Navya D P 2012

A COMPARATIVE STUDY ON THE EFFICACY OF PIPPALYADYA
ANJANA AND SHATAVARYADI CHURNA ABHYANTARA IN THE

MANAGEMENT OF ARMA

By
Dr. Navya.D.P.

A dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Bangalore,
for the partial fulfillment of Degree

AYURVEDA DHANVANTARI
M.S. (SHALAKYA TANTRA)

Under the guidance of
Dr. B N Ramesh, M.D. (Ayu) (Shalakya)
Professor and HOD, Department of Post Graduate Studies in Shalakya Tantra,
Government Ayurvedic Medical College, Bangalore.

DEPARTMENT OF POST GRADUATE STUDIES IN SHALAKYA TANTRA
GOVERNMENT AYURVEDIC MEDICAL COLLEGE
DHANWANTRI ROAD, BANGALORE 560 009

2011-2012

Dhanwantri Road, Bangalore 560 009

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled A COMPARATIVE STUDY
ON THE EFFICACY OF PIPPALYADYA ANJANA AND
SHATAVARYADI CHURNA ABHYANTRA IN THE MANAGEMENT
OF ARMA submitted by Dr.Navya.D.P, for the degree of Ayurveda
Dhanvantari M.S. (Shalakya Tantra) of the Rajiv Gandhi University of
Health Sciences, Bangalore, is a record of research work done by her under
my guidance and supervision during the period of the study in our department.
This dissertation has not previously formed the basis for the award of any
degree, diploma, associateship, fellowship or other similar titles.

I am recommending this dissertation for the above degree to the University
Assessment and approval.

Dr. B N Ramesh, M.D. (Ayu) (Shalakya)
Professor and HOD
Department of Postgraduate Studies in Shalakya Tantra,
Government Ayurvedic Medical College, Bangalore.

Date:
Place: Bangalore

Dhanwantri Road, Bangalore 560 009

ENDORSEMENT BY THE HOD & PRINCIPAL

This is to certify that the dissertation entitled is A COMPARATIVE
STUDY ON THE EFFICACY OF PIPPALYADYA ANJANA AND
OF ARMA is a bonafide and genuine research work done by Dr.Navya.D.P
under the guidance of Dr. B N Ramesh, M.D. (Ayu) (Shalakya), Professor and
HOD, Department of Post Graduate Studies in Shalakya Tantra, Government
Ayurvedic Medical College, Bangalore.

Dr. B.N. Ramesh, M.D. (Ayu)
Professor and HOD,
Department of P.G.studies,
Shalakya Tantra,
Government Ayurvedic Medical college,
Bangalore.
Principal,
Government Ayurvedic Medical College,
Bangalore

Date:
Place: Bangalore

Date:
Place: Bangalore

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled is A COMPARATIVE
STUDY ON THE EFFICACY OF PIPPALYADYA ANJANA AND
OF ARMAa bonafide and genuine research work carried out by me under
the guidance of Dr. B N Ramesh, M.D. (Ayu), Professor and HOD,
Department of Post Graduate Studies in Shalakya Tantra, Government
Ayurvedic Medical College, Bangalore.

Dr. NAVYA.D.P, B.A.M.S.

Date:
Place: Bangalore

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka shall have the rights to preserve, use and disseminate
this dissertation in print or electronic format for academic or research purpose.

Dr.NAVYA.D.P, B.A.M.S.

Date:
Place: Bangalore

Rajiv Gandhi University of Health Sciences, Karnataka

i

Acknowledgement
I offer my prayers to Lord Ganesha and Lord Dhanwantri who enabled me to
complete the study without hassles.

Words cannot express the feelings but still they are the only medium of
expression for human beings. I would like to take this opportunity to express
my gratitude to all those who have rendered help in conducting this clinical
study and compiling this dissertation (research work).

It is with deep sense of gratitude and respect that I express my heartfelt
reverence to my guide Dr. B.N. Ramesh, M.D. (Ayu) (Shalakya) professor and
HOD, Department of P.G. Studies in Shalakya Tantra, GAMC, Bangalore for
his valuable guidance, constant encouragement, motivation, deep concern and
kind co-operation without which the work would not have been completed. I
hereby submit my thanks for all the encouragement and support given by him.

I sincerely thank Dr. H. T. Sreenivas, M.D. Principal, GAMC, Bangalore for
having provided me an opportunity to carry out this research work.

I express my heartiest gratitude to Dr. Sumitra .T. Gowda, MD (Ayu),
Professor, Department of P.G. Studies in Shalakya Tantra, GAMC, Bangalore
for her valuable timely suggestions and constant motivation.

I express my sincere gratitude to Dr. Suja. K. Sreedhar, MD (Ayu), Professor,
Department of P.G. Studies in Shalakya Tantra, GAMC, Bangalore for her
valuable suggestion and inspiration.

I express sincerely my gratitude to Dr. S. G. Mangalagi, M.D. (Ayu), and
Dr. K. Viswambhara, M.D. (Ayu) (Shalakya), GAMC, Bangalore, for their timely
suggestions and motivation throughout my study.

ii

I owe my sincere gratitude to Dr. Munnavar Pasha, MD (Ayu), Lecturer,
Department of Shalakya Tantra, GAMC, Bangalore for his constant guidance,
affection, valuable suggestions and motivation given throughout the study.

I also express my sincere gratitude to Dr. Mohan Kumari, Dr. Aravind,
Dr. Shobharani, and Dr. Rajeshwari for their valuable suggestion and
guidance throughout the work.

I acknowledge the valuable help and guidance rendered by Dr. Ashalatha,
HOD, Department of P.G. Studies in Dravyaguna, Dr. M Ramesh Professor,
Dr. Vijayasarathi, HOD, Department of P.G.Studies in Shalya tantra GAMC,
Bangalore.

I express my sincere thanks to lecturers Dr.Srilatha kamath, Dr.Nagaraj,
Dr.Narayan for their help and suggestion throughout my study.

I also express my sincere thanks to lecturers Dr.Ramya, Minto Opthalmic
Hospital for valuable suggestions and encouragement throughout my study.

I thank my seniors Dr. Suma, Dr.Veeresh, Dr. Nishitha, Dr. Manasa,
Dr. Bharati, Dr. Satish, Dr. Lokanath, Dr. Apeksha, Dr. Uma, Dr. Rekha
for their timely help.

I thank my P.G. colleagues and friends, Dr. Gayathri, Dr. Chandrashekar,
Dr. Chiranjeevi, Dr. Santosh, Dr. Vivek, Dr. Sharan, for their kind help and
co-operation throughout the work.

I also wish to thank my Junior P.G. Colleagues and friends, Dr. Akshata.
Dr.Jayashree, Dr.Sahana, Dr.Sneha, Dr.Ameena, Dr.Bhavya, Dr. Keshavan
for all the kind help and support they have given during my study.

iii

I also wish to thank my PG friends Dr.Rashmi, Dr. Vanishree, Dr. Shridhar,
Dr. Nandakaishor, Dr. Manjunath, Dr Kamlesh, Dr.Mukund, Dr. Radika S.M,
Dr. Nazira, Dr.Poornima, Dr.Sushendra, Dr.Kusum, Dr. Radika, Dr.Triveni
and all others for their support in my work.

I wish to thank my friends Dr.Pallavi.G, Dr.Swaroopa and Geetha M.S.for
their kind help and suggestions throughout my studies.

I thank my parents Mrs. Jayarathna, Mr. Puttaiah, my husband Vijay, my
brother Lokesh and family members for their love and affection, blessings and
constant moral support shown on me, which helped me to complete my study
successfully.

I thank V4U, The Print Paradise for their printing and binding work.

Last but not the least, I render my sincere thanks to all my patients, without
whose co-operation, the work would not happen.

Date:
Place: Dr. Navya.D.P.

iv
ABSTRACT

Arma is the Shuklagata roga. Arma can be correlated to Pterygium based on the
character of growth. Pterygium is a common ocular-surface disorder capable of
causing significant visual impairment & cosmetic deformity. At present surgical
treatment is the only satisfactory approach, recurrence after surgical excision is
common & recurred lesions grow more aggressively than the primary lesions. The
ayurvedic approach of the disease mainly concentrates on preventing the progression
of the disease. With this aim clinical study was undertaken.
The objectives of the study are to evaluate the efficacy of Pippalyadya anjana in the
management of Arma, to evaluate the efficacy of Shatavaryadi churna in the
management of Arma, to evaluate the efficacy of Narikela rasakriya anjana in the
management of Arma and To establish the significance of the efficacy of pippalyadya
anjana and Shatavaryadi churna by comparing it with the efficacy of Narikela
rasakriya anjana in the management of Arma, which is an established study.
In present study 45 patients were randomly selected and divided into 3 groups, with
15 patients each. Group A patients were treated with Pippalyadya Anjana for 48 days.
Group B were treated with Shatavaryadi Churna internally for 48 days and Group C
with Narikela Rasakriya Anjana for 48days.
Subjective parameters like Redness, Watering, Foreign body sensation and objective
parameters like Length and Thickness were adopted. These were suitably graded to
assess the results that were statistically analysed.
RESULTS
In the present study, Group A showed moderate response& both Group B and
Group C have shown a mild response to the treatment. The details of clinical
observations and results are discussed in the complete work presented here forth.
v

LIST OF ABBREVIATIONS

A.hru Astanga Hrudayam
A.sam Astanga Sangraha
Bh.pr Bhavaprakasha
Bhai.rat Bhaishajya Ratnavali
Ca.sam Caraka Samhita
Cha Chakradutta
Dal Dalhana
M.Ni. Madhava nidana
Su. Sushruta Samhita
Sa.y Sahasra yoga
Sha.sam Sharangadhara Samhita
Yr Yogaratnakara
Dwi.kh Dwiteeya Khanda
Ma.kh Madhyama Khanda
Pu.kh Purva Khanda
Tri.kh Triteeya Khanda
Su. Sutrasthana
Ni Nidanasthana
Sha Shareerasthana
Vi Vimanasthana
Chi Chikitsa sthana
Ut Uttarardha / Uttarasthana
Tri.sth Triteeya sthana

vi

Sl.
No.
CONTENTS Page
No.
1. INTRODUCTION 1-3
2. OBJECTIVES OF THE STUDY 4
3. REVIEW OF LITERATURE
Historical / Ayurvedic Review 5-37
Modern Review 38-60
4. DRUG REVIEW 61-78
5. PROCEDURE REVIEW 81-90
6. METHODOLOGY 91-96
7. OBSERVATIONS AND RESULTS 97-124
8. DISCUSSION 125-142
9. CONCLUSION 143-144
10. SUMMARY 145-146
11. BIBLIOGRAPHY 147-151
12. ANNEXURE 152-156

vii

LIST OF TABLES
Sl.
No.
NAME OF THE TABLE
Page
No.
1. Showing Classification of Eye diseases on the basis of Adhistana 20
2. Showing Nidana of Netra vikaras according to various authors 23
3. Showing Classification of Arma 27
4. Showing Difference between True & Pseudopterygium 55
5. Showing Age Wise incidence of 45 patients 98
6. Showing Incidence of sex 99
7. Showing Religion Wise Distribution 100
8. Showing Occupation Wise Distribution 101
9. Showing Status Wise Distribution 102
10. Showing Diet Wise Distribution 103
11. Showing Place Wise Distribution 104
12. Showing Distribution of Chronicity 105
13. Showing Incidence of Nidana 106
14. Showing Incidence of Affected side of eye 107
15. Showing Incidence of Site of Arma 108
16. Showing Incidence of Different Parameters 109
18 Showing Incidence of Different Parameters 111
19 Showing Individual study of the parameters in Group A 112
20 Showing Individual study of the parameters in Group B 113
21 Showing Individual study of the parameters in Group C 115
22
Showing Comparative Study of the Overall effect of Treatment in
Group AC
116
23
Group BC

118
24 Showing Comparative Study of the Overall effect of Treatment in 119
viii
Group AB
25 Showing the overall assessment of the results in the Groups 121
26 Showing the overall assessment of the treatment in Percentage 122
27 Showing the percentage of recurrence in all groups 123

LIST OF DIAGRAMS AND FIGURES

No. NAME OF THE FIGURE
Page
No.
1. Showing Parts of Conjunctiva and Conjunctival glands 39
2. Showing Conjunctival fornices 41
3. Showing Microscopic structure of conjunctiva 43
4. Showing Goblet cell density in different parts of conjunctiva 45
5 I PIPPALADYA ANJANA INGREDIENTS 79
6 II SHATAVARYADI CHURNA INGREDIENTS 80
7 Procedure of Anjana karma 89

LIST OF FLOW CHARTS
Sl.
No.
NAME OF THE FLOW CHART
Page
No.
1. Showing Arma samprapthi 127
2. Showing pterygium pathogensis 128
3. Showing Probable Mode of Action of Tarpana 140

ix
LIST OF CHARTS

No. NAME OF CHART
Page
No.
1. Showing Age Wise incidence of 45 patients 98
2. Showing Incidence of sex 99
3. Showing Religion Wise Distribution 100
4. Showing Occupation Wise Distribution 101
5. Showing Status Wise Distribution 102
6. Showing Diet Wise Distribution 103
7. Showing Place Wise Distribution 104
8. Showing Distribution of Chronicity 105
9. Showing Incidence of Nidana 106
10. Showing Incidence of Affected side of eye 107
11. Showing Incidence of Site of Arma 108
15. Showing Individual study of the parameters in Group A 113
16. Showing Individual study of the parameters in Group B 114
17. Showing Individual study of the parameters in Group C 116
18.
Group AC
117
19.
Group BC
119
20.
Group AB
120
21. Showing the overall assessment of the results in the Groups 122
22. Showing the overall assessment of the treatment in Percentage 123
23 Showing the percentage of recurrence in all groups 124

A Study on Arma

Department of PG Studies Shalakya Tantra, GAMC, Bangalore Page 1

INTRODUCTION
It is very difficult to imagine the existence of mankind without eyesight. Thus one has
to admit the sayings - SARVENDRIYANAM NAYANAM PRADHANAM.
Eyes are the most important and beautiful among five sensory organs. It is said that
80% of the knowledge we gain is through our eyes. It is needless to mention here the
worth and praise about the eyes. Even though our eyes are one of the most important
organs in our body, people neglect to care about them and rarely pay attention until
there is some serious vision threatening problem.
Every person should try to protect his eyes throughout his life because the world is
useless since the day is as good as night for persons who are blind, though they might
possess plenty of wealth.
Arma is the Shuklagata roga, described in classical texts of Ayurveda. Clinical
features of arma are mamsavrudhi originating from Kaninika Sandhi, Apangasandhi
or from both sandhis towards the drustimandala causing loss of vision.
Disease Pterygium mentioned in modern science has its similarties with Arma based
on its site of manifestation, clinical presentation, & surgical method of management;
hence it is apt to correlate Arma with Pterygium.
Pterygium which is common ocular surface disorder characterized by triangular fold
of conjunctiva encroaching upon the cornea from either side within the interpalpebral
fissure.
A Study on Arma


In a 30-year (1971 to 2001) survey by the Cornea and External Disease Clinic of the
Department of Ophthalmology and Visual Sciences, University of the Philippines
Philippine General Hospital (UPPGH), Pterygium ranked eighth among the 10
leading conditions seen in the clinic and third among the most common
noninfectious conditions.
The pathogenesis of Pterygium is not fully understood. Various studies have
implicated environmental factors, such as ultraviolet light, chronic irritation. Recent
studies have also provided evidence implicating genetic components, antiapoptotic
mechanisms, cytokines, growth factors, extracellular matrix remodeling,
immunological mechanisms in the pathogenesis of the disease.
Pterygium has a moderate to high prevalence 30
0
above & below equator.
Pterygium is fairly common in our country, which is located within the tropics.
Basically the treatment of pterygium is surgical, but medical management can be tried
in cases where the pterygium is in early stage.
Cosmetic intolerance also forces the patient to turn towards surgical management
which is not devoid of complication.
These have only evoked passing interest in the treatment of pterygium. There is no
proper effective medical management & surgical management is the only line of
treatment in conventional system of medicine. Recurrence is commonest in either
method of treatments. Hence, these hindrances of modern science have stressed upon
the need for the study for effective measure which can cure the condition and prevent
recurrence.
Hence keeping these lacunae of modern medicine treatment for Arma, in mind this
study has been taken up.
A Study on Arma


Even with appreciable advancement in the field of medical science many ocular
problems are left out without any hopes of remedy. Under such circumstances
research in allied medical science is desired to aim at prevention, maintenance &
curative aspect of eye management.
In Ayurveda all the Acharyas have said about Lekhananjana for the treatment of
Arma which is in early stage and having thin membrane. When the growth encroaches
to Krishnamandala then it is surgically removed.
Kriyakalpas are the main mode of management in all types of nethra rogas and
Anjana is one of the simple yet very effective method of treatment in Arma. Keeping
its importance in nethra roga prevention, acharyas have adviced for regular use of
anjanas, which protects the eyes from diseases affecting especially from kapha. For
the medical management of Arma Anjanas especially Lekhnanjanas are extensively
quoted by our acharyas. Pippalyadya Anjana is also one of the lekhanajana yoga.
Pterygium is a degenerative condition. The subconjunctival tissue undergoes elastotic
degeneration and proliferates as vascularised granulation tissue, which causes the
further progression of the disease; hence use of antioxidant has received much
attention as a part of medical management. The rasayana approach provides drugs
having antioxidant activity, regenerative, adaptogenic effects etc, which may be
judiciously used to tackle degenerative problems of the eye.
Considering the above factors, in this present study an effort has been made to
evaluate the comparative efficacy of pippalyadya anjana & shatavaryadi churna
internally in the management of arma & also to evaluate its comparative effects with
Narikela Rasakriya anjana which has been established.

A Study on Arma


OBJECTIVES OF THE STUDY:
1. To evaluate the efficacy of Pippalyadya anjana in the management of Arma.
2 To evaluate the efficacy of Shatavaryadi churna internally in the management
of Arma.
3 To evaluate the efficacy of Narikela rasakriya anjana in the management of
Arma
4 To establish the significance of the efficacy of Pippalyadya anjana by
comparing it with the efficacy of Narikela rasakriya anjana in the management
of Arma, which is an established study.
5 To establish the significance of the efficacy of Shatavaryadi churna internally
by comparing it with the efficacy of Narikela rasakriya anjana in the
management of Arma, which is an established study.

A Study on Arma


HISTORICAL REVIEW: AYURVEDA
The History is the witness of the times. It tells us about the past time and how
the development and evolution of the mankind occurs. It helps to reveal hidden
facts and ideas of concerned subject. It also assists to pave pathway for future, but
these facts can be put together with structure to know what these facts are supposed to
tell us.
Description of Arma is available in detail in all Samhitas. The detailed description is
available in Sushruta samhita Uttaratantra 4
th
chapter Suklagataroga Vijnaneeya
Adhyaya.
Astanga Sangraha has explanation of Arma in 13
th
and 14
th
chapters of Uttarasthana
and in Astanga Hridaya at 10
th
and 11
th
chapters of uttarasthana.
References of Arma as quoted by Acharya Nimi and Videha are compiled by Dalhana
in his commentary Nibandhasangraha on Sushruta samhita uttaratantra 4
th
chapter.
Arma is also explained in Bhavaprakasha Madhyama Khanda 63
rd
Chapter, in
Netraroga chikitsaadhikara of Yogaratnakara, Chikitsasara sangraha of Vanagasena in
71 chapter and in Gadanigraha 3
rd
Chapter.
Madhavakara has explained about Arma at 59
th
chapter of Madyama Kandha and
Chakrapanidatta has explained the chikitsa of Arma in Netraroga Chikitsadhyaya.
References about netra roga and its chikitsa in detail are available in Sahasrayoga and
Chikitsa manjari.

A Study on Arma


HISTORICAL REVIEW: MODERN
36

Hippocrates (469BC) suggested the use of eye drops containing lead, zinc,
copper, iron, bile juices, urine & maternal milk.
Celso (50AC) & Galeno (131AC) also suggested a topical treatment with a
solution of white wine, vinegar and in more serious forms, the physical
removal.This was done by passing a thread underneath the growth & allowing
it to slide over the sclera surface with a to & fro movement as far as the medial
canthus; then when the pterygium was detached from the underlying sclera, it
was cut with scissors.
Other indications were given by Palo Egineta (660AC) and the Arab Asicenna
(1037AC) who suggested cutting the pterygium with scissors.
In 18
th
century, it was fashionable to treat pterygium with copper sulphate. In
the 19
th
century with silver nitrate & lead acetate & atropine was added to
encourage the healing of the associated corneal ulcer.
In 19
th
century saw the advent of surgery of pterygia.
Scarp (1802) removal of the head from the cornea using forceps, section of a
portion of the body (3-4mm) & subsequent concentric excision of the detached
tissue as far as the limbus.
In 20
th
century MC Reynolds (1902) who presented a modified Desmarres
technique which placed the head of the pterygium in a conjunctival pouch.

