uttaratantra, mithyayoga, ayoga and atiyoga
of artha, karma as apasmara hetu and also explanation of kala is available in
sutrasthana 6th chapter.
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Astanga Sangraha
Vagbhata sutrasthana explains trividha hetu in 1st, 22nd chapters and in 1st
chapter of nidanasthana.
Astanga Hrudaya
1st and 12nd chapter of sutrasthana, and under nidanapanchaka in nidanasthana.
Laghutrayee
Madhava Nidana-1st chapter explains about trividha hetu
d. Recent Ayurvedic literature
1. Nidanachikitsa hastamalaka: Vd Ranajit rai desai expalained hetu under nidana
panchaka.
2. Doctrines of pathology in Ayurveda: Dr K.R.Srikantha Murthy described hetu in
9th chapter
3. Ayurveda Vikriti Vignaan: Vd Vidyadhar shukla explained hetu in 20th chapter
under nidana panchaka.
Trividha Hetu Importance
1. For all sorts of vedana the trividha hetu in the form of dhi, dhriti and smriti
vibhramsha, karma, kaala samprapti and asatmendriyartha samyoga are main
causes.25
2. The mithyayoga, ayoga and atiyoga of Kaala (parinaama varshadi ritu), Buddhi
(prajna), Indriyartha (shabda, sparshadi, bhogya dravya guna karma) are the main
cause in all type of shareerika and manasika vikaras26.
3. This is again strengthened by charaka in sutrasthana stating them as ‘treeni
aayatanani’ & ‘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 SAMYOGA
Introduction
The literal meaning of Asatmendriyartha is a state unfavourable for the indriya
with their vishaya. The word indriyartha is applied for jnanendriya only which are
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five in number viz (Shabda, Sparshadi, etc).The hina yoga, atiyoga and mithya yoga
of indriyas with their respective vishyas create unfavourable situation specifically to
indriyas and thereby to the body causing a disease. Among trividha hetu’s it is the
nearest or immmediate cause in the disease manifestation.
Asatmya
Derivation
‘Asatmya’ word is formed by derived by adding two upasarga A+SA to Atma shabda
then the word Asatmya is formed. A+sa+atma = asatmya
Definition
Asatmya – Those vishaya of indriya creating unfavorable state for body and mind29
Indriya
Derivation
Indriya- derived from ‘Ida’ dhatu and ‘gha’ pratyaya meaning it is the ruler of the body.
Definition
Prana is termed as Indra and its linga is indriya. So, that which gives sensory
knowledge is called indriya.
Artha
Vishaya or knowledge attained through a particular indriya is called artha. Indriya
vishyas viz shabda, sparsha roopa rasa adi are the indriyarthas of shrotrendriya,
Sparshendriya etc
Samyoga
Derivation
It is derived from adding Sama (upasarga) + yuj (dhatu) + gha (pratyaya)
Definition
Samyogam nama dwayorbahoonaam vaa dravyanam samhatee bhavaha. Combination
of two or more dravyas is called Samyoga.
Types
Depending upon the indriya, its indriyartha and its hina, ati or mithya yoga the
asatmendriyartha samyoga is classified as follows30
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Table No.3 Asatmendriyartha Samyoga of Gnanendriya
Indriya Indriya Artham
Atiyoga Ayoga Mithyayoga
Karna Shravanam
Ati Shravanam
Ashravanam Uccha,parusha,bhishanadi shravanam
Twak Sparshanam
Ati Sparshanam
Asparshanam Abhighata,visha,vaatadi sparshanam
Chakshu Darshanam
Ati Darshanam
Adarshanam Sookshma,atidoora,bhaswa darshanam
Nasa Ghranam Ati Ghranam Aghranam Putya,medhyati,teekshna,ugra, ghranam
Jihwa Rasanam Ati Rasanam Arasanam Apathy,vishama,arasa grahanam
PARINAAMA
Introduction
Parinaama in general means avastha or parivartana brought by the influence of
kala. Acharya charaka had used tha word ‘kaala’ for parinaama31.since ati, hina and
mithya yoga of kaala brings dosha vitiation in the shareera and causes vyadhi. In
ayurveda kaala is also given importance and its explaination is found in many places
in classics.
Derivation
It is derived from ‘pari’ upasarga, ‘nama’ shabda and ‘ghama’ pratyaya.
Meaning of which is transformation32
Kaala
Ka + Aa+ La = Kaala
The lakaar and akaar of kaala shabda and lakaar of lee dhatu when unites the
kaala shabda occurs.Similarly, the one which destroys the entire things of the world
and 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 is
called kaala33
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Types
Though variety of classification of kaala is elaborately explained by our
acharyas 34 but for the vyadhi utapatti and chikitsa purpose the entire kaala is divided
into four in one samvtsara and again in the trividha kaala namely sheeta, ushna and
varsha are the main under which the remaining kaala is to be considered and treatment
can be carried based on this kaala only35.
Kaala Chart
Importance of Parinaama
1. The hina, ati or mithya yoga of any of the seasonal variation becomes a cause for
vyadhi utapatti36.
2. Parinaama is also understood as ‘kaala’ and since kaala is transforming the results
of shubha ashubha karma, dharma and adharma etc.,37
Kaala
Samvatsara
1. Visarga 2. Adana
Trividha Shadvidha Dvadashavidha
1. Sheeta 2. Ushna 3. Varsha
1. Sishira 2. Vasanta 3. Grishma 4. Varsha 5. Sharat 6. Hemanta
1. Magha 2. Phalguna 3. Chaitra 4. Vaishakha 5. Jyesta 6. Aashada 7. Shravana 8. Bhadrapada 9. Ashwaija 10. Kartika 11. Margasirsha 12. Pushya
Dvividha
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3. The kaalaja rogas are powerful in their respective kaala and hence their treatment
should 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.
PRAJNAPARADHA
Introduction
The very literal meaning of prajna is consciousness. It is one of the
important hetu among trividha hetu. Some commentators limit the meaning of prajna
to 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 limitation
of merely intellectual error40. The word ‘karma’ is used for prajnaparadha. The word
karma has a very wide meaning indicating the karma of kaya, vacha and manasa as
well as purvajanmakrita and sadyojanmakrita too. The word ashubha karma in the
definition states that disturbed state of dhi, dhriti, and smriti respectively. The hina, ati
and mithya yoga of such karma causes vyadhi utapatti. Thus prajnaparadha occupies
an important place in trividha hetu.
Derivation
It is derived from jna (mulashabda) – jnayate iti shabda, ‘pra’ upasrga, jnayate iti
artha 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 offence
Prajna
It is a streelinga shabda representing buddhi tattva of saraswati devi.
Aparadha
It is a pumlinga shabda derived from ‘apa’ and’ radha’ dhatu..
Definition
The ashubha karma brought about by kaya, vacha and manas in the disturbed
state of dhi, dhriti and smriti is said or defined as prajnaparadha.
Types
As per the definition it is classified into 3 types viz kayika, vachika and
manasika with again its three subtypes as hina, ati and mithyayoga respectively.
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Prajnaparadha as major cause for diseases
It 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 dwapaara
yuga. Along with it there is decline in the quality of sasya also.42
The factors like lobha, abhidroha and kopa are included under adharma in
janapadodhwansa adhyaya. It is mentioned in classics that for vatadi dusti and
adharma the prajnaparadha is the moola yoni or karana43. This clearly indicates that, it
is the prajnaparadha only in the form of adharma as the root cause in the jwaradi
rogas.
In the manifestation of almost all the disease the trividha hetu viz
asatmendriyarthadi always exists. However, prajnaparadha is the prime root in all the
disease maniefestation accompanied with asatmendriyartha samyoga and kaala. This
can be understood by nidanokta samprapti of diseases, which will reveal the fact that
all the diseases are caused by the stimuli of prajnaparadha associated with
asatmendriyartha samyoga and parinaama.
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NETRA SHAREERA
Importance of Eyes
One need not emphasize the importance of the eyes as scriptures say
‘Sarvendriyanaam Nayanam Pradhaanam’ “nothing in this world is as good and
perfect as, unaided vision”. Eyes were greatly valued by ancient Indians and much
importance was accorded to their protection and care.
Historical review
The description of eye can be traced in Vedic litrature.The divine Vaidyas,
Ashwini used to perform ophthalmic operations with the knowledge of anatomy. The
Brhadāranyaka Upanishad narrates about Akşhi. Chakshushopanishat is also devoted
to eye care.
The Uttara Tantra of sushruta samhita gives a vivid description of the eye, its
anatomical description, along with classification of its diseases and their management
is explained in detail44.
Synonyms of eye
Akşi, Cakşu, Dŗşţi, Netra, Nayana and Lochana are the different synonyms
used 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 a
widely used word for the organ of sight45-.
Panchabhautika concept of Netra
The Netra, like all other organs of the body is made up of Panchamahabhutas
and drushti is pancha maha bhuta prasasda bhaga.Sushruta has clearly mentioned the
contribution of Panchamahabhutas as follows46
Table No 4. Panchamahabhoota dominant parts in netra
Mahabhoota Part
Prithvi 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)
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Netra Rachana47
Situation: Siras is the uttamanga of the body. All the senses are situated in it and
supported by the head. Netra are the two among the seven external openings of the
Shiras
Shape: Acharya Sushruta in Sushruta Samhita Uttartantra has described Netra as
“Suvrittam, Gostanakaram Nayana Budbudam”, which denotes the shape and
consistency of the Netra.
Size: The measurements of the eyeball was described by Sushruta as 2 Angula
Bahulya (anterio posteriorly) or equal to central part of ones own thumb
(swangushtodara sammitam) and 2½ Angula Sarvata sardham (circumference).
Parts of Netra
The anatomical parts present in eye consists of 5 Mandala, 6 Sandhi and 6
Patala.The same division was adopted by Vagbhatta, Madhavakara and Bhavamishra
also.
Mandala
The word Mandala is made from root ‘Mad’ + ‘Klach’ pratyaya means,
covering circular areas or concentric circles. The are 5 Mandala
1) Pakshma Mandala
2) Vartma Mandala
3) Shweta Mandala
4) Krishna Mandala
5) Drishti Mandala
Sandhi
Sandhis are the junctional areas between two Mandalas. The Sandhis are
important 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 are
1. Pakshma – Vartma gata Sandhi
2. Vartma – Shukla gata Sandhi
3. Shukla – Krishna gata Sandhi
4. Krishna – Drishti gata Sandhi
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5. Apanga Sandhi
6. Kaneenika Sandhi
Patala
V.S. Apte, in his Sanskrit – English dictionary describes the meaning of Patala
as a film or coating over the eyes. According to Monier Williams, it can be considered
as a layer of the eyeball.
The thickness of each Patala is 1/5th of the Drishti Mandala.There are 2
Vartma Patalas and 4 Akshi Patalas. The Vartma Patalas can be considered as the
layers of the Vartma – the eyelids and palpebral conjunctiva
The four Akshi Patalas are related to the eyeball itself. 1st Patala Tejas + Jala,
2nd Patala Mamsa (Pisita or Mamsashrita), 3rd Patala Medas Medoashrita, 4th Patala
Asthi –Asthyashrita.
Akshi Bandhana
Sirā, Kandarā, Meda and Kālakāsthi aid in maintaining the position of netra.
Sira & Dhamani There 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 are
in each eye for transmission of Roopa (visual impulses) to the mind and other
dhamani are for ashru vahana.
Peshi and snayu
Mandala (circular) type of Peshi and Pruthu (broad) type of Snayu are found in
the eyes. They are respectively two and thirty in number.
Asthi and sandhi
Netra are situated in Akshi kosha surrounded by Tarunasthi
Marma
‘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.
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Description of Drishti
Etymology
Drish + ‘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 things
Drishti means vision. All the anatomical structures through which light passes to
reach the retina including the optical zone of cornea, aqueous humour, lens, vitreous
humour and retina can be included in the Drishti as per many scholars.
CONCEPT OF DRISHTI IN AYURVEDA
Visual perception, like all other sensory phenomena, is dependent upon the
state of mind and soul. Acharya Charaka has described this process as the conjuncture
of soul, mind and the sense organ with their objects. Kashyapa classifies senses into
Sannikrishta Indriyas and Viprakrishta Indriyas. Eyes and ears are Viprakrishta
Indriyas, where in object need not directly fall on the senses. Eyes are developed with
sufficient skills to perceive the object from a sufficiently large distance.
The theory of Panchapanchaka given by Acharya Charaka depicts the
phenomenon of sensory perception by enumerating the five important factors that take
part in this process. They are Indriya, Indriya Dravya, Indriya Artha, Indriya
Adhisthana and Indriya Buddhi. In case of eye, these factors are as follows
Table No.5. Indriya panchapanchaka of netra
Indriya Chakshu
Indriya Dravya Tejas
Indriya Artha Rupa
Indriya Adhishthana Eyes (2 Netra)
Indriya Buddhi Chakshurbuddhi
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Impulses from both these Akshis are collected at Chakshu47 (Indriya), which is
only 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 like
Prana 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 be
considered as the function of Jnanendriya. The physiology of vision can be
summarized as follows
Indriyartha (Object)
Vata
Indriyavayava
Chakshurvaisheshika Alochaka Pitta
Indriya Samvedaka (nerve impulse)
Prana Vayu
Buddhi (occipital cortex)
Buddhirvaisheshika Alochaka Pitta
Pratyakshajnana
(Atma – seat of knowledge)
Similar ideas are reflected in the description of two phases of Chakshurbuddhi48. The
momentary knowledge is obtained by Kshanika Chakshurbuddhi, which will be
further confirmed in the second stage by Nischayatmika Chakshurbuddhi, according
to Chakrapanidatta.
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ANATOMY OF EYE
Introduction
Even though the eye is small, it serves a very important function i.e. sense of
sight. Vision is arguably the most useful of the five senses and is one of the primary
means to gather information from the surroundings. Eye is often compared to a
camera. Two eye balls are situated in the two bony orbits of the norma-frontallis of
the skull49 and protected by eye lids and eye lashes. Each eye ball is a cystic structure
kept distended by the pressure inside it. Each of them gathers light and then
transforms that light into a “picture”.
Dimensions of an adult eye ball
Antero-posterior diameter 24mm
Lateral diameter 23.5mm
Vertical diameter 23mm
Circumference 75mm
Volume 6.5ml
Weight 7gms
Coats of the eye ball
The eye ball comprises of three coats
1) The outer fibrous tunic = sclera and cornea
2) The middle vascular tunic = iris, ciliary body and choroids
3) The inner nervous tunic = retina
Interior of the eyeball has the following structures
1) Aqueous humor
2) Lens
3) Vitreous
The accessory structures are
1) Eyebrows
2) Eyelids and eyelashes
3) Lacrimal apparatus
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Sclera
The sclera forms posterior 5/6 of the eye ball. It has received its name from its
extreme dense fibrous tissue which is hard and maintains the shape of eyeball. Its
external surface is white in colour.
Cornea
The 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 front
of the sclera. The cornea is dense and of uniform in thickness throughout; its posterior
surface is perfectly circular in outline, and exceeds the anterior surface slightly in
diameter. its separated from iris by the aqueous humour in the anterior chamber.
Iris The 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 the
cornea and lens, and perforated a little to the nasal side of its center by a circular
aperture, the pupil. On its periphery it is continuous with the ciliary body, and is also
connected with the posterior elastic lamina of the cornea by means of the pectinate
ligament; its surfaces are flattened, and look forward and backward, the anterior
toward the cornea, the posterior toward the ciliary processes and lens. The iris divides
the space between the lens and the cornea into an anterior and a posterior chamber.
Retina
The 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 it
soon becomes clouded, opaque, and bleached when exposed to sunlight. Exactly in
the center of the posterior part of the retina, corresponding to the axis of the eye, is an
oval yellowish area, the macula lutea; in the macula is a central depression in the
fovea centralis. At the fovea centralis the retina is exceedingly thin, and the dark color
of the choroid is distinctly seen through it. About 3 mm to the nasal side of the macula
lutea is the entrance of the optic nerve (optic disk), the circumference of which is
slightly raised to form an eminence (colliculus nervi optici) the arteria centralis retinæ
pierces the center of the disk.
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This is the only part of the surface of the retina which is insensitive to light, and it is
termed the blind spot.
Aqueous humor
The aqueous humor fills the anterior and posterior chambers of the eyeball. It
is small in quantity, has an alkaline reaction, and consists mainly of water, less than
one fiftieth of its weight being solid matter, chiefly chloride of sodium.
Crystalline lens
The lens is made up of soft cortical substance and a firm, central part, the
nucleus.The crystalline lens, enclosed in its capsule, is situated immediately behind
the iris, in front of the vitreous body, and encircled by the ciliary processes, which
slightly overlap its margin. The lens is a transparent, biconvex body, the convexity of
its anterior being less than that of its posterior surface.
Eyebrows
Eye brows are two arched eminences of integument, which surmount the
upper circumference of the orbits, and support numerous short, thick hairs, directed
obliquely on the surface.
Eyelids
Eyelids are two thin, movable folds, placed in front of the eye, protecting it
from injury by their closure. The upper eyelid is the larger, and the more movable of
the two, and is furnished with an elevator muscle, the Levator palpebrae superioris.
Eyelashes
Eyelashes 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, more
numerous and longer than those of the lower, curve upward; those of the lower eyelid
curve downward, so that they do not interlace in closing the lids.
Lacrimal apparatus
Lacrimal apparatus consists of the lacrimal glands, which secretes the tears
and convey the fluid to the surface of the eye, and its excretory ducts, the lacrimal
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ducts, the lacrimal sac, and the nasolacrimal duct by which the fluid is conveyed into
the cavity of the nose.
Physiology of vision
In some ways the eye is like a camera. Its optical elements focus the image of
objects on a light sensitive film- the Retina, while ensuring the correct amount of light
makes the proper exposure. In order to achieve clear vision, light reflected from
objects within the visual field is focused to the retina of both eyes. The processes
involved in producing a clear image are –
a) Refraction of the light rays by the lens and camera
b) Accommodation of the eyes to light
The retina is the photosensitive part of the eye. The light sensitive cells are the
rods and cones. When light falls upon the retina, it acts as a stimulus to the rods and
cones, which serve as the sensory nerves endings. An image focused on the retina
stimulates photo receptors, which transduce the light stimulus into receptor potential
and pass the information on to bipolar cells. Bipolar cells, in turn communicate
ganglion cells, which project their axons to the lateral geniculate body of the
thalamus. From the thalamus, fibers carrying visual nerve impulses extend to the
primary 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 this
process is absorption of light by rhodopsin/iodopsin (photopigments). These photo
pigments have two parts -
i) A glycoprotein - Opsin
ii) Derivative of Vitamin A - Retinal
Vitamin A derivates are formed from the carotenoids. Photopigments are
coloured proteins in outer segment membranes that undergo structural changes upon
light absorption. They initiate the events that lead to production of a receptor
potential. The single type of photopigment in rods is called rhodopsin. A cone
contains one of the three different kinds of photopigments, thus there are three types
of cones. Retinal is the light absorbing portion of all visual photopigments. In the
human retina, there are four different opsins, one for each cone photopigment and one
for rhodopsin. Small variations in the amino acid sequences of the different opsins
permit the rods and cones to absorb different colours of incoming light. Rhodopsin
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absorbs blue to green light most effectively whereas the three cone photo pigments
most 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 it
straightens out to a shape called Trans-retinal forming Cis Trans Isomerisation cis to
Tran’s conversion is called isomerisation and it is the first step in transduction.
Forming of a visual image begins with isomerisation of particular photopigments in
certain 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 retinal
isomerase can reconvert Trans to cis – retinal, which then binds to opsin and reforms
a functional photopigment. This is called regeneration.This process is contributed by
large storage of vitamin A by pigment epithelium.
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NETRA ROGA
The diseases occurring in various parts of the Netra are termed as Netra roga
Historical review of netra roga
1. Veda kaala
a) In Yajurveda Taittareeya sakha explanation of drushti prapti is mentioned50.
b) In Atharvana veda explanation is available about Andhatwa nivarana and
importance of drushti.
2. Upanishad & Purana kala
a) In Garuda purana explanation of netra roga is available
b) 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 a
netra roga51.
3. Darshana kaala
a) 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 kaala
Bruhatrayee
a) Acharya charaka mentioned netra rogas in trimarmeeya chikitsa adhyaya of
chikitsa 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.
Laghutrayee
a) Madhavakara in Madhavanidana explained nidana and lakshana of netra rogas in
Netraroganidana adhyaya.
b) Bhavamishra in Bhavaprakasha explained netra roga and their chikitsa in detail
under Netrarogaadhikara.
c) Sarangadhara explained netra roga and their chikitsa in detail in uttarakhanda.
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Other classical texts
a) Harita Samhita explained Netra roga and their chikitsa in netra roga chikitsa
adhyaya.
b) Yogaratnaka explained Netra roga and their Chikitsa
c) Chakradatta also explained Netra roga and their Chikitsa under chikitsa
prakarana.
Recent books
a) Dr Vishwanath Dwivedi in ‘Nimi tanthra’ book explained Netra roga and their
Chikitsa
b) Dr Ravindra Chandra Choudary in ‘Shalakya Vignana’ text book explained Netra
roga and their Chikitsa
c) Dr D.Lakshman Acharya in ‘Shalakya Tantra’ text book explained Netra roga and
their Chikitsa
d) Dr P.K.Shantakumari in text book ‘Opthalmology in Ayurveda’ explained Netra
roga and their Chikitsa
Classification of Netra Roga
Ayurveda Samhitas have classified the diseases according to nature of
occurrence and the site of occurrence. The netra roga also can be classified as
follows
Nature of Occurrence53
1. Aadi Bala Pravrutta- Includes hereditary disorders acquired from mother and
father.
2. Janma Bala Pravrutta- Includes Congenital abnormalities
3. Dosha Bala Pravrutta- Eye Problems caused by Dosha vitiation.
4. Sanghatha Bala Pravrutta. – Abhighata janya netra roga due to factors like
bhoutikaabhighata,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.
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Table No. 6 Netra Rogā according to different Āchārya 54-59
Su.Sa AS AH MN YR BP SA KT Sandhigata Rogās 09 09 09 09 09 09 09 09
Varthmagata Rogās 21 24 24 21 21 21 24 27
Śhuklagata Rogās 11 13 13 11 11 11 13 13
Kŗişhņagata Rogās 04 05 05 04 04 04 05 06
Sarvagata Rogās 17 16 16 17 17 17 16 16
Pakşhmagata Rogās - - - 02 02 02 - -
Dŗşhtigata rogās 12 27 27 12 12 12 27 25
Bahyaja 02 - - 02 - 02 - - Total 76 94 94 78 78 78 94 96
NIDANA OF NETRA ROGA60 -63
After discussing the definition derivations and classification of the netra roga
it is very essential to concentrate on etiological factors that are responsible for the
causation of the disease.