A Study on Arma


NETRA RACHANA SHAREERA

-||l||'|| ||| |||||
CHAKSHURENDRIYA occupies the key position among the other gyanendriyas.
The netra guhas shelter the two netras that are among the nine external openings in
the body.
Vyutpatti / Derivation of Netra:
| - |||| ||l| ||||l| sl| |+|:
2 ( p. 622 )

The word Netra is derived from the root Ni which means to guide or to lead. Netra
means chakshu or visual sensory faculty which is guiding in nature.
According to Moneir Williams, the word Netra means guide, leader or eye which is
the guiding organ.
5 (P.568-569)

Chakshu-
|2 |7||||l| |+| - |+|: l7|| '|| sl|l-|: -| | l7||
l7|||| |||7||+|||: 7||l||
2( P. 415)

The root chaksh with unadi suffix us in the absence of khyanjadesha forms the word
chakshu, meaning darshanendriya or organ of sight.
|+|-| |+| |||||||||||| 7|| '| l-|
1 (p.2842)

The term Chakshu is derived from the root Chaksh denoting Darshana (Sight) and
Karana (Organ responsible for sight).

A Study on Arma


Nirukti / Definition:
|2 | ||| | ||7||||l| |+||||+||||||||l|2|||||
8(Cha.S.Su.8/ 8 p. 56)
Chakshu is that sensual faculty situated in both the eye balls, which is responsible for
vision.

Synonyms:
|||| ||| ||||+|'| |+|+||'||
2|.........
5(sh 93 pg 235)

The other synonyms include- lochanam, nayan, akshi, druk, drishti.
EVOLUTION OF INDRIYAS
|||||||||||| ||||+||l|| -||||||||||l|
-|||l|l||'|| ||%|+|l| ..................|-|+||||l+||||
8(Cha.S.Su.8/14 P.57)

The sense faculties are to be inferred (rather than directly perceived).They consist of
five mahabhutas.However, the visual, auditory, olfactory, gustatory and tactile
faculties are specially dominated by tejas, akasha, prithvi, ap and vayu respectively.
9
(p.168-69)
|| ||l|||||-| -||||||+|'|||| (|7| sl||'||u|
6(S.S.Sha.1/4 P.338)

The eleven indriyas (five organs of senses and five organs of action and mind) are
created out of vaikarika ahankara with all its qualities with the help of Taijasa
ahankara Rupa (form), rupendriya (organ of sight) are derived from the qualities of
teja mahabhuta.
6(S.S.Sha.1/4 P.338)

A Study on Arma


EMBROYLOGICAL DEVELOPMENT OF NETRA
|||| ||l-| -||l||l'| -||||||%| ||||u||l+|l||||
8(Cha.S.Sha.4/11 P.318)

During the third month, all the senses and limbs along with their organs manifest
themselves simultaneously.
||| +||l|| -|||-|| ||+||||| | |-|||ll||l'|
||l| | || 7||'| |-|||| 7|4||'| || l||||
-|| '||'| |||||||, || l2|'| |+|||||
10(A.S.Sha.5/48-49 P.304)

Sense organs are formed from the channels carrying Kapha, Raktha and mahabhootas.
In eyes, Shuklamandala is formed from essence of Kapha and is a Pitruja Bhava
(Paternal in origin) while the Krishnamandala is formed from Raktha and is maternal
in origin. The middle portion, the Drushtimandala is derived from both (paternal and
maternal).
NETRA AKRITI / SHAPE:
-||| ||-|||| -||+|||'||7||
6(S.SUt.1/11 P.596)

Eye ball is round resembles the teat of cow in appearance and originates from all the
five elements with their attributes.
NETRA PRAMANA
l|u|||||| -||0|-|l|||
|| -||| -||| l+||5||| ||
6(S.SUt.1/10 P.596)

Taking central part of the patients own thumb as one finger unit, the eye ball
dimension should be known by clinicians which measure two finger units from before
backwards and two and half from side to side.

A Study on Arma


|| ||||l|+|||| '||'||||
'||| -|||l|7l| l2 l2l|7|||
6(S.SUt.1/13 P.596)

Krishnamandala measures 1/3
rd
of the eyeball. Dristimandala is 1/7
th
of the
krishnamandala.
In Aturopakramaneeya chapter of Sushruta Samhita sutrasthana (35
th
chapter)
pramana of dristi is mentioned as 1/9
th
part of Krishnamandala. According to Dalhana,
pramana of Dristimandala differs from persons to mahapurusha.

CONSTITUTION OF NETRA
|| +|||l||| ||||| '| l-|| ||||
||7||>|||||%| |||| |||
l2 ||| ||| |+| ||| |||l7||:
6(S.SUt.1/11-12 P.596)

Mamsa dhatu is made up of or originated from Prutvi mahabhuta, Rakta composed of
Agni, Krishnamandala of Vata, and Shweta mandala of Jala mahabhoota. The
Ashrumarga is composed of Akasha mahabhuta.
PARTS OF NETRA (NETRA BHAGA):-
|'||l| | -|||%| |||l| | ||||
|||| l|||||||| || | | || |
6(S.S.Ut.1/14 P.596)

Eye consists of mandalas, sandhi and patalas which are five, six and six in number
respectively.
MANDALAS:
|| || |||||: |'||l|
10 ( Indu.A.S. Sha.5/50 p.304
The consecutive circular layers of the eyes are termed as mandalas.They are 5 in
number:

A Study on Arma


|+|||%||'|2||| |'||l| |
||| | | |||%|||||| |||||
6(S.S.Ut.1/15 P.596)

The mandalas are pakshma, varthma, shweta, Krishna and Dristi.Successively the four
are in the centre while in the reverse order they are in periphery.
The five mandalas are:
1. Pakshma circle of eye lashes;
|+||l'| |||| ||||l||
6 ( dal.S.S.Ut.16 / 2 p.624)

Pakshma is the garland of hair present in varthma.
2. Vartma circle of eye lids;
Vartmas form two outer patalas.
6 (S.S.Ut.1/17 p.596)

|| | | || || ||||+|| ||||
10 ( Indu.A.S. Sha.5/50 p.304)

Upper and lower eye lids jointly form two vartma (bahya) patalas.
||||||| l|||||||>|| ||| || ||
15 (Srikantadatta. M.K, M.N..59/76 p.317)

Vartma are the two patalas which cover the eye balls and give ashraya for nimesha
and unmesha i.e, opening and closing of eye lids.Two nimeshini siras in varthma
performs the function of nimesha and unmesha.
6 (S.S.Ut.3/25 p.600)

Vartma patala gives shelter to 21 diseases according to Sushruta.
6 (su.s.ut.1/44 p.598)
and 24
diseases according to Vagbhata
11(A.H.Ut.8/25 p.706)

3. Shweta mandala- White layer of the eye; Shweta mandala is the seat of 11
diseases of the eye
6(S.S.Ut.1/44p.598)
and 13 diseases according to Vagbhata
11(A.H.Ut.10/19
p.810)

4. Krishna mandala- Krishnamandala is the portion, which lies in the centre of
shuklamandala.It is about 1/3
rd
of the eyeball.
A Study on Arma


It is the seat of four eye diseases
6(S.S.Ut.1/44p.598)
and 5 diseases according to Vagbhata
11(A.H.Ut.10/31 p.611)

5. Drishti mandala
|-|||||| | ||+|||-||||
|u|| l|-+l|5||+||l|7| |||l+|||:
|||| ||||+'||||| l|||l||
7|||-|||| |'|| l2|||||l|||:

6(S.S.Ut.7/3-4 p.605)

The experts of eye describe Drishti (pupil) as masuradala matra, originated from the
essence of panchamahabhutas, resembling glow-worm and spark, shining with
constant light, covered with the outermost layer of eyes, appearing like a hole and
suited to cold.
l2%| |||%| | ||| |||
6(S.S.Sha.4/60 p.360)

Vision and pores of the hair follicles never grow or increase in their number or size is
the definite opinion of lord Dhanwantari.
NETRA SANDHI
Sandhis are junctional areas between two mandalas.
|+|||||: -|l|||7|4|||||:
7|4|'|||-||: '|l2||||:
||: |||||: |0%||||5|: -||:
6 (S.S.Ut.1/16 p.596)
There are six sandhis in netra:
1.Pakshmavarthmagatha sandhi Junction between eye lashes and lids.
2.Varthmashuklagatha sandhi- the fornices(between eye lid and white circle).
3.ShuklaKrishnagatha sandhi- The Limbus.
A Study on Arma


4.Krishnadrishtigatha sandhi- Margin of the pupil.
5.Apanga- Outer canthus.
Apanga is situated at the end of eye brows.
||5| '|ll7| apanga is situated towards the ear.
10 ( Indu.A.S. Sha.5/50 p.304)

6.Kaninika-Inner canthus
||l||||| ||-||-|||||l-||:
6 (dal.S.S.Ut.1/16 p.596)

Is the junction of medial end of the eyelids near the nose.
PATALAS:
|| 2||| |+||| || sl| +||||
3 (p.18)

Patala means an enclosing membrane of the eye.
According to Moneir Williams- patala means veil, cover, a film over the eyes, an
enclosing membrane (of the eyes).
5(p.597)

The term patala denotes a thin membrane with a thickness of 1/5
th
of width of dristi.
10
(Indu.A.S.Sha.5/50 p.30)
|||| l|u|||||||l| ||l+|l'|

|||| l|l| || ||l|: |||'|:
6 (Su.Ut.1 / 17 p.596)

Two patalas should be known to be in eye lids and other four in the eye proper itself
in which Timira, a most formidable disease occurs.
7 ( p..8 &9)

||||||l>|| || |||| l|l7|||l>|||
|-|||| ||||l>|| |l-| ||||
||||7|-|| 2-||| |||l|||
6(Su.Ut.1 / 18 p.g596)

A Study on Arma


Out of them the outer most subsists in the tejas (fire) and the jala (water), the next
one in the muscle, the third patala in the meda and the last one in asthi. Their
thickness is said to be equal to 1/5
th
of the pupil.
1. Tejojalashritha patala :
Is the outer most among the four patalas.
| |||7|||||| ||: -|||>|| l-|||| ||7||
|| |||| -| |||:
6 (dal.S.S.Ut.1 / 18 p.596)

Dalhana interprets the word teja as Alochaka teja (pitta) present in blood of blood
vessels and jala as Rasa dhatu present in twak.
|| ||l>||||+|-|| |+|-||||l+||| ||+|| ||||l|||
8 ( Indu.A.S. Sha.5/50 p.304)

Bahya patala is supported by Agni and Ambhasi. This patala is nourished by Rasa and
Rakta dhatus.
2. Pishitashrita / Mamsashritha: It is supported by mamsa dhatu.
3. Medoshrita patala: It is supported by Medo dhatu.
4. Astyashrita patala: It is supported by Asthi and particularly by Kalakasthi.
6
(dal.S.S.Ut.7/3-4 p.606)

AKSHI BANDHANA:
l-||'|| '|'|| | |-|: ||-| |
|'||: |||| |: 7||| |||+'||: l-||||:
6 (S.S.Ut.1 / 19 p.596)
Eye balls are held in the position by the inherent properties of the vessels, tendons, the
adipose tissue and the kalakasthi as well as by the lining mucus membrane along
with its vessels next to the black portion.
Here sira denotes both sira and dhamani and kandara includes snayu.
6 (dal S..Ut.1/19 p.596)

A Study on Arma


SIRA AND DHAMANI:
There are thirty eight siras, out of which 8 siras carry vata, 10 pitta, 10 kapha and 10
rakta, to the eye.
6 (S.S.sha.7/7 p.377)

Sixty five siras are present in the eye; among them two siras does the function of
opening and closing the eyes.
11 (A.H.sh.3/29 p.391)

There are two dhamanis carrying rupa or visual impulses and two other dhamanis one
in each eye carrying tears.
6 (S.S.sha.9/5 p.384)

PESHI AND SNAYU:
There are two muscles in the eye.
6 (S.S.sha.5/37 p.368)

Two snayus are present in the eyes.
10 (Indu.A .S.Sha .5/75 p.307)
ASTHI AND SANDHI:
Asthi: Akshikosha or orbital cavity contains tarunasthi.
6(S.S.sha.5/20,p.366),10(A.S.sha.7/65p.306)

Sandhi: There are two joints in the lids of the eyes.
6(S.S.sha.5/26 p.366), 10(A .S. Sha.5/69 p.306)

MARMA:
1. Apanga- two apanga marmas,(Sira marma,measuring half angula ) are situated on
the outer side of the orbits below the lateral end of eyebrows. Injury to them causes
blindness or diminished vision.
6 (S.S.sha. 6/27 p.374)

2.Avartha- two avartha marmas (Sandhi marma, measuring half angula ) lie above
the eyebrows, injury to these marmas also results in blindness or diminished
vision.
6(S.S.sha.6/27 p.374)

A Study on Arma


NETRA KRIYA VIJNANA (PHYSIOLOGY OF VISION)

|| |+| >||| .................. ||l||l'
8(Cha.S.Su. 8/ 8 p.56)
Chakshu is the visual sensual faculty i.e. one of the panchendriyas.
Chakshu or visual faculty is only one.
8(Chakrapani, Cha. S.Su. 8/ 8 p. 56)
||l| ||||||| -|l|||| ||||
|4|| ||| || |l7: ||+| -|| l|||
8(Cha. S.Su. 11/20 p. 71)
A mental faculty instantaneously manifested (in a particular form) as a result of
proximity of the soul, sense faculties, mind and the objects is known as pratyaksha
(perception or direct observation).
9(p.211)
||: |:-||'||l||'|||'| -||||l| +||l| .
8(Cha.S..Su. 8/ 7 p.56)
The sense faculties are capable of perceiving their respective objects, only when they
are motivated by mind.
||l||7|: |+||7||l|: ||: ||ll|l|||-|||| -|l||||:,
+|l'|| l|%|||l||, s||| ||||| /
8(Cha. S.Su.8/ 12 p.56)
There are five kinds of perception viz., visual, tactile, auditory, gustatory and
olfactory. These are again the products of combination of sense faculties, their
objects, the mind and the soul; they are momentary and determinative.
sl| 7||l| .
sl||| |
sl| | |||||+||
sl||l|2|| - |+|
sl||l7 - |+||l7
A Study on Arma


These perceptions are momentary in the sense that they fade away soon; even
though sense perception fades away soon, they are determinative in relation to the
size, shape etc of the objects just as a momentary light of a lamp illuminates its
surroundings.
9(167-168)

-||| | ||'|||l| -|l|||| .................. ||+|||||l|:
8(Cha. S.Su.11/8 p.69)
There are things which though existent, cannot be directly perceived due to over
proximity, over distance, obstruction, weakness of senses, diversion of mind,
confusion with other similar objects, over shadowing and over minuteness.

sl|'||l|||| | -| |$|l| ||||:
l-|| ||||l|||||||||l|l|l-|l|:
6 (S.Sha.1/15 p.342)
||-| |+|-||-||| ||||
6 (dal.S.Sha.1/15 p.342)
Human beings have the perception of the objects of indriyas by that particular indriya
only, because the origin of both is similar. One indriya cannot perceive the object of
another indriya.
Eye which receives the light and light which illuminates the objects both are
derivatives of teja mahabhuta. Hence eye perceives only rupa of the object and not
other characters like sound etc. Rupa is the adhibhuta, God Surya is adhidaiva of
chakshu which is adhyatma (pertains to soul).
6 (S.Sha.1/7 p.339)
||: |2|||l|l||'|| ||l'| ||l'| l||2 -|l|2|||l|
||%|+|: >|||l|l| l||2|||l|, ||'| -|||l|l| -|l|2|||l|
21(K.S.Sha.1/3 p.110.,111)
Among six indriyas including manas, three perform functions with remoteness and
three with proximation. Amongst these, manas, eyes and ears function with
remoteness, while nose, tongue and skin function with proximity.
A Study on Arma


The Role of Alochakapitta in Visual Perception:
l|| 7|| l||||||: ................. 7|||7||| .................
8(Cha.S.Su.12/1 p. 80)

It is Agni alone represented by Pitta which is responsible for vision or loss of vision
depending on its normal or abnormal state.
7|||7|| ||||-|||||-|
8(chakrapani, Cha. S.Su 12/11 p. 80)

Alochakapitta present in netra is responsible for vision or loss of vision.
||| l|| |l-|||||||l|ll|, -| | ||'||l||:
6 (S.S.Su.21/10. p.101)

Pitta which is located in the eye is known as Alochakagni. Its function is to form the
image of an external object presented to the eye.
|||||||: -|| -||||||
10 ( A.H.Su.12/14 p.194)

Alochakapitta is situated in the eye and its function is rupagrahana or forming images
presented to it.
||||||| ||| ||7|||||| ||7: -| ll||: |+||7|l|| |l7|7|l|%|l|
......................|7|l|| ||| || +||||u >|||-|:|l7|7||||||||l|
20 (B.S.4/5 p.206)
Bhela has mentioned two aspects of alochakapitta viz. chakshurvaisheshika and
buddhirvaisheshika. He has quoted atreya punarvasu, as saying that alochaka is that
which is excited by varsha (rain), sheeta (cold) and atapa (sun). The
chakshurvaisheshika alochaka pitta begins its function after the co-relation of atma
and manas, when the object has made contact with it, leading to the production in
chitta, the knowledge of the characteristics, form, color etc of such things as flowers,
fruits, leaves etc.
Buddhirvaisheshika is that which is located in shringataka, between the two
eyebrows. It seizes subtle objects, retains and recalls them. This is the factor which
enables concentration, responses and cognition.
A Study on Arma


Role of other doshas in visual perception:
||| ................... -||l||'|||u||: -||l|||||||l+|||7| .................
8(Cha. S.Su.12/ 8 p. 246)

Vayu is the stimulator of all sensory organs and makes them to perceive their
respective objects.
Pranavayu attends the function of chakshuradi sense organs.
11(A.H.Su.12/ 4 p.193)
Vyanavayu is responsible for closing and opening of the eyes.
11 (A.H.Su.12/ 7 p.193)
l7|: -|-||+|||'||| ||:
11(A.H.Su.12/ 17 p.195)
Akshitarpana is the function of tarpaka kapha which is present in shira.

A Study on Arma


NETRA ROGA SANKYA AND CLASSIFICATION
In Ayurvedic classics netravikaras are classified into various types based on their
adhishtana, chikitsa, sadhyasadhyata etc. Acharya Sushrutha has mentioned 76 eye
diseases.Charaka has explained only 4 types of netrarogas based on doshas.According
to Vagbhata and Sharngadhara there are 94 types of netrarogas,while Bhavaprakasha
and Yogaratnakara have mentioned 78 and 76 types of netravikaras respectively.

Table 1: Classification of eye disaeases on the basis of adhistana:

Adhistana Sushrutha Astanga
Sangraha

Astanga
Hridaya
Madhava
Nidana
Yogarat
nakara
Karala &
Chakrapani

Sandhi 9 9 9 9 9 9
Vartma 21 24 24 21 21 27
Shukla 11 13 13 11 11 13
Krishna 4 5 5 4 4 6
Dristi 12 27 27 12 12 16
Sarvaja 17 16 16 17 17 25
Bahya 2 - - 2 2 -
Total 76 94 94 78 78 96

A Study on Arma


DISEASE REVIEW
Description of Arma is available in detail in all Samhitas. The detailed description is
available in Sushruta samhita Uttaratantra 4
th
chapter Suklagataroga Vijnaneeya
Adhyaya.
Astanga Sangraha has explanation of Arma in 13
th
and 14
th
chapters of Uttarasthana
and in Astanga Hridaya at 10
th
and 11
th
chapters of uttarasthana.
References of Arma as quoted by Acharya Nimi and Videha are compiled by Dalhana
in his commentary Nibandhasangraha on Sushruta samhita uttaratantra 4
th
chapter.
Arma is also explained in Bhavaprakasha Madhyama Khanda 63
rd
Chapter, in
Netraroga chikitsaadhikara of Yogaratnakara, Chikitsasara sangraha of Vanagasena in
71 chapter and in Gadanigraha 3
rd
Chapter.
Madhavakara has explained about Arma at 59
th
chapter of Madyama Kandha and
Chakrapanidatta has explained the chikitsa of Arma in Netraroga Chikitsadhyaya.
References about netra roga and its chikitsa in detail are available in Sahasrayoga and
Chikitsa manjari.
Sushruta explains 11 different types of diseases which are occurring in shuklamandala
of eye.The Prastari arma, Shuklarma, Kshtajarma, Adhimamsarma, Snayuarma, and
Shuktika, Arjuna, Pistaka, Sirajala, Sirapidaka and Balasagrathitha.
Acharya Vagbhata adds Sirotpata and Siraharsha to the shuklamandala vikaras.Thus
he describes thirteen rogas in shuklamandala.

A Study on Arma


Nirukti:-
The term Arma originated from Ru dhatu along with Manain pratyaya means
always growing.
22
Iyarthi gacchathi ithi Arma the gradually spreading extra membrane in shukla
mandala (mamsa vruddhi) is known as Arma.
22
NIDANA
'||l+|||-| ||||7|||
+|'||| -||l|||||| |
|-|-||| || 7||
4|7||l+|||||| l|||||| |
7||||||| |||||-
l|||'||| ||l|l|||| |
-|||| ||l|||'||| |
7:l|||||| ||||l||||||
|||||| -|+|l||+|'||| |
||l|||| |||l| |||:
6 (S.S.Ut.1 / 26-27 p.597)

Sudden plunging into water after exposure to heat, excessive staring at distant objects,
abnormal sleeping habits, continuous weeping, anger/grief/suffering, injury to head,
excessive sexual intercourse, excessive use of vinegar and sour gruels, kulatta and
masha, pulses, suppression of physiological calls of nature, excessive perspiration,
smoking, suppression of excessive vomiting, suppression of tears, concentrating on
minute objects.