Nidana is one of the five factors of diagnosis of any disease called as nidana
panchaka. It is the factor which is the cause of any diseases. It is also that factor which
directs us towards a diagnosis of disease.
Nidana is classified into different groups in Ayurvedic classics on different
basis. Some of them are in relation to the time taken in causing a disease and some are
on the basis of their diagnostic significance.In this chapter the causative factor of
netra 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 varieties
of where as the specific etiological factors are responsible for the specific variety of
netra roga.The Nidana Panchaka consists of Nidana, Purvaroopa, Lakshana, Upashaya
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and Samprapti which help to understand the disease in detail.The Nidana Panchaka of
Netra Roga is explained below.
Acharya Charaka in sutrasthana 18 chapter Trishotheeya adhyaya says that it’s
not necessary to name all the diseases and it’s not possible also to name them.an
intelligent physician should diagonise the disease, basing on dosha because the same
tridosha getting prakopa due to various factors gets lodged in various parts of shareera
and causes various diseases. Thus this Siddhanta of Acharya Charaka is valid in
understanding new diseases like CVS which though not mentioned in Ayurveda
Samhitas can be understood by applying panchlakshana nidana as follows.
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Table No. 7 Netraroga Nidana
No Etiological factors of Netra Roga
Su.Sa MN BP YR
1. Ushna Abhitaptasya Jala Pravesha
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 -
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Acharya Dalhana while commenting on uttaratanthra 19th chapter ‘Nayanabhighata
pratishedha adhyaya’ has mentioned about Abhighata nidana causing netra roga by
amoortha 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 contact
with excessively sparkling, fast moving and minute objects.
Pujyapada Muni in Netra Prakashika gives the following nidanas wrong way
of oil bath -either in excess or less, witch craft, drug addiction, weight lifting ,staring
at luminous objects like sun,jwala-nireekshana etc cause netra roga.
Table No. 8 Netra roga Nidana according to Commentators
Ckp Dal
Avakshira shayya - +
Shiro ucchitha - +
Kshara sevana - +
Darshana ayoga + +
Darshana atiyoga + +
Darshana mithya yoga + +
Bhasavarna + +
Upasarga - +
Acharya Chakrapani73 while commenting on Matrashitiya adhyaya of Charaka
Samhita sutrasthana in the context of guru and laghu aahara and its relation to agni
says that “the eye is the seat of tejas. Perception of vision occurs due to the union of
the eye with tejas. The same tejas if excess causes loss of vision or impairs the
vision”.
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POORVAROOPA
The feebly manifested symptoms which are produced during the processes of
sthana samshaya avastha of kriya kala in the manifestation of disease process are
known as poorva rupas65.
Poorvaroopa are that group of signs and symptoms appearing in milder form
and indicative of forth coming disease.
The description of prodromal symptoms of netra roga was not given separately
in 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 as
follows. 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. Avila
2. Samrambha
3. Ashru
4. Kandu
5. Upadeha
6. Guru
7. Oosha
8. Toda
9. Ragayuktam
10. Sashoolam vartma-kosheshu
11. Shukapurnabham
Acharya 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 this
stage. Purva roopa has not been specifically mentioned by Acharya Charaka and
Vagbhata and it is implied that the lakshnas in lesser intensity are to be considered as
poorva roopa of netra rogas.
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ROOPA
The stage of disease manifestation where the signs and symptoms are
exhibited clearly is the vyakthavasta and such a group of clinical features is called as
roopaor lakshana of the disease.
This roopa can be very specific to a disease and indicative of the underlying
pathology. This can be subjective or objective however, it becomes the main aid in
diagnosis due to clear cut manifestation of disease at this stage.
Generally rupa are classified into samanya and vishista rupas. Under samanya
Roopa/Lakshanas the following Lakshanas can be considered based on dosha
predominance according to Acharya Charaka66.
Table No.9 Dosha predominant lakshana in netra roga
Vata Pitta Kapha
Alparaga Daha Shuklopadeha
Upadeha Atiruja Bahu picchila ashru
Toda Raga Guruta
Bheda
Peetopadeha Kandu
ROOPA wsr TO CVS
Signs and symptoms of Computer Vision Syndrome and the probable dosha vitiation
involved in it is being considered based on the signs and symptoms as follows. The
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
Light Sensitivity,
Double Vision
Backache
Neck Ache
Muscle Fatigue
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Eye Strain
Difficulty Refocusing the Eyes.
Table No.10 CVS symptoms and their dosha involvement
The lakshana of netra roga based on dosha predominance wsr to CVS is compared
here.
Table No.11 Netra Roga Lakshana in comparision to CVS
Vata Lakshana CVS
Alparaga Redness
Upadeha Excessive secretions of eye / stickiness
Toda Mild pain (pricking)
Bheda
Tearing pain
Pitta Lakshana
Symptoms Ayurvedic terms Dosha vitiation
Dry and irritated eyes Visushka Netra / Rooksha Netra
Vata
Eye Strain Netra Klama Vata Blurred vision Avila Darshanam Pitta Red Eyes Netra Raaga Pitta Burning Eyes Netra Daha Pitta Excessive lacrimation Ashru Bahulata Vata Double vision Dwidha pashyati (Mithya
darshana) Vata
Difficulty in focusing Roopa darshana asahyata (heena tarpita lakshana)
Vata
Change in colour perception Vikruta varna patavam Vata / Pitta
Photophobia Prakasha Asahyatva Vata / Pitta Headache Sirashoola Vata/Pitta Pain in shoulder, neck and back. Greeva, Bahu ,
Kati Shoola Vata
Contact lens discomfort --------------- -
Slowness in changing focus Alpa kriya laghava of netra
Vata
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Daha Burning sensation
Atiruja Excessive pain
Raga Redness
Peetopadeha Yellow discoloration -
Kapha Lakshana
Shuklopadeha
White discoloration -
Bahu picchila ashru
Excess sticky secretions in eyes -
Guruta
Heaviness
Kandu Itching
UPASHAYA
Upashaya-Anupashaya67
The Ahara-Vihara-Aushadha, which helps to relieve disease symptoms, is
called as Upashaya and that which cause aggravation of the symptoms is called
Anupashaya.In the context of netra roga direct reference is available about Upashaya
& Anupashaya. Hence, all those factors mentioned under anupashaya along with
apathyas and nidana can be considered as Anupashaya and in Upashaya those factors
which relieve symptoms of Netra roga, can be included. Upashaya and Anupashaya
for netra roga will be discussed in detail under netra roga pathyapathya and samanya
chikitsa.
SAMPARPTHI
After discussing nidana it is very essential to consider samprapti of the disease
proper. Samprapti is that, which explains disease process starting from dosha dusti,
their spread and the manifestation of the disease. Thus complete knowledge of
samprapti is very essential in planning the successful treatment.The samanya
samprapthi of netra roga according to various Acharyas is as follows.
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Charaka68
Charaka considers netraroga under trimarmeeya rogas and its samprapthi is
explained as the dusta vayu reaches the indriyas and manifests loss of function of that
sense organ (loss of vision if it’s the eye,etc) .In the same sloka he says that if dushta
vayu gets inside the sira it manifests as mild pain, (mandaruk) oedema, (shofa) dries
up, (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.
Sushruta69
The doshas are vitiated due to achakshushya nidana and enter the urdhwagata
siras, lodge in the various parts of the eye and manifest as netrarogas.Commenting on
the above Dalhana says "the siras referred here are the netragata siras, the term
Netrabhaga means the different structures of the eye, and according to some it means
netraraaji i.e., the capillaries supplying the eye.
Vagbhata70
The doshas getting vitiated by achakshushya nidana as mentioned in sarvaroga
nidana with predominance of pitta dosha enter the urdwagata siras, and lodging in
different parts of the eye manifest the netrarogas
Illustration Showing the Scheme of Samprapti in Netra Roga
Achakshushya Nidana Sevana
Dosha Vruddhi and Dosha Dushti
(Nidana sevana continued)
Dosha prakopa with predominance of Vata and Pitta Dosha
Spreading of dosha in the body through all sira and srotas
Entry of doshas into Urdhwagata Sira
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Urdhwagati of Prakupita Dosha through the Urdhwagata Sira
Sthana Samshraya of Prakupita Dosha in various parts of the Netra
Poorvaroopa lakshana
Manifestation of Netra Roga
Samprapti 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- Chirakari
VYAVACCHEDAKA NIDANA
Before confirming the diagnosis of CVS, it has to be differentiated from other
diseases which mimic netra roga with some specific symptoms. For this one should
take proper examinations as well as investigations in order to differentiate it from
other diseases which have similar specific symptoms mentioned in Ayurveda Samhita.
For this the following disorders can be considered.
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Table 13.Comparision of CVS with Netra Roga mentioned by various Acharyas
The lakshanas of CVS resemble the lakshana of the diseases mentioned in
Ayurveda, as above but a detailed examination and interrogation is necessary to rule
out the above said diseases.CVS is not a very severe disease, compared to the diseases
taken for Vyavacchedaka nidana and CVS is also always associated with patients
working with computers.these diseases may occur along with CVS and make the
condition severe and worse but CVS cannot be compared as such with any of theses.
SADHYASADHYATA
Before going to start the chikitsa of a particular disease one should know about
the sadhyasadhyata of a disease, i.e. According to prabhava, the diseases are classified
as 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 early
and if nidanaparivarjana and pathya are followed properly. But if nidana parivarjana
and pathy are not followed by computer user’s then CVS becomes a kricchra sadhya
or yapya vyadhi.
UPADRAVA
In Ayurveda, Acharyas has not described the Upadrava separately for
individual netra roga but mentioned that if netraroga are left untreated they become
chronic and lead to complications like timira
Name of disease Charaka Sushruta As Ah Mn
Vatabhishyanda -
Sushkaakshipaka -
Asopha -
Sasopha -
Sirotpata -
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NETRA ROGA CHIKITSA
“Yaabhihi kriyaabhihi jaayanthe shareere dhatava samaah
Sa chikitsa vikaaranaam karma tat bhishaja smrutham” (Ch .su.16/34)
Chikitsa is that procedure/entity which brings the bodily components to a state of
normalcy. In general, Chikitsa for any roga is told as
Samshodhanam Samshamanam nidaanasya cha varjanam
etavatbhishajaa karyam roge roge yatha vidhihi (Ch-vi 7/30)
The management principles of Netra Roga in general consist of avoidance of
etiological factors as the first line of management. The second principle is to counter
act increased Vata and other Doshas in the poorvaroopa stage itself, because if
neglected these diseases progress rapidly and become incurable in later stages.
Management of netra roga can be broadly classified into71
a) Nidana parivarjana (Prophylactic measures)
It is the first line of treatment of any disease and it is most important line of
treatment for Netra roga also.It indicates that the root of Samprapti process is nidana
and it must be avoided for best management of the disease. In netra roga the factors
which are mentioned as Nidana of the disease should be avoided.Nidana parivarjanam
includes 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 in
causing Netra roga by shamana and shodhana.
Aushadha
In Nayanabhighata pratishedha adhyaya Acharya Dalhana says that
pittaabhishyanda, raktaabhishyanda and vataabhishyanda chikitsa is to be followed in
abhighataja netra rogas with drugs having drushti prasaadana properties, like Nasya,
Aalepa, snigdha dravya which are drushtiprasaadajanana should be used.
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Triphala 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 with
Deepana, Pācana properties. A number of herbal and animal drugs like madhu, ghrita,
yashtimadhu etc are mentioned as Chakshushya in the Samhitas and Nighantus where
as many mineral drugs are described in the text books of Rasashastra, which can be
used in treating various netra roga.
Kriyakalpa72
Sushruta has recommended ‘Kriyakalpa’ for the management of netra roga, along
with other types of treatment. They can be advocated in almost all eye diseases and it
comprises of Tarpana, Putapaka, Anjana, Aschyotana and Seka.Later scholars like
bhavaprakasha have advocated the use of Swarasa and Arka for local use in Netra
roga.
Shastra karma
The shalya treatment of Netra roga begins with shastra karma including chedana
etc procedures to relieve Rakta and mamsa dushti.
Panchakarma
Panchakarma is indicated for sarva deha gata dosha shodhana, A number of
nasya, vamana and vasti yoga are also described for Netra Roga based on the dosha.
Pathyaapathya73
Pathysevana 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 old
Ghrita prepared from Shatavari or Amalaki, Yava cooked with sufficient quantity of
Ghrita and the decoction of Triphala etc, by taking these ane has no reason to fear
from even the severest form of Netra Roga.
The cooked vegetables of Jivanti, Sunishannaka, Tanduliya, good quantity of
Vastuka, Moolakapotika and jangala mamsa are beneficial for eyesight. Patola,
Karkotaka, Karavellaka, Vartaka, Tarkari, Karira fruits, Shigru and Aartagala etc,. all
these vegetables cooked with Ghrita also promote eyesight. Acharya Vangasena
supports the same views.
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Acharya Bhavaprakasha has mentioned that use of certain procedures like Lepa,
Abhyanjana, Sechana, Dhavana, etc. in the sole of foot are beneficial for the
improvement of eyesight
Aştāňga Hŗdaya advocates Raktamokşaņa, Virecana, purity of mind, relaxation,
Anjana, Nasya, meat of birds, oil. (A. S. Ut. 13/99-100). Pādābhyanga and
Pādarakşādhāraņa, Śitodaka Parişeka, Śitodaka Snāna, Śitodaka Gandūşadhāraņa,
Dakşiņamāruta,keeping palmar region of the hands to the eyes are stated for the
rejuvenation of the eye sight74.
The Chakshushya regimen mentioned in the classics is be useful in controlling
the progress of the disease. A combination of the above said drugs, in the form of oral
supplement, and kriyakalpas will play a definite role in the management of netra roga.
NETRA ROGA SAMANYA CHIKITSĀ
Nidana Parivarjana Dosha Shamana (Shodhana/Shamana)
Sthanika Sarvadehika
Aushadha Shastra Panchakarma
Aushadha Kriya Kalpa
Triphala Seka Chedana Snehana Pathyapathya
Yashtimadhu Āścyotana Bhedana Swedana Vishrama
Saptamritaloha Pindi Lekhana Vamana
Etc.drugs Bidālaka Vyadhana Virecana
Tarpana Raktamoksana Basti
Putapāka Kshara karma Nasya
Anjana Agnikarma
Netra vyayama Jalukavacharana
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The samanya chikitsa of netra roga are mentioned above but to plan a chikitsa
Siddhanta for a disease not mentioned in samhita the following points are to be
considered.
CVS is a netra roga caused due to Nija and Aganthu karana janya dosha
prakopa.
Nidana parivarjana is the first line of treatment in all aganthuja rogas.
Vataadi dosha shamana is the second line of treatment for the prakupita dosha
causing specific lakshana in this particular vyadhi.
In Nayanaabhighata Pratishedha adhyaya Acharya Sushruta mentioned netra
prasadana janana, drushtiprasadajanana drugs should be used along with
vaatabhishyanda chikitsa.i.e. procedures like aschotana ,tarpana putapaka and
Rasayana.
PATHYA APATHYA
Practicing appropriate Pathya-Apathya along with the treatment of disease is
one of the unique characteristics of Ayurvedic science. Classical texts emphasize that
success or failure of the treatment depends to a large extent on the practice of Pathya
and Apathya. The food articles, drugs and regimens which do not affect the body and
mind adversely are regarded as Pathya and in the same way which adversely affects
the body are considered to be Apathya75.
By following the Pathya and avoiding apathya mentioned in the Ayurvedic
classics one can maintain his healthy vision and prevent it from many diseases.
Table 14.Pathya in Netra Roga
Aahara Su.Sa AH YR CD
Yava
Godhuma -
Sali -
Shastika -
Mudga -
Kodrava -
Saindhava -
Sharkara -
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Varsha jala - - -
Aushadha
Triphala
Amalaki
Punarnava -
Dadima -
Yashtimadhu
Shatavari -
Karavellaka -
Kustumburu -
Patola -
Draksha -
Lodhra -
Godugdha
Goghruta
Jangala mamsa
Karma
Shirobhyanga
Padabhyanga
Netra aschotana
Chatra dharana
Padatra dharana
Manasika
Manasika santulana
Sattwa pradhana
Table 15.Apathya in Netra Roga
Aahara Su.Sa AH YR CD
Pathrashaka
Pinyaka -
Dadhi -
Matsya -
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Amla sura
Atiyoga of Lavana
Teekshna -
Katu -
Ushna -
Guru
Atyamla -
Vidahi -
Vihara
Kshudha & other vega dharana
Abhighata
Suryavalokana
Diwaswapna
Ratrijagarana
Rukshata atisevana
Utkatasana
Bhashpa sevana
Dhooma sevana
Manasika
Chinta
Shoka
Bhaya
Krodha
Kriya
Ativamana
Ati virechana
Ati nasya
Mithya yoga of netra kriyakalpa
“Ahita ashanaat sada nivrutti,
Bhrusha bhasva chala sookshma veekshanaatcha”
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According to Acharya Nimi76 apathya for netra roga are ahita aahara and visual
contact with excessively sparkling, fast moving and minute objects.By judiciously
applying the above said principles netra roga can be prevented and treated.
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DRUG REVIEW
DRUG REVIEW OF TRIPHALA YASHTIMADHU YOGA
Acharya Vagbhata recomends Triphala mixed with honey and ghee to be taken
in the night to improve visual acuity77.
Amalaki and yasthimadhu pacifies pitta and alleviates defects of vision
according to Vangasena78.
Nimi opines that taking Triphala and Yasthimadhu churna with ghee and honey
at night, consuming wholesome diet and amalaki water helps one attain excellent
vision79.
HARITAKI80
Name Haritaki
Botanical name Terminalia chebula retz
Family Combretaceae
Synonyms Abhaya,Amrutha,Pathya,Putana,Jaya,
Avyatha,Haimavathi,Kayastha,Vayastha,
Siva,Chetaki,Pranadaa,Jivanthi,Rohini,
Vijaya,Shreyasi
Rasa Pancharasa (Lavana Varjita) Guna Laghu Ruksha Virya Ushna Vipaka Madhura Prabhava Tridoshaghna,Deeepana,Prajasthapana, Medhya,Chakshushya,Hrudya,Anulomana, Rasayana
Parts used Phala, Phalamajja
Gana Charaka-Jwaraghna,Arśoghna,Kāsaghna,
Kustaghna,Prajāsthāpana
Suśhruta-Āmalakyādi, Parushakādi, Triphalā
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Vāgbhata-Parushakādi
Chemical composition Fruit:Anthraquinone,Glycosides, Chebulic
Acid, TannicAcid, Terchebin, Vit-C
Fruitkernel:Arachidic acid,
Oleic acid, Palmitic acid, Behenic acid
& Stearic acid
Flower: Chebulin.
Pharmacological activity
Antimicrobial, Antifungal, Antibacterial, Antistress,Antispasmodic,
Hypotensive,Antihepatitis B virus activity, Inhibitory activity against
HIV-1Protease.
VIBHITAKI81
Name Vibhitaki
Botanical Name Terminalia bellerica roxb
Family Combretaceae
Synonyms Akshaphala,Karshaphala,Kalidruma,
Bhootavasa,Kaliyugalaya,Trilinga
Rasa Kashaya
Guna Laghu Ruksha
Virya Ushna
Vipaka Madhura
Prabhava Tridoshahara
Karma Keshya,Krimihara,Vatahara,Chakshushya
Parts Used Phala, Phalamajja
Gana Charaka-Jwarahara, Kāsahara, Virechanopaga
Suśhruta-Mustādi, Triphalā
Vāgbhata-Mustādi
Chemical Composition Fruit:Fructose,Galactose,Mannitol,Glucose,
Rhamnose,B-Sitosterol
Pharmacological activity
Antihistaminic, purgative, antifungal, blood pressure dipressent, activity against viral
hepatitis and vitiligo, bronchodialator, antispasmodic, CNS stimulant.
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AMALAKI82
Name Amalaki
Botanical Name Emblica officinalis
Family Euphorbiaceae
Synonyms Abhaya,Amruthaphala,Dhatri,
Vayastha,Sitaphala,Tishyaphala,
Sriphala,Vrishya,Vayasya.
Rasa Amlapradhana Pancharasa
Guna Snigdha,Sita
virya Sita
Vipaka Madhura
Doshaghnata Tridoshahara
Karma Vayasthapana,Rasayana,Vrishya,
Chakshushya,pramehahara,raktapittahara
Parts used Phalamajja
Gana Charaka-Jwaragna,Kāsagna,Virechanopaga,
Kustagna, Vayasthāpana
Suśhruta - Amalakyadi, Parushakādi, Triphalā
Vāgbhata – Parushakadi
Chemical Composition Vit-C, Phyllembin, Linolic acid, Indole Acetic
acid,Axyubrin,Corialgin,Trigaloyl Glucose.
Elagic acid, and salts
Pharmacological activity
Antimicrobial, anti fungal, anti inflammatory, anti bacterial, anti ulcer, spasmolytic,
mild CNS depressant, hypolipidemic, antiatherosclerotic, antimutagenic, antioxidant,
and immunomodulator.
YASHTIMADHU83
Name Yashtimadhu
Botanical Name Glycyrrhiza Glabra
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Family Fabaceae
Synonyms Klitaka,Madhuka,Madhuyashti,Madhulika
Rasa Madhura
Guna Guru,Snigdha
Virya Sita
Vipaka Madhura
Doshaghnata Kaphavata Shamaka, Tridoshahara
Karma Netrya,Swarya,Rasayana,Vrishya,Chakshushya
Parts used Root
Chemical composition Glycyrrhizine, Glycyrrhizic acid,
Iso Neo Liquirtin, Liquirtinogen, Glabrin,
Licoridin,
GHRITA84
Name Ghrita
Zoological Name Bos taurus
Family Herbivora
Synonyms jeevaneeya, pavithra, navaneetha,
Sarpi, adhara, aajya, havi, amrutahva
Rasa Madhura
Guna Guru, Snigdha, mrudu, yogavahi
Virya Sita
Vipaka Madhura
Doshaghnata Pitta vata Shamaka, Tridoshashamaka,rasayana
Karma Rasayanaparam,chakshushya,jeevaneeya,
Buddhi, smruthivardhaka
Chemical composition 5gms of ghee contains vit-A 165 I.U,
vit -D 25 I.U.Copper- 0.075%
MADHU85
Name Madhu
Zoological Name APIS
Family Orthropoda
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Synonyms Makshika,Kshaudra,Madhvika,Sharadam,
Varati,Bhringavantham,Pushparasodbhavam,
Kusumasavam,Pushparasam.
Rasa Madhura, kashaya anurasa
Guna Sheeta,Laghu,Ruksha
Virya Sita (Ch) Ushna (Su,Bp)
Vipaka Katu (A.S)
Doshaghnata Tridoshashmaka,mainly Kapha shamaka.
Karma Chakshushya, chhedi,vishaharavatala
Uses 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 of
Madhura, 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 Dosha
Karmata,and by combination they act as Chakshushya,Rasyana and Tridosha shamaka
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Table No.16 Rasa panchaka of Drugs in Triphala Yashtimadhu Yoga
Rasa Guna Virya Vipaka Dosha Karma
Drug Name M A L K T K
S LA
GU
RU
SU
U S M A K V P K
Haritaki + + - + + + + - + - + - + - - + + +
Vibhitaki - - - - - + + - + - + - + - - + + +
Amalaki + + - + + + - + - + - + + - - + + -
Yashtimadhu
+ - - - - - - + - + - + + - - + + -
Madhu + - - - - + - + + - + + - - + - - +
Ghrita + - - - - - - + - + - + + - - + + -
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FIGURES SHOWING THE DRUGS IN TRIPHALA YASHTIMADHU YOGA
Haritaki Aamalaki
Vibhitaki Yashtimadhu
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Triphala Yashtimadhu Yoga
Triphala Choorna Yashtimadhu Choorna
Ghrita Madhu
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COMPUTER VISION SYNDROME (CVS)
As we entered the 21st century, the growing use of computers be at home or
office, brings with it an increase in health risks, especially sense organs, more so the
eyes.
A WHO press release (1998) mentions that glare and reflections from VDT
displays are a source of eyestrain and headache. Surveys of computer workers reveal
that vision related problems are most frequently reported health problems, occurring
in over 70 percent of computer workers. The pain and discomfort associated with the
problem can affect workplace performance and domestic activities also. With a few
preventative measures, however, the symptoms associated with CVS can be easily
avoided86.
Definition of CVS
The American Optometric Association (AOA) defines Computer Vision
Syndrome as “The complex of eye and vision problems related to near work which
are experienced during or related to computer use” CVS is a temporary condition
resulting from focusing the eyes on a computer display for protracted, uninterrupted
period of time87.
Incidence
Most studies indicate that computer operators, who view their Video Display
Terminals (VDTs), report more eye-related problems than non-VDT office workers.
A number of investigators have reported that visual symptoms occur in 75-90% of
VDT workers. In contrast to the popular conception regarding carpal tunnel
syndrome, 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 examinations
are annually done primarily because of visual problems at VDTs. This study
delineated the series of symptoms which eventually called as CVS. The causes for
these visual symptoms are a combination of individual visual problems, poor
workplace conditions and improper work habits. The above mentioned survey also
concluded that two-thirds of the complaints were related to vision problems while
one-third was due to environmental factors. Many people have marginal vision
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disorders which do not cause symptoms when performing less demanding visual
tasks. However, it has also been shown that VDT users also have a higher incidence
of complaints than non-VDT users in the same environment.
Etiology of CVS
The main causes of CVS include an unsuitable environment and the improper
use of eyeglasses or contact lenses along with that working at a computer is more
visually demanding than doing other standard office work such as reading printed
documents etc., aspects of the design of the computer video display such as screen
resolution and contrast, image refresh rates and flicker, and screen glare, as well as
working distances and angles all may contribute to worker symptoms.
In order to accomplish specific computer related tasks, frequent eye
movements from work document to the computer screen, or from the screen to the
keyboard and back again, are performed. In addition, as the object being viewed
changes, 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 lens
within 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 in
human eyes is 16-20 per minute. Studies have shown the blink rate decreases to as
low as 6-8 blinks/minute for persons working on the computer screen. This leads to
dry eyes.
Additionally, the near focusing effort required for such long hours puts strain
on ciliary muscles of the eye. This induces symptoms of asthenopia and leads to a
feeling of tiredness in the eyes after long hours of work. Some patients present with
inability to properly focus on near objects after a short duration. This can be seen in
people aged around 30-40 yrs of age, leading to a decrease in the accommodative and
focusing mechanisms of the eye. This can be a setting in due to early presbyopia.
Signs & symptoms of CVS
The 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
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Light Sensitivity,
Double Vision
Backache
Neck Ache
Muscle Fatigue
Eye Strain,
Difficulty Refocusing the Eyes.
Symptoms and their manifestation
Dry and irritated eyes
Dry and irritated eye is one among the most common problem of Computer
and VDT users. It is also termed as VDTS Video Display Terminal Syndrome.The
frontal surface of the eye is covered with a tissue consisting of lacrimal glands which
secrete the tears. These tears cover the eye surface and maintain moisture for the
normal functioning of the eye. They also help to maintain the proper oxygen balance
of 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 the
eyelids.
The blink reflex is one of the fastest reflexes in the body. However, these blink
rate varies with different activities faster when we are very active, slower when we are
steady or concentrating. Research has shown that the blink rate of VDT workers
dropped very significantly during work at a Computer/VDT compared to before and
after work. Possible explanations for the decreased blink rate include concentration on
the task or a relatively limited range of eye movements. The size of the eye opening is
related to the direction of gaze- as we gaze higher, the eyes open wider. The amount
of evaporation roughly relates to eye opening, the higher gaze angle when viewing a
VDT screen results in faster tear loss and reduced percentage of blinks which result in
dry eyes leading to irritation.
Red eyes
Eyes appear red because of the excess flow of blood to the capillaries in the
eye.Sometimes it may be also due to soreness in the eye. This may be due to poor
office ergonomics and unclean environment.
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Headache
Headache is one of the ‘discomfort’ symptoms of CVS and is the primary
reason, for which most people seek an eye examination. Visual headaches occur more
frequently, often occur toward the front of the head, occur most often toward the
middle or end of the day, and can occur on one side of the head more than the
other.VDT workers most likely get tension-type headaches. These can be precipitated
by 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 eyes Blinking is very essential to maintain the moisture of the eye surface. When
the blinking rate slows down due to continuous viewing the eyes become dry and
cause burning sensation.
Blurred vision
The ability of the eye to change its focal power is called accommodation and
varies due to many factors. An image that is not focused accurately will appear
blurred.Blurred vision symptoms can result from refractive error (e.g., hyperopia,
myopia, and astigmatism), improper prescription lenses, presbyopia (age-related
focusing problem) or other focusing disorders. Considering the working environment,
blurred images can also arise from a dirty screen, poor viewing angle, reflected glare
or a poor quality or defective monitor. All of these factors should be considered when
this symptom occurs.
Double vision
Double vision is a very uncomfortable and unacceptable condition for the visual
system. Double vision is a serious symptom and can be caused by several factors. A
complete eye examination is indicated if this symptom persists.
Photophobia / glare sensitivity The eyes are designed to be stimulated by the light and to control the amount
of light entering the eyeball. Lighting conditions in office environment are foreign to
the natural lighting and can cause an adverse reaction to light. The largest single
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factor in the workplace is glare which is mostly caused by large disparities in
brightness in the field of view. It is much desirable to eliminate bright sources of light
from 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 brighter
and when it is closer to the point of attention.
Neck, shoulder and back ache It is often heard in medical circles that ‘the eyes lead the body’. Nature has
designed our visual system to be so dominant that we will alter our body posture to
accommodate any deficiency in the way we see. In many office situations the vision
of a worker is compromised and they must adapt their posture to ease the strain on the
visual system. Uncomfortable seating arrangements and continuous, working with
computers for longer duration in the same posture causes pain in shoulder, neck and
back.
Contact lens discomfort This is commonly found in regular Contact lens users. Computer viewing
results in decreasing blinking rates to one third of normal, while the straight-ahead
gaze needed to look at a screen exposes to more air. Combined, this causes the eye to
dry out and become itchy much faster than usual.If frequent blinking is not enough to
eliminate the dryness and itching, an ophthalmologist prescribed eye drops made
especially for contact lenses can be used.
Changes in colour perception Changes in colour perception results from long working hours,long standing
eye pathologies and flickering colours resolution of VDT screen.
Fatigue It is a general symptom of tiredness because of improper work station conditions.It can also occur due to mental tension, work overload or long working hours. Eyestrain
Eyestrain is one of those vague terms that have different meanings. The term
eye care professionals use for eyestrain is asthenopia (AS-then-OH-pee-ah),.
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asthenopia is defined as the subjective complaint of uncomfortable, painful and
irritable vision caused from problems such as focusing spasm, difference of vision in
each eye, astigmatism, Hyperopia (far-sighted), Myopia (near-sighted), excess light,
voluntary focusing, eye coordination difficulties, etc., In the VDT environment,
eyestrain in all of its manifestations may be caused by a number of different
environmental and visual conditions97.
Aggravating factors
The symptoms of CVS can be further aggravated by
Long working hours
Improper lighting conditions (ie. bright overhead lighting or glare)
Air moving past the eyes (e.g. overhead vents, direct air from a fan).
Altered sleeping habits
Refraction errors
Age
Although CVS has not been found to cause any permanent damage to the eyes, its
painful symptoms can affect performance at work and home90.
Treatment modalities for CVS
In the opinion of AOA four hours of continuous work on a computer was considered
safe. The treatment modalities followed for the management used in CVS include91
a. Medical
b. Non medical
Medical
Analgesics
Topical NSAIDs
Topical Steroids
Topical Cycloplegics
Topical Anesthetics
Sedatives/ Anxiolytics
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Non Medical
Looking away from the computer screen and blinking periodically
Use of convergence and divergence exercises
Use of bifocals, trifocals or any spectacles for protection of eyes.
Viewing angle /Ergonomics
Anti glare screens
Medical
The treatment adopted in modern medicine is for symptomatic relief comprising
regular usage of above said drugs based on the predominance of symptoms and no
definite cure is promised.
Non Medical
Looking away from the computer screen and blinking periodically92
Proper rest to the eye and its muscles is recommended to relieve the associated
eye strain. Giving the eyes and body frequent breaks from computer work to reduce
eye and muscle fatigue is recommended.Since prolonged computer use requires a
person to sit in the same position for an extended period, taking time out to stand,
stretch and look around will not only help muscles, but will also give the eyes a
chance to relax. If the opportunity to get up for full breaks is not frequently available,
then “mini” breaks will suffice by looking up from the computer into the distance
about every 15 minutes. Frequent blinking or the use of eye drops too, will keep eyes
from drying out and feeling itchy. A routinely recommended approach is to
consciously blink the eyes every now and then (this helps replenish the tear film), and
look out of the window into a distance object or the sky - (this provides rest to the
ciliary muscles). One of the catchy phrases is the "20-20-20 rule": every 20 minutes,
focus the eyes on an object 20 feet (6 meters) away for 20 seconds. This basically
gives a convenient distance and time frame for a person to follow the advice from the
ophthalmologist. Otherwise, the patient is advised to close his/her eyes (which have a
similar effect) for 20 seconds, at least every half hour or even more frequently.
Eyeglasses
A visit to an ophthalmologist for update of prescription is the first step in
improving the effectiveness of optical aids in eliminating the symptoms of CVS.
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Patients should be sure to include information on special lifestyle concerns, such as
computer use, to help the doctor find the right prescription for their needs. With this in
mind, the doctor may find that a person who does not normally need glasses should
wear them when using a computer. Additionally, the ophthalmologist can diagnose
whether another unsuspected disease is the cause of certain symptoms and
recommend treatment options
Viewing angle /Ergonomics101
Various studies have shown that viewing angle can be a contributing factor in
the occurrence of asthenopia.Taptagaporn et al as well as Quaranta et al.
recommended a downward gaze so as to work comfortably on VDT. When the
computer operator keeps the terminal at about eye level rather than below eye level.
Jaschinski et al. in their study found that high screens at or above the eye level
reported result in greater eyestrain and asthenopia than low screens.
Anti glare screens
Use of antiglare filters over VDT screens has been associated with shorter, less
frequent and less intense eye complaints.some Studies had proved that significantly
lower prevalence of asthenopia in the subjects who used antiglare screen. Similar was
the observation in those who adjusted the contrast and brightness of the monitor
screen as per their need.
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LIST OF PREVIOUS WORKS
1. ‘The Study of Trividha Hetu wsr to present day life style and Asatmendriyartha
Samyoga of Chakshurindriya’.Pawar Vishali Dinakar, Dept of Ayurveda
Siddhanta B.V.College of Ayurveda, B.V.University, Pune, 2002.
2. ‘A Study on Computer Vision Syndrome and its management with Indigenous
medicine –A clinical study’.- Siddhapur Chandrasekhar.M, Dept of Shalakya,
G.A.M.C.Bangalore, RGUHS 2002.
3. Effect of selected yoga techniques in “Computer Vision Syndrome” in
comparison with selected Ayurvedic modalities.- Venkata Krishna.K.V, Dept of
Svasthavritta, Govt Ayurveda College, Trivandrum University, 2003.
4. A Study on Asatmendriyartha Samyoga wsr to Chakshurendriya’-Archana
D.Jugale, Dept of Ayurveda Siddhanta BNMET Ayurveda College, Bijapur,
RGUHS, 2007.
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MATERIALS AND METHODS
MATERIALS
1. Literary study
2. Drugs
3. Instruments
Collection of Materials
1) Literary Study
The Literary source for the present study was obtained from, vedic scriptures,
classical texts of Ayurveda, Sanskrit dictionaries, Modern texts, published articles in
reputed journals and also from various media like internet etc.,followed by a
retrospective study of related research works.
2) Drugs
The ingredients comprises of Triphala (Harithaki, Vibhitaki, Amalaki) and
Yashtimadhu. Triphala and Yashthimadhu were taken in equal quantity. All these raw
drugs were properly identified and purchased from NKCA pharmacy Mysore.
PREPARATION OF MEDICINE
Triphala Yashtimadhu Yoga
Haritaki 4 kg
Vibhitaki 4 kg
Amalaki 4 kg
Yashtimadhu 12 kg
The obtained raw drugs were cleaned, finely powdered and sieved through
strainer to get a sookshma choorna.A total of 22 kg of raw drug was obtained with
wastage of 2 kg.For Anupana patients were advised to mix Madhu and Ghrita during
the administration of medicine.All the patients were advised to take Dabur Honey,
and Cow Ghee manufactured from Nandini Dairy as both are easily available over the
counter.
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INSTRUMENTS
1. Snellen’s distant vision chart
2. Jaeger’s near vision chart
3. Schirmer’s test strips – Conta care opthalmics and diagnoistics ltd vadodra
4. Torch light - Everyday electronics ltd
METHODS
AIM
The present study was undertaken to study the disease Computer Vision
Syndrome based on Ayurveda Siddhantas like Trividha Hetu, Panchalakshana Nidana
and to find out a suitable chikitsa siddhanta and the efficacy of TriphalaYashtimadhu
yoga in this disease clinically.
OBJECTIVES
1. 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
in causation of the disorder.
4. To evaluate a suitable Chikitsa based on the above observations.
5. To evaluate the efficacy of TriphalaYasthimadhu yoga in patients of Computer
Vision Syndrome clinically.
RESEARCH DESIGN
OBSERVATIONAL STUDY
Patients were diagnosed as having Computer Vision Syndrome based on a
detailed questionnaire including signs and symptoms (Annexure-II). The general and
specific examination was carried out as per the Ayurvedic and modern parameters.
The data was collected after enquiring different nidanas.Those nidanas were collected
and analyzed under the heading of nidana including Prajnaparadha in the form of
aharaja, viharaja etc., and the role of sleep pattern, nature of work and its duration and
its role on the disease were studied.
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CLINICAL STUDY
All the patients of CVS were administered Triphala Yashtimadhu yoga to
evaluate the efficacy of the drug clinically.
SOURCE OF PATIENTS
Patients from OPD, IPD, other referrals and special camps conducted in
GAMC and hospital Mysore were selected for the study, appropriately satisfying the
selection criteria.
METHOD OF COLLECTION OF DATA
1. Patients suffering from CVS belonging to either sex were selected randomly
and made into a single group.
2. Informed consent was obtained before study.
3. Those patients were registered and studied with a case-sheet proforma prepared
for the study based on history of signs and symptoms, no of working hours,
habits, TV watching, duration of work,aahara sevana,agni,prakruthi, etc.
SELECTION CRITERIA
1. Patient diagnosed as having CVS
2. Patients were selected with respect to age irrespective of sex, caste, occupation
and socio economical status.
3. Patients fulfilling inclusion criteria.
4. Patient willing to participate in the study were selected by explaining the
intervention in detail.
INCLUSION CRITERIA
1. Patients indulging in occupation of working with computers for more than 4
hours a day having signs and symptoms of Computer Vision Syndrome
2. Patients of either sex.
3. Patients between the age group of 20-50 Years.
EXCLUSION CRITERIA
1. Patients suffering from chronic systemic diseases.
2. Degenerative eye diseases and severe ocular problems including high myopia.
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3. Patients suffering from congenital ocular Anomalies.
DIAGNOSTIC CRITERIA
The diagnosis of CVS was made based on a questionnaire containing signs and
symptoms index stated by AOA (American optometric Association).
SAMPLING METHOD
Total 30 patients of Computer Vision Syndrome were randomly selected and
made in to a single group.
STUDY DESIGN
Present study was observational and a single blind clinical study with pre and
post test design,
INVESTIGATIONS
TESTS FOR DISTANT VISION BY SNELLEN’S CHART
Distant central vision is estimated with snellens chart. The snellen’s chart is
placed at 6 meters or 20 feet distance from the patient. The patient is asked to sit on a
stool facing the chart at 6 meters distance and asked to read the prints of the
chart.(Each eye may be closed alternately for the reading of individual eyes).The chart
contains different sized prints in 8 lines, from bigger size to smaller from top to
bottom. Each line is marked with a specific number. They are (from top to bottom)
60, 36, 24, 18, 12, 9, 6, 5.If the patient is able to read up to 6 number row; his vision is
6/6- normal. If the patient is able to read only first line his vision is 6/60. 2nd line 6/36:
3rd line 6/24,: 4th line 6/18,: 5th line 6/12,: 6th line 6/9,: 7th line 6/6,: and 8th line 6/5.
TESTS FOR NEAR VISION BY JAEGER’S TEST TYPES
Visual acuity at the ordinary reading distance is assessed by using reading test
types of varying sizes. The notation being based on the printer’s point system. The
smallest point is N14 and largest is N1. The near vision is recorded as the smallest
type which the patient can read comfortably.
Materials and Methods70
Ayurveda Siddhanta & Computer Vision Syndrome
SCHIRMER’S TEST- I
This test measures the rate of tear formation or basic tear function. It
determines whether the eye produces enough tears to keep it moist. This test is used
when a person experiences very dry eyes or excessive watering of the eyes. It poses
no risk to the subject. Schirmer's test uses paper strips inserted into the eye for several
minutes to measure the production of tears.In this test both eyes are tested at the same
time.
A negative (more than 10 mm of moisture on the filter paper in 5 minutes) test
result is normal. Both eyes normally secrete the same amount of moisture. A young
person normally moistens 20 mm of each paper strip.Physiologically Hypolacrimation
occurs with ageing.
Procedure
This test consists of placing a small strip of filter paper inside the lower eyelid.
Take a 5 x 30 mm strip of no 41 Whatman filter paper. A 5mm tab is folded and
gently inserted into the lower lid (conjunctival sac). The eyes are closed for 5 minutes.
The paper is then removed and the amount of moisture is measured. If the wetting is
less than 10 mm after 5 minutes. It is diagnostic of dry eye. The normal range is 10-
25mm in 5 minutes.
TORCH LIGHT
Eye examination was done by the torch.
Materials and Methods71
Ayurveda Siddhanta & Computer Vision Syndrome
SCHIRMERS TEST STRIPS
SCHIRMERS TEST -1
Materials and Methods72
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INTERVENTION
1. All the 30 patients were administered with Triphala Yashtimadhu choorna.
2. The drug is administered with anupana of of ghrita and madhu in
asamapramana (unequal quantity) i.e., more quantity of Ghrita was advised
than Madhu in the ratio of 2:1.
3. The dose of drug administered is 12 grams per day (1 karsha) in divided doses
of 6 grams twice a day.
4. The time of administration of drug is once in early morning, and once in night
before sleep.
5. The duration of treatment is for 60 days.
6. Data was collected before treatment, after completion of treatment and at the
end of follow up.
7. All the patients were advised to avoid aahara like madyapana, dadhi, teekshna,
katu, amla, vidahi and abhishyandi aahara, upavasa and vishamashana.
8. All the patients were advised to avoid vihara like dhoomapaana, doorekshana,
swapna viparyaya, ratri jagarana, ushna jala sira snana,vegadharana, bhaya,
shoka, kopa, atimaithuna, dhooma ,raja sevana, excessive exposure to sun light
etc.,
9. All the patients were advised to do abhyanga to siras and pada, wash their eyes
with cold water frequently and take aahara which is madhura, snigdha, and
also advised to take ghrita in their aahara.
10. All the patients were advised to reduce the duration of TV watching from their
regular watching duration.
11. All the patients were advised to follow the 20-20-20 rule mentioned by AOA.
12. All the patients were advised to take short breaks frequently, and adjust the
seating position and to use spectacles if they are having previously.
ASSESSMENT FOR CLINICAL IMPROVEMENT
Clinical improvement in the signs and symptoms of CVS after the trial were
assessed based on the reduction of the individual signs and symptoms and overall
severity as below. The values are compared with before treatment after treatment and
Materials and Methods73
Ayurveda Siddhanta & Computer Vision Syndrome
follow up by utilising the normal values for objective parameters and grading for
subjective parameters.
GRADING FOR SUBJECTIVE VARIABLES
IRRITATION IN THE EYE
I0- No Irritation in the Eye
I1- Irritation occurs after 1 hour of working and disappears after work
I2-Irritation occurs after 1 hour of working and continues for 2 hrs after withdrawal
from work.
I3- Irritation continues for the whole day and relieved after sleep
REDNESS OF EYES
R0- No Redness of Eyes
R1- Redness occurs after 1 hour of working and disappears after work
R2- Redness occurs after 1 hour of working and continues for 2 hrs after
withdrawal from work.
R3- Redness continues for the whole day and relieved after sleep
TEARING OF EYES
T0- No tears
T1- Tearing occurs after 1 hour of working and disappears after work
T2- Tearing occurs after 1 hour of working and continues for 2 hrs after withdrawal
from work.