A Study on Arma


Table No-2: Showing nidana of Netra vikaras according to various authors
Causative factors S.S M.N B.P Y.R V.S H.S
Sudden plunging into water after exposure to
heat.
+ + + + + -
Excessive staring at distant objects + + + + + -
Abnormal sleeping habits + + + + + -
Continuous weeping + + + + + -
Anger/grief/suffering + + + + + -
Injury to head + + + + + +
Excessive sexual intercourse + + + + + -
Excessive use of vinegar and sour gruels + - + - - -
Kulatta and masha pulses + - + - - -
Suppression of physiological calls of nature + + + + + -
Excessive perspiration +

+ + + + -
Smoking + + + + + -
Suppression of excessive vomiting + + + + + -
Suppression of tears + + + + + -
Concentrating on minute objects + + + + + +
Intake of fluids at night - + - + + -
Alcohol - + - + + -
Appearance of unusual features during season - + + + + -
Travelling at high speed - - + - - -
Excessive intake of ushna, kshara and katu food
articles
- - - - - +

A Study on Arma


Other causes of Netra vikaras:
Dalhana has mentioned avak and uchrita shira shayana i.e, sleeping with the head at a
too low or too higher level, ritu viparyaya, jvaropata as some of the causes of
eyediseases.
6 (S.S.Ut.1 /26-27)

Yogaratnakara adds these:
Excessive intake of fluids, excessive intake of alcoholic drinks, by physical contact,
by inhaling and coming in contact with a respired air, eating together, using the same
bed, seat, garlands, beds, clothes, cosmetics, one can be infected by the following
diseases, kusta (skin disease), jwara (fever), sosha (wasting), netrabhisyanda
(conjunctivitis). So netrabhisyanda is infectious in nature.

PURVA RUPA:
|||l|| -|-|+||>|'|||
||||||||u|2 ||||+|'|:
-|7|| ||||| 7||'||+||| |
l||||| | || l||-|l+| ||| ||
2|| ||||| ||| ||'||l|l0| | ||
6 (S.S.Ut.1 /21 p.597)

Dirtiness, congestion, lacrimation, itching, stickiness, heaviness, burning sensation,
pricking pain, redness etc are the prodromal features of the eye diseases. There may
be feeling as if the cavity of the eye lids is full of painful bristles, impairment in
vision or function of the eyes as compared with what they were before. As soon as the
above features are seen, the intelligent clinician should regard that (eye) to have
become afflicted with doshas.
Depending upon the dosha undergone Sthanasamshraya, poorvaroopa shows such
A Study on Arma


Doshic lakshanas like- |||l = ||| l|
||l = l|| l|
|||ll+|: = + l|
|||l = l|
These are just sensation but not appeared. If neglected, they get exhibited. Hence,
|| -|+||||-||u ||||| l+||l|||
l||||||| ||| |||| -||||.
6 (S.S.Ut.1 /24 p.597)

Treatment should be aimed at this stage as further all netrarogas become balavattara.

SAMPRAAPTI/ PATHOGENESIS
l-|||-|||l+|: ||: l||'|: |||||:
|||| ||+|||| ||| |||'||
6 (S.S.Ut.1 /20 p.597)

The vimargagamana of the increased doshas through Urdhwagaami siras results in
various complicated diseases of netra. When they get localized in Shuklamandala due
to its susceptibility because of weakness caused by one or more nidanas results in any
of 11 SHUKLAMANDALAGATA ROGAS.
1. Prastari arma 2. Shukla arma
3. Kshtajarma 4. Adhimamsa arma
5. Snayu arma 6. Shuktika
7. Arjuna 8. Pistaka
9 .Sirajala 10. Sirapidaka
11. Balasagrathitha

A Study on Arma


Acc to Vagbhata -13
1.Prastari arma 2.Shuklarma 3.Shonitarma 4.Adhimamsarma5.Snayuarma 6.Shuktika
7.Arjuna 8.Pistaka 9.Sirajala 10.Sirapidaka 11.Balasagrathitha 12.Siraharsha
13.Sirotpata
ROOPA
|-||l |l||l||| 7|4|+||
l|-||'| || l||+| -|||||
6 (S.S.Ut.4 /4 p.601)

Prastari arma (pterygium) arising in the white portion is extensive, thin, having
bloody lustre & bluish.This is caused by tridosha & is curable.
7|4||| | ||l| 7|4|+|||
-|%|| -||l| ||| l|'|
6 (S.S.Ut.4 /4 p.601)

Sukla arma appearing in white portion is soft, whitish & even & has delayed growth.
It is caused by kapha & is curable.
|||-| |||||l| 7|4|+|||
||+| ||l7|l| ||l|||
6 (S.S.Ut.4 /5 p.601)

The fleshy tissue having lotus-like lustre & growing in the white portion is known as
raktarma. This is caused by rakta & is curable.
l|-||'| | || |||7|
7||| || |l|||-|||| l|u||
6 (S.S.Ut.4 /5 p.601)

Adhimamsa is extensive, soft, thick, liver-like or blackish. This is caused by sannipata
& is curable.

A Study on Arma


7|4| || l|l7||||l| |l7|||
-|||||l+||l| | |||'
6 (S.S.Ut.4 /6 p.601)

Fleshy tissue rough & pale, growing in white portion is known as Snayu arma.
Both Sushruta and Vagbhata described five varieties of Arma and a lot of
resemblance is seen in all aspects such as names, etiology and description except in
the name of Shonitarma. Sushruta named this disease as Kshatajarma or Lohitarma.

Table No-3: Showing Classification of Arma & laxanas explained according to
various authors

TYPES OF ARMA

SUSHRUTHA

VAGBHAT

BHAVAPRAKASH
YOGARATNAKARA
PRASTHARIARMA
COLOUR
NATUREOFTHEGROWTH
NATURE OF THE MASS
DOSHA

l||+|, -|l|||
l|-||'|
||
l|||

7||| ||l|
7||7|
|
|||with

7||| l|+|
l|-||'|
||
l|||

SHUKLARMA
COLOUR
NATUREOFTHEGROWTH
NATURE OF THE MASS
DOSHA

7|4| -|%||
||| l|'|
|
+

7|4|
l||7|
l|||-||
+

7|4| -|%||
||| l|'|
|
+

A Study on Arma


KSHATAJA/LOHITHARMA
COLOUR
NATUREOFTHEGROWTH
NATURE OF THE MASS
DOSHA

|+||
|||||l|

|+||
l|||-|
7|+'|

|+||
|

ABHIMAMSARMA
COLOUR
NATUREOFTHEGROWTH
NATURE OF THE MASS
DOSHA

|||7|
7||| l|-||'|
| ||
-|l|||||

-| l|' 7|||
||
7| ||
-|l|||||

|l|+|
|| |
||
-|l|||||

SNAYUARMA
COLOUR
NATUREOFTHEGROWTH
NATURE OF THE MASS
DOSHA

|||'
|l7|||
|
l||||

-|||-|l|+|

l-|
||-||7|
l||||

SADHYASADHYATA
Sadhyasadhayata gives the clear picture of prognosis of the disease. It depends upon
many factors like nature of diseases, severity of diseases, vaya, prakruti, bala of
patient etc. Arma is chedana sadhya vyadhi
CHIKITSA
The first and foremost method of treatment of Arma is Chedana. Procedure of surgery
described by Sushrutha and Vagbhata.They explained all the pre and post operative
aspects also.According to modern medical science surgery is only treatment for this
disease. But Ayurveda prescribes certain Anjanas for the treatment in addition to the
surgery.It is widely used in early stage of Arma to prevent the speedy growth of the
A Study on Arma


membrane.This is highly beneficial after the surgical treatment for the successful
prevention of growth after surgery.
Anjana are mainly of lekhana properties which can gradually taper the thickness of
the membrane and thereby preventing the growth and also reduces the size.
| ||| l|l|+| ||| |||l| ||
|-| || ||l| 7|||||||
|||+| || || -|||||-||||||
7u|| || -||| '||'|| | ||
6 (S.S.Ut.15 /17-18 p.623)

Arma which is small, curd-like, blue or red, grey and thin should also be treated like
sukra. Alpam-inextent; dahinibham-suklarma; nilam-prastari, raktam-lohitarma; tanu-
snayvarma; ca & api indicate mamsarma. Thus arma of five types should be
treated with scarping collyrium like sukra.
Arma which is leathery, thick & densely covered with fibres & fleshy tissue and has
reached the black circle i.e, Krishna mandal should be excised verily.
|| |||| || || |||l|| | ||
| l|l|+| | 7|||-| +||||
11 (A.H.Ut.11 /13 p.813)

Among the five varieties of Arma described that which is thin, turbid like smoke, red
& which resembles curds are to be treated in the same manner as of Sukra.

A Study on Arma


ARMA CHEDANA:

POORVA KARMA:-

l-|| +|||| |||l|2-| |-||:
-||||| ||| l+|| |'|-| |||'|
6 (S.S.Ut.15 /3 p.622)
After shareera shodhan.patient is given oleus substances to eat or drink and made
to sit comfortably.Then the physician should do the arma shithalikarana by putting
powder of saindhava in the eye.After the eye is properly enraged,it should be
fomented quickly and movements made.
According to Astanga hrudaya-saindhava macereted with juice of bijapura is applied
as an eyesalve.
Astanga sangrahakara advises intake of peya,vilepi,mamsarasa after oleation therapy;
then made to perform auspicious rites,then to lie on a comfortable bed with his face
up,head slightly bent down; the eyes are then given mild fomentation with cotton
swab dipped in warmwater; saindhava mixed with the juice of bijapura is put into the
eye;and then the eyelid is massaged by the thumb till balasa grathita develops; by this
method of enraging the eye,the muscular over-growth becomes moveable;during the
conduct of this act an attendant should hold the head of the patient.
PRADHANA KARMA
||: -||l|| |'| -|l-|| |l||||
| || |||||| ||||||l7|
|| |+|||'|-| |l7|| -|||l|:
||'||| ||||| -|||-||'| || ||:
A Study on Arma


| |||||||| l+|| |||+||| | ||
7|-|||||+||||-| |||| |||*7|
||: |l7|l|||+|| l|l+|| l||l|||
l|||'|||'| ||+'|| |l7|||||
l|| -|||%||l| '||74|| |'|||
|||| ||||||| l7u|||l|||||
||+||||l-|| ||-| ||l+| |||l||7l|
||||||-| ||| ||||||||
||7|| |||l 7||||||l||7l|
6 (S.S.Ut.15 /4-9 p622)

The patient is asked to look towards apanga sandhi.Then the physician should hold
the arma at the place where it has wrinkles,catch it with badisha yantra and
muchundiyantra again with the help of suchi and sutra it should be raised but should
not be lifted too much suddenly;at the same time the lids should be held firmly to
avoid surgical injury.Thus when loosened being held with all the three,it should be
lifted and all its connection are removed with sharp mandalagra shastra and freed
fully from black & white circles. It should be taken near the inner canthus & excised
not touching inner canthus.If one fourth of the tissue remains there is no risk to eyes
but if inner canthus is injured, it may cause haemorrhage or sinus.If inadequate
excision there will be quick growth once again.
| |||| ||l| ||||| |l|||
l7u|'| 7|-|'| ||7|4||||l>|||
6 (S.S.Ut.15 /10 p.622)

A Study on Arma


Arma which has spread like a net & situated at the end of vartma & shukla should be
lifted up, pulled and cut with the sharp curved instrument.
According to Astanga hrudaya, while cutting, the inner canthus & tear ducts being
protected; injury to the inner canthus leads to profuse flow of tears through the tear
ducts.In case the arma is more developed towards the outer canthus, the patient should
be asked to look towards the inner canthu & then the cutting done suitably.
According to Astanga sangraha arma is cut by mandalagra shastra or by vruddhipatra
shastra.
| | 7||| '|||| +||u|
|l7|l|7 -|||| l|+|| ||| ||||
14(B.R.N.R.Chi 65/133 p.997)
According to Bhaishajya ratnavali arma should be cut leaving one third of it behind
at kaninika.
PASCHAT KARMA:-
|l|-||'||+'||-| ||: ||||||
||||||-| |'|| l||||'|-| |
-|l||| ||: ||%||||||| 7||| l+||
|||||||7|: -| || |||l||
|'||| -|l|||| | |-| |||: ||
||||| -| || 7||||||||
6 (S.S.Ut.15 /11-13 p.622)

Thereafter eyes should be rubbed with powder of yavanala, trikatu &
saindhavalavana; followed by fomentation. Skilled physician should anoint the eye
and apply bandage considering the strength of the doshas, rutu & kala.Then vrana
A Study on Arma


chikitsa should be done; after three days the bandage should be removed, the wound
fomented with hand and cleaned.
According to Astanga hrudaya,after proper cutting,the eye should be smeared with
honey,vyosa & saindhava;next warm ghee is put in,then the eye is annointed with
honey & ghee mixed together and bandaged.On the third day it is removed & eye
washed with milk boiled with seeds of karanja.Next on fifth day it should be washed
with decoction of the two nisa,rodhra,patoli,yasti,kimsuka & buds of kuranta mixed
with honey.On the seventh day the bandage should be removed finally.
According to Astanga sangraha, ascertaining perfect haemostasis, saindhava mixed
with honey is applied on & off. Ash of yava plant may be used with madhu for same
purpose.Then eyes are washed with either cold water or warm water.Warmghritha or
mixture of ghirtha & madhu are put into the eye & then bandaged.
Shathadhoutha ghritha or paste of drugs which are sheetaveerya should be applied
over the head and feet of the patient.
He should adopt the activites prescribed in oleation therapy. From second day
onwards, warm decoction of madhuka with ghritha should be sprinkled both in the
morning & evening over the head & eye with the bandage intact for five days the
patient should consume ghee followed by drinking warm water. After ghee gets
digested, he should eat suitable food.
On the third day,the bandage should be removed & the eye given fomentation with
milk boiled with seeds of karanja.Decoction of lodhra,madhuka,kimsuka,patola & the
two haridra & buds of koranda added with honey be used for ascyotana & again
bandaged.
On the seventh day, the bandage is removed finally and patient directed to avoid
exposure to sun & sky.
A Study on Arma


|||||||||: -||l|| ||:

l|||>|||| 7|| l: +||-||||
|||||l|||+| ||l|
|||:-|||: 7|||: +||l|l2: |7|-||
6 (S.S.Ut.15 /14-15 p.622-623)

If pain is noticed in the eyes milk boiled with the seeds of karanja, amalaki &
madhuka with madhu is ideal for ascyotana to be done twice a day.
Madhuka, utpala, kinjalka & durva made as paste with milk added with ghritha &
applied as cold poultice on the head is greatly beneficial.
According to Astanga sangraha, if there is swelling of the eyes dhoompana &
shirovirechana should be done.If the redness of the eye does not subside then
raktamokshana should be done. If there is discharge from the eyes nasya should be
administered.
|||||||7|| +||ul
6 (S.S.Ut.15 /16 p.623)

If there is residual of arma, it should be removed by lekhananjana.
SAMYAK LAKSHANAS OF LEKHANA:-
l|7|7|'||l4|2 l||-|l+| ||4|||
l7||l'| +||| -|||||-||||||
6 (S.S.Ut.15 /19 p.623)

When arma is excised properly, eye regains normal colour, function with ease,
relieved of fatigue & free from complications.
According to Astanga hrudaya
-|| l7| +||-||-| |||l|7||| |||
-|||||+|l|l+|||||||'|:
11(A.H.Ut.11/23 p.813)

A Study on Arma


Proper cutting leads to health; the diseases arising from inadequate or excess cutting
should be treated by proper seka, lekhananjana & brmhananjana.
| -|| l7| |'|l|7|l7: -|-||| |
||7|| |||7| |||>||||||7|7|||+|||l |
l|7|l+|||-|+|-+'||-|-|l|l|l|-|+|l|||||l|
|| ||-| ||||| |l||||
16(A.S.Ut 14/21p.126)
If the cutting has been properly done, there will be transparency of colour and
normalcy.
If the cutting is inadequate, there will be recurrence, redness, more of tears, inability
to see light etc.
By over cutting, ulceration, loss of movement, throbbing pain, flow of blood,
blindness, anger and lids sticking together etc. These conditions should be treated
according to the doshas aggravated.
Nagara,manasila,ela,saindhava & sarkara each half karsha added to half- pala of
rasanjana liquefied by addition of honey and used as collyrium cures residual
arma,blindness due to aggravation of kapha & eye disease known as pilla.
According to Astanga hrudaya, the outer portion of any of triphala is macerated in
water put inside an earthen saucer with another saucer, their edges sealed, both
together are coated with mud, dried in sun & then placed inside a heap & cooked.Next
it is powdered nicely & soaked in the decoction of the other two drugs separately.This
ash is then mixed with the two lavana and macerated well.These three eye salves are
best lekhana says NIMI.

A Study on Arma


Other yogas explained in the classics:-
Shankhadi Anjana
Shilanjana
Nayanasukhavarti
Chandrodayavarti
Samudraphenavarti
Guduchyadi Anjana
Marichyadi Churnanjana

PATHYA-APATHYA
AHARA:
Pathya : Purana ghrita, triphala, shatavari, patola, mudga, amalaki, yava, lohita shali,
whole grains like yava and godhuma, Cooked vegetables of jivanti, sunishannaka,
tanduleeya, vastuka, chilli, mulaka, meat of birds and wild animals, karkotaka,
karavella, vartaka, karira, shigru, tarkari.
6(S.S.Ut. 17 / 50-51 p.690)
Yogaratnakara adds- peya, vilepi, tiktha and laghu ahara, shalitandula, godhuma,
saindhava, goghritha, gopaya, sitha, kshoudra, draksha, kustumburu, , surana, naveena
mocha, matsyakshi, punarnava to the above.
19(Y.R.N.R.Chi.sl.1-4 p.395)

Apathya: Masha, aranala, katuthaila, patra shaka, matsya, dadhi, phanita, vesavara,
pinyaka (oil cake), virudhaka (sprouts), ambupana, madhukapushpa, sura(alcohol),
ajangalamamsa, tambula, food and drinks which are amla, lavana, vidahi, teekshna,
katu, ushna and guru .
19(Y.R.N.R.Chi.sl.5-7,10. p.395)

VIHARA:

Pathya: Manaso nivritti (withdrawing the mind from objects of senses.),
padabhyanga, sita jala prakshalana etc.
A Study on Arma


Apathya: Krodha, shoka, maithuna, vata, vinmutra, nidra, vami, vegavarodha,
sukshmekshana (looking at minute objects), snana, atapa, prajalpana (excessive
talking), chardana.
19(Y.R.N.R.chi..Sl-6,. p.395)

(AOUSHADA) MEDICATION:
Pathya:
Anjana, nasya, padapuja (anointing, using foot wear etc), rudhirasriti (blood letting),
vishuddhi (purificatory therapies).
11( .A. H .Ut. 13/99 p.825)

Yogaratnakara adds- aschyotana, langhana, sveda, pratisarana, prapoorana,
shastrakriya, and lepa to the above.
19(Y.R.N.R.Chi..sl.2. p.395)

A Study on Arma


ANATOMY OF CONJUNCTIVA:
26

The conjunctiva is a translucent mucous membrane which lines the posterior surface
of the eyelids and anterior aspect of the eyeball.
The name conjunctiva (conjoin: to join) has been given to this mucous membrane
owing to the fact that it joins the eyeball to the lids. It stretches from the lid margin to
the limbus and encloses a complex space called conjunctival sac which is open in
front at the palpebral fissure.
PARTS OF CONJUNCTIVA
Conjunctiva can be divided into following parts:-
1. Palpebral conjunctiva: marginal, tarsal and orbital
2. Bulbar conjunctiva: sclera and limbal
3. Conjunctival fornix: superior, inferior, lateral and medial
1. PALPEBRAL CONJUNCTIVA
It lines the lids and can be subdivided into marginal, tarsal and orbital conjunctiva.
(i)Marginal conjunctiva extends from the lid margin to about 2mm on the back of
the lid upto a shallow groove- the sulcus subtarsalis. It is actually a transitional zone
between skin and the conjunctiva proper.At the sulcus subtarsalis, the perforating
vessels pass through the tarsus to supply the conjunctiva. This sulcus is a common site
for lodgement of a conjunctival foreign body.
(ii)Tarsal conjunctiva- is thin, transparent and highly vascular. It is firmly adherent to
the whole tarsal plate in the upper lid. In the lower lid, it is adherent only to half width
of the tarsus.The tarsal glands are seen through it as yellow streaks. Tarsal
conjunctiva is a common site for the follicular and papillary reactions.
(iii)Orbital part-of palpebral conjunctiva lies loose between the tarsal plate and
fornix.Orbital conjunctiva of the upper lid is loose and lies over the muller
s muscle.
A Study on Arma


2 .BULBAR CONJUNCTIVA
It is thin, transparent and lies loose over the underlying structures and thus can be
moved easily. It is separated from the anterior sclera by episcleral tissue and Tenons
capsule.Subconjunctival vessels and the anterior forming the pericorneal plexus can
be seen in the loose tissue under the bulbar conjunctiva. A 3mm ridge of bulbar
conjunctiva around the cornea is called limbal conjunctiva. In the area of limbus,the
conjunctiva,Tenon
s capsule and the episcleral tissue are fused into a dense tissue
which is strongly adherent to the underlying corneo-scleral junction.It is the preferred
site for obtaining a firm hold(fixation) of the eyeball with the forceps during ocular
surgery. At the limbus, the epithelium of conjunctiva becomes continuous with that of
cornea.