T3- Tearing continues for the whole day and relieved after sleep
HEADACHE
H0- No Headache
H1- Headache occurs after 1 hour of working and disappears after work
H2- Headache occurs after 1 hour of working and continues for 2 hrs after
withdrawal from work.
H3- Headache continues for the whole day and relieved after sleep
Materials and Methods74
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BURNING IN EYES
Bu0- No Burning in Eyes
Bu1- Burning in Eyes occurs after 1 hour of working and disappears after work
Bu2- Burning in Eyes occurs after 1 hour of working and continues for 2 hrs after
withdrawal from work.
Bu3- Burning in Eyes continues for the whole day and relieved after sleep
BLURRED VISION
Bl0- No Blurred vision
Bl1- Blurred vision occurs after 1 hour of working and disappears after work.
Bl2- Blurred vision occurs after 1 hour of working and continues for 2 hrs after
withdrawal from work.
Bl3- Blurred vision continues for the whole day and relieved after sleep
DIPLOPIA
D0- No Diplopia
D1- Diplopia occurs after 1 hour of working and disappears after work
D2- Diplopia occurs after 1 hour of working and continues for 2 hrs after withdrawl
from work.
D3- Diplopia continues for the whole day and relieved after sleep
OBSERVATIONAL PARAMETERS
1. Photophobia Present/ absent
2. Contact lens discomfort Present/ absent
3. Slowness in changing focus of eyes Present/ absent
4. Changes in colour perception Present/ absent
5. Pain in shoulder Present/ absent
6. Pain in Neck Present/ absent
7. Pain in Back Present/ absent
Materials and Methods75
Ayurveda Siddhanta & Computer Vision Syndrome
GRADING FOR CLINICAL IMPROVEMENT OF INDIVIDUAL SYMPTOMS
AND OVERALL SEVERITY IS GRADED AS BELOW
CD Clinically detiorated i.e., increase in severity score against the initial score.
CS Clinically stable i.e., severity score remains same against the initial score.
CI-1 Encouraging i.e., one degree reduction in severity score against the initial
score
CI-2 Good i.e., two degree reduction in severity score against the initial score
CI- 3 Excellent i.e., three degree reduction in severity score against the initial
score
DATA COLLECTION
Data was collected before treatment, after treatment and at the end of follow up.
ASSESSMENT
Assessment of the patients was made before the treatment after treatment and
at the end of follow up. The data was collected and analysed for the total score before
treatment, after treatment and after follow up was assessed by using.
• Chi-square test
• Frequencies / Descriptives
• Contingency Co efficient
• Paired-Samples T Test
• Repeated measure ANOVA
Analysis was done through SPSS for Window (Statistical Presentation System Software),
version 14.0, evaluation version (SPSS, 2005, SPSS Inc. New York).
Observations 76
Ayurveda Siddhanta & Computer Vision Syndrome
OBSERVATIONS
Total 30 patients coming under the inclusion criteria were randomly taken for
the clinical study and made into a single group. Observations in the present study
were done in three stages.
i) General Observations for all the patients
ii) Observations on Nidanas in Computer Vision Syndrome
iii) Result related observations pre, post treatment and follow up.
GENERAL OBSERVATIONS
In the present study total 42 patients were registered, out of which 12 patients
discontinued the treatment during various stages of the clinical study and with 30
patients the clinical study was completed.
Table No.17 Age wise distribution of 30 patients with CVS
Age in years No. of patients Percentage (%)
21-30 yrs 21 70.0%
31-40 yrs 3 10.0%
41-50 yrs 6 20.0%
AGE
In present study there was limitation for age. The patients of the age between 20-50
yrs were selected. It was found that the patients of age group between 21-30 yrs are 21
(70.0%) 31-40 yrs are 3 (10.0%) 41-50 yrs are 6 (20.0%).
Table No.18 Sex wise distribution of 30 patients with CVS
Sex group No. of patients Percentage (%)
Male 16 53.33%
Female 14 46.66%
SEX
In the present study it was observed that more number of patients were males i.e., 16
(53.33%) and female patients were 14 (46.66%).
Observations 77
Ayurveda Siddhanta & Computer Vision Syndrome
Table No.19 Occupation wise distribution of 30 patients with CVS
Occupation No. of patients Percentage (%) Students 1 3.33%
Software professionals 11 36.66% Office Clerk 8 26.66% Accountants 4 13.33%
Medical transcription 2 6.66% Call centre employee 4 13.33%
OCCUPATION
In this study it was observed that majority of the patients were software professionals
are 11 (36.66%) office clerk category were 8 (26.66%), accountants 4 (13.33%), call
centre employees 4 (13.33%), medical transcriptionists 2 (6.66%) and students were 1
(3.33%).
Table No.20 Education wise distribution of 30 patients with CVS
Education No. of patients Percentage (%)
Graduation 24 80.0%
Post- Graduation 6 20.0%
EDUCATION
In the present study it was found that the majority of patients are graduates
i.e., 24 (80.0%) and Post graduates were 6 (20.0%).
Table No.21 Marital status wise distribution of 30 patients with CVS
Marital Status No. of patients Percentage (%)
Unmarried 18 60.0%
Married 12 40.0%
MARITAL STATUS
In the present study it was observed that majority of patients were unmarried.i.e.
18 (60.0%) and married were i.e., 12 (40%).
Table No.22 Socio economic status wise distribution of 30 patients with CVS
Socio economic status No. of patients Percentage (%)
Middle class 23 76.66%
Observations 78
Ayurveda Siddhanta & Computer Vision Syndrome
Upper middle class 6 20.0% Rich 1 3.33%
SOCIO ECONOMIC STATUS
In the present study it was found that majority of the patients belong to middle
class i.e., 23 (76.66%) upper middle class were 6 (20 %) and rich are 1 (3.33%).
Table No.23 Religion wise distribution of 30 patients with CVS
Religion No of patients Percentage
Hindu 24 80.0%
Muslim 2 6.66%
Christian 1 3.33% Others 3 10.00%
RELIGION
In the present study it was observed that majority of patients were from Hindu
community i.e., 24 (80.0%) from Muslim community are 2 (6.66%) from christian
community are 1 (3.33%) and others (Jain) are 3 (10.0%) respectively.
Table No.24 Locality wise distribution of 30 patients with CVS
Habitat No. of patients Percentage (%) Urban 28 93.33 Rural 2 6.66
LOCALITY
In the present study it was found that the patients from urban residency are more i.e.,
28 (93.33%) and patients belonging to Rural were 2 (6.66%).
Table No.25 Diet wise distribution of 30 patients with CVS
Diet Pattern No. of patients Percentage Vegetarian 15 50%
Mixed 15 50%
Observations 79
Ayurveda Siddhanta & Computer Vision Syndrome
DIET
In the present study it was found that the patients with vegetarian diet are 15 (50%)
and mixed diet are 15 (50%) both are equally present.
Table No.26 Diet pattern wise distribution of 30 patients with CVS
Diet Pattern No. of patients Percentage
Vishamashana 26 86.77%
Samashana 4 13.33%
DIET PATTERN
In the present study it was found that the patients following vishamashana are more
i.e., 26 (86.77%) and patients following samashana were 4 (13.33%).
Table No.27 Rasa Sevana wise distribution of 30 patients with CVS
Rasa Sevana No. of patients Percentage
MAL 5 16.66%
MALK 21 70.0%
MALKT 2 6.66%
Sarvarasa 2 6.66%
RASA SEVANA
In the present study it was found that the patients taking 4 rasa MALK are 21 (70.0%)
taking 3 rasa MAL are 5 (16.66%) and taking 5 rasa MALKT are 2 (6.66%) and
taking all the 6 rasa are also 2 (6.66%).
Table No.28 Sleep wise distribution of 30 patients with CVS
Sleep Pattern No. of patients Percentage
Sound Sleep 15 50%
Disturbed 15 50%
SLEEP
In the present study it was found that the patients with sound sleep are 15 (50%) and
disturbed sleep are 15 (50%) both are equally present.
Observations 80
Ayurveda Siddhanta & Computer Vision Syndrome
Table No.29 Duty wise distribution of 30 patients with CVS
Duty Shift Pattern No. of patients Percentage
Day Shift (Ratri Swapna) 15 50%
Night Shift (Diwaswapna) 15 50%
DUTY
In the present study it was found that the patients working in day shifts (doing ratri
swapna) are 15 (50%) and those working in night shift (doing diwa swapna) are 15
(50%) both are equally present.
Table No.30 Addiction wise distribution of 30 patients with CVS
Addiction No. of Patients Percentage Milk 1 3.33% Tea 24 80.0%
Coffee 5 16.66% Smoking 7 23.33% Alcohol 7 23.33%
Tobacco chewing 2 6.66% ADDICTION
In the present study it was found that the patients having the habit of drinking tea
were 24 (80%) habit of smoking were 7 (23.33%) drinking alcohol were 7 (23.33%)
drinking coffee were 5 (16.66%) and tobacco chewing were 2 (6.66%) and taking
milk were only 1 (3.33%) respectively
Table No.31 TV watching duration wise distribution of 30 patients with CVS
Duration in hours No of Patients Percentage 1 9 30%
2 12 40%
3 4 13.33%
4 4 13.33%
5 1 3.33%
Observations 81
Ayurveda Siddhanta & Computer Vision Syndrome
WORK DURATION
In the present study it was found that the patients having the habit of watching TV for
5 hours were 1 (3.33%) for 4 hours are 4 (13.33%),, for 3 hours are 4 (13.33%), for 2
hours are 12(40%), for 1 hour are 9 (30%), respectively.
Table No.32 Duration of Occupation wise distribution of 30 patients with CVS
Duration No of Patients Percentage 3 months 1 3.33%
4 months 2 6.66%
6 months 1 3.33%
7 months 1 3.33%
10 months 1 3.33%
1 year 5 16.66%
2 year 3 10%
3 year 5 16.66%
4 year 1 3.33%
5 year 4 13.33%
6 year 2 6.66%
7 year 2 6.66%
8 year 2 6.66%
OCCUPATION
In the present study it was found that the patients working with computers from 8
years were 2 (6.66%) 7 years were 2 (6.66%) 6 years were 2 (6.66%) 5 years were 4
(13.33%) 4 years were 1 (3.33%) 3 years were 5 (16.66%) 2 years were 3 (10%) 1
year were 5 (16.66%). And patients working from 3,6,7 and 10 months were 1 each
i.e.total 4 (13.33%) and 4 months were 2 respectively (6.66%)
Observations 82
Ayurveda Siddhanta & Computer Vision Syndrome
Table No.33 Duration of working with computers wise distribution of CVS patients
Duration No of Patients Percentage 3 hr 1 3.33%
4 hr 2 6.66%
5 hr 3 10%
6 hr 3 10%
7 hr 1 3.33%
8 hr 8 26.66%
9 hr 2 6.66%
10 hr 3 10%
12 hr 4 13.33%
15 hr 2 6.66%
16 hr 1 3.33%
In the present study it was found that the patients working with computers for 16 hrs
were 1 (3.33%) 15 hrs were 2 (6.66%) 12 hrs were 4 (13.33%) 10 hrs were 3 (10%) 9
hrs were 2 (6.66%) 8 hrs were 8 (26.66%) 7 hrs were 1 (3.33%) 6 hrs were 3 (10%) 5
hrs were 3 (10%) 4 hrs were 2 (6.66%) 3 hrs were 1 (3.33%)
Table No.34 Duration of computers work in a week wise distribution of CVS patients
Duration No of Patients Percentage 4 days 1 3.33%
5 days 4 13.33%
6 days 15 50%
7 days 10 33.33%
DURATION OF WORK
In the present study it was found that the patients working with computers for 7 days a
week were 10 (33.33%) for 6 days a week are 15 (50%), for 5 days a week are 4
(13.33%), for 4 days a week are 1 (3.33%), respectively.
Observations 83
Ayurveda Siddhanta & Computer Vision Syndrome
Table No.35 Prakruthi wise distribution of 30 patients with CVS
Prakruthi No. of patients Percentage (%)
Vata pitta 15 50.0%
Vata kapha 5 16.7%
Kapha pitta 10 33.33%
PRAKRUTHI
In the present study among 30 patents 15 patients (50%) had Vata pitta prakruthi, 5
patients (16.66%) had Vata kapha prakruthi and 10 patients (33.33%) belong to kapha
pitta prakruthi.
Table No.36 Sara wise distribution of 30 patients with CVS
Sara No. of patients Percentage (%)
Avara 0 0%
Madhyama 30 100%
Pravara 0 0%
In the present study all the 30 patients (100%) were having madhyama sara.
Table No.37 Samhanana wise distribution of 30 patients with CVS
Samhanana No. of patients Percentage (%)
Avara 1 3.33%
Madhyama 29 96.66%
Pravara 0 0%
SAMHANANA
Among 30 patents 29 patients (96.66%) had madhyama samhanana, 1 patient (3.33%)
has avara samhanana.
Table No.38 Pramana wise distribution of 30 patients with CVS
Pramana No. of patients Percentage (%)
Avara 0 0%
Madhyama 30 100%
Pravara 0 0%
Observations 84
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PRAMANA
OIn the present study all the 30 patients (100%) were having madhyama pramana.
Table No.39 Satmya wise distribution of 30 patients with CVS
Satmya No. of patients Percentage (%) Avara 1 3.33%
Madhyama 29 96.66% Pravara 0 0%
SATMYA
Among 30 patients 29 patients (96.66%) had madhyama satmya and 1 patient (3.33%)
had avara satmya.
Table No.40 Satwa wise distribution of 30 patients with CVS
Satwa No. of patients Percentage (%) Avara 4 13.33%
Madhyama 26 86.66% Pravara 0 0%
SATWA
Among 30 patents 26 patients (86.66%) had madhyama satwa and 4 patients (13.33%)
had avara satwa.
Table No.41 Agni wise distribution of 30 patients with CVS
Agni No. of patients Percentage (%)
Manda 8 26.66%
Vishama 18 60.0%
Teekshna 4 13.33%
Sama 0 0%
AGNI
Among 30 patents 18 patients (60%) had Vishamagni, 8 patients (26.66%) had
mandagni and 4 patients (13.33%) were having teekshna agni.
Observations 85
Ayurveda Siddhanta & Computer Vision Syndrome
Table No.42 Vyayama Shakthi wise distribution of 30 patients with CVS
Vyayama Shakthi No. of patients Percentage (%)
Avara 2 6.66%
Madhyama 28 93.33%
Pravara 0 0%
VYAYAMA SHAKTI
Among 30 patents 28 patients (93.33%) had madhyama vyayama shakti, and 2
patients (6.66%) were having avara vyayama shakti.
Table No.43 Desha wise distribution of 30 patients with CVS
Desha No. of patients Percentage (%) Anupa 24 80.0% Jangala 6 20.0%
Sadharana 0 0% DESHA
Among 30 patents 24 patients (80%) belong to Anupa Desha, and 6 patients (20%)
belong to Jangala Desha respectively.
Table No.44 Chief complaints wise distribution of the patients with CVS
Symptoms No of patients Percentage Dry & Irritated eyes 24 80% Redness of eyes 25 83.33% Tearing in eyes 18 60% Headache 28 93.33% Burning in eyes 30 100% Blurred vision 17 56.66% Diplopia 0 0% Photophobia 20 66.66% Contact lens discomfort 5 16.66% Slowness in changing focus of eyes
12 40%
Changes in colour perception
1 3.33%
Pain in shoulder 25 83.33% Pain in Neck 27 90% Pain in Back 21 70%
Observations 86
Ayurveda Siddhanta & Computer Vision Syndrome
CHIEF COMPLAINTS
In the present study it was observed that patients having Dry & Irritated eyes were 24
(80%),Redness of eyes were 25 (83.33%),Tearing of eyes are 18 (60%),Headache
were 28 (93.33%),Burning in eyes were 30 (100%),Blurred vision were 17 (56.66%)
Diplopia were 0 (0%),Photophobia are 20 (66.66%),Contact lens discomfort are 5
(16.66%),Slowness in changing focus of eyes are 12 (40%),Changes in colour
perception of eyes are 1 (3.33%),Pain in shoulder are 25 (83.33%),Pain in Neck are
27 (90%) and having Pain in Back are 21 (70%)
Table No.45 Assessment of subjective symptoms before treatment
Dry & Irritated Eyes
Majority of patients are from Grade-2,in 17 patients, (56.66%) Grade-3 were 6
patients, (20%) Grade-1 were 1 pt, (3.33%) and Grade-0 i.e., normal were 6 patients
(20%)
Redness Of Eyes
Majority of patients are from Grade-2 20 patients, (66.66%) Grade-3 were 4 patients,
(13.33%) Grade-1 were 1 pt, (3.33%) and Grade-0 i.e., normal were 5 patients
(16.66%)
Symptoms Grade 0 Grade 1 Grade 2 Grade3
Dry & Irritated
Eyes
6 20% 1 3.33% 17 56.66% 6 20%
Redness Of Eyes 5 16.66% 1 3.33% 20 66.66% 4 13.33%
Tearing In Eyes 12 40% 5 16.66% 13 43.33% 0 0%
Headache 2 6.66% 1 3.33% 20 66.66% 7 23.66%
Burning In Eyes 0 0% 2 6.66% 19 63.33% 9 30%
Blurred Vision 13 43.33% 4 13.33% 10 33.33% 3 10%
Diplopia 30 100% 0 0% 0 0% 0 0%
Observations 87
Ayurveda Siddhanta & Computer Vision Syndrome
Tearing In Eyes
Majority of patients are from Grade-2 13 patients, (43.33%) Grade-3 were 0 patients,
(0%) Grade-1 were 5 patients, (16.66%) and Grade-0 i.e., normal were 12 patients
(40%).
Headache
Majority of patients are from Grade-2 20 patients, (66.66%) Grade-3 were 7patients,
(23.33%) Grade-1 were 1 patients, (3.33%) and Grade-0 i.e., normal were 2 patients
(6.66%).
Burning in Eyes
Majority of patients are from Grade-2 19 patients, (63.33%) Grade-3 were 9patients,
(30.0%) Grade-1 were 2 patients, (6.66%) and Grade-0 i.e., normal were 0 patients
(0%).
Blurred Vision
Majority of patients are from Grade-2 10 patients, (33.33%) Grade-1 were 4patients,
(13.33%) Grade-3 were 3 patients, (10%) and Grade-0 i.e., normal were 13 patients
(43.33%).
Diplopia
None of the patients were having Diplopia. All the 30 patients (100%) were normal.
INTERVENTION BASED OBSERVATIONS
1. All the patients selected for the study are having on or the other signs and
symptoms of CVS.
2. All the patients followed pathyapathya without interruption and discontinuity.
3. All the patients took the drug treatment without interruption and discontinuity.
4. The drug dose was adjusted to 12 grams divided in 2 equal doses of 6 grams
each.
5. Patients were comfortable at the end of treatment.
6. There were no complications observed in patients during the study.
7. Patients received the drug treatment for 60 days.
Observations 88
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF AGE AMONG THE 30 PATIENTS TAKEN FOR STUDY
ILLUSTRATION TO SHOW DISTRIBUTION OF SEX AMONG THE 30 PATIENTS TAKEN FOR STUDY
Observations 89
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF OCCUPATION AMONG THE 30 PATIENTS TAKEN FOR STUDY
ILLUSTRATION TO SHOW DISTRIBUTION OF EDUCATION AMONG THE 30 PATIENTS TAKEN FOR STUDY
Observations 90
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF MARITAL STATUS AMONG THE 30 PATIENTS TAKEN FOR STUDY
ILLUSTRATION TO SHOW DISTRIBUTION OF SOCIO ECONOMIC STATUS AMONG THE 30 PATIENTS TAKEN FOR STUDY
Observations 91
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF RELIGION AMONG THE 30 PATIENTS TAKEN FOR STUDY
ILLUSTRATION TO SHOW DISTRIBUTION OF LOCALITY AMONG THE 30 PATIENTS TAKEN FOR STUDY
Observations 92
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF DIET AMONG HE 30 PATIENTS TAKEN FOR STUDY
ILLUSTRATION TO SHOW DISTRIBUTION OF DIET PATTERN AMONG THE 30 PATIENTS TAKEN FOR STUDY
Observations 93
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF RASA SEVANA AMONG THE 30 PATIENTS TAKEN FOR STUDY
ILLUSTRATION TO SHOW DISTRIBUTION OF NIDRA AMONG THE 30 PATIENTS TAKEN FOR STUDY
Observations 94
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF DUTY AMONG THE 30 PATIENTS TAKEN FOR STUDY
ILLUSTRATION TO SHOW DISTRIBUTION OF VYASANA AMONG THE 30 PATIENTS TAKEN FOR STUDY
Observations 95
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF WORK DURATION AMONG THE 30 PATIENTS TAKEN FOR STUDY
ILLUSTRATION TO SHOW DISTRIBUTION OF AGNI AMONG THE 30 PATIENTS TAKEN FOR STUDY
Observations96
Ayurveda Siddhanta & Computer Vision Syndrome
ILLUSTRATION TO SHOW DISTRIBUTION OF SYMPTOMS AMONG THE 30 PATIENTS TAKEN FOR STUDY
Results97
Ayurveda Siddhanta & Computer Vision Syndrome
RESULTS RELATED OBSERVATIONS
OBJECTIVE PARAMETERS
Table No.46 Showing the result on Schirmers Test-I Assessment Mean
Length SD N
Before 21.8667 2.87358 30
After 22.5000 3.17045 30
Schirmers Test -I
Follow up 22.5000 3.17045 30
Source Sum of
Squares df Mean
Square F Significance
Change 8.022 2 4.011 26.913 .000 Error
change 8.644
58 .149
P = .000 HS
SCHIRMERS TEST-I Before treatment the Mean Length was 21.8667 with SD of 2.87358, after treatment
Mean Length was 22.5000 with SD of 3.17045 after follow up the Mean Length was
22.5000 with SD of 3.17045,
P values for overall changes from before treatment to after treatment and after
treatment to follow up is found to be statistically significant at .000.
This shows that the wetting in eyes increased from before treatment to after treatment
and remained stable during the follow up period.
Table No.47 showing the result on Distant Vision (Snellen’s Chart)
Assessment 6/6D 6/9D 6/12D 6/18D 6/24D 6/60D N
Before 16 3 2 3 5 1 30
After 17 2 2 3 5 1 30
Follow up 17 2 2 3 5 1 30
Results98
Ayurveda Siddhanta & Computer Vision Syndrome
P = 1.000 NS DISTANT VISION BY SNELLEN’S CHART P values for overall changes from before treatment to after treatment and after
treatment to follow up is found to be statistically non significant at 1.000.
This shows that the Acuity for Distant Vision in both eyes remained same from before
treatment to after treatment and follow up in 29 paitients and in 1 patient the visual
acuity improved from 6/9 to 6/6 and remained stable during follow up period.
Table No.48 showing the result on Near Vision (Jaeger’s Chart)
Assessment N5 N6 N7 N8 N12 N13 N14 N
Before 1 4 1 1 2 18 3 30
After 1 4 1 1 2 17 4 30
Follow up 1 4 1 1 2 17 4 30
Symmetric Measures Value Approx. Sig.
Nominal by Nominal Contingency Coefficient
.049 1.000
N of Valid Cases 90 P = 1.000 NS
NEAR VISION BY JAEGER’S CHART P values for overall changes from before treatment to after treatment and after
treatment to follow up is found to be statistically non significant at 1.000.
This shows that the Acuity for Near Vision in both eyes remained same from before
treatment to after treatment and follow up in 29 paitients and in 1 patient the visual
acuity improved from N13 to N14 and remained stable during follow up period.
Symmetric Measures Value Approx. Sig. Nominal by
Nominal Contingency Coefficient
.060 1.000
N of Valid Cases 90
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SUBJECTIVE PARAMETERS
Table No.49 Showing the result on Dry and Irritated Eyes Assessment Mean SD N
Before 1.7667 1.00630 30
After .7000 .74971 30
Dry and
Irritated Eyes Follow up .7333 .73968 30
Source Sum of
Squares df Mean
Square F Significance
Change 22.067 2 11.033 43.831 .000 Error change
14.600 58 .252
P = .000 HS
DRY AND IRRITATED EYES
Before treatment the Mean grading was 1.7667 with SD of 1.00630, after treatment
Mean grading was 0.7000 with SD of 0.74971 after follow up the Mean grading was
0.7333 with SD of 0.73968,
P values for overall changes from before treatment to after treatment and after
treatment to follow up is found to be statistically highly significant at .000 HS.
This shows that the symptom Dry and Irritated Eyes reduced from before treatment to
after treatment but slightly increased during the follow up period.
Table No.50 Showing the result on Redness of eyes
Assessment Mean SD N
Before 1.7667 .89763 30
After .6667 .75810 30
Redness of eyes
Follow up .7333 .73968 30
Source Sum of
Squares df Mean Square F Significance
Change 22.822 2 11.411 59.211 .000 Error change 11.178 58 .193
P = .000HS
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REDNESS OF EYES
Before treatment the Mean grading was 1.7667 with SD of 0.89763, after treatment
Mean grading was 0.6667 with SD of 0.75810 after follow up the Mean grading was
0.7333 with SD of 0.73968.
P values for overall changes from before treatment to after treatment and after
treatment to follow up is found to be statistically highly significant at .000 HS.
This shows that the symptom Redness of Eyes reduced from before treatment to after
treatment but slightly increased during the follow up period.
Table No.51 Showing the result on Tearing in eyes
Assessment Mean SD N
Before 1.0333 .92786 30
After .4000 .56324 30
Tearing in eyes
Follow up .3667 .55605 30
Source Sum of
Squares df Mean
Square F Significance
Change 8.467 2 4.233 29.943 .000 Error change 8.200 58 .141
P = .000 HS
TEARING IN EYES
Before treatment the Mean grading was 1.0333 with SD of 0.92786, after treatment
Mean grading was 0.4000 with SD of 0.56324 after follow up the Mean grading was
0.3667 with SD of 0.55605.
P values for overall changes from before treatment to after treatment and after
treatment to follow up is found to be statistically highly significant at .000 HS.
This shows that the symptom Tearing in Eyes reduced from before treatment to after
treatment and further decreased during the follow up period
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Table No.52 Showing the result on Headache Assessment Mean SD N
Before 2.0667 .73968 30
After .7667 .77385 30
Headache
Follow up .7333 .78492 30
Source Sum of
Squares df Mean
Square F Significance
Change 34.689 2 17.344 88.937 .000 Error change 11.311 58 .195
P = .000 HS
HEADACHE
Before treatment the Mean grading was 2.0667 with SD of .73968, after treatment
Mean grading was 0.7667 with SD of 0.77385 after follow up the Mean grading was
0.7333 with SD of 0.78492.
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically highly significant at .000 HS
This shows that the symptom Headache reduced from before treatment to after
treatment and further decreased during the follow up period.
Table No.53 Showing the result on Burning in eyes Assessment Mean SD N
Before 2.2333 .56832 30
After .8000 .80516 30
Burning in eyes
Follow up .8000 .80516 30
Source Sum of
Squares df Mean
Square F Significance
Change 41.089 2 20.544 124.411 .000 Error change 9.578 58 .165
P = .000 HS
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BURNING IN EYES
Before treatment the Mean grading was 2.2333 with SD of 0.56832, after treatment
Mean grading was 0.8000 with SD of 0.80516 after follow up the Mean grading was
0.8000 with SD of 0.80516,
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically highly significant at .000 HS
This shows that the symptom Burning in Eyes reduced from before treatment to after
treatment and remained stable during the follow up period.
Table No.54 Showing the result on Blurred vision
Assessment Mean SD N
Before 1.1000 1.09387 30
After .3333 .75810 30
Blurred vision
Follow up .3333 .75810 30
Source Sum of
Squares df Mean Square F Significance
Change 11.756 2 5.878 20.159 .000 Error change
16.911 58 .292
P = .000 HS
BLURRED VISION
Before treatment the Mean grading was 1.1000 with SD of 1.09387, after treatment
Mean grading was 0.3333 with SD of 0.75180 after follow up the Mean grading was
0.3333 with SD of 0.75810.
P values for overall changes from before treatment to after treatment and after
treatment to follow up is found to be statistically highly significant at .000 HS
This shows that the symptom Blurred Vision reduced from before treatment to after
treatment and remained stable during the follow up period.
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OBSERVATIONAL PARAMETERS Table No.55 Showing the result on Photophobia
Assessment Absent Present Total Before 10 20 30 After 26 4 30
Photophobia
Follow up 25 5 30
Value Approx. Sig. Nominal by Nominal
Contingency Coefficient
.463 .000
N of Valid Cases 90 P = .000 HS
PHOTOPHOBIA
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically highly significant at .000
Out of total 30 patients, 20 patients (66.66%) had photophobia before treatment. After
treatment 16 (53.33%) patients got relieved, but 4 patients (13.33%) persisted with
Photophobia. After the completion of follow up 5 patients (16.66%), persisted with
photophobia with increase in 1 patient (3.33%).
Table No.56 Showing the result on Contact Lens Discomfort
Assessment Absent Present Total Before 25 5 30 After 26 4 30
Contact Lens Discomfort
Follow up 26 4 30
Value Approx. Sig. Nominal by Nominal
Contingency Coefficient
.045 .914
N of Valid Cases 90
P = .914 NS
CONTACT LENS DISCOMFORT
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically non significant at .914
Results104
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Out of total 30 patients, 5 patients (16.66%) had Contact Lens Discomfort. After
treatment only 1 (3.33%) patient got relieved,but 4 patients (13.33%) persisted with
Contact Lens Discomfort. After the completion of follow up 4 patients (13.33%),
persisted with Contact Lens Discomfort. This shows that during follow up period the
condition is stable.
Table No.57 Showing the result on Slowness in Focusing
Assessment Absent Present Total Before 18 12 30 After 24 6 30
Slowness in
Focusing Follow up 24 6 30
P = .129 NS
SLOWNESS IN FOCUSING
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically non significant at .129
Out of 30 patients, 12 patients (40%) had Slowness in Focusing. After treatment 6
(20%) patients got relieved,but 6 patients (20%) persisted with Slowness in
Focusing.After the completion of follow up 6 patients (20%), persisted with Slowness
in focusing with no further decrease. This shows that during follow up the condition is
stable.
Table No.58 Showing the result on Change in Colour Perception
Assessment Absent Present Total Before 29 1 30 After 29 1 30
Change in Colour
Perception Follow up 29 1 30
Value Approx. Sig.Nominal by Nominal Contingency
Coefficient .000 1.000
N of Valid Cases 90 P = 1.000 NS
Value Approx. Sig. Nominal by
Nominal Contingency Coefficient
.209 .129
N of Valid Cases 90
Results105
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CHANGE IN COLOUR PERCEPTION
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically non significant at 1.000
Out of 30 patients, only 1 patient (3.33%) had Change in Colour Perception.After
treatment no relief was found in Change in Colour Perception.After the completion of
followup patient, persisted with Change in Colour Perception without any
improvement. This shows that during follow up the condition is stable without any
relief.
Table No.59 Showing the result on Shoulder pain
Assessment Absent Present Total Before 5 25 30 After 10 20 30
Shoulder Pain Follow up 12 18 30
Value Approx. Sig. Nominal by Nominal
Contingency Coefficient
.209 .127
N of Valid Cases 90 P = .127 NS
SHOULDER PAIN
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically non significant at .127
Out of 30 patients, 25 patients (83.33%) had shoulder pain.After treatment 5 (16.66%)
patients got relieved,but 20 patients (66.66%) persisted with Shoulder pain. After the
completion of follow up 18 patients (60%), persisted with shoulder pain and 2 patients
(6.66%) got relieved in follow up period.
Table No.60 Showing the result on Neck pain
Assessment Absent Present Total Before 3 27 30 After 6 24 30
Neck Pain Follow up 7 23 30
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Value Approx. Sig. Nominal by Nominal
Contingency Coefficient
.147 .372
N of Valid Cases 90 P = .372 NS
NECK PAIN
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically non significant at .372
Out of 30 patients, 27 patients (90%) had neck pain .After treatment 3 (10%) patients
got relieved, but 24 patients (80%) persisted with neck pain. After the completion of
follow up 23 patients (76.66%), persisted with shoulder pain and 1 patients (3.33%)
got relieved in follow up period. The result obtained regarding the parameter shoulder
pain is showing statistically non significant result with relief only in 4 patients.
Table No.61 Showing the result on Back Pain
Assessment Absent Present Total Before 9 21 30 After 11 19 30
Back Pain Follow up 11 19 30
Value Approx. Sig. Nominal by Nominal
Contingency Coefficient
.066 .821
N of Valid Cases 90 P = .821 NS
BACK PAIN
P values for overall changes from before treatment to after treatment and after
treatment to follow up is is found to be statistically non significant at .821
Out of 30 patients, 21 patients (70%) had Back pain .After treatment 2 (6.66%)
patients got relieved, but 19 patients (63.33%) persisted with Back pain. After the
completion of follow up 19 patients (63.33%), persisted with Back pain and no
patients (0%) got relieved in follow up period. The result obtained regarding the
parameter back pain is showing statistically non significant result.
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RESULT RELATED OBSERVATIONS FOR SYMPTOMS AFTER
TREATMENT
Table 62 The response of the therapy for individual symptoms after treatment
Symptoms CD CS CI-1 CI-2 CI-3
Dry & Irritated eyes 0 2 14 6 2
Redness of eyes 0 2 13 10 0
Tearing in eyes 0 1 15 2 0
Headache 0 2 13 13 0
Burning in eyes 0 2 14 13 1
Blurred vision 0 3 6 7 1
Diplopia - - - - -
EXCELLENT
2 patients (6.67%) with Dry & Irritated eyes, 1 patient (3.34%) with Burning
in eyes and 1 patient (3.34%) with Blurred vision showed excellent response.
GOOD
6 patients (20%) with Dry & Irritated eyes, 10 patients (33.34%) with Redness of
eyes,2 patients (6.67%) with Tearing in eyes, 13 patients (43.34%) with Headache
,13 patients (43.34%) with Burning in eyes, and 7 patients (23.34%) with Blurred
vision showed good response at the end of the treatment.
ENCOURAGING
14 patients (46.67%) with Dry & Irritated eyes, 13 patients (43.34%) with Redness
of eyes,15 patients (50%) with Tearing in eyes, 13 patients (43.34%) with Headache
,14 patients (46.67%) with Burning in eyes,and 6 patients (23.34%) with Blurred
vision showed encouraging response at the end of the treatment.
STABLE
2 patients (6.67%) with Dry & Irritated eyes, 2 patients (6.67%) with Redness of
Results108
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eyes,1 patient (3.34%) with Tearing in eyes, 2 patients (6.67%) with Headache ,2
patients (6.67%) with Burning in eyes,and 3 patients (10%) with Blurred vision were
stable and showed no response at the end of the treatment.
DETIORATED
None of the patients showed increase in severity of symptoms.
RESULT RELATED OBSERVATIONS FOR SYMPTOMS AFTER FOLLOW
UP
Table 63 The response of the therapy for individual symptoms after follow up
Symptoms CD CS CI-1 CI-2 CI-3
Dry & Irritated eyes 0 2 15 5 2
Redness of eyes 0 2 15 8 0
Tearing in eyes 0 1 14 3 0
Headache 0 2 13 12 1
Burning in eyes 0 2 14 13 1
Blurred vision 0 3 6 7 1
Diplopia - - - - -
EXCELLENT
2 patients (6.67%) with Dry & Irritated eyes, 1 patient (3.34%) with headache,1
patient (3.34%) with Burning in eyes and 1 patient (3.34%) with Blurred vision
showed excellent response at the end of follow up.
GOOD
5 patients (16.67%) with Dry & Irritated eyes, 8 patients (26.67%) with Redness of
eyes,3 patients (10%) with Tearing in eyes, 12 patients (40%) with Headache ,13
patients (43.34%) with Burning in eyes, and 7 patients (23.34%) with Blurred vision
showed good response at the end of follow up.
Results109
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ENCOURAGING
15patients (50%) with Dry & Irritated eyes, 15 patients (50%) with Redness of
eyes,14 patients (46.67%) with Tearing in eyes, 13 patients (43.34%) with Headache
14 patients (46.67%) with Burning in eyes,and 6 patients (23.34%) with Blurred
vision showed encouraging response at the end of follow up.
STABLE
2 patients (6.67%) with Dry & Irritated eyes, 2 patients (6.67%) with Redness of
eyes,1 patient (3.34%) with Tearing in eyes, 2 patients (6.67%) with Headache ,2
patients (6.67%) with Burning in eyes,and 3 patients (10%) with Blurred vision were
stable and showed no response at the end of follow up.
DETIORATED
None of the patients showed increase in severity of symptoms.
Table.64 STATISTICAL ANALYSIS OF RESULTS
Variable Grading
on Mean SD SE T P-
value Significa
nce BT 1.76 1.0 0.18 AT 0.70 0.74 0.13 6.72 .000 HS
DRY & IRRITATED EYES FU 0.73 0.73 0.13 6.65 .000 HS
BT 1.76 0.89 0.16 AT 0.66 0.75 0.13 7.94 .000 HS
REDNESS OF EYES
FU 0.73 0.73 0.13 7.87 .000 HS BT 1.03 0.92 0.17 AT 0.40 0.56 0.10 5.64 .000 HS
TEARING IN EYES
FU 0.36 0.55 0.10 5.52 .000 HS BT 2.06 0.73 0.13 AT 0.76 0.77 0.14 10.14 .000 HS
HEADACHE
FU 0.73 0.78 0.14 9.63 .000 HS BT 2.23 0.56 0.10 AT 0.80 0.80 0.14 11.56 .000 HS
BURNING IN EYES
FU 0.80 0.80 0.10 11.56 .000 HS BT 1.10 1.09 0.14 AT 0.33 0.75 0.13 4.49 .000 HS
BLURRED VISION
FU 0.33 0.75 0.13 4.49 .000 HS
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RESULTS
ILLUSTRATION SHOWING THE DRUG EFFECT ON SCIRMERS TEST
BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
ILLUSTRATION SHOWING THE DRUG EFFECT ON DRY EYES BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
Results111
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ILLUSTRATION SHOWING THE DRUG EFFECT ON RED EYES BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
ILLUSTRATION SHOWING THE DRUG EFFECT ON TEARING EYES BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
Results112
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ILLUSTRATION SHOWING THE DRUG EFFECT ON HEADACHE BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
ILLUSTRATION SHOWING THE DRUG EFFECT ON BURNING EYES BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
Results113
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ILLUSTRATION SHOWING THE DRUG EFFECT ON BLURRED VISION BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
ILLUSTRATION SHOWING THE DRUG EFFECT ON PHOTOPHOBIA BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
Results114
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ILLUSTRATION SHOWING THE DRUG EFFECT ON TOTAL SYMPYOMS BEFORE TREATMENT, AFTER TREATMENT AND AFTER FOLLOW UP
Results115
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ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN DRY AND IRRITATED EYES GRADINGS AFTER TREATMENT AND AFTER
FOLLOW UP
ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN REDNESS OF EYES GRADINGS AFTER TREATMENT AND AFTER FOLLOW UP
ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN TEARING OF EYES GRADINGS AFTER TREATMENT AND AFTER FOLLOW UP
Results116
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ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN HEADACHE GRADINGS AFTER TREATMENT AND AFTER FOLLOW UP
ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN BURNING
EYES AFTER TREATMENT AND AFTER FOLLOW UP
ILLUSTRATION SHOWING THE CLNICAL IMPROVEMENT IN BLURRED VISION AFTER TREATMENT AND AFTER FOLLOW UP
Discussion117
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DISCUSSION ON REVIEW
TITLE OF THE STUDY
“Application of Ayurveda Siddhanta in the Management of Computer Vision
Syndrome.”
This study is intended to understand Ayurveda Siddhantas that can be applied
to understand a new disease, Computer Vision Syndrome in all its aspects, i.e., its
diagnosis prevention and treatment.In this present work an attempt was made to
understand Computer Vision Syndrome based on the Ayurveda Siddhantas like Hetu,
Trividha hetu, Nidanapanchaka, and to find out a sitable Chikitsa and to find the role
of Rasayana in its treatment..
Computer is an Electronic device
Vision is physiological function of cognition
Syndrome A group of symptoms, signs, laboratory findings or physiological
disturbances that are linked by a common anatomical, biochemical or pathological
history.
So CVS means a a group of eye or vision related signs or symptoms occurring in
excessive computer users.
DISCUSSION ON REVIEW OF LITERATURE
Hetu
Definition
The factor which causes rogotpatti by vitiating the dosha is called nidana.
All the definitions of hetu in general mean that hetu is an etiological, causative factor
for a disease manifestation, gives rise to a disease or karana for a vyadhi. Hetu word is
also used as synonymous to nidana in many contexts in the classiscs.
The disease CVS is caused due to working or seeing computer screens continuosly for
longer duration.Here watching computers is the etiological/causative factor for a
disease manifestation; it gives rise to the disease and is a karana for a vyadhi. So in
this disease Computer watching is the hetu or nidana for manifestation of CVS.
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Classification of Hetu
The various hetu explained in samhita can be applied here stating their
causative efficacy in disease Computer Vision Syndrome and their nature of
influencing a disease.
Bahya hetu
The external factors causing dosha prakopa are bahya hetu.
Working with computers and watching television for longer duration, looking at fast
moving images and bhasvara vasthu darshana and multiple colours very frequently,
improper lighting arrangement, improper seating position, etc acts as a bahya hetu in
causing Computer Vision Syndrome.
Abhyantara hetu
The hetu present internally is responsible in the disease origin. Ex – Doshas,
vata, pitta kapha, Vatadi dosha prakopa due to various nidana which cause the disease
and its lakshans are to be considered as abhyantara hetu. In Computer Vision
Syndrome already prakupita tridosha due to various nidanas along with existing eye
diseases like Presbyopia, Myopia, Asthenopia, Dry Eye, Glaucoma further aggravate
the severity.These factors act as abhyantara hetu.
Utapadaka hetu
The hetu bringing dosha vitation by its nature as it is the important chief or
potent cause. Ex - Madhura rasa sevana causes increase of kapha
Sitting in uncomfortable positions and following mithya ahara, mithya vihara,
vyasana,etc act as hetu for vatadi dosha prakopa and cause manifestation of disease
and they are to be considered as utpadaka hetu.
Vyanjaka hetu
The hetu stimulating for a disease origin, the hetu excites the already sanchita
dosha to produce disease. Ex– Surya santapa in vasantha rutu acting as a cause for
kaphaja rogas.Following the acts which cause the prakopa of already increased dosha
like ratrijagarana, and alpashana and vishamashana acts as vyanjaka hetu in Computer
Vision Syndrome.
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Ubhaya hetu
The hetu responsible for disease considering both dosha and vyadhi.Watching
and working with computers for longer duration causes both vaatadi dosha prakopa
and netra vyadhi thus can be considered under ubhaya hetu.
Sannikrushta hetu
The nearest or immediate cause responsible in the disease origin.Ex –Vatadi
dosha prakopa in disease origin.In Computer Vision Syndrome the sannikrushta hetu
is Asatmendriyartha Samyoga (Atiyoga) of Chakshurendriya.
Pradhanika hetu
A powerful or potent cause capable of producing a disease by itself.
In Computer Vision Syndrome the pradhanika hetu is watching ati bhrusha, bhasvara
chala and sookshma vastu darshana.
DISCUSSION ON TRIVIDHA HETU
Asatmendriyartha samyoga
Among the trividha hetu, the asatmendriartha samyoga is related mainly to
Pancha gnanendriya based on hinayoga, mithyayoga and atiyoga with their vishayas.
The asatmendriyartha samyoga of chakshurendriya are as follows.
Ati Yoga
Ati Darshanam i.e., seeing very bright light or objects for long periods of time.
In the present study the following factors were found which can be considered as
Atiyoga of chakshurendriya like working with computers for more than 8 hrs a day
were 20 patients i.e., (66.67%)
In the present study it was found that all the 30 patients were having the habit
of watching TV which can also be considered under Chakshurendriya Atiyoga.
Ayoga
Adarshanam remaining in dim light or darkness, seeing objects and reading in
dim light or not utilizing the Chakshurendriya properly.In the present study no patient
was found following ayoga of Chakshurendriya.
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Mithya yoga
Seeing for a long time those objects which are very near or very far, which are very
minute, which are very bright and sparkling. In the present study it was found that
patients were having the habit of following various Netra indriya mithyayoga like
• Watching computer from very near (10 ‐33.33%)
• Working with computer and watching TV in darkness or dim light or
improper lighting. (6 ‐20.0%)
• Reading small font and watching flickering images (15‐50%)
• Sitting in an improper position while working with computers (15‐50%)
Prajnaparadha
In the present study it was observed that maximum no of patients ie 15 were
working for 6 days a week and 10 patients working 7 days a week with computers
with average of 8.5 hrs a day. In this study it was observed that maximum no of
patients were working with computers from 1 year 5 patients, 3 year 5 patients and 5
years 4 patients with an average working period of 3.5 years with computers. Based
on these observations it can be considered as kayika prajnaparadha atiyoga.