Figure-1 Parts of Conjunctiva and Conjunctival Glands
3. CONJUNCTIVAL FORNIX
Conjunctival fornix is a continuous circular cul-de-sac, which is broken only on the
medial side by caruncle and the plica semilunaris.Conjunctival fornix joins the bulbar
A Study on Arma


conjunctiva with the palpebral conjunctiva.It can be subdivided into superior, inferior,
medial and lateral fornices.
(i)Superior fornix- it extends from slightly above the upper border of the tarsal plate
to a distance about 10mm from the upper limbus and is thus located at level of
superior orbital margin.The extension of the fascial sheath of the levator and superior
rectus muscles is attached to the conjunctiva in the upper part of the superior fornix.It
helps in maintaining the recess of the superior fornix in the movements of the upper
lid.In the subconjunctival tissue of the superior fornix are present glands of Krause
and the Muller
s muscle.A knife passed through the superior fornix,enters the fibrous

tissue between the levator and superior rectus muscle.A foreign body lodged in the
superior fornix can be seen after double eversion of the upper lid.
(ii)Inferior fornix It extends from slightly below the lower border of the lower
tarsal plate to a distance about 8mm from the lower limbus and is located near the
inferior orbital margin.The extension of the fascial sheath of the conjunctival fold in
the lower fornix.It helps in maintaining the recess of the inferior fornix during
movements of the lower lid. Glands of Krause are lodged in the subconjunctival tissue
of the lower fornix. A knife passed through the lower fornix will enter the fibrous
tissue between the inferior rectus and inferior palpebral muscles and on further push it
hits the aponeurotic expansion from the inferior rectus and inferior oblique muscles.
(iii)Lateral fornix- It is a small cul-de-sac which extends to just behind the equator
of the eyeball and is about 14mm from the lateral limbus and about 5mm from the
lateral canthus.
(iv)Medial fornix- It is a shallow cul-de-sac in which lie the caruncle and plica
semilunaris dipped in the pool of tears called the lacus lacrimalis or tear-lake.
A Study on Arma


Figure -2 Conjunctival fornices

STRUCTURE OF CONJUNCTIVA
Histologically conjunctiva consists of three layers, namely (1) Epithelium,
(2) Adenoid layer, and (3) Fibrous layer
1. Epithelium
(a)The layers of epithelial cells in conjunctiva vary from region to region and its
different parts are as follows
Marginal conjunctiva has 5 layered non keratinized stratified squamous type
of epithelium.The most superficial layer is of squamous cells, intermediate 3
layers of polyhedral cells and deepest layer of cylindrical cells.Goblet cells,
absent at mucocutaneous junction; begin to appear in this part of conjunctival
epithelium.
Tarsal conjunctiva has two- layered epithelium, superficial layer of cylindrical
cells and a deep layer of cubical cells in the upper lid.While the lower tarsal
conjunctiva is composed of 3-4 layers of cells which from deep to superficial
are layers of cubical cells, polygonal cells, elongated wedge-shaped cells and
the cone-shaped cells.
A Study on Arma


Fornix and bulbar conjunctiva has three-layered epithelium, a superficial layer
of cylindrical cells, middle layer of polyhedral cells and a deep layer of
cuboidal cells.
Limbal conjunctiva is again many-layered (8 to 10) stratified squamous
epithelium. Most superficial are one to two layers of squamous
cells.Intermediate several layers are of polygonal cells and basal layer is of
small cylindrical or cubical cells.The limbal epithelium forms the papillae of
the limbal palisades of Vogt.The epithelium of palisade zone provides the
germinative zone for the corneal epithelium.
(b)Goblet cells are present in between the epithelial cells in all regions of
conjunctiva.
(c)Melanocytes are found in the conjunctiva at limbus, fornix, and caruncle and at
the site of entry of anterior ciliary vessels.
(d)Langerhans cells were originally described in humans as dendritic cells in the
basal corneal epithelium.Now it has been demonstrated that they are also present
in almost all parts of the conjunctiva.In fact,Langerhans cells appear to represent a
highly differentiated cell line from bone marrow related to monocyte-
macrophage-histiocyte series,which are present in the epidermis,mucous
membranes,thymus and lymph nodes.These cells stain positively for ATPase and
have no desmosomes.The Langerhans cells have surface receptors for the Fc
component of IgG,the third component of compliment and surface HLA-
DR(Ia)antigen.They are not phagocytic but function in antigenic
presentation,lymphokine and prostaglandin production,and stimulation of T-
lymphocytes.They are reported to be involved in allograft rejection of the
cornea,and in contact hypersensitivity of the skin.
A Study on Arma


2. Adenoid layer
It is also called lymphoid layer and consists of fine connective tissue reticulum in the
meshes of which lie lymphocytes.This layer is most developed in the fornices and
ends at the subtarsal fold.It is not present since birth but develops after 2-3months of
life.For this reason,conjunctival inflammation in an infant does not produce follicular
reaction.
3. Fibrous layer
It consists of a meshwork of collagenous and elastic fibres.It is thicker than the
adenoid layer, except in the region of tarsal conjunctiva, where it is very thin.This
layer contains vessels and nerves of conjunctiva.It blends with the underlying Tenons
capsule in the region of bulbar conjunctiva.
The adenoid layer and the fibrous layer are collectively known as the substantia
propria of the conjunctiva.

Figure -3 Microscopic structure of conjunctiva showing three layers
A Study on Arma


THE CONJUNCTIVAL GLANDS
The conjunctiva contains two types of glands: the mucin secretory glands (goblet
cells, crypts of henle, and glands of Manz) and the accessory lacrimal glands (glands
of Krause and glands of Wolfring)
The mucin glands
1. Goblet cells. - These are unicellular mucous glands located abundantly within the
mucocutaneous junction and limbal conjunctiva.The goblet cells are formed from the
deepest cells (basal layer) of the conjunctiva and migrate towards the surface.These
cells are destroyed after discharging their content, the mucin.The density of goblet
cells is high in children and young adults.They are more numerous on the nasal side,
particularly in the bulbar conjunctiva and inferior fornix.
The conjunctival-associated lymphoid tissue (CALT) consists of T and B
lymphocytes, without plasma cells.Further, lymphoid aggregations corresponding to
the mucosal associated lymphoid tissue (MALT) of the gut and bronchi are also found
in the conjunctiva.
The goblet cells are round or oval in shape with an eccentric flattened nucleus near
the base of the cell. It contains a prominent Golgi apparatus with numerous mucus
pockets in the cytoplasm.
The mucin secreted by goblet cells lubricates and protects the epithelial cells of the
conjunctiva and the cornea and ensures the tear film stability by lowering the surface
tension.
The absence of tear fluid has no effect on the dessication, but destruction of the goblet
cells as in epithelial xerosis (hypovitaminosis A) and parenchymatous xerosis, leads
to dessication of the conjunctiva.The number of goblet cells is greatly increased in the
inflammatory conditions.
A Study on Arma


2.Henles glands-Crypts of Henle are not true glands but folds of the mucous
membrane present in the palpebral conjunctiva between the tarsal plates and the
fornices.These are tubular structures with lumina of 15-30 m which contains a few
goblet cells.These resemble Lieberkuhns crypts in the large intestine.
3. Glands of Manz-These are found in the limbal conjunctiva in animals like pig, calf
or ox.Their existence in human beings is controversial.

Figure-4 Goblet cell density in different parts of conjunctiva
Acessory lacrimal glands
1. Glands of Krause-present in subconjunctival connective tissue of fornix, about 42
in upper fornix and 8 in lower fornix
2. Glands of Wolfring-present along the upper border of superior tarsus and along
the lower border of inferior tarsus
3. Rudimentary accessory lacrimal glands.

A Study on Arma


THE PLICA SEMILUNARIS
It is a pinkish crescentric fold of the conjunctiva,present in the medial canthus.Its
lateral free border is concave which becomes less prominent on abduction but forms a
cul-de-sac about 2mm in depth when the eyeball is adducted.It is a vestigial structure
in human beings and represents the nictitating membrane (the third eyelid)of the
lower animals.
Microscopic structure The epithelium of this part of the conjunctiva consists of 8 to
10 layer of cells with many goblet cells.The deepest layer is cylindrical instead of the
normal cubical.
The substantia propria is composed of loose connective tissue containing numerous
blood vessels,a lobule of fat,a few non-striated muscle and melanophores.
THE CARUNCLE
The caruncle is a small (5mm x 3mm) ,soft,ovoid,pinkish mass situated in the inner
canthus,just medial to plica semilunaris.In reality,it is a piece of modified skin (a part
of the margin of the lower lid which gets cut off due to development of the inferior
canaliculi)and so is covered with stratified squamous epithelium and contains sweat
glands,sebaceous glands and hair follicles.It differs from the skin by the presence of
accessory lacrimal glands of Krause,presence of plenty of goblet cells and absence of
keratinisation in the epithelium.The connective tissue underlying the caruncle is in
contact with the septum orbitale and the medial check ligament.
Blood supply is through the superior medial palpebral artery
Lymphatics drain into submandibular lymph glands.
Nerve supply is from the inferior trochlear nerve.

A Study on Arma


BLOOD SUPPLY OF THE CONJUNCTIVA
Arteries supplying the conjunctiva are derived from three sources:-
(1)Marginal arcade of the eyelid
(2)Peripheral arterial arcade of eyelids
(3)Anterior ciliary arteries
1. The marginal arterial arcade
It is formed by anastomosis of medial and lateral palpebral arteries and lies in the
submuscular plane in front of the tarsal plate, 2mm away from the lid margin, in each
lid.The perforating branches from the marginal arterial arcade pierce the tarsus at the
sulcus subtarsalis to reach the conjunctiva, where they divide into marginal and tarsal
branches.The tarsal branches anastomose with the branches from the peripheral
arcade.
2. The peripheral arterial arcade
It is situated at the upper border of the tarsus in the upper lid.Its perforating branches
pierce the palpebral muscles to reach the conjunctiva and sends off descending and
ascending branches.
The descending branches supply the tarsal conjunctiva and anastomose with the
branches of the marginal arterial arcade at level of sulcus subtarsalis.
The ascending branches pass upwards and then bend round the superior fornix to
descend under the bulbar conjunctiva as posterior conjunctival arteries.At about 4mm
from the limbus,the posterior conjunctival arteries anastomose with the anterior
conjunctival arteries (branches of anterior ciliary arteries)forming the pericorneal
plexus.The posterior conjunctival vessels move with the movement of the bulbar
conjunctivitis,there is hyperaemia of the superficial conjunctival vessels derived from
the posterior conjunctival vessels.
A Study on Arma


3. The anterior cilliary arteries
These are branches of muscular arteries (total7-2 from each rectus muscle except 1
from the lateral rectus).These arteries give off anterior conjunctival arteries just before
piercing the sclera at about 4mm from the limbus.
The anterior conjunctival arteries move forward towards the limbus at a plane deeper
than the posterior conjunctival arteries.These anastomose with each other forming a
series of arcades parallel to the corneal margin and also form the pericorneal plexus.
To summarize, the palpebral conjunctiva and fornices are supplied by branches from
the marginal and peripheral arcades of the eyelids. Bulbar conjunctiva is supplied by
posterior conjunctival arteries and anterior conjunctival arteries.
VENOUS DRAINAGE OF CONJUNCTIVA
The veins from the conjunctiva drain into the venous plexus of eyelids which in turn
drain into the superior or inferior ophthalmic veins.
A circumcorneal zone of veins about 5-6mm from the limbus drain into the anterior
ciliary veins.

LYMPHATICS OF THE CONJUNCTIVA
Conjunctival lymphatics are arranged in two layers: a superficial and a deep.
Lymphatics from the lateral side drain into preauricular lymph nodes and those from
the medial side into the submandibular lymph nodes.
NERVE SUPPLY OF CONJUNCTIVA
A circumcorneal zone of conjunctiva is supplied by branches from long ciliary nerves
which supply the cornea. Rest of the conjunctiva is supplied by branches from
lacrimal, infratrochlear, supratrochlear, supraorbital and frontal nerves.
A Study on Arma


These nerves form a subepithelial plexus in the superficial part of substantia
propria.From this plexus, the fibres pass to form an intraepithelial plexus around the
base of the epithelial cells and send free nerve fibrils between these epithelial
cells.These nerves do not posses the myelin sheath.

A Study on Arma


PTERYGIUM
Pterygium is a Greek word meaning WING
DEFINITION:-Pterygium is a wing shaped fold on conjunctiva encroaching upon the
cornea from either side within the interpalpebral fissure at the 3 or 9 oclock position
adjacent to the limbus.
AETIOLOGY:-
36
There are several reviews explaining the etiology of pterygium
1) Radiational Factors-There is strong circumstantial evidence that exposure to
ultraviolet light is important in the etiology of pterygium.
2) Environmental Factors-Environmental irritative factors, such as heat, dry
atmosphere, high winds and abundance of dust are most frequently associated with
this condition.
Fuchs suggested that location of pterygium was related to the degree of exposure of
bulbar conjunctiva to sunny, smoky and dusty conditions.Chemicals irritants such as
fumes of oil wells have also been proposed.
Anderson postulated a causal relationship between temperature and
pterygium.Another is microtrauma caused by dust particles.
3) Tear film abnormality- The uneven spreading of tear film gives rise to dellen
formation, when cornea becomes dry & thin the epithelium desquamates and the
Bowmans membrane along with superficial stroma gets affected causing the
pterygium to progress.
4) Inflammation and Infection factors-It has been assumed that pterygium starts
with a corneal ulcer (Von Arlt), an episcleritis (Mannhardt, Boeckmann), trachoma
(Musabeili and Ismail-Zade) or other conjunctival infection.
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5) Degenerative factor-Hyaline & elastotic degeneration changes in the deeper parts
of the tissue.
6) Allergic factor- Hilgers (1960) postulated that prolonged exposure of bulbar
conjunctiva to solar radiation produces degenerative changes with formation of
denatured protein.These proteins may cause antigen-antibody reactions.
7) Neoplastic aetiology - initially suggested by Winther (1856), has received
considerable support (Schreiter, Redslob). It was based on the fact that, pterygium
shows a progressive growth, invasion of normal tissue and recurrence after its
removal.
8) Heredity factor- Heredity has an undoubted influence in the occurrence of
pterygia although its influence is not crucial.
9) Neutrophic factor A neurotrophic condition of the conjunctiva so that it reacts
exaggeratedly to external irritants was suggested by Sapuppo (1953).
10) Other factors Trophic changes leading to hyperplasia (Spyratos), associated
with malnutrition (Shreck and Carriker), or a deficiency of choline (Beard &
Dimitry), or a raised cholesterol (Holt); but a relationship with deficiency diseases or
with social status of the patient has been denied.

RISK FACTORS OF PTERYGIUM
Ultraviolet light exposure (both UV-A and UV-B) appears to be the most
significant factors in the development of pterygium including living in
subtropical and tropical climates. People living near the equator are often
affected.
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People who spend considerable time in the sun (for example, farmer,
fishermen, surfers, gardeners) are much more likely to have pterygium than
people living mostly indoors.
Engaging in occupations that require exposure to ultraviolet, for example
welders.
Other agents that may contribute to the formation of pterygia include
allergens, noxious chemicals and irritants (e.g, wind, dirt, dust, air pollution).
Incidence of pterygium
Geographical distribution Pterygium is a disease of tropical & subtropical areas.
It is common between the altitude of 37
o
northand south of the equator.

PATHOLOGY
Pathologically Pterygium is a Degenerative and Hyperplastic condition of the
conjunctiva.
The subconjunctival tissue undergoes elastotic degeneration & proliferates as
vascularised granulation tissues under the epithelium, which ultimately encroaches the
cornea.The corneal epithelium, Bowmans layer & superficial stroma, are destroyed.
PARTS OF PTERYGIUM
27
Head (Apical part present on the cornea)
Neck (Limbal part)
Body (Scleral part extending between limbus & the canthus)
Cap (The grey subepithelial fibrous tissue at the leading edge of the head)

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TYPES
27
Progressive Pterygium
Regressive Pterygium/Stationary /Atrophic

PROGRESSIVE PTERYGIUM-
Thick fleshy with prominent vascularity.
Gradually increased in size and encroaching towards the centre of cornea.
Opaque infiltrative spot (cap) is seen just in front of apex of the pterygium.
REGRESSIVE PTERYGIUM
Thin attenuated with poor vascularity.
No opaque spot is seen.
Duke Elders Classification
36

Progressive (Pterygium crasum, vasculosum, carnosum)
When the growth is continuous, fleshy and vascular.
Regressive pterygium
When it ceases to grow, the vascularity disappears.The pterygium becomes
thin, grey, membranous and anaemic.
SYMPTOMS
Redness
Irritation
Watering
Foreign body sensation
Mild photophobia
Diminished vision due to covering of papillary area, diplopia due to limitation of
movements of eye ball in later condition.
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SIGNS
Triangular fold of conjunctiva seen encroaching on cornea.
Type 1
28
- extends less than 2mm onto cornea. A deposit of iron (Stocker line) may be
seen in the corneal epithelium anterior to the advancing head of the pterygium.
Type 2
28
- involves upto 4mm of the cornea and may be primary or recurrent following
surgery.
Type 3
28
- encroaches onto more than 4mm of the cornea and involves the visual axis.
Visual acuity normal, affected because of covering of pupillary area.
DIFFERENTIAL DIAGNOSIS
30
Pinguecula
Pseudopterygium
Squamous cell carcinoma
Conjunctival intra epithelial neoplasia

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Table No-4: DIFFERENCE BETWEEN TRUE PTERYGIUM AND
PSEUDOPTERYGIUM
27

PTERYGIUM PESUDOPTERYGIUM
ETIOLOGY Dengerative process Inflammatory process
AGE Usually occurs in elderly
persons
Can occur at any age
SITE Always situated in the
palpebral aperture
Can occur at any site
STAGES Either progressive,regressive
or stationary
Always stationary
PROBE TEST Probe cannot be passed
underneath
A probe can be passed under
the neck

MANAGEMENT OF PTERYGIUM
The management of Pterygium can be grouped as follows
a) Medical management
b) Surgical management
c) Combined Medical and Surgical management
d) Management of recurrent Pterygium

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MEDICAL MANAGEMENT
Basically treatment of Pterygium is surgical. But medical management can
be tried in cases where in the Pterygium is early small or inactive with minimal
vascularization and not encroached cornea.
1) HYALURONIDASE:
Hyaluronic acid is the connective tissue ground substance. It is very much needed for
forming new connective tissue in Pterygium.
When hyaluronidase is given subconjunctivally at this stage, it depolymerises the
hyaluronic acid which affects the connective tissue metabolism resulting in regression
or arrest of growth of the Pterygium.
Hylase is commercially available in the form of an odourless, freeze dried powder in
ampoules containing 1500IU. For clinical use freshly prepared hylase and 0.5ml of
2% Xylocaine is given subconjunctivally to the upper border of the pterygium. This
causes ballooning of the pterygium away from the sclera.The injection are repeated at
weekly intervals for 5-6 weeks.
2) CORTICOSTEROIDS
In early cases of pterygium they act by inhibiting the fibrovascular and epithelial
proliferation, there by retarding the further growth of pterygium.
They also bring down the hyperaemia and reduces the bulk of pterygium .But
pterygium does not disappear.They are used in the form of topical drops and eye
ointments.
They are also recommended post operatively after pterygium surgery, to check the
recurrences.
3) LUBRICANTS

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4) Recent advances
Angiogenic mechanisms in the pathology of pterygium i.e, abundant expression of
VEGF in Pterygium, have lead to the development of anti-VEGF therapy aimed at
inducing regression of blood vessels & size of pterygium.