Manasika prajnaparadha is also found in the patients of Computer Vision
Syndrome as most of them are stressed from the nature of the job especially those
working in software companies and call centre.
Vachika prajnaparadha is not found in all the patients except call centre
employees whose nature of job is voice based so have to answer and talk continuously
while attending the calls.
Parinama
The hina, mithya and atiyoga of kaala lead to vatadi dosha prakopa by the
influence of the kaala leading to the diseases manifestation.
In the present study it was observed that more exposure to cold in air
conditioned atmosphere also aggravates vatadi dosha and increases the dryness in
eyes as its not a natural atmosphere.It becomes a factor of kala mithya yoga i.e
different from external natural enviroment and atiyoga i.e,sheeta guna atiyoga causing
dosha prakopa. The duration of work can also be considered under kala i.e., more the
Discussion121
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duration the patient is exposed to computer work he is more prone to develop
Computer Vision Syndrome.
DISCUSSION ON CHAKSHURENDRIYA
Chakshu is the organ of vision and first and the most important among the
Pancha Gnanendriya.In Ayurveda samhita a lot of importance has been given
regarding this and a detailed discussion regarding its utpatti,its adhishthana,
mahabhoota and its importance. Acharya Nimi in astanga hrudaya says for a blind
person day and night are same even though he is having a lot of wealth stating the
importance of netra.In Sushruta samhita acharya sushruta has explained measures to
protect one’s eyes and the treatment of netra roga in detail in uttaratantra. In
Ayurvedic literature it is also mentioned that “sarvendriyanam nayanam
pradhanam“stating the importance of chakshurendriya.
Sclera
The sclera forms posterior 5/6 of the eye ball. It has received its name from its
extreme dense fibrous tissue which is hard and maintains the shape of eyeball. Its
external surface is white in colour. In Computer Vision Syndrome the sclera turns red
which is called as the red eye due to excessive flow of blood to eye or inflammation
or due to continuous work.
Lacrimal apparatus
These lacrimal apparatus keeps the eye moistened and supplies essential
nutrition and lubrication.In Computer Vision Syndrome due to uninterrupted watching
and reduced blink rate of eyes, the tear secretion decreases or tears quickly get
evapourated and the eye is not properly moistened.This causes the sensation of dry
eye and burning in the eyes.
Muscles of the eye
Eye ball is kept in position by the Ocular muscles.All the muscles help in the
movement of the eye ball in multi directions.Persons working with computer need to
move their eyes frequently as to focus on the screen and on the near by documents
alternatively while entering various data which causes muscle strain resulting in eye
strain, tiredness and pain in the eyes.
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DISCUSSION ON NETRA ROGA
Detail description of netra roga is available in in Sushruta uttaratantra along
with their etiology, pathogenesis, symptoms, complications, medical and surgical
treatments and sadhyasadhyata. In the same sthana there is description about the
panchalakshana nidana and samanya chikitsa of aganthuja/abhighataja diseases in
detail. Apart from nija rogas Aganthuja netra roga have also been mentioned caused
due to Abhighata,and other external factors.CVS can be included under bahya or
Abhighata janya netra roga.
DISCUSSION ON NIDANA PANCHAKA
The samanya Nidana of netra roga mentioned in Sushruta Samhita
Uttaratanthra should be considered while eliciting the Nidana of Computer Vision
Syndrome which is also a netra vyadhi.
Nidana
The Nidana of netra roga can be classified as Aaharaja, Viharaja Manasika based on
their cause and their role in aggravating doshas.
1. Aharaja- The aharaja Nidana again can be catogorised as vata prakopaka,pitta
prakopaka and kapha prakopaka nidana.
Vata prakopa nidana: In this present study it was observed that most of the patients
26 (86.77%) were following vishamashan which causes vata prakopa.
Pitta prakopa nidana: In the present study it was found that the patients having the
habit of drinking tea were 24 (80%) drinking alcohol were 7 (23.33%) drinking coffee
were 5 (16.66%) respectively which causes pitta prakopa.
Kapha prakopa nidana:In the present study it was found that 6 (20%) patients take
curd in the night which causes kapha prakopa.
2. Viharaja
Vata prakopa nidana: In this present study it was observed that most of the patients
were following Ratrijagarana (Vata Pitta prakopaka) 15 (50%) patients and
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diwaswapna (Vata Kapha prakopaka) were 15 (50%) patients, vegadharana and ,
disturbed sleep 15 (50%) which causes vata prakopa.
Pitta prakopa nidana:In the present study dhooma pana was found in 7 (23.33%)
patients and ratrijagarana in 15 (50%) and madyapana in 7 (23.33%) of patients which
also causes pitta prakopa.
Kapha prakopa nidana: In the present study it was found that 15 (50%) patients
were divaswapna which may cause kapha prakopa.
Manasika- The manasika Nidana mentioned in netra roga Nidana are
kopa,shoka,klesha, Prasaktha smrodana, shrantha, klantha etc mansika bhava.In the
present study most of the patients are stressed and complained of various manasika
bhavas like shrantha,klantha,kopa,Klesha,chinta,udwega.
According to Acharya Nimi Nidana for netra roga are ahita aahara and visual
contact with excessively sparkling, fast moving and minute objects.In the present
study all the 30 patients were found to follow this Nidana of watching excessively
sparkling, fast moving and minute objects while working with computers and
watching TV.
Thus watching and working with computers is the cause for the netra vyadhi
Computer Vision Syndrome and various ahitakara ahara vihara and manasa bhavas
help in promoting the disease further and they in turn also act as sahakari karana.
Poorvaroopa
No specific prodromal symptoms were mentioned for the disease Computer
Vision Syndrome.In the present study the roopa of CVS i.e., burning in eyes, watering
in eyes, dry and irritated eyes, headache, redness of eyes and blurred vision difficulty
in focusing and photophobia with less severity are considered as prodromal
symptoms,as these symptoms are found in patients with less severity.
Roopa/Lakshana
The Visishta lakshanas of Computer Vision Syndrome are
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Eye Irritation (Dry Eyes, Itchy Eyes, Irritated Eyes)
Red Eyes
Blurred Vision (Distance Or Near),
Headache
Light Sensitivity,
Double Vision
Backache
Neck Ache
Muscle Fatigue
Eye Strain,
Difficulty Refocusing the Eyes.
In the present study a comparision was made regarding the lakshanas told in
Ayurveda samhitas and their probable dosha involvement which is as follows.
Symptoms Ayurvedic terms Dosha vitiation
Dry and irritated eyes Visushka Netra / Rooksha Netra
Vata
Eye Strain Netra Klama Vata Blurred vision Avila Darshanam Pitta Red Eyes Netra Raaga Pitta Burning Eyes Netra Daha Pitta Excessive lacrimation Ashru Bahulata Vata Double vision Dwidha pashyati
(Mithya darshana) Vata
Difficulty in focusing Roopa darshana asahyata (heena tarpita lakshana)
Vata
Change in colour perception Vikruta varna patavam
Vata / pitta
Photophobia Prakasha Asahyatva Vata / pitta Headache Sirashoola Vata/pitta Pain in shoulder, neck and back.
Greeva, Bahu , Kati Shoola
Vata
Contact lens discomfort --------------- -
Slowness in changing focus Alpa kriya laghava of netra
Vata
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When the lakshanas of Computer Vision Syndrome are compared with dosha
predominance and lakshanas told in Ayurveda it is assumed that Computer Vision
Syndrome is a disease with Vata Pitta dosha predominance. In the present study it was
observed that the Samanya Poorvaroopa Lakshana of Netra Roga are similar with the
lakshana of Computer Vision Syndrome.So it can be assumed that the samanya
Poorvaroopa lakshana of netra roga are similar to the Poorvaroopa and also to the
Roopa of Computer Vision Syndrome.Though an exact comparision of Computer
Vision Syndrome with the existing netra roga cant be made in this study, it can be
inferred that Computer Vision Syndrome is the poorva roopa condition of netra roga
with predominance of vata pitta dosha and CVS is also an independent netra vyadhi.
Upashaya and Anupashaya
In the present study it was observed that taking break from work intermittently every
1 hour (intermittent rest), maintaining eye hygine,good night sleep,good seating
position, less glare from computer screens and sitting in a properly illuminated room
without shadows on screen and healthy nutritious food are to be considered upashaya
in CVS.
The factors exactly opposite to upashaya like ratrijagarana, alpashana, anashana,
improper lighting, and improper seating are to be considered as anupashaya in CVS.
Samprapthi
The samprapthi of Computer Vision Syndrome can be explained as follows.
Samprapti Ghataka
Dosha- Vata Pitta Pradhana Tri Dosha
Dooshya- Rasa,Rakta,Mamsa,Majja
Srotas- Netragata Sira
Srotodusti- Sanga,Atipravrutti
Udbhava sthana- Chakshu (Netra).
Vyaktha sthana-Netra
Sanchara sthana- Urdhwagata Sira
Rogamarga- Madhyama
Adhisthana- Chakshurendriya.
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Swabhava- Chirakari
Illustration No Showing the Scheme of Samprapti of CVS
Achakshushya Nidana Sevana
(Working with computer for longer duration & following other dosha aggravating
factors )
Dosha Vruddhi and Dosha Dushti
(Nidana sevana continued further)
Dosha prakopa with predominance of Vata and Pitta Dosha
Spreading of dosha in the body through all sira and srotas
Entry of doshas into Urdhwagata Sira
Urdhwagati of Prakupita Dosha through the Urdhwagata Sira
Sthana Samshraya of Prakupita Dosha in various parts of the Netra
Poorvaroopa lakshana
Manifestation of Netra Roga (Computer Vision Syndrome)
Sadhyasadhyata
Computer Vision Syndrome is an easily curable condition i.e.,
sukhasadhya if chikitsa is started early and if nidanaparivarjana and pathya are
followed properly. But if nidana parivarjana and pathya are not followed by computer
users then Computer Vision Syndrome becomes a kricchra sadhya or yapya vyadhi.
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Upadrava and Arishta Lakshana
In the present study during the period of intervention no upadravas or arishta
lakshana were seen.
Discussion on Netra Roga Chikitsa Sidddhanta
The management principles of Netra Roga in general consist of avoidance of
etiological factors as the first line of management. The second principle is to counter
act increased Vata and other Doshas in the poorvaroopa stage itself, because if
neglected these diseases progress rapidly and become incurable in later stages.i.e.,
a) Nidana parivarjana (Prophylactic measures)
In patients of Computer Vision Syndrome Nidanaparivarjana in total as such is
not possible and is far from practical as all of the computer workers are dependent on
the job for their livelihood.
In the present study 5 patients applied leave due to various reasons and took a break
from office work for 1 month, in them the severity of symptoms was found less
during the period of vacation.Based on this observation it can be infered that nidana
parivarjana is the best chikitsa.
b) Vaatadi dosha shamanam (Curative measures)
Vaatadi doshashama includes sthanika and sarvadehika traeatment procedures
like shamana and shodhana which include Rasayana, Aushadha, Kriyakalpa, though
the disease Computer Vision Syndrome is not mentioned in Ayurveda Samhitas based
on the principles the following Chikitsa Siddhanta can be formulated.
In an aganthu karana vyadhi like Computer Vision Syndrome netra prasadana
janana, drushtiprasadajanana drugs should be used which cause dosha shamana and
samprapthi vighatana along with vaatabhishyanda chikitsa.i.e, procedures like
Aschotana, Tarpana, Putapaka etc with netrya and snigdha vtahara drugs are
beneficial.In Netra vyadhi Chakshushya rasayana drugs are to be administrated like
Triphala as vatatapika rasayana sevana vidhi. All rasayana are beneficial in
indriyajanya vyadhi especially which are chakshushya.vatatapika chakshushya
rasayana thus administered gives strength to that particular indriya and prevent
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diseasease due to asatmendriyartha samyoga and help in performing the daily
activities.
In the present study the patients are unable to follow nidana parivarjana as
their livelihood is dependent on the job and also lengthy and time consuming
treatment procedures like tarpana and putapaka could not be administered due to lack
of time and nature of job. So a Chakshushya rasayana yoga was selected which is very
easy to consume and also having the properties of vatadi dosha shamana, Rasayana
and Netrya.In the present study it was also observed that Computer Vision Syndrome
is associated with non ocular symptoms like pain in shoulder, neck and back due to
improper seating arrangement and poor office ergonomics. So giving only
chakshushya rasayana may not cure the disease completely but a multicentric
approach like pathya sevana,vata hara/shoola hara aushadhies,use of spectacles,mild
exercise to prevent pain in shoulder back etc and proper office ergonomics are
beneficial which can be considered under yukthivyapashraya chikitsa. If all the
mentioned principles are followed rationally Computer Vision Syndrome can be
easily cured.
DISCUSSION ON MATERIALS AND METHODS Instruments Near vision Jacquers Chart Near vision eye examination was done to find out the Acuity of near vision in patients
of CVS.
Distant vision Snellen’s Chart Distant vision eye examination was done to find out the Acuity of distant vision in
patients of CVS
Schirmers test -1 Schimmers test -1 examination was done to find out the amount of dryness in eyes of
patients suffering from CVS.As dry eyes is a common symptom complained by all
computer users this test was done to find out the amount of dryness.
Discussion on Drug-Triphala Yashtimadhu Yoga
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The ingredients of Triphala Yashtimadhu Yoga are Haritaki, Vibhitaki,
Amalaki and Yashtimadhu. All the above drugs were selected on the basis of their
indication in Netra roga as they are mentioned as Netrya, Swarya, Chakshushya,
Rasayana, Antistress and also as Anti inflammatory. They are useful in the preventing
and curing various types of Netra roga and they also improve vision. They are Madura
rasa pradhana, snigdha guna, sheeta virya and madhura vipaka, jeevaneeya and
tridosha shamaka in nature.Thus this drug was taken for the study based on the above
properties and also as it is directly indicated in netra roga.
Discussion on Anupana
Madhu and Ghrita are used as Anupana in the present study as per their
indication in the classics. Madhu and Ghrita are having Madhura rasa, guru snigdha
mrudu yogavahi guna,also having Rasayana karma,and Chakshushya prabhava thus
they are specially indicated in Netra roga.
All the above drugs are easily available, economical and the preparation of Choorna is
also easy.Therefore with the above intention Triphala Yashtimadhu Yoga with
anupana of Madhu and Ghrita is selected to evaluate its efficacy in netra roga like
Computer Vision Syndrome.
Selection Criteria
Patients were selected by screening with the help of a detailed questionnaire,
and those fulfilling the inclusion criteria, and willing to take the treatment.As patients
of both sex work with computers the study was conducted irrespective of sex.
Patients of age group between 20-50 years were selected as subjects of age group in
the range of 20-50 years are commonly found in computer related jobs.In this study
patients having high myopia, colour-blindness, cataract, glaucoma, and with other
ocular problems were excluded as these diseases are chronic and need different and
various modalities of treatment.
Inclusion Criteria
Patients indulging in occupation of working with computers for more than 4
hours a day were taken for the study because 4 hours of computer work is considered
safe as per different studies available.Patients of either sex are taken as both male and
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female are equally working with computers. Age group of 20-50 years was included
as people of this age group are found more in computer jobs and work for more than 4
hrs in a day.
Exclusion Criteria
Patients suffering from chronic systemic diseases, degenerative eye diseases
and severe ocular problems including high myopia and from congenital ocular
anomalies as they may interfere with the course of the study.
Diagnostic Criteria
The diagnosis of patients suffering with CVS was made based on a
questionnaire containing signs and symptoms index stated by AOA (American
optometric Association) though the individual symptoms found in CVS may mimic
other disesases,but are collectively found in CVS only.
Sampling Method
The patients were randomly selected and made in to a single group to avoid
bias.
Study Design
Present study was an observational and a single blind clinical study with pre
and post test design.This study design was taken to assess the changes in severity of
symptoms before and after drug trial to find out the clinical efficacy of drug on CVS.
Grading for subjective variables
The gradings for subjective parameters were done based on the previous
research works done in various institutes on the same subject Computer Vision
Syndrome.
Data collection
Data collection was done before treatment, after and follows up to assess the
effect of drug and pathya from before treatment to after treatment and after treatment
to follow up.
Discussion on Intervention
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The dose of drug administered in the present study was 12 grams per day (1
karsha).In classics the Chakshushya drugs were to be taken during night.The dosage
of the drug was made 6 grams twice a day for easy administration with anupana of
Ghrita and Madhu.
Discussion on Observations
The observations were made in the patients of Computer Vision Syndrome
excluding dropouts were based on the clinical trial on 30 patients registered for the
study. The data was collected in a case sheet and were analyzed after the completion
of the study.
Dropouts
Total 40 patients got registered for the study, out of which 10 patients
discontinued the treatment after various stages. Among the dropouts 5 patients
discontinued due to personal reasons and 5 patients discontinued due to lack of time
for follow-up visits.
Availability
All the cases were reported to OPD of GAMC & H directly during the 6
months camp period.
Age
In the present clinical study it was observed that maximum numbers of
patients were in the age group between 21-30 years. The collected data indicates that
the incidence of Computer Vision Syndrome is higher in youngsters as more job
opportunities are available in computer related field for freshers.
Sex
Among 30 patients in the present study 16 patients were male and 14 patients
were female. The ratio of male and female is almost similar stating that job
opportunities are equal for both sexes in computer related jobs thus both are equally
prone to this disease.
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Occupation
In this study it was observed that majority of the patients were software
professionals are 11 (36.66%), office clerk 8 (26.66%), accountants 4 (13.33%), call
centre employees 4 (13.33%), medical transcriptionists 2 (6.66%) and students were 1
(3.33%).The collected data indicates that the incidence of Computer Vision Syndrome
is usually more in software professionals as they have relatively more work load and
long working hours as per the demands of the employer.
Education
In the present study it was observed that maximum i.e., 24 patients (80%)
were graduates, and 6 patients (20%) are post-graduates. Due to easy employment and
attractive salaries more people are opting for computer jobs than for higher education.
It was also observed that 9 (30%) people are studying through correspondence for
higher degrees because, though these jobs pay good for freshers,career growth,
promotions and pay scale are qualification dependent.
Marital Status
Among 30 patients maximum numbers of patients were unmarried i.e. 18
(60%) and 12 (40%) patients were married.Though marital age in india is 21 as good
job and higher salary are requsite for marriage in the present society the urban Indian
marital age is nearing 30 due to good career.Though the exact relation of the disease
with marital status though could not be established in this study,the reason may be
need for good career,thats why majority of patients are unmarried.
Religion
In the present study it was observed that majority of patients were from Hindu
community i.e., 24 (80.0%) from Muslim community are 2 (6.66%) from Christian
community are 1 (3.33%) and others (Jain) are 3 (10.0%) respectively. As Indian
society is hindu dominant with more literacy rate is found in hindus suffering with
Computer Vision Syndrome.
Socio Economic status
Among 30 patients maximum numbers of patients were from middle class i.e.
23 (76.7%) and 6 (20%) patients were from upper middle class and only 1 (3.33%)
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patient was from rich class. As more Indians are from middle class.It can be
concluded that people with middle socio-economic status are the majority working in
computer jobs due to higher salary, and they also can’t do Nidanaparivarjana as their
livelihood is job related, thus they are more prone to Computer Vision Syndrome.
Locality
It was observed that out of 30 patients, majority of the patients i.e. 28 (93.3%)
patients were from urban area followed by 2 (6.66) patients from rural area.This
shows that software companies and computer firms are more in urban areas, thus
people residing and working in urban are more prone to Computer Vision Syndrome.
Tv watching
In the present study it was found that all the patients were having the habit of
watching TV. Watching TV for 5 hours were 1 (3.33%) for 4 hours are 4 (13.33%),,
for 3 hours are 4 (13.33%), for 2 hours are 12(40%), for 1 hour are 9 (30%),
respectively.Computer job doers also watch TV for relaxation,but for less duration
compared to professionals of other jobs but watching TV more frequently along with
computer work further aggravates the condition of Computer Vision Syndrome.
Working hours
In the present study on observing the no of working hours the minimum were
3 hrs and maximum was 16 hrs with more no of patients working for 8hrs. As per
AOA the safe number of working hours to work with a computer are 4 but in the
study the mean no of working duration is 8.5 hrs which is twice the time mentioned
by AOA. So it can be inferred that more computer working duration further
aggravates the condition of Computer Vision Syndrome.
Working duration
In the present study on observing the working duration the minimum were 3
months and maximum was 8 years with more no of patients working for 5 years.So it
can be inferred that exposure to computers for longer duration of time aggravates the
condition of Computer Vision Syndrome.
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Working in a week
In the present study on observing the no of working days the minimum were 4
days and maximum was 7 days with more no of patients working for 6 days a
week.So it can be inferred that more computer working duration further aggravates
the condition of Computer Vision Syndrome.
Prakruti
Among 30 patients it was observed that majority of patients 15 (50%) had
Vata Pitta Prakruti followed by Pitta Kapha Prakruti in 10 patients (33.33%) and
Vatakapha Prakruti is present in 5 (16.7%) patients. It shows that Vata Pitta Prakruti
persons are more prone to this disease because working for longer hours with
computers and sitting in same posture causes Vata Pitta Prakopa and Vata Pitta
Prakruthi persons because of their parakruthi which may be an aggravating factor in
this condition.
Diet
In the present study it was found that the patients with vegetarian diet are 15
(50%) and mixed diet are 15 (50%) both are equally present. Diet Pattern and its
correlation with the incidence of the disease couldn’t be established in the present
study.
Diet pattern
In the present study it was found that the patients following vishamashana are
more i.e., 26 (86.77%) and patients following samashana were 4 (13.33%).this shows
that persons following vishamasana are more in number due to busy work schedule
and unable to take timely food.vishamashana causes vata dosha prakopa and further
causes the already sanchita dosha to prakopa avstha and may help in causing the
vyadhi.
Rasa sevana
In the present study it was found that the patients taking 4 rasa MALK are 21
(70.0%) taking 3 rasa MAL are 5 (16.66%) and taking 5 rasa MALKT are 2 (6.66%)
and taking all the 6 rasa are also 2 (6.66%).It was observed that patients taking
MALK rasa are having more symptoms. But with the available sample size no
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Ayurveda Siddhanta & Computer Vision Syndrome
conclusions can be drawn on the role of rasa sevana in causing Computer Vision
Syndrome.