SURGICAL MANAGEMENT
INDICATION-
Defective vision because of
a) Induced astigmatism
b) Progressive pterygium involving the central region of cornea.
c) Diplopia due to interference in ocular movements
d) Cosmetic reasons
e) Severe irritation not relieved by medical therapy.
TECHNIQUE
27
After topical anaesthesia, eye is cleaned, draped & exposed using universal
eye speculum.
Head of the Pterygium is lifted & dissected off the cornea very meticulously.
The main mass of the pterygium is then separated from the sclera underneath
& the conjunctiva superficially.
Pterygium tissue is then excised taking care not to damage the underlying
medial rectus muscle.
Haemostasis is achieved & the episcleral tissue exposed is cauterized
thoroughly.
Next step differs depending upon the technique adopted as follows:-
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Simple excision with closure of the wound, the conjunctiva is sutured back to
cover the sclera.
Bare sclera method- Some part of conjunctiva is excised and its edges are
sutured to the underlying episcleral tissue leaving some part of sclera near the
limbus.
Free conjunctival membrane graft may be used to cover the bare sclera.
Amniotic membrane graft is used
Mucous membrane from lip.
This procedure is more effective in reducing recurrences.Free conjunctiva
from the same or opposite eye may be used as a graft.
Limibal conjunctival autograft transplantation to cover the defect after
pterygium excision is the latest & most effective technique in the management
of pterygium.
Recurrence of the pterygium after surgical excision is the main problem; however it
can be reduced by any of the following measures
Post operative Beta irradiations.
Post operative use of anti mitotic drugs such as Mitomycin-C
COMPLICATION
33

Iatrogenic damage to the rectus muscles
Persistent epithelial defect
Infection
Corneal scarring
Recurrence of pterygium

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RECURRENCE RATE OF PTERYGIUM SURGERY
Bare sclera technique 40%
Excision with mitomycini C intraoperative application 10%
Conjunctival autograft - 8%
Mitomycin C + Conjunctival autograft 5%
PREVENTION
The best method of preventing pterygium is to regularly wear UV 400 rated
sunglasses when outdoors in sunny conditions.
Sunglasses with a wrap around design provide better protection than those with large
gaps between the sunglasses frame and the skin around the eyes.
Wearing a hat with a wide brim provide valuable additional protection.
GREATER PREDILICATION ON NASAL SIDE:-
1) Normal flow of tears is from temporal to nasal side, towards puncti & carries dust
particles of the conjunctival sac & accumulates it in lacus lacrimalis.These
concentrated dust particles may cause greater irritation of nasal conjunctiva.
2) Greater exposure of nasal interpalpebral conjunctiva to U.V. radiation.
3) There are two anterior ciliary arteries on the nasal side & only one on the temporal
side. It is considered that due to this fact, any irritant will lead to greater hyperaemia
on the nasal side & results in pterygium on nasal side.
4) The predominance of pterygia on the nasal side is possibly a result of the sun's rays
passing laterally through the cornea, where it undergoes refraction and becomes
focused on the limbic area. Sunlight passes unobstructed from the lateral side of the
eye, focusing on the medial limbus after passing through the cornea. On the
contralateral (medial) side, however, the shadow of the nose medially reduces the
intensity of sunlight focussed on the lateral/temporal limbus.
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FACTS ABOUT PTERYGIUM
A pinguecula may develop into pterygium.
Commonly found in individuals who spend a lot of time in the sun or
live in dry, windy, smoky, dusty, sandy tropical climates.
Reported to occur in males twice as frequently as in females.
One or both eyes may be involved.
Some pterygium grows slowly throughout a persons life while others
stop growing after a certain point.
Not dangerous (non- malignant) but can become uncomfortable.
Can eventually distort vision due to growth onto the cornea &
eventually even onto the central part of the eye blocking light from
entering.
Removing a pterygium surgically will take care of the problem.
Rate of recurrence is as high as 40% and they tend to come back bigger
and faster.

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DRUG REVIEW
Acharya Charaka has considered dravya as one among the chikitsa chatushpada, thus
giving a vital role in treating the diseases. Without the knowledge of the dravya, the
knowledge of ayurvedic system of medicine becomes incomplete.
The yogas selected in the present study are Pippalyadya Anjana mentioned in Yoga
ratnakara, Netra Roga Nidana Chikitsa Prakarana and Shatavaryadi churna
mentioned in Yoga ratnakara, Netra Roga Nidana Chikitsa Prakarana. Narikela
Rasakriyanjana mentioned in Sahasra yoga.
The Drugs of Pippalyadya Anjana:
PIPPALI
Botanical name - Piper longum
Family - Piperaceae
Synonyms - Kana, Krsna, Kola, Capala, Tiksna Tandula, Magadhi,
Vernacular names - English- Long pepper
Hindi- Pipala
Part used - Fruit
Pharmacodyamics - Rasa- Katu
Guna- Laghu, Snigdha, Teekshna, Pramathi
Veerya- Anushna sheetha
Vipaka-Madhura
Doshagnata- KaphaVata shamaka (shushka);
Pittashamaka (ardhra)
Chemical constituents - Piperine, Pipalatine Pipalatine alkaloid, Sesanin,
Pipalsetrol.

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Action - chakshushya, rasaayana, deepana
Gana- Dipaniya, Kanthya, Asthapanopaga, Sirovirecanopaga (ch)
Pippalyadi, Urdhvabhagahara (su)
Pippalyadi (vag)
VIBHITAKI
Botanical name - Terminalia bellerica
Family - Combretaceae
Synonyms - Bibhitaka, Karshaphala, Kalidruma
Vernacular names - English name - Belleric Myrobolan.
Hindi name - Baheda, Bhaira
Kannada name - Tare Kayi, Santi Kayi.
Part used - Fruits, Seed.
Pharmacodynamics - Rasa - Kashaya
Guna - Laghu, Ruksha
Veerya - Ushna
Vipaka - Madhura
Doshagnata - Kapha Pittahara
Chemical constituents - Tannin and essential oils, saponins, - sitosterol, chebulagic
acid, ellagic acid, gallic acid, oxalic acid, oleic and linoleic acid.
Action - Chaksushya, Keshya, Krimighna, Charmarogahara, Deepana, Dhatuvardaka.
Gana Jvarahara, Kasahara, Virechanopaga (Ch)
Triphala, Mustadi (Su)
Haritakyadi (Bh.P)

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AMALAKI
Botanical name - Emblica Officinalis
Family - Euphorbiaceae
Synonyms - Vayasya, Dhatriphala, Amritaphala
Vernacular names - English name -EmblicMyrobolan, IndianGooseberry
Hindi name -Amla, Amalak
Kannada name -Nelli, Nellikai
Part used - Fruit
Pharmacodynamics - Rasa - Lavana varjita pancha rasa
Guna - Guru, Ruksha
Veerya - Sheeta
Vipaka - Madhura
Doshagnata - Tridoshahara

Chemical constituents - Tannins, Gallic acid, ellagic acid, Glucose, Vitamin C,
Proteins; sitosterol, diterpene, triterpene, flavonoid glucosides
Action - chakshushya, rasaayana
Gana - Jvaragna, kustagna, vayasthapana (Ch)
Amalakyadi, Parushakadi, Triphala (Su)
Parushakadi (Vag)
Research Works on antioxidant effect -
i). Ghosal et al., 1996 Antioxidant effect is due to low molecular weight
tannins.
ii).
Tewari et al., 1968 By raising the total protein level and brings a positive
nitrogen balance.

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HARITAKI
Botanical name - Terminalia Chebula
Family - Combretaceae
Synonyms - Abhaya, Pathya, Shiva, Vayastha
Vernacular names - English name - Chebulic myrobolan
Hindi name -Harad
Kannada name -Karakkayi, Alalekayi
Part used - Fruit
Pharmacodynamics - Rasa - Lavana varjita Pancha rasa
Guna - Laghu, Ruksha
Veerya - Ushna
Vipaka - Madhura
Doshagnata - Tridoshashamaka

Chemical constituents - Chebulinic acid, gallic acid, tannin, anthraquinone, lindric,
oleic, palmitic and stearic acids.
Action Netraroga, Kustagna, Rasayana, Brumhana, Ropana, Shothahara,
srothovibandhahara
Gana Jvaragna, Kustagna, Arshogna, Kasaghna (Ch)
Parushakadi (Vag)
Research works on antioxidant and adaptogenic activity
Fu Naiwu et al., 1992 and Chem. Abstr. 1993, 119, 269367C

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LAKSHA
Botanical Name: Laccifer (Tuchardia), Lacca Kerr (Lac producing insect)
Family- Coccideae
Part used- Lac (Lac resin).
Pharmacodynamics Rasa Tikta, Kashaya
Guna Laghu, Snigdha
Veerya Usna, anushna
Vipaka Katu
Doshagnata - Kaphapittanashaka, Pittaprashamana.
Chemical Constituents: Resin or Resinous matter, wax and coluring matter,
Pigment Laccin. Lac resin is composed of inter esters of hydroxyl fatty acid
derivatives; Aleuritic acid is the major constituent.
Action -Sandhaniya, Kasagna,
LODHRA
Botanical Name - Symplocos racemosa
Family - Symplocaceae
Synonyms - SambaraSthula, valkala, Rodhra, Aksibhaisajya, Kandahina
Vernacular names - English Symplocos tree
Hindi-Lodhra
Kannada Pachettu
Part used - Stem Bark, flower
Pharmacodynamics Rasa - Kashaya Tikta
Guna - Laghu Ruksha
Vipaka - Katu
Virya - Sheeta
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Doshagnata - Kapha Pittahara.
Chemical Constituents: Symposide, epifzelechin, loturine, loturidine, colloturine etc.
Action - Chaksusya, Rakta sthambana, Vranaropaka.
Gana: Sonitasthapana, Sandhaniya, Kasaya skandha (ch)
Lodhradi, Nyagrodhadi gana (su)
Nyagrodhadi, Rodhradi (vag)
SAINDHAVA LAVANA
Latin Name: Sodium Chloride
Synonyms: Sindhu,Sindhuttha,Nadeya,
Sindhuja, Shiva,Manimantha.
Vernacular Names Sanskrit- Saindhava lavana
Kannada - Sendra lavana, sendhur lavana
Hindi -Sendhalon
English -Rock salt, sodium chlorate

Pharmacodynamics Rasa- Lavana, Susvadu (Ishad Madhura)
Guna- Tikshna Laghu, Snigdha, Sukshma, Vyavayi
Virya- Shita
Vipaka-Madhura
Doshaghnata-Tridoshara
Action Dipana, Pachana, Vrushya, Ruchya, Avidahi.
BHRUNGARAJA
Botanical name - Eclipta alba
Family - Compositae
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Synonyms - Markava, Kesharaja, Kesharanjana, Bhrungara
Vernacular names - English name - Eclipta
Hindi name -Mochkand, Bhangra
Kannada name -Garga
Part used - Panchanga
Pharmacodynamics - Rasa - Katu, Tikta
Guna - Laghu, Ruksha,
Veerya - Ushna
Vipaka - Katu
Doshagnata - Kapha Vata hara

Chemical constituents - Ecliptine (alkaloid), Nicotine, -Carotene Saponins, Stigma
sterol, phytosterol-A, 5 amino acids cystine, glutamic acid, phenylalanine, tyrosine
& methionine, fatty acids. Roots stigmasterol, triterpenoid
Action -Chaksusya, Keshya, Twachya, Krimigna, Rasayana, Balya, Shirorogahara.
The Drugs of Shatavaryadi Churna:
SHATAVARI
Botanical name - Asparagus racemoses
Family - Liliacea
Synonyms - Satamuli, Satavirya, Suksamapatra, Atirasa.
Vernacular names- English-Pillipichara
Hindi-Satavare
Kannada- Majjige gadde
Part used- Tuberous roots.
Pharmacodynamics Rasa- Madhura, Tikta
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Guna- Guru, Snigdha
Veerya- Sheeta
Vipaka-Madhura
Doshagnata-VataPitta shamaka
Chemical constituents
Sarsapogenin, 2Spirostanolic, 2Furostanolic, Sponins, Sitosterol.
Action-Chakshushya, rasayana
Gana-Balya, Vayahsthapana, Madhura skandha (ch)
Vidarigandhadi (su)
Vidarigandhadi (vag)
ELA
Botanical name - Elletaria Cardemomum
Family - Scitaminaceae
Synonyms - Dravidi, Triputa, Trti.
Vernacular names- English - Lesser Cardamom
Hindi - Choti Ilaychi
Kannada - Elakki
Part used - Fruit
Pharmacodynamics- Rasa - Katu, Madhura
Guna - Laghu, Rooksha
Veerya - Sheetha
Vipaka - Madhura
Doshagnata - tridosha shamaka
Chemical constituents - Stable oil 5%, Volatile oil 3%, Starch 3%, Mucin 2%,
Bhasma 6-10% Bhasma contains Manganese
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Gana- Sirovirecana, Angamarda prasamana (ch)
Eladi (su)
Eladi, Caturjataka (vag)
VIDANGA
Botanical name - Embelia ribes
Family - Myrsinaceae
Synonyms - Vrishanasana, Chitratandula, Janthunashana
Veranacular names - English name - Babreng.
Hindi name -Baberung
Kannada name-Vayuvidanga
Part used - Berries (Fruit), Leaves and Root Bark
Pharmacodynamics - Rasa - Katu
Guna - Laghu, ruksha, teekshna.
Veerya - Ushna
Vipaka - Katu
Doshagnata - Kapha Vatahara

Chemical constituents - Alkaloids Christembine, Flavonoids, Quinones embelin,
vilangin which are the major active principles, proteins and saponins.
Action -Rasayana
Vidanga is the greatest Rasayana dravya. It gradually reduces the rigidity of the body,
improve circulation, agni and texture of the skin. Vidanga and iron formulations can
be used as very good rasayana.
A rasayana dravya -as quoted by sushruta
Gana - Krimigna, Kustagna, Truptigna (Ch)
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Surasadi, Pippalyadi (Su)
Surasadi, Pippalyadi (Vag)
AMALAKI
Botanical name - Emblica Officinalis Gaertn
Natural order - Euphorbiaceae
Synonyms - Vayasya, Dhatriphala, Amritaphala
Vernacular names English name -EmblicMyrobolan, Indian Gooseberry
Hindi name -Amla, Amalak
Kannada name -Nelli, Nellikai
Part used - Furit
Pharmacodynamics - Rasa - Lavana varjita pancha rasa
Guna - Guru, Ruksha
Veerya - Sheeta
Vipaka - Madhura
Doshagnata - Tridoshahara

Chemical constituents - Tannins, Gallic acid, ellagic acid, Glucose, Vitamin C,
Proteins; sitosterol, diterpene, triterpene, flavonoid glucosides
Action - chakshushya, rasaayana
A Rasayana which acts on all dhatus
Gana - Jvaragna, kustagna, vayasthapana (Cha)
Parushakadi (Vag)

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Research Works on antioxidant effect -
i). Ghosal et al., 1996 Antioxidant effect is due to low molecular weight
tannins.
ii).
Tewari et al., 1968 By raising the total protein level and brings a positive
nitrogen balance.

PIPPALI

Botanical name - Piper longum
Family - Piperaceae
Synonyms - Kana, Krsna, Kola, Capala, Tiksna Tandula, Magadhi,
Vernacular names - English- Long pepper
Hindi- Pipala
Part used -Fruit
Pharmacodyamics Rasa- Katu
Guna- Laghu, Snigdha, Teekshna, Pramathi
Veerya- Anushna sheetha
Vipaka-Madhura
Dosha Karma- KaphaVata shamaka (shushka);
Pittashamaka (ardhra)
Chemical constituents- Piperine, Pipalatine Pipalatine alkaloid, Sesanin, Pipalsetrol
Action- chakshushya, rasaayana, deepana
Gana- Dipaniya,Kanthya, Asthapanopaga,Sirovirecanopaga(ch)
Pippalyadi,Urdhvabhagahara(su)
Pippalyadi (vag)

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MARICHA
Botanical name - Piper nigrum
Family - Piperaceae
Synonyms - Usana, Krsna, Vellaja,Sakanga.
Vernacular names - English- Black pepper
Hindi-Kali Mirchi
Kannada- Karemanesu
Part used - Fruit
Pharmacodynamics Rasa- Katu
Guna- Laghu, Teekshna, Pramathi
Veerya- Ushna
Vipaka- Katu
Doshagata- KaphaVatahara
Chemical constituents- Piperine, alkaloid, Sesanin, Pipalsetrol
Action- chakshushya, Rasayana, deepana.
Gana- Dipaniya, Sirovirecanopaga(ch)
Pippalyadi (su)
Pippalyadi (vag)
MADHU
English name - Honey
Hindi name - Shehad
Kannada name - Jenutuppa
Pharmacodynamics - Rasa - Madhura, Kashaya
Guna - Laghu, Ruksha, Sukshma
Veerya - Sheeta
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Vipaka - Madhura
Doshagnata - Kapha Pittahara
Chemical constituents Glucose 84.9%, formic acid, sucrose 2.69%, alkaloids
0.12%, nitrogen 1.29%
Action - Vilekhana, Deepana, Srotovishodhana, Deepana
Yogavahi pervades the minute srotas

GHRUTA
English name - Ghee (Cows Ghee)
Hindi name - Ghee
Kannada name - Tuppa
Pharmacodynamics - Rasa - Madhura
Guna - Guru, Snigdha
Veerya - Sheeta
Vipaka - Madhura
Doshagnata - Pitta Vata hara
Action - Ojovruddhikara, Balya, Rasayana

The Drugs of Narikela Rasakriya Anjana
RASAANJANA/ DARUHARIDRA:
Botanical name - Berberis aristata
Family - Berberidacea
Synonyms - Daru nisa, Pita daru, Pacampaca, Katankateri, Parjani, Darvi
Vernacular names- English- Indian Berry
Hindi- Daruhaldi
Part used - Root, Stem, and Fruit.
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Pharmacodyamics Rasa- Tikta, Kashaya
Guna- Laghu, Rooksha
Veerya- Ushna
Vipaka- Katu
Doshagata- Kapha Pitta shamaka
Chemical Constituents- Berberin, Oxyanthin, Umballitine
Action- Chakshushya
Gana- Arsoghna, lekaniya (ch)
Haridradi, Mustadi (su)
Haridradi, Mustadi (vag)
YASHTI MADHU
Botanical name - Glycyrrhiza glabra
Family - Leguminaceae
Synonyms - Klitaka, Madhuka, Jalajayasti, Madhuyasti
Vernacular names - English- Liquorice
Hindi- Mulethi
Part used - Root
Pharmacodyamics - Rasa- Madhura
Guna- Guru, Snigdha
Veerya- Seetha
Vipaka- Madhura
Doshagata- Tridosahara
Chemical Constituents- Glycyrrhizin, Glycyrrhetinic acid, Liquirtin, Glabrine
Action- Chakshushya, Rasayana
Gana- Jivaniya, Sonitasthapana, Kanthya, Vamanopaga.(ch)
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Kakolyadi, Sarivadi, Anjanadi (su)
Sarivadi, Anjanadi (vag)
NARIKELA
Botanical name - Cocos nucifera
Family - Palmae
Synonyms - Nalikera, Trnaraja, Drdha phala, Tunga.
Vernacular names - English- Coconut tree
Hindi- Narial
Part used - Fruit, Flower, Oil, Root, Fruit shell
Pharmacodyamics - Rasa- Madhura
Guna- Guru, Snigdha
Veerya- Seetha
Vipaka- Madhura
Doshagata- Vatapittahara
Chemical Constituents - Phenol, p-cresol, Caproic acid, Crotonaldehyde, Furfural
Action- Balya, Brmhana
KARPURA
Botanical name - Cinnamomum Camphora
Family - Lauraceae
Synonyms - Ghanasara, Candraprabha, Sitabhra, Hima, Himavaluka
Vernacular names - English- Camphor
Hindi- Karpur
Part used - Niryasa
Pharmacodyamics - Rasa- Tikta, Katu, Madhura
Guna- Laghu, Ruksa
A Study on Arma


Veerya- Seetha
Vipaka- Katu
Doshagata- Tridosahara
Chemical Constituents - Campher, Campherol, Cineol, Pinene, Camphene,
Dipentene, Terpineol, Safrole, Reticuline.
Action- Chakshushya,

A Study on Arma


RESULT OF DRUG ANALYSIS

1. Name of the sample: PIPPALYADYA ANJANA
Description: The varthi is black in colour
Results of Analysis
Identity, purity and strength Found
Loss on drying at 110deg .C - 5.03% w/w
Total Ash - 19.14% w/w
Acid insoluble Ash - 3.56% w/w
Alcohol soluble extract - 44.19% w/w
Water soluble extract - 36.9% w/w
pH of 1% aqueous solution - 4.19

A Study on Arma


2. Name of the sample: SHATAVARYADI CHURNA

Description: The powder is light brown in colour, odour characteristic and bitter and
pungent in taste

Results of Analysis
Identity, purity and strength Found
Loss on drying at 110deg .C - 7.77% w/w
Total Ash - 3.6% w/w
Acid insoluble Ash - 0.59% w/w
Alcohol soluble extract - 17.568% w/w
Water soluble extract - 32.264% w/w
pH of 1% aqueous solution - 4.30

A Study on Arma


INGREDIENTS OF PIPPALYADYA ANJANA

PIPPALI AMALAKI HARITAKI

VIBHITAKI LODHRA LAKSHA

SAINDHAVA BHRINGARAJA SWARASA PIPPAYADYA ANJANA

A Study on Arma


INGREDIENTS OF SHATAVARYADI CHURNA

SHATAVARI AMALAKAASTHIBEEJA PIPPALI

VIDANGA MARICHA ELA

]
SHATAVARYADI CHURNA

A Study on Arma


PROCEDURE REVIEW
ANJANA:
Anjana is one among the kriyakalpas. It forms an important line of management.
||'| |||%| -| |%|||||||
|| ||||l2|l| ||| ||-| l|||| |
6(Su.S.Ut.18/4 p.633)
Anjana is one of the topical drug administrations in netra rogas, which is usually
adopted after tarpanadi karma. Thus it can be an approach in advance stages of all eye
diseases.
NIRUKTI AND PARIBHASHA:
|||| || '| |
1(pg94)
The word Anjana is derived from the root anuj added with lyut pratyaya.
|l || sl| ||
1(pg94)