Vyasana
In the present study it was found that the patients having the habit of drinking
tea were 24 (80%) habit of smoking were 7 (23.33%) drinking alcohol were 7
(23.33%) drinking coffee were 5 (16.66%) and tobacco chewing were 2 (6.66%) and
taking milk were 1 (3.33%) respectively.vyasana like smoking,tobacco chewing and
drinking alcohol further increase doshaprakopa and may aggravate the condition.
Duty
In the present study on interrogation it was found that people working in night
shifts are are complaining of discomfort with the shift, and sleep deprivation.
It can be inferred that people working in night shift were having more
discomfort compared to day shift and its an aggravating factor for Computer Vision
Syndrome as ratrijagarana causes Vata Pitta dosha prakopa.
Sleep
In the present study it was found that the patients with sound sleep are 15
(50%) and disturbed sleep are 15 (50%) both are equally present. On interrogation it
was found that people having disturbed sleep are complaining of discomfort with the
eyes.It was observed that persons with disturbed sleep are suffering more from
Computer Vision Syndrome.
Treatment
Maximum number of patient i.e. 27 patients freshly reported for the study.
This clearly indicates the ignorance of the patients regarding this disease. So that until
all the symptoms of the disease get manifested they do not approach the medical
authority.
Mode of Onset
Among 30 patients all patients had gradual onset and no patient had
complained of sudden onset. Based on above observation in the present study it was
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inferred that all the patients had gradual onset of symptoms and Computer Vision
Syndrome is said to be gradual in onset.
Sara
In the present study it was found that all the 30 (100%) patients were of
madhyama sara. With the available sample size no conclusions can be drawn on the
role of sara in causation of Computer Vision Syndrome.
Samhanana
In the present study it was found maximum number of the patients 29
(96.66%) were of madhyama samhanana. With the available sample size no
conclusions can be drawn on the role of Samhanana in causation of Computer Vision
Syndrome.
Pramana
In the present study it was found that all the 30 (100%) patients were of
madhyama Pramana. With the available sample size no conclusions can be drawn on
the role of Pramana in causation of Computer Vision Syndrome.
Satmya
In the present study it was found maximum number of the patients 29
(96.66%) were of madhyama satmya. With the available sample size no conclusions
can be drawn on the role of Satmya in causation of Computer Vision Syndrome.
Satwa
In the present study it was found maximum number of the patients 26
(96.66%) were of madhyama satva and 4 were with avara satwa. Satwa bala has a
definite role to play in causation of Computer Vision Syndrome as chinta shoka bhaya
anxiety like emotions may further aggravate due to work load associated manasika
karana and cause dosha prakopa,which may further aggravate the condition.
Agni
Among 30 patients it was observed that majority of patients 18 (60%) had
Vishamagni and 8 (26.7%) had mandagni and 4 patients (13.33%) had teekshnagni.
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this shows that as the vyadhi is vata pitta pradhana and vishamagni may be
aggravating the comndition by vata dosha prakopa.
Vyayama
In the present study it was found maximum number of the patients 20
(66.66%) were doing madhyama vyayama and 10 (33.34%) were doing avara
vyayama. vyayama bala has a definite role to play in prevention of Computer Vision
Syndrome as a person can withstand from stress for longer duration with vyayama.
Desha
In the present study it was found maximum number of the patients 24 (80%)
were belonging to anupa desha.and 6 patients belong to jangala desha (20%). With the
available sample size no conclusions can be drawn on the role of Desha in the
causation of Computer Vision Syndrome.
DISCUSSION ON RESULTS
30 patients who completed the clinical trial were considered for assessing the
results. The cardinal symptoms were considered for statistical analysis and were
assessed totally 3 times, before the treatment and after 2 month of drugs trial and after
follow up. Along with the symptomatology vision tests and Schirmer test-I values
were statistically assessed by comparing pre, post tests and follow up values.
In the present study it is observed that Triphala yashtimadhu yoga with
anupana of madhu and ghrita along with pathya sevana and correction in work station
and usage of glasses has reduced some of the signs and symptoms of Computer
Vision Syndrome significantly.
OBJECTIVE PARAMETERS
Schirmer’s Test-I
The levels of Schirmers test-I showing raised values initially, but remained in
normal levels after the study period of 60 days and after follow up. The result
indicated statistically significant P < 0.001 was observed.This signifies that the drug
increases the moisture content of the eyes and normalizes the lacrimal secretion
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maintaining the snigdhata of the netra, and is effective in dry and irritated eyes.This
proves the chakshushya,rasayana,netrya properties of the triphala yashtimadhu yoga.
Visual acuity Distant and Near Vision
In patients having defects in visual acuity only 1 patient has improvement of
reading in distant vision from 6/9 to 6/6 all other patients readings were stable. In
readings of near vision only 1 patient has improvement of acuity of near vision from
N13 to N14. Remaining other’s readings was stable. None of the values obtained are
showing statistical significance.
As the duration of the present study was short no conclusions can be drawn
based on the results. But improvement of 1 patient each for distant and near vision
proves the Chakshushya effect of the drugs used in the yoga and it can be inferred that
that the drug may be improving the visual acuity of the eyes and if continued for
longer duration may have a significant role to play in the management of acuity of
vision associated with Computer Vision Syndrome.
SUBJECTIVE PARAMETERS
Dry and irritated eyes
The drug effect was statistically highly significant in patients with Dry and
irritated eyes after the completion of treatment but increased slightly during the follow
up period.Out of total 24 patients complaining dry eyes only 2 patients had no
result.Grade 3 improvement was found in 2 patients. Grade 2 improvement was found
in 5 patients and Grade 1 improvement was found in 15 patients.This proves the effect
of Chakshushya, Netrya, Tridoshashmaka, Rasayana, and Antistress, Anti
inflammatory properties of the drugs in the yoga and also having guru snigdha guna
which reduces the dryness and irritation in the eye. It suggests that the theraphy if
continued for longer duration gives better results.
Redness of Eyes
The drug effect was statistically highly significant in patients with Redness of
eyes after the completion of treatment but increased slightly during the follow up
period. Out of total 25 patients complaining red eyes only 2 patients had no
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result.Grade 3 improvement was found in none. Grade 2 improvement was found in 8
patients and Grade 1 improvement was found in 15 patients.This proves the effect of
Chakshushya,Tridoshashmaka,Rasayana,Antistress,and Anti inflammatory properties
of the drugs in the yoga and also having guru snigdha guna and sheeta veerya they
,may be acting as vata pitta shamaka thus reducing the redness of the eyes. It suggests
that the theraphy if continued for longer duration gives better results.
Tearing of Eyes
The drug effect was statistically highly significant in patients with Tearing of
eyes after the completion of treatment and follow up. Out of total 18 patients
complaining tearing eyes only 1 patient had no result.Grade 3 improvement was found
in none. Grade 2 improvement was found in 3 patients and Grade 1 improvement was
found in 14 patients.This proves the action of tear regularization of the drug along
with Chakshushya Tridoshashmaka, Rasayana, Anti inflammatory and Antistress
properties of the drugs in the yoga.
Headache
The drug effect was statistically highly significant in patients with Headache
after the completion of treatment and follow up. Out of total 28 patients complaining
headache only 2 patients had no result.Grade 3 improvement was found in 1 patient.
Grade 2 improvement was found in 12 patients and Grade 1 improvement was found
in 13 patients. This proves the effect of Chakshushya Tridoshashmaka,
Rasayana,saumanasa janana and medhya,Antistress and Antiinflammatory properties
of the drugs in the yoga, and this yoga is also effective in reducing the headache
associated with Computer Vision Syndrome.
Burning in Eyes
The drug effect was statistically highly significant in patients with Burning in
Eyes after the completion of treatment and follow up. Out of 30 patients complaining
Burning eyes only 2 people had no result.Grade 3 improvement was found in 1
patient. Grade 2 improvement was found in 13 patients and Grade 1 improvement was
found in 14 patients.This proves the effect of Chakshushya Tridoshashmaka,
Discussion140
Ayurveda Siddhanta & Computer Vision Syndrome
Rasayana, and Antistress, Anti inflammatory properties of the drugs in the yoga and
also having guru snigdha, sheeta guna.
Blurred Vision
The drug effect was statistically highly significant in patients with Blurred
Vision after the completion of treatment and follow up. Out of total 17 patients
complaining dry eyes only 3 people had no result.Grade 3 improvement was found in
1 patient. Grade 2 improvements were found in 7 patients and Grade 1 improvement
was found in 6 patients. This proves the effect of Chakshushya Tridoshashmaka,
Rasayana , and Antistress Anti inflammatory properties of the drugs in the yoga
because of which it is reducing the blurred vision arising due to excess computer
viewing.
OBSERVATIONAL PARAMETERS
Photophobia
The drug effect is statistically highly significant in patients with photophobia
after completion but increased slightly during the follow up period. Out of total 20
patients complaining Photophobia 5 people had no result after treatment meaning that
15 patients got complete relief from photophobia.This proves the effect of
Chakshushya Tridoshashmaka, Rasayana, and Antistress, Anti inflammatory
properties of the drugs in the yoga. It suggests that the theraphy if continued for
longer duration gives better results.
Contact lens discomfort
The drugs effect was non-significant in patients with contact lens discomfort
in the present study. Out of total 5 patients complaining Contact lens discomfort 4
people had no result.as contact lens discomfort is an individual specific symptom
found only in contact lens users and as lens are foreign body to the eyes the symptom
may not be relieved so all the patients are advised to shift to spectacles instead of
contact lenses.
Discussion141
Ayurveda Siddhanta & Computer Vision Syndrome
Slowness in changing focus of eyes
The drugs effect was non-significant in patients with slowness in changing
focus of eyes. Out of total 12 patients complaining Slowness in changing focus of
eyes 6 people had no result after treatment. The above intervention if continued for
longer duration may have some significant effect on Slowness in changing focus of
eyes associated with Computer Vision Syndrome.
Changes in Colour perception
The drugs effect was non-significant in patients with changes in colour
perception of eyes. Only 1 patient complaining Changes in Colour perception had no
result after treatment.The above intervention if continued for longer duration may
have some significant effect in the management of Changes in Colour perception of
eyes associated with Computer Vision Syndrome.
Pain in shoulder
Out of total 25 patients complaining Pain in shoulder 20 people had no result
after treatment.The drugs effect was non-significant in patients with pain in shoulder.
As the symptom is due to improper seating and frequent movement in position of
hand, the trial drug having only chakshushya rasayana properties may not give
complete relief. Exercise, vatahara drugs and changing to comfortable seating position
should be tried which may give better results.
Pain in Neck
Out of total 27 patients complaining Pain in neck 24 people had no result after
treatment.The drugs effect was non-significant in patients with pain in neck.As the
symptom is due to improper seating and frequent movement in position of neck while
watching monitors,the trial drug having only chakshushya rasayana properties may
not give complete relief. Exercise, vatahara drugs and changing to comfortable seating
position should be tried which may give better results.
Pain in Back
Out of total 21 patients complaining Pain in back 19 people had no result after
treatment.The drugs effect was non-significant in patients with pain in back.As the
symptom is due to improper seating position and lack of support to spine while
Discussion142
Ayurveda Siddhanta & Computer Vision Syndrome
watching monitors, the trial drug having only chakshushya rasayana properties may
not give complete relief. Exercise, vatahara drugs and changing to comfortable seating
position should be tried which may give better results.
GENERAL OBSERVATIONS
1. In the present study during the drug trial it was observed that patients have
slight difficulty in swallowing the drug because of its taste.
2. In the present study during the drug trial it was observed that 3 patients got
relieved of constipation.this may be due to anulomana property of the drug.
3. In the present study during the drug trial it was observed that 2 patients got
relieved of amlapitta.this may be due to sheetha guna, madhra rasa and
rasayana property of the drug.
4. In the present study during the drug trial it was observed that 6 patients got
sound sleep after taking the drug.this may be due to rasayana and anti stress
property of the drugs.
Conclusion144
Ayurveda Siddhanta & Computer Vision Syndrome
CONCLUSION
On the basis of conceptual analysis and obseravations made in this clinical
study the following conclusions can be drawn.
The Ayurveda siddanthas are formulated, time tested and applied since
centuries to understand diseases, and to plan their management. This present study
have the following points as a befitting conclusion proving that Ayurveda siddhantas
are eternal and can be applied in understanding newer diseases like Computer Vision
Syndrome.
Asatmendriyartha samyoga Atiyoga of chakshurendriya like watching highly
luminous, fast moving flashing colours for a prolonged time have been mentioned in
classics and has been validated in understanding the aetiological factors of CVS.
All aspects of pragnaparadha play an important role in exacerbation of the
symptoms. Improper ergonomics add up to cause further vitiation.
Duration of computer work is directly proportional to the severity of
symptoms in CVS.
The Siddhanta Nidana parivarjanameva chikitsa is validated in the present
study.
If the diseases are treated in poorvaroopavastha itself they don’t become
severe.This Siddhanta is validated in CVS also.
Chakshshya yoga selected in this study has proved that they are beneficial in
diseases where nidana parivarjana is not completely possible.
145
Ayurveda Siddhanta & Computer Vision Syndrome
RECOMMENDATIONS FOR FUTURE STUDY
• The same study can be conducted on larger sample with longer duration along
with yogasanas and relaxation techniques.
• The study can be done by comparing the drug along with Kriyakalpa
• The same study can be conducted with other Chaksushya and vatahara
Rasayanas.
• The study can be restricted to IPD only, as complete abstinence of nidana is
possible.
• Similar studies can be conducted to understand newer diseases and their
treatment.
Summary
145
Ayurveda Siddhanta & Computer Vision Syndrome
SUMMARY
The study titled “Application of Ayurveda Siddhanta in the Management of
Computer Vision Syndrome” was selected for the study to provide an understanding
for a new disease not mentioned in Ayurvedic classics based on Ayurveda siddhantas
and to find out the role of prakruthi, and a suitable chikitsa siddhanta and the efficacy
of Triphala Yashtimadhu yoga in Computer Vision Syndrome (CVS). The work is
presented in two parts. The first part deals with the Review of Literature consisting of
Hetu,Trividha hetu,Nirukti, Paryaya, Bheda of Netra roga, Nidana Panchaka,
Sadhyasadhyata, Chikitsa, Pathyapathya and Drug Review and literature on Computer
Vision Syndrome.the second part consists of the observations,results of the clinical
trial with Triphala Yashtimadhu Yoga,discussion and conclusion.
Total 30 cases were randomly selected and were sampled into a single group,
followed by a clinical study consisting of 30 patients with a pre-post test design.
Statistical analysis was done using contingency coefficient table analysis, and
single‘t’ test.
The diagnosis was based on clinical features mentioned by AOA, American
Optometric Association.
Among 30 patients taken for the study, Dry & Irritated eyes is found in 24
patients, Redness of eyes is found in 25 patients, Tearing eyes is found in 18 patients,
Headache is found in 18 patients,Burning sensation in eyes is found in 30 patients,
Blurred Vision is found in 17 patients, Photophobia is found in 20 patients, Contact
lens discomfort is found in 5 patients, Slowness in changing focus of eyes is found in
12 patients, Changes in Colour perception is found in 1 patient, Pain in shoulder is
found in 25 patients, Pain in Neck is found in 27 patients and Pain in Back is found in
21patients respectively.
In the present study Asatmendriyartha samyoga especially chakshurendriya
atiyoga i.e., excessive watching and working with computers for longer duration
Summary
146
Ayurveda Siddhanta & Computer Vision Syndrome
along with mithyahara and vihara were the most common nidanas encountered in the
patients of CVS.
All the patients were administered Triphala Yashtimadhu Yoga 12 grams a
day in divided doses with anupana of ghrita and madhu for 60 days, once in the
morning and once during bed time.
Data regarding age, sex, occupation, education, economic status, diet,
addiction etc were analysed after the study.The observations of the study also
included the etiological factors of the disease. It was observed and recorded that CVS
was prevalent in both sexes equally. Its incidence was high in the age group of 21-30
yrs; people belonging to middle socioeconomic status were more susceptible for the
disease.
The assessment of improvement was based on the above parameters
mentioned by AOA. The results revealed that a favorable response was obtained in all
30 patients (100%). The percentage of reduction in the relief of symptoms was
statistically highly significant in ocular problems like the increase in schirmers test–I
values, the reduction in the dryness of eye, redness of eye, tearing, headache, burning
eyes, blurred vision, and photophobia.No significant result was observed in Slowness
in changing focus of eyes, Changes in Colour perception, Contact lens discomfort and
in non-ocular symptoms like Neck, Back and Shoulder pain.
The conclusions derived on the basis of detailed observations are presented
under the chapter of conclusion.Future prospects of this study are highlighted as an
aid for the future research workers.
Bibliography147
Ayurveda Siddhanta & Computer Vision Syndrome
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Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
ANNEXURE CLASSICAL REFERENCE
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²rÉÉ´ÉrÉÉlÉÉÇ urÉÉÍkÉlÉÉÇ Ì§ÉÌuÉkÉÉå WåûiÉÑ xÉÇaÉëWû || (cÉ. xÉÑ. 1/54) AxÉÉiqrÉÍqÉÌiÉ iÉ̲±É±³É rÉÉÌiÉ xÉWûÉiqÉiÉÉqÉ | (cÉ, vÉÉ. 1/127) kÉÏkÉ×ÌiÉxqÉ×ÌiÉ ÌuÉpÉë¹: MüqÉï rÉiÉ MÑüÂiÉå AvÉÑpÉqÉ | mÉë¥ÉÉmÉUÉkÉÇ iÉÇ ÌuɱÉiÉ xÉuÉïSÉwÉmÉëMüÉåmÉhÉqÉ || (cÉ. vÉÉ, 1/102) ÍvÉiÉÉåwhÉuÉwÉïsɤÉhÉÉ: mÉÑlÉWåïûqÉliÉaÉëÏwqÉuÉwÉÉï xÉÇuÉixÉU: xÉ MüÉsÉÈ | MüÉsÉ mÉÑlÉÈ mÉËUhÉÉqÉ EcrÉiÉå || (cÉ xÉÑ. 11/12)
qÉlÉ vÉUÏU xÉÇoÉÇkÉ:-
vÉUÏUÇ xÉiuÉxÉÇ¥ÉÇ cÉ urÉÉkÉÏlÉÉqÉÉ´ÉrÉÉå qÉiÉÈ | iÉjÉÉ xÉÑZÉÉlÉÉÇ rÉÉåaÉxiÉÑ xÉÑZÉÉlÉÉÇ MüÉUhÉÇ xÉqÉ: || (cÉ. xÉÑ. 1/55)
iÉå cÉ ÌuÉMüÉUÉ: mÉUxmÉUqÉlÉÑuÉiÉïqÉÉlÉÉ: MüSÉÍcÉSlÉÑoÉklÉÎliÉ
MüÉqÉÉSrÉÉå euÉUÉSrÉ¶É | (cÉ. ÌuÉ. 6/8)
mÉë¥ÉÉmÉUÉkÉ qÉWûiuÉ:-
mÉë¥ÉÉmÉUÉkÉɬrÉÌWûiÉÉlÉjÉÉïlÉ mÉgcÉ ÌlÉwÉåuÉåiÉ | xÉlkÉÉUrÉÌiÉ uÉåaÉÉÇ¶É xÉåuÉåiÉ xÉÉWûxÉÉÌlÉ cÉ || (cÉ. xÉÑ. 28/39)
lÉ ÌWû MüqÉï qÉWûiÉ ÌMügcÉÏiÉ ÄTüsÉÇ rÉxrÉ lÉ pÉÑerÉiÉå |
Ì¢ürÉÉblÉÉ: MüqÉïeÉÉ UÉåaÉÉ: mÉëvÉqÉÇ rÉÉÎliÉ iÉi¤ÉrÉÉiÉ || (cÉ. vÉÉ. 1/117)
UÉåaÉÉåimɨÉÏ ¢üqÉ:-
iÉiÉx§ÉåiÉÉrÉÉÇ sÉÉåpÉÉSÍpÉSìÉåWûÈ AÍpÉSìÉåWûÉSlÉ×iÉuÉcÉlÉqÉ AlÉ×iÉuÉcÉlÉÉiÉ | MüÉqÉ¢üÉåkÉqÉÉlɲåvÉmÉÉÂwrÉÉÍpÉbÉÉiÉpÉrÉiÉÉmÉvÉÉåMüÍcÉliÉÉå²åaÉÉSrÉ: mÉëM×üiÉ: || (cÉ. ÌuÉ. 3/24)
iÉ§É mÉëjÉqÉiÉ LuÉ iÉÉuÉSɱÉssÉÉåpÉÉÍpÉSìÉåWûMüÉåmÉmÉëpÉuÉÉlɹÉåÇ urÉÉkÉÏlÉ |
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
ÌlÉSÉlÉmÉÑuÉåïlÉ ¢üqÉåhÉ urÉÉZrÉÉxrÉÉqÉ iÉjÉÉ xÉÑ§É xÉÇQû.aÉëWûqÉɧÉÇ ÍcÉÌMüixÉÉrÉÉ: | (cÉ.ÌuÉ.1/15)
mÉëÌiÉMüÉU:-
irÉÉaÉ: mÉë¥ÉÉmÉUÉkÉÉlÉÉÍqÉÎlSìrÉÉåmÉvÉqÉ: xqÉ×ÌiÉ: | SåvÉMüÉsÉÉiqÉÌuÉ¥ÉÉlÉÇ xÉSuÉרÉxrÉÉlÉÑuÉiÉïlÉqÉ || (A. WØû. xÉÑ. 4/32)
lÉå§É UÉåaÉ xÉÇZrÉÉ lÉuÉxÉlkrÉÉ´ÉrÉÉxiÉåzÉÑ uÉiqÉïeÉÉxcÉåMüÌuÉÇzÉÌiÉ: zÉÑYsÉpÉaÉå SzÉæMüxcÉ cÉiuÉU:û¢ÑüwÉçhÉpÉÉaÉeÉÉ: xÉuÉï´ÉrÉÉ xÉmiSzÉ: SìÓÎzOûeÉÉ ²SzÉæuÉiÉÑ oÉɽeÉÉæ ²Éæ xÉqÉZrÉiÉÉæ UÉåaÉÉ: mÉUqÉ SÂhÉÉæ pÉÔrÉ rÉåiÉÉlÉç mÉëuɤrÉÉÍqÉ xÉlZrÉÉÃmÉÍcÉÌMüÎixÉiÉæ: || (xÉÑ E 1/44) lÉå§É UÉåaÉ ÌlÉSÉlÉÇ EwhÉÉÍpÉiÉmiÉxrÉ eÉsÉå mÉëuÉåzÉɬÕUåYzÉhÉÉiÉç xuÉmlÉÌuÉmÉrÉïrÉÉŠ | mÉëxÉYixÉÇUÉåSlÉzÉÉåMüMüÉåmÉYsÉåzÉÉÍpÉbÉÉiÉÉSÌiÉqÉæjÉÑlÉÉŠ || zÉÑ£üÉUhÉÉsÉÉqsÉMÑüsÉijÉqÉÉwÉÌlÉwÉåuÉhÉɲåaÉÌuÉÌlÉaÉëWûÉŠ | xuÉåSÉSrÉÉå kÉÔqÉÌlÉwÉåuÉhÉÉŠ NûSåïÌuÉïbÉÉiÉɲqÉlÉÉÌiÉrÉÉåaÉÉiÉç pÉÉwmÉaÉëWûÉiÉç xÉÔ¤qÉÌlÉUϤÉhÉÉŠ lÉå§Éå ÌuÉMüÉUÉlÉç eÉlÉrÉÎliÉ SÉåwÉÉ: || (xÉÑ E 1/26-27) lÉå§É UÉåaÉ xÉÉqÉÉlrÉ mÉÔuÉïÃmÉ iɧÉÉÌuÉsÉÇ xÉxÉÇUqpÉÇA´ÉÑMülQÕûmÉSåWûuÉiÉç aÉÑÃwÉiÉÉåSUaÉɱæeÉÑï¹Ç cÉurÉY¨ÉsɤÉhÉæ: | xÉ zÉÔÔsÉÇ uÉiqÉï MüÉåwÉåwÉÑ zÉÔMümÉÔhÉÉïpÉqÉåuÉ cÉ|| ÌuÉWûlrÉqÉÉlÉÇ ÂmÉåuÉÉÌ¢ürÉÉxuÉÍ¤É rÉjÉÉ mÉÑUÉ || SìÓ¹æuÉ kÉÏqÉÉlÉç oÉÑSèkrÉåiÉ SÉåwÉåhÉÉÍkÉÎzPûiÉÇ iÉÑ iÉiÉç || (zÉÑ F 1/22) lÉå§É UÉåaÉ xÉÉqÉÉlrÉ sɤhÉ
AsmÉxiÉÑ UaÉÉå AlÉÑmÉSåWûrÉÉÇxcÉ xÉiÉÉåSpÉåSÉÌlÉsÉeÉÉͤÉUÉåaÉå ÌmɨÉÉiÉç xÉSWûÉåAÌiÉÂeÉ: xÉUÉaÉ: mÉÏiÉÉåmÉSåWû: xÉÑpÉëÑzÉÉåwhÉuÉÉWûÏ zÉÑYsÉÉåmÉSåWÇû oÉWÒûÌmÉΊsÉÉ´ÉÑ lÉå§ÉÇ MüTüÉiÉç xrɪÒÂiÉÉ xÉMühQÒû: xÉuÉÉïÍhÉ ÃmÉÉÍhÉ iÉÑ xÉͳÉmÉÉiÉÉ....|| (cÉ ÍcÉ 26/129-130) lÉå§É UÉåaÉ xÉÉqÉÉlrÉ xÉqmÉëÉÎmiÉ ÍxÉUlÉÑxÉÉËUÍpÉSÉåïwÉæ:ÌuÉaÉÑhÉæÃkuÉïqÉÉaÉiÉæ: eÉrÉljÉå lÉå§É
pÉÉaÉåwÉÑ UÉåaÉÉ: mÉUqÉSÂhÉ: || (zÉÑ F 1/21)
lÉå§É UÉåaÉ xÉÉqÉlrÉ ÍcÉÌMüixÉÉ xÉǤÉåmÉiÉ: Ì¢ürÉrÉÉåaÉÉå ÌlÉSÉlÉmÉËUuÉeÉïlÉÇ |
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
uÉÉiÉÉSÏlÉÉÇ mÉëiÉÏbÉÉiÉ: mÉëÉå£üÉå ÌuÉxiÉUiÉ: mÉÑlÉ: (xÉÑ E 1/25)
lÉå§É zÉÉUÏU ÌuɱɲrÉlaÉÑsÉ oÉÉWÒûsrÉÇ xuÉÉlaÉÑwOûÉåSU xÉÎqqÉiÉqÉç ²rÉlaÉÑsÉqÉ xÉuÉïiÉ: xÉÉkÉï ÍpÉwÉaÉlÉrÉlÉ oÉÑ Ò̄SqÉç || xÉÑuÉëѨÉÇ aÉÉåxiÉlÉÉMüÉUÇ xÉuÉïpÉÔiÉaÉÑhÉÉå°uÉÇ | mÉsÉÇ pÉÑuÉÉåAÎalÉiÉÉåU£Çü uÉÉiÉÉiÉç ¢ÑüwhÉÇ ÍxÉiÉÇ eÉsÉÉiÉç AMüÉÉzÉÉS´ÉÑqÉÉaÉÉïxcÉ eÉÉrÉliÉå lÉå§É oÉÑ Ò̄Så || (xÉÑ E 1/11)
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
Annexure –II
COMPUTER VISION SYNDROME -Questionnaire
According to American optometric association, (AOA) Computer Vision Syndrome is
a complex of eye and vision problems related to near work that are experienced
during or related to computer work. In other words, you work on a computer for a
while and your eyes bother you. This survey is an effort to identify and find out
whether you are suffering from CVS. We invite you to answer the following questions
and to check out yourselves. If you find suffering from 3-4 of the symptoms and your
profession involves prolonged usage of computers, you could be suffering from
Computer Vision Syndrome.