To anoint or to smear with is anjana.
|+|'| |||| ||'|
1(pg94)

That which spreads or propagates is Anjana.
|l ||||| ll7| +||| ||7|| |
1(pg94)

Anjana increases the brightness, protects the eye and enables to see in all directions
clearly.
|| 7||+|||l| |||, |||+|||l|||
8(Cha.S.Su.5/14 p.38)
Abhyanjana means akshi anjana
Thus anjana is a topical application of drugs into the eye in the form of a smooth paste
with the help of a shalaka or finger. This clears the defects in vision due to
accumulation of doshas, thus enhancing the power/function of vision.
A Study on Arma


INDICATION OF ANJANA:
| || ||| 7|7||-| ||
|| (| l-|| || ||||||||||
6(S.S.Ut.18/51-52 p.636)
| || -||||| |||| |||| ||||
According to this statement, anjana is never applied in saamaavastha. After Shirah
kaaya shodhana, when the doshas purely localize in eye, then anjana is applied to
remove it from this region.
|+||| -|7||| || -||5||||| |||
8(Cha.S.Chi 26/236 p.690)
|||| ||l|| ||||l+||||'|| |'| |||| ||l||
|||+|'| ||||- |7|-||||| ||+'||: -|+||>||7|||||
||||| ' |4||l+|| |+|'||
After a thorough wash anjana should be applied to netra, but only after 3 days of
vyaadhi utpatti. The 3 days indicates paaka kaala of netra rogas from saamavastha.
Reduction in watering, swelling of lids, pain, itching indicates paaka lakshana.
TYPES OF ANJANA:
A. Karma Bhedha: - According to the action:
6( Su.S.Ut.18/76 p.638)
1. Lekhana Anjana
2. Ropana Anjana
3. Snehana / Prasadana Anjana
Anjana prepared with tikta, kashaya, amla, katu, lavana and kshara dravyas are
used as lekhana anjana.
Anjana prepared from kashaya, tikta dravyas and oil or ghee is used as ropana
anjana.
A Study on Arma


Anjana prepared with madhura dravyas, oil and ghee, is used as snehana /
prasadana anjana.
B. Akruthi Bhedha:- According to the form they can be made into 3
types:
6(Su.S.Ut.18/88 p.637)

1. Pindi or gutika
2. Rasakriya
3. Choorna
In conditions where the doshas are prabala Pindi / gutika anjana is used. In cases of
madhyama dosha, Rasakriya is used. Choorna is used in case of durbala dosha.
C. Based on Dravya Veerya:- According to Potency of Drug.
1. Mrudu anjana * Snehana
* Ropana
* Prasaadana
2. Teekshna anjana Lekhana
D. Based on Rasa: According to drug taste
Madhura anjana, Amla anjana, Lavana anjana, Katu anjana, Tiktha anjana,
Kashaya anjana
DOSE OF ANJANA:
According to Sushrutha
6(Su.S.Ut.18/59 p. 637)

Lekhananjana 1 harenu
Ropananjana 1 harena
Snehana / Prasadananjana 2 harenu.
According to Sharangadhara:
Gutikanjana with Tikshna (LEKHANA) - 1 harenu
(Pill form) Madhyama (ROPANA) - 1 harenu
A Study on Arma


Mrudu (SNEHANA) - 2 harenu
Rasakriyanjana uttama matra - 3 vidanga
(Semisolid form) Madhyama matra - 2 vidanga
Heena matra - 1 vidanga
Choornanjana for virechana karma (LEKHANA) - 2 shalakas
(Powder form) for mrudu karma (ROPANA) - 3 shalakas
for snehana karma (SNEHANA) - 4 shalakas.
Each succeeding one is poorer in efficacy than the previous one.
Time for Application of Anjana:
Anjana is applied to the eyes when the doshas have become pakwa. According
to Sushrutha, anjana should be applied in the morning, noon and night according to
the dosha vitiated. In kaphaja vikara, it should be applied in the morning. In vataja
vikara it is applied in the evening. In pittaja vikara, it is applied during night.
According to Sharangadhara:
In hemantha & sishira ritu- afternoon
Grishma ritu - morning time
Sarat ritu - evening time
Varsha ritu - time when it is neither too cold nor too hot
(Having no clouds)
Vasantha rutu - at any time
LEKHANADI ANJANA DRAVYAS:
|| ||-||| |-||||u-||l||||
|||| ||| |||| |||||||l|
6(Su.S.Ut.18/53 p. 636)

All 5 rasas excepting madhura rasa based on dosha has to be selected for lekhana
anjana.
A Study on Arma


In Vata dosha amla, lavana
Pitta dosha tikta, kashaya
Kapha dosha katu, tikta, kashaya
Rakta dosha pittavat
Sannipata combination of 2 or 3 rasas.

Definition of Lekhanaanjana:
||| ||-|||'||| |||-| l|'||
Lekhana brings about dosha sraavana and there by eye becomes clear from doshas.

Mode of action:
||||l-|||7|-||| 7|||l>|||
||||-||l+|l+||||||-|| -||||| ||
6(Su.S.Ut.18/54 p.637)

The mode of action of lekhana anjana has an effect on the siras of netra palakas, netra
srothosas, and the Shringataka marmas. It brings out the vitiated doshas accumulated
in the eye and hence improves the vision.
ROPANAANJANA:
||| l| ||l|-|-| ||'| |||
|| -|7||| |'| -|| 2%| ||||||
6(Su.S.Ut.18/55 p 637)
Ropanaanjana should be prepared with drugs having kashaya,tikta rasas and
snehadravyas such as ghrutha. It is good for healing purpose.
Mode of action:
Due to sheeta veerya and snigdhata of grutha it improves colour and promotes vision.

A Study on Arma


PRASAADAANJANA:
|| -|-|||||| | |-||||
l2|||-|||| -|||| | |l7||
6(Su.S.Ut.18/56 p.637)

Prasaadanjana should be prepared with the drugs of madhura rasa and with plenty of
ghrita in it. It imparts soothing of the doshas of vision and is beneficial for the unction
purpose also.
Pindi or gutikanjana should be used in severe diseases, rasakriyanjana in medium
diseases and choornaanjana in mild condition of doshas of the diseases.
Samyak Lakshanas of lekhananjana:
There will be clarity in vision, lightness, free from discharges, improved power of
vision, absence of secretion and eye will be free from complications. These are the
symptoms indicating proper action of lekhananjana.
Ati Yoga Lakshanas of lekhananjana:
Excessive lekhananjana results in the eye become crooked, hard, with abnormal
colour, drooping, too rough and discharges excessively.
Management:
Santarpana karma should be adopted for the management of atiyoga.For this, netra
tarpana is the ideal method of choice.Along with other vata- alleviating measures.
Hina Yoga Lakshanas of lekhananjana:
In case anjana is applied in less quantity, then the doshas will be vitiated in excess.
Management:
In such cases doshas can be eliminated by Nasya, Dhooma and Anjana therapy.

A Study on Arma


Contra Indication for Anjana Application:
Anjana should not be applied to person suffering from shrama, udavarta,
vegavarodha, rodhana, .madyapana, Krodha, Bhaya, jwara, shiroroga.
In condition of nidrakshaya, if anjana is applied it leads to netra kriya hani. If anjana
is applied in places where there is excess of wind, it leads to loss of vision.If eye is
contaminated with dust and dirt it leads to srava and adhimantha. Applying anjana at
the end of nasya karma leads to netra shopha, shoola etc.In case of shirashoola
application of anjana will increase it.Anjana if applied soon after shirahsnana,
sheetakala, before sunrise one will not be able to achieve proper anjana lakshanas, as
the dosha in this period will be in vitiated condition.In case of ajeernasvastha, if
anjana is applied, it leads to doshavriddi, as there will be srotorodha.
During vegavastha,anjana prayoga leads to upadravas like raga,shopha,etc.Therefore
physician must take care of all the above condition to avoid complication.The above
contra-indication relates particularly to lekhanajana.
The symptoms should be treated with seka, aschotana, lepa, dhoomapana, kavala,
nasya with due regard to specific nature of deranged doshas.
Shalaka:
Shalaka is an instrument by which anjana is applied to the eye. The two sides
of the shalaka used resemble the mukula or mallikadi kusuma. It should be 8 angulas
in length and devoid of karkashata. The shalaka should be of copper (tamra) for
lekhana karma. In ropanaanjana finger is used as shalaka. Gold and silver shalaka are
used in Prasaadaanjana.

A Study on Arma


Anjana paatra.
The containers for storing the anjana should also be made of similar properties such as
gold, silver, horn, vaidurya, bell metal, copper and iron for storage of madhuradi
shadrasa yukta anjana respectively.
Anjana Vidhi:
| || ||| 7|7||-| ||
|| (| l-|| | | ||||||||||
6(Su.S.Ut.18/ 51-52 p .636)
When the clinical features of doshas have become manifest, the body of the patient
has been cleansed and the doshas have got localized in the eyeball proper, the
appropriate collyrium should be applied.
The lids of the affected eye should be drawn apart with the left hand of the physician
and anjana should be carefully applied by holding the shalaka in the right hand, and
by constant movement of the rod from the kaneenika to the apaanga and viceversa.
Taking care not to apply the anjana too less nor in excess or neither thick nor very
thin and applied with finger when it would be necessary to be used on the lids. The
collyrium which is meant to be applied on the lids only should be applied with fingers
alone. After application, the eyes are closed and the eyeball should be moved slowly
so that the anjana will spread uniformly.

Precautions to be taken:
The physician should not apply excessive collyrium towards the inner as well as the
outer ends of the palpebral fissure nor should he produce discomfort in the eye during
its application. Washing should not be done until the doshas are completely
eliminated because in such case the recurrence of doshas is likely to damage the
A Study on Arma


visual capacity. Opening and closing, blinking, squeezing and washing of the eyes
should not be done as the doshas may stagnate in the eyes.

PROCEDURE OF ANJANA KARMA

A Study on Arma


Churna kalpana:
Churna is a synonym of Sushka Kalka.
|| -|+| || | -|l|2 |-|||l|||
|| -||| |'| | +|| ||||| | -|l|||
18(Sh.S.Mk.6 p.137)
A dry powder, filtered through a fine cloth is called as Churna.
Types of choorna:
i) Sthula churna: Coarse powder for Hima, Phanta, Kashaya
ii) Sookshma: Fine powder for Vati, Lehya, Nasya
iii) Atyanta sookshma (vastra gaalita): very fine for bhasmas, anjanas.
General method of preparation:
The drug, taken in completely dry form should be pounded well in Ulookala yantra
(pounding machine) and sieved through different sized sieves, as per the need and
use.
Shelf life: 6months.
According to Shaarangadhara 2 months.
General dose of Churna: 1 karsha=12 gms
Advantages of Powder form:
a) fixation of the dose is more easier
b) Powders are more stable than liquids, because chemical reactions take place more
rapidly in atmospheric conditions when the drugs are in liquid form.
c) The finer or smaller sized particles/powders dissolve more rapidly in the body
fluids than other solid dosage forms of medicament.
The rapid dissolution increases the blood concentration in shorter time, there by
the action is produced in a lesser time.
They are more economical compared to other preparations
A Study on Arma


METHODOLOGY
A definite protocol of the study is one among the basic requirement to be fulifilled in
a clinical study .The methodology followed in the present study consist the following
aspects
Aims and objectives
Source of data
Selection of patient
Inclusion and exclusion criteria
Study design
Treatment schedule and follow up
Assesment criteria
Assesment of response.

Aims and objectives
1. To evaluate the efficacy of Pippalyadya anjana in the management of Arma.
2. To evaluate the efficacy of Shatavaryadi churna internally in the management
of Arma.
3. To evaluate the efficacy of Narikela rasakriya anjana in the management of
Arma.
4. To establish the significance of the efficacy of Pippalyadya anjana by
comparing it with the efficacy of Narikela rasakriya anjana in the
management of Arma, which is an established study
5. To establish the significance of the efficacy of Shatavaryadi churna internally
by comparing it with the efficacy of Narikela rasakriya anjana in the
management of Arma, which is an established study
A Study on Arma


Source of data
Patients were selected from the out patient and in patient departments of Sri.
Jayachamarajendra Institute of Indian Medicine, Bangalore between December 2010
to Januray 2012.
Selection of patient
The selection was done on the basis of clinical examination. A careful clinical history
of all those patients complaining of Netra ragata, Ashrusrava and Toda were
considered.The patients were then subjected to a throrough, examination and after
establishing the diagnosis; the patients were taken for the clinical study.
Inclusion criteria
Patient aged below 15-55 years
Clinical features as per classics
Pterygium presented with or without Redness, Watering, and Foreign body
sensation.
Sex, either sex.
Pterygium which is limited to limbus
Exclusion criteria
Patient with any other systemic disease.
Pseudopterygium
The patient who had undergone excision of pterygium (recurred)
Study design
Group A- 15 Patients were subjected for Pippalyadi anjana.
Group B- 15 Patients were subjected for Shatavaryadi churna internally.
Group C-15 Patients were subjected for Narikela rasakriya anjana.

A Study on Arma


Procurement of the Drugs
The drugs for the Pippalayadya anjana and Shatavaryadi churna were procured from
the Sri Ayurvedic Centre Banagalore.
Preparation of the Drugs
Preparation of Pippalayadya anjana
Pippali, Triphala, Laksha, Lodhra, Saindhava are taken in equal quantity & pounded
in khalva yantra till it becomes fine powder.Vastraghalana is done to get fine
powder.This fine powder is taken, and then subjected to bhavana with sufficient
quantity of Bhringaraja swarasa till it become soft in consistency.This is then made
into varthi form of about 2cm length and dried in sun shade and preserved in air tight
container.
Preparation of Shatavaryadi churna
12 parts of shatavari, 10 parts of ela (seeds), 8 parts of vidanga, 6 parts of
amalakasthibija, 4 parts of maricha and 3 parts of pippali .All ingredients were taken
and powdered separately by using kalva yantra, sieved through a clean cotton cloth
(Kora cloth) .All the powders of the drugs were then thoroughly mixed together over
kalva yantra and then stored in airtight container.
Narikela rasakriya anjana was the market sample from The Nikhila Karnataka
central Ayurvedic pharma, Batch no MS-33

DURATION AND MODE OF ADMINISTRATION OF THE YOGAS

Group A: Pippalayadya anjana
Purvakarma The patient is explained about the entire procedure, and then patient is
made to sit on a knee height chair comfortably
A Study on Arma


Pradhana karma: The eye of the patient is opened with left hand. Then holding the
shalaka dipped in anjana having harenu matra with right hand anjana is smeared from
kaneenika sandhi to apanga sandhi on the inner side of the eyelid uniformly. It was
applied once daily in the morning for 48days.
Paschat Karma: When tears start flowing out of the eye, the eye is washed with
lukewarm water or triphala kashaya.
Group B: Shatavaryadi churna
Patients were treated with Shatavaryadi Churna half karsha (6grams) with madhu and
ghrutha internally once daily at night for 48days.
Group C: Nairkela rasakriya anjana
Procedure is similar to group A, instead of pippalayada anjana Nairkela rasakriya
anjana was used once in morning for 48 days.
Follow up period:
A follow up period of 90 days was fixed to observe the possible recurrences in cases
where total relief was obtained by the treatment.
ASSESSMENT CRITERIA
Subjective parameters
1) Redness
Absence (0) - No redness
Mild (1) - Scanty redness
Moderate (2) - Moderate redness
Severe (3) - Severe redness.
2) Foreign body sensation
Absence (0) - No Foreign body sensation
Mild (1) - Occasional Foreign body sensation
Moderate (2) - Frequent Foreign body sensation
A Study on Arma


Severe (3) - Continous Foreign body sensation.
3) Watering
Absence (0) - No watering
Mild (1) - Occasional watering
Moderate (2) - Frequent watering
Severe (3) - Excessive watering.
Objective parameter
1) Length
Absence (0) - Begining of the growth (0.5cm)
Mild (1) - In between the canthus and limbus(0.75cm)
Moderate (2) - In between the canthus and limbus (1cm)
Severe (3) - Upto limbus (1.5cm).
2) Thickness
Absence (0) - Negligible growth
Mild (1) - Had clearly visible episcleral vessels under the body of
Pterygium (Atrophic)
Moderate (2) - Had partially visible episcleral vessels under the body of
Pterygium (Intermediate)
Severe (3) - Had totally obscured episcleral vessels underlying the body of
Pterygium (Fleshy).

A Study on Arma


ASSESSMENT OF RESPONSE
The net result obtained by various parameters of assessment both before and after
treatment was taken into consideration to assess the overall effect of the therapies.
Then they were graded in terms of percentage of relief in subjective and objective
parameters.

Good response/ improvement More than 65% relief in objective and
subjective parameters.
Moderate response/ Improvement 40-65% relief in objective and subjective
parameters.
Mild response/Improvement 15-40% relief in objective and subjective
parameters.
Poor response/Improvement less 15% relief in objective and subjective
parameters

.

A Study on Arma


OBSERVATIONS AND RESULTS
Fourty five Patients were selected and divided into 3 groups (Group A,B and C).
Containing 15 patients each. GroupA was treated with Pippalyadya anjana, GroupB
with Shatavaryadi Churna, Group C with Narikela rasakriya anjana. Subjective and
objective changes were considered for the assessment of the efficiency of research
work.
Data were collected as follows:
a. Demographic data
b. Data related to disease
c. Data related to response.

A Study on Arma


DEMOGRAPHIC DATA:
Table-5: Showing Age Wise incidence of 45 patients

Age In Years
Group A

Group B Group C Total
No of
Ptnts
% No of
Ptnts
% No of
Ptnts
% No of
Ptnts
%
15-24 00 00 00 00 00 00 00 00
25-34 01 06 03 20 01 06 05 11
35-44 07 47 04 26 06 40 17 38
45-54 07 47 08 54 08 54 23 51

Out of 45 patients selected for clinical study 00(0%) patients were between the age
group of 15-24years, 05(11%) patients were between the age group of 25-34years,
17(38%) between 35-44years, 23(51%)patients were between the age group 45-54
years of age.

Figure 1- Age wise distribution

5
10
15
20
25
30
35
40
45
50
55
15-24 25-34 35-44 45-54 Age in years
P
e
r
c
e
n
t
a
g
e
Group A
Group B
Group C
Total

A Study on Arma


Table-6: Showing Incidence of sex

Sex
Group A

No of
Ptnts
% No of
Ptnts
% No of
Ptnts
% No of
Ptnts
%
Male 5 33 07 46 10 67 22 49

Female 10 67 08 54 05 33 23 51

Out of 45 patients selected for clinical trial 22(49%) were Male and 23(51%) were
Female.

Figure-2: Incidence of sex

A Study on Arma


Table-7: Showing Religion Wise Distribution

Religion Group A Group B Group C Total
No of
Ptnts
% No of
Ptnts
% No of
Ptnts
% No of
Ptnts
%
Hindu 14 94 13 88 13 88 40 89
Muslim 01 06 01 06 01 06 03 07
Christian 00 00 01 06 01 06 02 04

Out of 45 patients taken for clinical study 40(89%) were Hindus, 03(07%) were
Muslims, 02(04%) were Christian.

Figure 3-Incidence of Religion
0
10
20
30
40
50
60
70
80
90
100
Group A Group B Group C Total
P
e
r
c
e
n
t
a
g
e
Hindu
Muslim
christian

A Study on Arma


Table-8: Showing Occupation Wise Distribution

Occupation Group A

No
of
Ptnts
% No of
Ptnts
% No of
Ptnts
% No of
Ptnts
%
Field Workers 05 34 04 26 02 13 11 24
House Wife 06 40 05 34 04 27 15 33
Outdoor Work 02 13 03 20 03 20 08 18
Office Work 00 00 03 20 04 27 07 16
Business 02 13 00 00 02 13 04 09

Out of 45 patients, 11(24%) were Fieldworkers, 15(33%) were Housewife, 08(18%)
were Outdoor work and 07(16%) were Office work, 04(09%) were Business men.

Figure 4-Incidence of occupation
0
5
10
15
20
25
30
35
40
45
P
e
r
c
e
n
t
a
g
e
Fieldworker
Housewife
Outdoor
Officework
Business

A Study on Arma


Table-9: Showing Economic Status Wise Distribution

Economic
Status
Group A

No of
Ptnts
% No of
Ptnts
% No of
Ptnts
% No of
Ptnts
%
Upper
Class
00 00 01 06 00 0 01 02
Middle
Class
13 87 08 54 11 74 32 71
Lower
Class
02 13 06 40 04 26 12 27

Out of 45 patients, 1(02%) patients were of upper class category, 32(71%) were
middle class, 12(27%) patients were lower class.

Figure 5-Distribution of Patients based on Economic state
0
10
20
30
40
50
60
70
80
90
100
P
e
r
c
e
n
t
a
g
e
Upper Class
Middle Class
Lower Class

A Study on Arma


Table-10: Showing Diet Wise Distribution

Diet Group A

No of
Ptnts
% No of
Ptnts
% No of
Ptnts
% No of
Ptnts
%
Vegetarian 06 40 07 46 05 33 18 40

Mixed 09 60 08 54 10 67 27 60

Out of 45 patients, 18(40%) were of vegetarians and 27(60%) patients were of mixed
diet.

Figure 6- Incidence of Diet

Vegetarian, 40
%
Mixed, 60%
Incidence of Diet
Vegetarian
Mixed

A Study on Arma


Table-11: Showing Place Wise Distribution

Place Group A

No of
Ptnts
% No of
Ptnts
% No of
Ptnts
% No of
Ptnts
%
Urban 09 60 09 60 11 74 29 64
Rural 06 40 06 40 04 26 16 36

Out of 45 patients, 29(64%) patients were living in urban area, 16(36%) patients were
of rural basis.

Figure 7-Incidence of Place

0
10
20
30
40
50
60
70
80
P
e
r
c
e
n
t
a
g
e
Urban
Rural

A Study on Arma


Table-12: Showing Distribution of Chronicity

Chronicity
(Years)
Group A

No of
Ptnts
% No of
Ptnts
% No of
Ptnts
% No of
Ptnts
%
0-1 10 68 09 61 07 48 26 58
1-2 01 06 03 20 02 13 06 13
2-3 01 06 02 13 02 13 05 12
3-4 03 20 01 06 02 13 06 13
4-5 00 00 00 00 02 13 02 04

Out of 45 patients, 26(58%) patients were between 0-1years chronicity,
06(13%) patients between 1-2years chronicity, 05(12%) patients between 2-3years
chronicity, 06(13%) patients between 3-4years chronicity, 02(04%) patients with
4-5years chronicity.

Figure 8- Distribution Of Chronicity

0
10
20
30
40
50
60
70
N
o

o
f

P
a
t
i
e
n
t
s
0-1
1-2
2-3
3-4
4-5

A Study on Arma


Table-13: Showing Incidence of Nidana

Nidanas Group A

No % No % No % No %
Dhoop sevana 04 27 08 53 01 06 13 29
Rajasevana 05 33 06 40 07 48 18 40
Marutasevana 00 00 00 00 00 00 00 00
Atigamana 01 06 00 00 00 00 01 02
Dhoomasevana 02 13 01 06 00 00 03 07

Out of 45 patients taken for clinical study, 13 patients (29%) had nidana of
Dhoopsevana, 18 patients (40%) had Rajasevana, 01 patient (02%) had Atigamana
and 03(07%) had Dhoomasevana.

Figure 9-Incidence of nidana

0
2
4
6
8
10
N
o

o
f

P
a
t
i
e
n
t
s
Group A
Group B
Group C

A Study on Arma


Table-14: Showing Incidence of Affected side of Eye

Affected
Eye
Group A

No of
Patients
No of
Patients

No of
Patients
No of
Patients
%
Only
Right
05 03

03 11 24
Only
Left
03 04 04 11 24
Both 07 08 08 23 52

Out of 68 eyes of 45 patients taken for the study, 11(24%) patient having Pterygium
affected to Right Eye only, 11(24%) patients having Pterygium affected to only Left
Eye and 23(52%) patients were having Pterygium affected to both of their eyes.

Figure 10-Incidence Right-Left Side Eyes

0
5
10
15
20
25
Right Eye only Left Eye only Both
N
o

o
f

P
a
t
i
e
n
t
s
Group A
Group B
Group C
Total

A Study on Arma


Table-15: Showing Incidence of Site Of Arma

Site Of
Arma
Group A

No of
Patients
No of
Patients

No of
Patients
No of
Patients
%
Medial
Canthus
15 15

15 45 100
Lateral
Canthus
00 00 00 00 00
Both
Canthus
00 00 00 00 00

Out of 45 patients, all 45 patients (100%) were having on medial canthus.

Figure 11-Incidence of Site of Arma

0
5
10
15
20
25
30
35
40
45
50
Medial Canthus Lateral Canthus Both Canthus
N
o

o
f

P
a
t
i
e
n
t
s
Group A
Group B
Group C
Total

A Study on Arma


Table-16: Showing Incidence of Different Parameters

Parameters Group A

No of
Patients
No of Patients No of Patients No of
Patients
%
Redness 14 15 15 44 98
Watering 11 09 10 30 67
Foreign
BodySensation
15 15 11 41 91

Out of 45 patients, 44 (98%) patients were having Redness, 30(67%) patients were
having Watering, 41(91%) were having Foreign body sensation.

Figure 12-Incidence of Different Parameters

0
5
10
15
20
25
30
35
40
45
50
N
o

o
f

P
a
t
i
e
n
t
s
Redness
Watering
Foreign Body sensation

A Study on Arma



Parameters Group A

No of
Patients
No of Patients No of Patients No of
Patients
%
Length 15 15 15 45 100
Thickness 15 15 15 45 100

Out of 45 patients, 45 (100%) patients were having Length, 45(100%) patients were
having Thickness.

.

0
5
10
15
20
25
30
35
40
45
50
Length Thickness
N
o

o
f

P
a
t
i
e
n
t
s
Group A
Group B
Group C
Total

A Study on Arma



Parameter
No of
Eyes
% No of
Eyes
% No of
Eyes
% No of
Eyes
%
Redness 21 95 23 100 23 100 67 99
Watering 15 68 14 61 15 65 44 65
Foreignbodysensation 22 100 23 100 17 74 62 91
Length 22 100 23 100 23 100 68 100
Thickness 22 100 23 100 23 100 68 100

Out of 68 eyes of 45 patients taken for clinical study, 67(99%) eyes were having
Redness, 44(65%) eyes were having Watering, 62(91%) eyes were having Foreign
body sensation, 68(100%) eyes were having Length, and 68 (100%) eyes were having
Thickness.

0
10
20
30
40
50
60
70
80
90
100
110
120
P
e
r
c
e
n
t
a
g
e

o
f

N
u
m
b
e
r

o
f

E
y
e
s
Group A
Group B
Group C
Total

A Study on Arma


RESULTS

Table-19: Showing Individual study of the parameters in Group A

Paramet
er
Average Diffe
r
% of
diffe
r
SD SE df T
valu
e
P
value
Rema
rks
BT AT (d) % d
Redness 1.67 0.9
3
0.74 44.3 0.438 0.080 2
9
9.25 <0.00
1
HS
Watering 1.07 0.5 0.57 53.2 0.495 0.090 2
9
6.33 <0.00
1
HS
Foreign
body
sensation
1.93 1.0
7
0.86 44.5 0.347 0.063 2
9
13.6
5
<0.00
1
HS
Length 2.2 2.2 0 0 0 0 2
9
0 >0.05 NS
Thicknes
s
1.53 1.4 0.13 8.4 0.336 0.061 2
9
2.12 >0.05 S

1. Analysis of the Redness shows that mean score before treatment was 1.67
which reduced to 0.93, there was 44.3% of improvement in the symptom, with
t value 9.25 the result was statistically highly significant (p<0.001).
2. Analysis of Watering shows that mean value before treatment was 1.07 which
reduced to 0.5, there was a 53.2% improvement in the symptom, with t value
6.33 the result was statistically highly significant (p<0.001).
3. Analysis of the Foreign body sensation shows that mean value before
treatment 1.93 which reduced to 1.07, there was a 44.5% improvement in the
symptom, with t value 13.6 the result was statistically highly significant
(p<0.001).
4. Analysis of the Length shows that mean value before treatment 2.2 which
remained same 2.2, there was no change in the feature,with t value 0 the result
was statically not significant at (p> 0.05)
5. Analysis of the Thickness shows that mean value before treatment 1.53which
reduced to 1.4, there was a 8.4% of improvement in the sign, with t value 2.12
the result was statistically significant (p>0.05).
A Study on Arma


Figure 15-Individual study of parameters in Group A

0
0.5
1
1.5
2
2.5
Redness Watering Foreign
body
sensation
length thickness
M
e
a
n

V
a
l
u
e
BT
AT

Table-20: Showing Individual study of the parameters in Group B

Paramet
er
Average Diffe
r
% of
diffe
r
SD SE df T
valu
e
P
value
Rema
rks
BT AT (d) % d
Redness 1.6 1.0
3
0.5 35.6 0.495 0.090 2
9
6.33 <0.00
1
HS
Watering 1.2 0.7
3
0.47 39.1 0.499 0.091 2
9
5.16 <0.00
1
HS
Foreign
body
sensation
2.07 1.3 0.77 37.1 0.421 0.077 2
9
10 <0.00
1
HS
Length 2.16 2.1
6
0 0 0 0 2
9
0 >0.05 NS
Thicknes
s
1.5 1.4
7
0.03 2 0.171 0.031 2
9
0.96
4
>0.05 NS

A Study on Arma


which reduced to 1.03, there was 35.6% of improvement in the symptom, with
t value 6.33 the result was statistically highly significant (p<0.001).
symptom, with t value 10 the result was statistically highly significant
(p<0.001).
remained same 2.16, there was no change in the feature,with t value 0 the
result was statically not significant at (p> 0.05)
reduced to 1.47, there was a 2% of improvement in the sign, with t value 0.964
the result was not statistically significant (p>0.05).

Figure 16-Individual study of parameters in Group B

0
0.5
1
1.5
2
2.5
body
sensation
length thickness
M
e
a
n

V
a
l
u
e
BT
AT

A Study on Arma


Table-21: Showing Individual study of the parameters in Group C

Paramete
r
Average Diffe
r
% of
diffe
r
SD SE df T
valu
e
P
value
Rem
arks
BT AT (d) % d
Redness 1.77 1.3 0.47 26.5 0.499 0.092 2
9
5.07 <0.00
1
HS
Watering 1.2 0.7
3
0.5 41.6 0.5 0.091 2
9
5.49 <0.00
1
HS
Foreign
body
sensation
1.37 0.8
7
0.5 36.4 0.5 0.091 2
9
5.49 <0.00
1
HS
Length 2.27 2.2
7
0 0 0 0 2
9
0 >0.05 NS
Thickness 1.7 1.6
7
0.03 1.7 0.171 0.031 2
9
0.96
4
>0.05 NS

which reduced to 1.3, there was 26.5% of improvement in the symptom, with t
value 5.07 the result was statistically highly significant (p<0.001).
symptom, with t value 5.49 the result was statistically highly significant
(p<0.001).
remained same 2.27, there was no change in the feature,with t value 0 the
result was statically not significant at (p> 0.05)
reduced to 1.67, there was a 1.7% of improvement in the sign, with t value
0.964 the result was not statistically significant (p>0.05).

A Study on Arma


Figure 17-Individual study of parameters in Group C

0
0.5
1
1.5
2
2.5
body
sensation
length thickness
M
e
a
n

V
a
l
u
e
BT
AT

INTER GROUP COMPARISON/ COMPARATIVE EFFECT OF
TREATMENTS:

Table 22: Comparison of effect of treatment on Parameters in Group A
and Group C:

Parameter Group Mean
% of
differ
SD SE
T-
Value
P-
Value
Remarks
Redness
A 0.733 44.3 0.639 0.116
1.78 <0.10 S
C 0.466 26.5 0.507 0.092
Watering
A 0.566 53.2 0.727 0.132
0.39 >0.05 NS
C 0.5 41.6 0.572 0.104
Foreignbody
sensation
A 0.866 44.5 0.628 0.114
2.48 <0.01 HS
C 0.5 36.4 0.508 0.092
Length
A 0 0 0 0
0 >0.05 NS
C 0 0 0 0
Thickness
A 0.2 8.4 0.484 0.088
1.76 <0.10 S
C 0.033 1.7 0.182 0.033

A Study on Arma


1. Comparative analysis of effect of treatment on Redness between Group A&C,
with t-value 1.78, the result is statistically significant (p<0.10).However there
was 44.3% improvement in Group A and 26.5% improvement in the
Group C treatment individually.
2. Comparative analysis of effect of treatment on Watering between Group
A&C, with t-value 0.39, the result is statistically not significant
(p>0.05).However there was 53.2% improvement in Group A and 41.6%
improvement in the Group C treatment individually.
3. Comparative analysis of effect of treatment on Foreign body sensation
between Group A&C, with t-value 2.48, the result is statistically significant
(p<0.01).However there was 44.5% improvement in Group A and
36.4%improvement in the Group C treatment individually.
4. Comparative analysis of effect of treatment on Length between Group A&C,
with t-value 0, the result is statistically not significant (p>0.05).However there
was 0% improvement in Group A and Group C treatment individually
suggesting both having same effect.
5. Comparative analysis of effect of treatment on Thickness between Group
A&C, with t-value 1.76, the result is statistically significant (p<0.10).
However there was 8.4% improvement in GroupA and1.7% improvement in
the Group C treatment individually.

Figure 18-Comparision of Percentage of difference between Groups A& C

0
10
20
30
40
50
60
body
sensation
length thickness
p
e
r
c
e
n
t
a
g
e

o
f

r
e
l
i
e
f
Group A
Group C

A Study on Arma


Table 23: Comparison of effect of treatment on Parameters in Group B
and Group C:

% of
differ
SD SE
T-
Value
P-
Value
Remarks
Redness
B 0.566 35.6 0.504 0.092
0.76 >0.05 S
C 0.466 26.5 0.507 0.092
Watering
B 0.466 39.1 0.571 0.104
0.22 >0.05 NS
C 0.5 41.6 0.572 0.104
Foreignbody
sensation
B 0.766 37.1 0.626 0.114
1.81 <0.10 S
C 0.5 36.4 0.508 0.092
Length
B 0 0 0 0
0 >0.05 NS
C 0 0 0 0
Thickness
B 0.033 2 0.182 0.033
0 >0.05 NS
C 0.033 1.7 0.182 0.033

1. Comparative analysis of effect of treatment on Redness between Group B&C,
with t-value 0.76, the result is statistically not significant (p>0.05).However
there was 35.6% improvement in Group B and 26.5% improvement in the
2. Comparative analysis of effect of treatment on Watering between Group B&C,
there was 39.1% improvement in Group B and 41.6% improvement in the
3. Comparative analysis of effect of treatment on Foreign bodysensation between
Group B&C, with t-value 1.81, the result is statistically significant
(p<0.10).However there was 37.1% improvement in Group B and
36.4%improvement in the Group C treatment individually.
4. Comparative analysis of effect of treatment on Length between Group B&C,
was 0% improvement in Group B and Group C treatment individually
B&C, with t-value 0, the result is statistically not significant
(p>0.05).However there was 2% improvement in Group B and1.7%
improvement in the Group C treatment individually.

A Study on Arma


Figure 19-Comparision of Percentage of difference between Groups B& C

0
5
10
15
20
25
30
35
40
45
body
sensation
length thickness
p
e
r
c
e
n
t
a
g
e

o
f

r
e
l
i
e
f
GroupB
Group C

Table 24: Comparison of effect of treatment on Parameters in Group A
and Group B:

% of
differ
SD SE
T-
Value
P-
Value
Remarks
Redness
A 0.733 44.3 0.639 0.116
1.21 >0.05 NS
B 0.566 35.6 0.504 0.092
Watering
A 0.566 53.2 0.727 0.132
0.59 >0.05 NS
B 0.466 39.1 0.571 0.104
Foreignbody
sensation
A 0.866 44.5 0.628 0.114
0.61 >0.05 NS
B 0.766 37.1 0.626 0.114
Length
A 0 0 0 0
0 >0.05 NS
B 0 0 0 0
Thickness
A 0.2 8.4 0.484 0.088
1.76 <0.10 S
B 0.033 2 0.182 0.033

A Study on Arma


1. Comparative analysis of effect of treatment on Redness between Group A&B,
there was 44.3% improvement in Group A and 35.6% improvement in the
Group B treatment individually.
2. Comparative analysis of effect of treatment on Watering between Group
A&B, with t-value 0.59, the result is statistically not significant
improvement in the Group B treatment individually.
3. Comparative analysis of effect of treatment on Foreign bodysensation between
Group A&B, with t-value 0.61, the result is statistically not significant
improvement in the Group B treatment individually.
4. Comparative analysis of effect of treatment on Length between Group A&B,
was 0% improvement in Group A and Group B treatment individually
A&B, with t-value 1.76, the result is statistically significant (p<0.10).However
there was 8.4% improvement in GroupA and 2% improvement in the
Group B treatment individually.

Figure 20-Comparision of Percentage of difference between Groups A& B

0
10
20
30
40
50
60
body
sensation
length thickness
p
e
r
c
e
n
t
a
g
e

o
f

r
e
l
i
e
f
Group A
GroupB

A Study on Arma


OVERALL ASSESSMENT OF THE RESULTS.

Table No. 25. Showing the overall assessment of the results in the groups.

Response

Group-A

Group-B

Group-C

No of patients

No of patients

No of patients

Good response

0

0

0

Moderate response

2

0

0

Mild response

19

19

16

Poor response

1

5

7

The study reveals that in groupA, 0 eye had good response, 2 eyes had moderate
response, 19 eyes had mild response and 1 eye had poor response.
In group B, 0 eye had good response, 0 eye had moderate response, 19 eyes had Mild
response and 5 eyes had poor response.
In group C, 0 eye had good response, 0 eye had moderate response, 16 eyes had
Mild response and 7 eyes had poor response.

A Study on Arma


Figure 21- Showing the overall assessment of the results in the groups.

0
2
4
6
8
10
12
14
16
18
20
Good Moderate Mild Poor
N
o

o
f

P
a
t
i
e
n
t
s
Group A
Group B
Group C

Table No. 26 Showing the over all assessment of the tretment in percentage:

Groups

GroupA GroupB GroupC
Percentage of relief

46% 36.8% 30%

The overall assessment of parameters shows 46% relief in Group A, 36.8%
relief in GroupB and 30% relief in Group C.
Group A showed moderate response to the treatment. Both Group B and Group C
have shown mild response.

A Study on Arma


Figure 22 - Showing the over all assessment of the tretment in percentage:

Group -A
Group -B
Group -C
46%
36.8%
30%

Table-27: Showing the percentage of recurrence in all the groups

PTERYGIUM Group A Group B Group C Total
No of
Patients
% No of
Patients
% No of
Patients
% No of
Patients
%
Recurrence 01 07 03 20 04 27 08 12
Non-
Recurrence
14 93 12 80 11 73 37 82

During 90 days follow up period 07% of Group A, 20% of Group B and 27% in
Group C had recurrence of complaints.

A Study on Arma


Figure-23: Showing the percentage of recurrence in all the groups

0
10
20
30
40
50
60
70
80
90
100
Recurrence Non-recurrence
07%
93%
20%
80%
27%
73%
P
e
r
c
e
n
t
a
g
e
Pterygium
Group A
Group B
Group C

A Study on Arma


DISCUSSION
In every research work, discussion part is most important because it brings into light -
about the logical analysis, reasoning and rational interpretations to ignite new ideas,
which are helpful in filling the research gaps in the scientific world. Hence, here is an
attempt to discuss the concepts, observations and experiences in the clinical study.
The discussion is categorized into following ways for the ease of understanding.

1. Discussion on selection of the topic
2. Discussion on review of literature
3. Discussion on observations
4. Discussion on results
5. Discussion on drugs, their mode of action on the disease, Probable mode of
action anjana

1. Discussion on selection of the topic
Arma is a suklaghatha roga, characterized by mamsavruddhi in suklamandala. Hence
the classical approach towards the management of the disease would be Lekhana
anjana in early stages, when it encroaches the krishnamandala then it is removed by
chedana karma.
Pterygium though being symptomless & non troublesome condition if left untreated
may develop signs of inflammation followed by growth resulting in visual
disturbance.
The management of pterygium in early stage is through, application of topical
lubricants, anti-inflammatory & corticosteroids. All these are effective for a short
A Study on Arma


period & there are no proper effective medicaments & surgery is the only line of
treatment according to modern science. Recurrence rate is very high & cosmetic
appearance forces the patient to turn towards surgical management which is not
devoid of complication.
Ptreygium is more prevalent now a days & the reason for the same may be attributed
to the present day exposure to pollutants i.e, Heat, Smoke, and Dust.
A review into the pathodynamics of pterygium is suggestive of hyperplasia of
fibrovascular growth due to elastotic degeneration of subconjunctival tissue.
Hence simple & effective measures as suggested by our Acharyas when adopted act
definately on the pathological events that occur in genesis of pterygium i.e,
Lekhananjana on Hyperplastic tissue & Rasayana on regeneration of normal healthy
cells & there by prevent the further degeneration.
Though Pippalyadya anjana & Shatavaryadi churna have been indicated in the disease
of Arma, no studies have been undertaken. Hence the present study of Pippalayadya
anjana & Shatavaryadi churna Abyantra was taken up.