Name:
Age: Sex:
Occupation:
Phone No: Place of work:
Email: Designation:
Postal Address:
1. Primary use of computer
Data entry/ DTP
Communication internet / email
Clerical
Financial accounting
Web designing
Others
2. No of hours spent on computer per day______ since ______months/years.
3. No of days spent in a week with computer _______
4. Do you use vision corrective / protective lenses? Yes / no
If yes since____ months/years. What is their refraction and the purpose of usage?
1. Is any of your family members suffering from eye related problems?
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
Yes/no. If yes, please specify?
6. Have you ever noticed any of the following symptoms during or after prolonged
usage of computer?
Dry and irritated eyes
Blurred vision
Redness of eyes
Burning in Eyes
Tearing of eyes
Diplopia
Headache
Photophobia
Contact lens discomfort
Slowness in changing focus of eyes
Changes in colour perception
Fatigue
Pain in shoulder, neck and back
7. Any other symptoms
8. You are experiencing the above symptoms since ____ weeks/months/years.
9. The above symptoms if present do they disappear after discontinuing the work
within ________ min/hrs/days.
10. Are you undergoing any treatment or techniques (yoga/exercise, etc) to prevent or
manage the above symptoms? If yes, please specify.
Place:
Date: Signature:
DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA
GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. PROFORMA OF CASE SHEET FOR THE STUDY OF
“APPLICATION OF AYURVEDA SIDDHANTA IN THE MANAGEMENT OF COMPUTER VISION SYNDROME”
H.O.D : Dr.N.Anjaneya Murthy, M.D. (Ayu) Guide : Dr.Naseema Akthar, M.D. (Ayu)
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
Co-Guide : Dr.T.R.Shantala Priyadarshini M.S.(Ayu) Researcher : K.S.Dutta Sharma.G
History taking Examination
SL No.: O.P.No
Name Date
Age: Sex:
Occupation:
Marital status: UM M W D
Religion: Hindu Muslim Christian Others
Socio-economic status: P LM M UM R
Education: 10 10+2 G PG
Locality: Urban / Rural
Phone No:
Email:
Postal Address:
Diagnosis:
Pradhana vedana with Avadhi Dry and irritated eyes
Blurred vision
Redness of eyes
Burning in Eyes
Tearing of eyes
Diplopia
Headache
Photophobia
Contact lens discomfort
Slowness in changing focus of eyes
Changes in colour perception
Fatigue
Pain in shoulder, neck and back.
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
Anubandha Vedana: (Associated complaints) Avadhi
Poorvavyadhivrittanta: (History of past illness)
Chikitsa vrittanta: (Treatment history)
Medical: Surgical:
Paarivaarika vrittanta: (Family history)
Maternal: Paternal: Siblings:
Personal history: (Vayaktika Vrittanta)
Ahara : Veg / Non-Veg regular/occasional
Rasa : Madhura / Amla / Lavana / Katu / Tikta / Kashaya
Type : Samashana / Adhayashana / Vishamashana / Anashana
Nidra : Day - regular / irregular disturbed/ sound
Night - regular / irregular disturbed/ sound
Duration :
Vyasana Habits Continuing Regular Occasional Quantity Stopped Coffee/Tea Smoking Alcohol Tobacco others Vyavasaya vrittanta:
(Occupational History):
1. Nature of work:
Primary use of computer:
Data entry/ DTP
Communication internet / email
Clerical
Financial accounting
Web designing
Others
2. Working hours:
No of hours spent on computer per day______ since ______months/years.
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
3. No of days spent in a week with computer _______
4. Working conditions:
Day bright light/ dim light
Night bright light/ dim light
5. Duration of the present occupation:
Previous occupation:
6. Do you use vision corrective / protective lenses? Yes / no
If yes since____ months/years. What is their refraction and the purpose of usage?
7. Any other details
ROGI PAREEKSHA Dashavidha Pareeksha: Prakriti :Vata/Pita/Kapha/Vatapitta/Vatakapha/Kapha pitta/ Sannipata
Vikruthi : Dosha: Dushya
Sara : Pravara / Madhyama / Avara
Samhanana : Pravara / Madhyama / Avara
Pramana : Pravara / Madhyama / Avaras
Satmya :Pravara / Madhyama / Avara
Satwa :Pravara / Madhyama / Avara
Ahara shakti :Pravara / Madhyama / Avara
Vyayama shakti :Pravara / Madhyama / Avara
Vaya :Baalya /Madhyama / Vridda
Desha :Anupa / Janghala / Saadharana
Ashtasthana pareeksha
Nadi Shabda
Mutra Sparsha
Mala Druk
Jihwa Aakruthi
Srotopariksha: Ashruvaha Srotas (lachrymal gland)
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
Local examination
1. Head and face
2. Lids and eyelashes
3. Conjunctiva and Sclera
4. Cornea Iris and anterior chamber
5. Lens and pupil
Netra Pareeksha Mandala
1. Pakshma
2. Varthma
3. Shukla
4. Krishna
5. Drishti
Sandhi
1. Pakshma Varthmagata
2. Varthma Shuklagata
3. Shukla Krishnagata
4. Krishna Drishtigata
5. Kaneena
6. Apanga
Interpretation
Vikrutitah Pareeksha: Nidana: Aahara: Vihara: Manasika: Poorvaroopa: Roopa: Upashaya: Rest Sleep Dark room taking a break
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
Anupashaya Bright light Tension Seating position Noise Strenuous work Sleeplessness Sampraptighataka Dosha : Dushya: Agni : Koshta : Ama : Srotas : Srotodusti prakara: Udbhava sthana : Sanchara sthana : Vyakta sthana : Adhisthana : Rogamarga : Samprapti : Vyadhivinischaya :
Chikitsa Shamanoushadhi: Dose: Kala: Anupana: Date of commencement: Pathya: Date of completion: Apathya:
Observation & Assessment
Objective parameters
Dryness of the eye - Present/ absent
Schirmers test I
Right eye BT AT FU
Left eye
Annexure
Ayurveda Siddhanta & Computer Vision Syndrome
Acuity of Vision Distant and Near
Without Glasses
BT AT FU
NV DV NV DV NV DV Both eyes Right eye Left eye
Subjective parameters
Symptoms BT AT FU 1. Irritation in eyes 2. Redness of eyes 3. Tearing in eyes 4. Headache 5. Burning in eyes 6. Blurred vision 7. Diplopia
Observational parameters
Symptoms BT AT FU Present/ Absent P A P A P A
1. Photophobia 2. Contact lens
discomfort
3. Slowness in changing focus of eyes
4. Changes in colour perception
5. Pain in shoulder 6. Pain in Neck 7. Pain in Back
Result: Signature of HOD:
Signature of Researcher:
Signature of Co Guide:
Signature of Guide:
MASTER CHART
CASE NO
AGE SEX OCC REL E.S M.S SES LOC
AAHARA
PRAKRUTI
SARA SAMHANANA
PRAMANA
SATMYA
SATWA AGNI
VYAYAMA
DESHA
1. 23 F CC MU PG UM UMC UR MI PK M M M M M Ma M A 2. 26 F ST HI PG UM UMC UR MI VP M M M M M Vi M J 3. 22 M SW HI G UM UMC UR VE VP M M M M M Te M A 4. 29 F A HI G M MC UR MI VP M M M M M Ma M A 5. 31 F A HI G M MC UR MI VK M M M M M Vi M A 6. 40 F CL HI G M MC UR MI PK M M M M M Ma M A 7. 50 M A HI G M MC UR MI PK M M M M M Vi M A 8. 27 M A MU G M MC UR MI VP M M M M M Vi M A 9. 24 F CC CI G UM MC UR MI VK M M M M M Vi M A 10. 39 F CL HI G M MC UR VE PK M M M M M Ma M A 11. 24 M CC HI G UM MC UR VE VP M M M M M Vi M A 12. 23 M CL HI G UM MC RU MI VK M M M M M Vi M A 13. 30 M SW HI PG M RIC UR VE VP M M M M M Te M J 14. 49 M MT HI G M UMC UR MI PK M M M M M Ma M J 15. 50 M CL JA G M MC UR VE PK M M M M M Te M A 16. 28 F CL JA G UM MC UR VE VP M M M M M Vi M A 17. 26 F SW JA G UM MC UR VE PK M M M M M Vi M A 18. 49 M CC HI G M MC UR MI PK M M M M M Vi M A 19. 21 F SW HI G UM UMC UR MI VP M M M M M Vi M J 20. 21 M SW HI G UM MC UR VE VP M M M M M Vi M J 21. 28 F SW HI PG UM MC UR VE PK M M M A A Vi M A 22. 25 F SW HI G UM MC UR MI VP M M M M M Ma M A 23. 25 F CL HI G UM MC UR MI VK M M M M M Vi M A 24. 21 M CL HI G UM MC RU MI VP M M M M M Ma M A 25. 23 F SW HI G UM MC UR VE PK M M M M M Vi M A 26. 26 M SW HI G UM MC UR VE VP M M M M M Te M J 27. 49 M CL HI G M MC UR VE VP M M M M A Vi A A 28. 26 M SW HI G UM MC UR VE VP M A M M M Vi A A 29. 49 M MT HI PG M UMC UR VE VK M M M M A Ma M A 30. 26 M SW HI PG UM MC UR VE VP M M M M A Vi M
A
BEFORE TREATMENT AFTER TREATMENT FOLLOW UP
ST DE RE TE HE BU BL DI ST DE RE TE HE BU BL DI ST DE RE TE HE BU BL DI
1. 20 I2 R2 T1 H2 BU3 BL1 DI 0 20 I1 R0 T0 H0 BU1 BL0 DI 0 20 I1 R0 T0 H0 BU1 BL0 DI 0 2. 22 I2 R3 T2 H2 BU3 BL0 DI 0 23 I1 R1 T0 H0 BU2 BL0 DI 0 23 I1 R1 T0 H0 BU2 BL0 DI 0 3. 20 I0 R2 T0 H2 BU2 BL1 DI 0 21 I0 R1 T0 H1 BU1 BL0 DI 0 21 I0 R1 T0 H1 BU1 BL0 DI 0 4. 22 I2 R2 T2 H2 BU2 BL0 DI 0 23 I0 R0 T1 H2 BU1 BL0 DI 0 23 I0 R1 T1 H2 BU1 BL0 DI 0 5. 21 I2 R2 T2 H2 BU2 BL0 DI 0 21 I1 R1 T1 H2 BU0 BL0 DI 0 21 I1 R1 T1 H2 BU0 BL0 DI 0 6. 18 I2 R3 T2 H2 BU2 BL2 DI 0 19 I1 R1 T1 H0 BU0 BL0 DI 0 19 I1 R1 T1 H0 BU0 BL0 DI 0 7. 19 I2 R0 T0 H2 BU2 BL2 DI 0 20 I1 R0 T0 H1 BU0 BL1 DI 0 20 I1 R0 T0 H1 BU0 BL1 DI 0 8. 23 I0 R1 T1 H2 BU2 BL0 DI 0 23 I0 R0 T0 H0 BU1 BL0 DI 0 23 I0 R0 T0 H0 BU1 BL0 DI 0 9. 21 I2 R0 T0 H2 BU2 BL2 DI 0 21 I0 R0 T0 H0 BU0 BL1 DI 0 21 I0 R0 T0 H0 BU0 BL1 DI 0
10. 26 I3 R3 T0 H3 BU3 BL2 DI 0 28 I2 R2 T0 H2 BU2 BL2 DI 0 28 I2 R2 T0 H2 BU2 BL2 DI 0 11. 18 I2 R2 T2 H2 BU2 BL2 DI 0 18 I1 R1 T1 H1 BU0 BL0 DI 0 18 I1 R1 T1 H1 BU0 BL0 DI 0 12. 21 I2 R2 T2 H3 BU3 BL0 DI 0 21 I1 R1 T1 H2 BU2 BL0 DI 0 21 I1 R1 T1 H2 BU2 BL0 DI 0 13. 25 I2 R2 T0 H2 BU2 BL0 DI 0 26 I0 R0 T0 H0 BU0 BL0 DI 0 26 I1 R1 T0 H1 BU1 BL0 DI 0 14. 23 I0 R2 T2 H0 BU3 BL3 DI 0 25 I0 R1 T1 H0 BU1 BL1 DI 0 25 I0 R1 T1 H0 BU1 BL1 DI 0 15. 28 I2 R2 T0 H3 BU2 BL2 DI 0 29 I1 R0 T0 H1 BU1 BL0 DI 0 29 I1 R0 T0 H1 BU1 BL0 DI 0 16. 20 I3 R2 T2 H2 BU2 BL1 DI 0 20 I1 R1 T1 H1 BU1 BL0 DI 0 20 I1 R1 T0 H0 BU1 BL0 DI 0 17. 28 I0 R2 T2 H3 BU3 BL0 DI 0 29 I0 R1 T1 H1 BU1 BL0 DI 0 29 I0 R1 T1 H1 BU1 BL0 DI 0 18. 18 I2 R2 T0 H3 BU2 BL2 DI 0 19 I2 R2 T0 H2 BU2 BL2 DI 0 19 I2 R2 T0 H2 BU2 BL2 DI 0 19. 25 I3 R2 T1 H2 BU1 BL1 DI 0 25 I0 R0 T0 H0 BU0 BL0 DI 0 25 I0 R0 T0 H0 BU0 BL0 DI 0 20. 25 I2 R2 T1 H3 BU2 BL0 DI 0 26 I1 R1 T0 H1 BU0 BL0 DI 0 26 I1 R1 T0 H0 BU0 BL0 DI 0 21. 24 I3 R2 T0 H3 BU3 BL3 DI 0 26 I0 R0 T0 H2 BU1 BL0 DI 0 26 I0 R0 T0 H2 BU1 BL0 DI 0 22. 25 I2 R2 T2 H2 BU3 BL2 DI 0 26 I0 R0 T1 H0 BU0 BL0 DI 0 26 I0 R0 T1 H0 BU0 BL0 DI 0 23. 24 I2 R2 T0 H2 BU2 BL0 DI 0 24 I1 R1 T0 H1 BU1 BL0 DI 0 24 I1 R1 T0 H1 BU1 BL0 DI 0 24. 20 I3 R3 T2 H2 BU3 BL3 DI 0 20 I3 R3 T2 H1 BU3 BL3 DI 0 20 I3 R3 T2 H1 BU3 BL3 DI 0 25. 20 I0 R0 T0 H1 BU1 BL2 DI 0 20 I0 R0 T0 H0 BU0 BL0 DI 0 20 I0 R0 T0 H0 BU0 BL0 DI 0 26. 19 I0 R2 T2 H0 BU2 BL0 DI 0 20 I0 R1 T1 H0 BU1 BL0 DI 0 20 I0 R1 T1 H0 BU0 BL0 DI 0 27. 19 I3 R0 T0 H2 BU2 BL2 DI 0 19 I1 R0 T0 H1 BU1 BL0 DI 0 19 I1 R0 T0 H1 BU1 BL0 DI 0 28. 20 I1 R2 T1 H2 BU2 BL0 DI 0 20 I0 R0 T0 H0 BU0 BL0 DI 0 20 I0 R0 T0 H0 BU0 BL0 DI 0 29. 20 I2 R2 T0 H2 BU2 BL0 DI 0 21 I1 R1 T0 H1 BU0 BL0 DI 0 21 I1 R1 T0 H1 BU0 BL0 DI 0 30. 22 I2 R0 T2 H2 BU2 BL0 DI 0 22 I1 R0 T0 H0 BU1 BL0 DI 0 22 I1 R0 T0 H0 BU1 BL0 DI 0
Sex
Male – M
Female –F
Age – Ag
Religion – R
Hindu – HI
Muslim – MU
Christian – CI
Other (Jain)– JA
Marital Status – M.S.
Unmarried – UM
Married – M
Socio Economical
Status – SES
Middle Class ‐MC
Upper Middle Class UMC
Rich – RI
Locality – L
Urban – UR
Rural – RU
Diet – D
Vegetarian – VE
Mixed – MI
Occupation – OCC
Student –ST
Cll Centre‐CC
Software‐SW
Accountant‐A
Clerk –CL
Medical Transcription –MT
Education – E.D.
Graduated – G
Post Graduated – PG
Ashana – AS.
Samashana – SA
Anashana – AN
Adhyashana – AD
Vishamashana – VI
Vihara – VI
Shramaja – 1
Ashramaja – 2
Appetite – AP
Avara – 1
Madhyama – 2
Pravara – 3
Results
BT-Before Treatment
AT- After Treatment
FU-Follow Up
Prakruthi‐ PRAK
VataPitta – VP
VataKapha – VK
PittaKapha – PK
Sara‐SARA
Madhyama‐M
Avara‐A
Samhanana‐ SAM
Madhyama‐M
Avara‐A
Pramana‐PRAMA
Madhyama‐M
Avara‐A
Satmya‐ SATM
Madhyama‐M
Avara‐A
Sattva‐ SAT
Madhyama‐M
Avara‐A
Agni‐ AG
Manda –Ma
Vishama Vi
Teekshna –Te
Vyayama‐VYAYA
Madhyama‐M
Avara‐A
Key to master chart