A Study on Arma


2. Discussion on Review of literature:
Arma is one of the shukalamandal roga explained by sushruta, Vagabhata
Madhavakara, Yogaratnakar, Bhava prakash. All the acharyas have the same opinion
about the seat of this disease, nidana & chikitsa prakarna. Arma is one among the 11
types of Shuklamandal roga. It is characterized by Mamsavruddi in suklabhaga.
It can be corrected with Pterygium in contemporary science, as both these
condition are diagnosed based on the character of the growth.
Nidana
The exact pathology of Arma is obscure but can be understood by Netra Samanya
Nidana.
Purvarupa also have not been mentioned for Arma, however Samanya Purvarupa
can be considered here.
Flow chart-1: Samprapti of Arma
Samprapti
Nidana sevana (Achakshusya factors)

Vitiation of Tridosha

Inturn Vitiates Rasa, Rakta, Mamsa

Sthana samshraya in sukla mandala

Vyakta sthana in Suklamandala

Manifestation of Arma
A Study on Arma


Flow chart-2: Depicting Pterygium Pathognesis
The Pathogensis of Pterygium is characterized by:-

Conjunctival epithelium is more prone to ultraviolet damage because it does not
have a protective coating known as keratin.

Because of chronic irritation due to U.V. rays results in elastotic degeneration.

The subconjunctival tissue undergoes elastotic degeneration & proliferates as
vascularised granulation tissue under the epithelium.

Loss of limbal epithelial basal stem cells leads to encroaching of conjunctival
vasculature on to cornea.

It is been postulated that the development of pterygium depends on a changed
angiogenic stimulator to inhibitor ratio.Pterygia contain drastically decreased
levels of pigment epithelium derived factors, an angiogenic inhibitor & elevated
VEGF (Vascular endothelial growth factors) levels hence there is proliferation of
vascularised granulation tissue.
It is also found that there is marked elevation of VEGF in pterygia compared with
normal conjunctival samples.

A Study on Arma


Chikitsa
The demarcation of Samprapti helps in planning the treatment. Arma is considered as
a Chedana sadhya Vyadhi. In early stages of the disease Lekhana Anjanas are used
and when it encroaches the krishnamandala, Chedana is the only option. Sushruta has
explained a special surgical procedure for the Arma Chedana.
Based on samprapthi or Arma & pathogensis of Pterygium, it can be managed by
exploring the following treatment principles.
Tridosha samaka.
Lekhana.
Rasayana.
Anti-VEGF drugs.
Chakshushya.
The main objectives of the treatment are:-
To reduce the symptoms.
To remove or scrape out the extra growth in the subconjunctiva.
To prevent the further degeneration.
3. Discussion on observations
By considering all the relevant points, the comparative clinical study was carried out
on 45 patients. The observations made during the study were discussed below.
Observations on General Points
Age
The incidence of disease Arma was observed to be higher in age group of
45-54(51%) followed by 35-44(38%) which indicates that incidence of disease is
more prevalent among the middle aged persons, it may be because of more exposure
to dust, sunlight, smoke & external atmosphere.
A Study on Arma


Sex
A higher prevalence was seen in females (51%) than in males (49%) may be because
females were very cautious of cosmetic appearance. However if the study was carried
out in larger sample size could be conclusive.
Religion
The incidence of patients of Hindu religion (80%) were more in the trial groups; this
may be because of the higher population of Hindus in the society.
Occupation
The incidence of housewife was higher (33%) followed by fieldworkers (24%),
outdoor work (18%), office work (16%) and business (9%); the reason is exposure to
heat. By this we can infer that working environment plays an important role in
causing Arma.
Economic status
The incidence of patients belonging to middleclass was higher (71%) in this study;
this is because of the larger middle class population in the society.
Diet
Out of 45 patients taken for the study, 40% were vegetarians and 60% were of mixed
diet variety. Since study sample is small relation with diet cannot be drawn.
Place
It is observed that incidence of arma is 64% in urban areas and 36% in rural area.This
shows it is more prevalent in urban area than the rural because of their maximum
exposure to the pollutants in urban areas.
Observations Related To Disease
Chronicity
Out of 45 patients, maximum number had the duration of 0-1yr (58%)
A Study on Arma


Incidence of nidana
The incidence of Rajasevana was higher (40%), followed by Dhoopsevana (29%),
Dhoomasevana (7%) and Atigamana (2%), this probabaly shows the relation
between exposure to outer atmosphere with the higher incidence of pterygium.
Affected side of Eye
A total of 23 patients (52%) had Pterygium in their both eyes. Only right eye was
affected in 11 patients (24%), and only left eye was affected in 11 patients (24%).
This indicates Pterygium can occur bilateral or unilateral.
Site of Arma
Out of 45 patients of Pterygium taken for the clinical study all the patients had
Pterygium in medial canthus. This is due to reasons said before for the greater
predilection on nasal side.
Incidence of parameters
Out of 68 eyes of 45 patients taken for the clinical study, 99% of eyes with redness
followed by 65% of eyes with watering, 91% of eyes with foreign body sensation,
100% with length & 100% with thickness was observed.
4. Discussion on Results
To evaluate the effect of treatment on individual parameters in Group A, Group B and
Group C paired t-test was applied and also to compare the efficacies between the
groups unpaired t-test was applied. The obtained results are discussed here.
Effect of therapy on individual parameter in Group A-B-C
1. Redness
In Group AThere was a 44.3% of improvement in the symptom with t-value 9.25,
which is statistically highly significant at p<0.0001.
A Study on Arma


In Group BThere was a 35.6% of improvement in the symptom with t-value 6.33,
In Group CThere was a 26.5% of improvement in the symptom with t-value 5.07,
Interpretation: All 3 Groups have shown statistically highly significant result
(p<0.0001) in treatment of Redness, and there is a higher percentage of success rate
(44.3%) in treating Redness by Pippalyadya anjana (Group A) than Shatavaryadi
churna (Group B) and Narikelarasakriya anjana (Group C) alone.
2. Watering
In Group AThere was a 53.2% of improvement in the symptom with t-value 6.33,
In Group BThere was a 39.1% of improvement in the symptom with t-value 5.16,
In Group CThere was a 41.6% of improvement in the symptom with t-value 5.49,
(p<0.0001) in treatment of Watering, and there is a higher percentage of success rate
(53.2%) in treating Watering by Pippalyadya anjana (Group A) than Narikela
rasakriya anjana (Group C) and Shatavaryadi churna (Group B)alone.
3. Foreign body sensation
In Group AThere was a 44.5% of improvement in the sign with t-value 13.65,
In Group BThere was a 37.1% of improvement in the sign with t-value 10, which
is statistically highly significant at p<0.0001.
A Study on Arma


In Group CThere was a 36.4% of improvement in the sign with t-value 5.49,
(p<0.0001) in treatment of Foreign body sensation, and there is a higher percentage
success rate (44.5%) in treating Watering by Pippalyadya anjana (Group A) than
Shatavaryadi churna (Group B) and Narikela rasakriya anjana (Group C) alone.
4. Length
In Group AThere was a 0% of improvement in the feature with t-value 0, which is
statistically not significant at p<0.05.
In Group BThere was a 0% of improvement in the feature with t-value 0, which is
statistically not significant at p>0.05.
In Group C There was a 0% of improvement in the feature with t-value 0, which is
statistically not significant at p>0.05.
Interpretation: None of the Group is effective in reducing the length.
5. Thickness
In Group AThere was a 8.4% of improvement in the sign with t-value 2.12, which
is statisticallyt significant at p<0.05.
In Group BThere was a 2% of improvement in the sign with t-value 0.964, which
is statistically not significant at p>0.05.
In Group CThere was a 1.7% of improvement in the sign with t-value 0.964,
which is statistically not significant at p>0.05.
Interpretation: There is a statistically significant result (p<0.05),having 8.4% of
success rate in the clinical feature of thickness treated by Pippalyadya anjana (Group
A) than treatment with other two Groups which are statistically not significant
(p>0.05).Even though there is improvement by 2% in the clinical feature treated by
A Study on Arma


Shatavaryadi churna (Group B) and 1.7% improvement in the clinical feature treated
by Narikela rasakriya anjana (Group C) the result are not conclusive to say the effect
of treatment since the results are statistically not significant (p>0.05).
Here failure to give better reponse can be attributed to reason, since grade 2 & grade 3
Pterygium having thicker and greater amount of fibrovascular tissue compared with
those of the early stage, were taken for the study.
By reducing the thickness, vascularity will be reduced, in turn stops the
progression of the Pterygium.

Overall Comparative Effect of therapy between the Groups AC-BC-AB
1. Redness
Comparing the effect of treatment on Redness between Group A&C with t-value 1.78
shows statistically just significant result (p<0.10) between the two treatments. This is
obvious with success rate of improvement of 44.3% & 26.5% in the individual
treatments of Groups A&C respectively.
Comparing the effect of treatment on Redness between Group B&C with t-value
0.765 shows statistically not significant result (p>0.05) between the two treatments.
However there is a 35.6% & 26.5% of success rate of improvement in the individual
treatments of Groups B&C respectively.
Comparing the effect of treatment on Redness between Group A&B with t-value 1.12
shows statistically not significant result (p>0.05) between the two treatments.
treatments of Groups A&B respectively.

A Study on Arma


2. Watering
Comparing the effect of treatment on Watering between Group A&C with t-value
treatments of Groups A&C respectively.
Comparing the effect of treatment on Watering between Group B&C with t-value
Comparing the effect of treatment on Watering between Group A&B with t-value
3. Foreign body sensation
Comparing the effect of treatment on Foreign body sensation between Group A&C
with t-value 2.483 shows statistically significant result (p<0.01) between the two
treatments. This is obvious with success rate of improvement of 44.5% & 27.55% in
the individual treatment of Groups A&C respectively.
Comparing the effect of treatment on Foreign body sensation between Group B&C
with t-value 1.81 shows statistically significant result (p<0.10) between the two
treatments. However there is a 37.1% & 36.4% of success rate of improvement in the
individual treatments of Groups B&C respectively.
Comparing the effect of treatment on Foreign body sensation between Group A&B
with t-value 0.61 shows statistically not significant result (p>0.05) between the two
A Study on Arma


treatments. However there is a 44.5% & 37.1% of success rate of improvement in the
individual treatments of Groups A&B respectively.
4. Length
Comparing the effect of treatment on Length between Group AC & BC & AB with
t-value 0 shows statistically not significant result (p>0.05) between the treatments is
0.
5. Thickness
Comparing the effect of treatment on Thickness between Group A & C with t-value
1.76 shows statistically just significant result (p<0.10) between the two treatments.
This is obvious with success rate of improvement of 8.4% & 1.7% in the individual
treatments of Groups A & C respectively.
Comparing the effect of treatment on Thickness between Group B&C with t-value 0
shows statistically not significant result (p>0.05) between the two treatments.
However there is a 2% & 1.7% of success rate of improvement in the individual
Comparing the effect of treatment on Thickness between Group A&B with t-value
1.76 shows statistically just significant result (p<0.10) between the two treatments.
This is obvious with success rate of improvement of 8.4% & 2% in the individual
Overall assessment of the results in the groups
Good response-
After 48 days of the treatment, none of the eye of Group A, B & C showed good
response.
Moderate response
After 48 days of treatment, 2 eyes of Group A showed Moderate response
A Study on Arma


None of eye of Group B & C showed moderate response.
Mild response
After 48 days of the treatment, 19 eyes of Group A showed mild response,
19 eyes of Group B & 16 eyes of Group C showed mild response.
Poor response After 48 days of the treatment, 1 eye of Group A showed poor
response. 4 eyes of Group B & 7 eyes of Group C showed poor response.
Follow up- During the post treatment period of 90 days, 07% of patients from Group
A and 20% of patients from Group B and 27% of patients from Group C had
recurrence of the complaints suggesting a higher rate of recurrence in the treatment
with Narikela rasakriya anjana which indicates the necessity for a prolonged duration
of therapy.Even though the recurrence was seen it was observed that symptoms and
sign was not so severe as it was seen in the beginning of the treatment.This shows that
Pippalyadya anjana is more efficacious then other two yogas. Topical application
found more effective followed by internal medicine.
During the treatment period and follow up, the length of the pterygium remained the
same in all the three groups.

5. Discussion on Probable mode of action
Probable mode of action of Pippalyadya Anjana:-
The ingredients of Pippalyadya Anjana are Pippali, Triphala, Laksha, Lodhra,
Saindhava lavana, Bhringaraja.
Pippali- having katu rasa, laghu, snigdha, teekshna, pramathi guna, anushna
sheetha veerya does lekhana action. By its madhura vipaka has rasayana and
chakshushya property also act has anti-inflammatory, anti-allergic, immune
stimulatory.
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Pippali is a well known as a yogavahi; its benefits are increased bioavailability
& enchances the absorption of other active ingredients of the medicinal
compound.
The piperine of pippali is the best bioavalibality enchancer drug.
Triphala- Anti-oxidant, immunomodulatory, adaptogenic, capillary
strengthening. Vit-C and Vit-E present in Amalaki helps in inhibiting platelet
aggregation by thromboxane A2 synthesis have tridoshahara, srotho
vibandahara.
It is chakshushya and rasayana
Owing to katu.tikhta, kashaya rasa it does lekhana action.
In Triphala, Amalaki & Vibhitaki contain flavonoids which inhibit
angiogensis by regulating expression of VEGF, there by prevent the further
growth.
Triphala also contain Hyaluronidase, Hyaluronidase acts by depolymarising
the hyaluronic acid.
Hyaluronic acid is the connective tissue ground substance.It is very much
needed for forming new connective tissue in Pterygium as it forms the gel in
mesenchyme.When Hyaluronidase is given it depolymerises the hyaluronic
acid which affect the connective tissue metabolism resulting in the regression
or arrest the growth of Pterygium.
Laksha- Sandhaniya, snigha guna helps laksha to bind wound as a part of
regenerative process .Having kashya rasa, laghu snigha guna does lekhana
action.
Lodhra- styptic, cooling, anti-inflammatory and anti-microbial properties
A Study on Arma


having kashaya, tikta rasa, laghu ruksha guna, katu vipaka, sheetha virya is
kapha pittasamaka because of kashaya tikta rasa & ruksha guna has lekhana
property. It is also chakushushya.
Saindhava lavana-having tikshna,laghu,suskshmaguna penetrate in
Sukshma srotas also take other dravyas along with it & gives the best effect of
lekhana kriya hence commoly used as drug of pratisarana.
Bhringaraja- Ama nashaka, chakshuhya, rasayana, raktashodhana & effective
anti-inflammatory.Having katu vipaka & laghu ruksha guna & katu tikta rasa
does the lekhana & it is kaphavatashamaka.
Thus most of the ingredients of Pippalayadya Anjana have lekhana property
there by scrapes away the extra growth which is occurring on the
shuklamandala.
By virtue of their combined pharmacological action of tridhosha shamaka,
lekhana, raktashodaka chakshushya & rasayana.Formulation has a potency to
relieve the clinical features.
If we use drug having antiangiogensis property in the preparation of lekhana
anjana, it prevents vascularity & reduces the further growth & there by prevent
further complication.

A Study on Arma


Probable mode of action of Anjana:-
PIPPALYADYA ANJANA
(Applied to inner side of eye lid)

The anjana is administerd in suspension form & particles size is in
Nanometer, thus particles are retained in the conjunctival cul-de-sac,
This increases the contact time of the drug with the absorption surface.

Drugs are water soluble hence absorption will be more.

Transient microscopic hyperaemia in the vascularity of the conjunctiva
i.e, conjunctival capillaries. In response to this hyperaemia capillaries inturn
changes the permeability (i.e, structural intergerity of capillaries is altered)
for a short duration.This causes drugs to gain access into capillaries which
again interconnected with the vascular system of the eye.

The drug has acidic pH suggested from phytochemical analysis help in
enhancement of lekhana property.

Thus gradually scarpes the fibrovascular growth thereby desired
Therapeutic effect is obtained.

Flow chart-3: Probable mode of action of Anjana

A Study on Arma


Probable mode of action of Shatavaryadi Churna:-
Shatavaryadi churna: This yoga is mentioned by Yogaratnakara in Arma hence was
taken for the study for assessing the efficacy. The churna form of medicine is very
beneficial, as it is very easy for administration, easy for fixing the dose and better in
absorption.
The ingredients of Shatavaryadi churna are- Shatavari, Ela (seeds), Vidanga,
Amalakasthibija, Maricha and Pippali.
Shatavari- having madhura rasa, madhura vipaka & sheetavirya it is having Rasayana
property hence maintains the normal structure of cells & normal development.
It is an adaptogenic agent; adaptogenic property of shatavari is due to phytochemicals
Sarsapogenin, 8 fructo oligosaccharides. Rich in vitamin A, B
6
& powerful
antioxidant.
Ela- a-pinene, b-pinene, limonene, p-cymene, terpinolene, methyl eugenol, terpineol
are the main phytochemicals present in the ela. These enhance the permeation effect
of various drugs. Antioxidants- phenolics and flavonoids.Have anti-inflammatory
activity, powder of cardamom seeds is specifically indicated for the treatment of
symptoms resulting from excess of heat.
Vidanga-the phytochemicals of vidanga contains sitosterol, benzoquinone. Quercitol
is flavonoids which acts as an antiangiogentic agent there by prevent the further
progression of fibrovascular growth & also has antioxidant property.
Pippali and Maricha best bioavalibality enhancer because of presence of piperine.
Oral supplementation of piperine leads to altered phase II enzymes and reduces
damage. Ethanol crude extracts of maricha possess potent antioxidant and free radical
scavenging; Maricha has many important functions in the ocular therapeutics.
A Study on Arma


The polysaccharides in maricha may help in immune enhancement. The piperine
alters the permeability characteristics. It acts on the hydrophobic portions of lipid in
membranes. This property is of importance in the (mode of action of kriyakalpas)
permeability/penetration of the drugs used topically.
Amalaki richest source of antioxidant also contain flavonoids which prevent
fibrovascular growth of Pterygium.It is tridosha shamaka and also Rasayana and
Chakshushya.
Madhu having ruksha guna & kashaya rasa does lekhana action.
Ghritha is yogavahi also has the property of samskarasaya anuvartana property.It can
penetrate into sookshma srotas. Thus can cross the barriers of absorptions.
Ghritha itself is a Rasayana.It is pittha vatahara, hence works towards the normalcy of
the doshas responsible for triggering the disease.
All the ingredients of Shatavaryadi churna possess chakshusya, rasayana & tridosha
samaka action.Long term administration would also help in retarding the progression
of the disease and helps in arresting the further degeneration of the tissue.

Probable mode of action of Narikela rasakriya Anjana:-
Narikela Rasakriya anjana having, Narikela Jala possesses Anti-inflammatory, Anti-
bacterial, Anti-neoplastic, Anti-oxidant property. Daru Haridra having Anti-
inflammatory, Anti-bacterial, Anti-tumour, Anti-oxidant property.
Most of the drugs are Chakshushya,having Katu,Tikta,Kashaya rasa,Laghu,Ruksha
guna and Tridoshagna and Rasayana property.These drugs act through Anti
inflammatory,Anti-bacterial,Anti oxidant properties.

A Study on Arma


CONCLUSION
The clinical features of Arma are closely related to Pterygium.
The occurrence of Pterygium is quite common, but most of the time it is
ignored.It should be treated in early stages if not treated at the earliest, will
gradually progress & leads to visual disturbances.
After observing the results of Group A, B &C, can come to the conclusion that
patients of GroupA who were treated with Pippalyadya anjana responded well.
All the three Groups were found to be effective in reducing the severity of the
symptoms like Redness, Watering & Foreign body sensation, and other
parameter like length did not produce any statistical significant result after
treatment in all the groups.
Thickness showed a statistically just significant result in patients of GroupA.
Overall assessment of result in percentage GroupA-44% ,Group B-37% &
Group C-33%.
By Lekhananjana Arma can be managed with conservative line of treatment in
the initial stage as told in the classics.
Shatavaryadi churna prevents the further degeneration and help in retarding
the progression of the disease.
Better results can be obtained, if patients do Nidana parivarjana.
No untoward effect was observed in any of the treatment groups.
Thus early diagnosis and adequate treatment of this definitely relieves the
patients from the disease without leading to much complication.

A Study on Arma


Recommendations for further study-
As the sample size was small and the disease is chronic nature. It is
recommended to carry the study on larger sample size.
Owing to the disease progressive nature it is recommended to have prolonged
duration of treatment and follow up.

A Study on Arma


SUMMARY
The present clinical study entitiled A Comparative study on the efficacy of
Pippalyadya Anjana and Shatavaryadi Churna Abyantara in the management of
Arma was limited to 45 patients having the features of Pterygium attending the OPD
and IPD of Department of Shalakya Tantra and SJIIM Hospital, Bangalore.It was
divided into Group A,B &C consisting of 15 patients in each Group.
The reference of Pippalyadya Anjana & Shatavaryadi Churna is from Yoga Ratnakar
& Narikela rasakriya is from Sasharyoga.
The work is presented in two section.The first section deals with review of the
literature available on the diseases; the formulation & the therapies adopted.
Historical review consists of an attempt to collect the references about Arma in
various literature, netra rachana and shareera kriya & Nidana, Lakshana and chikitsa
of Arma.
Anatomy of conjunctiva, Pterygium definition, aetiology, incidence, pathology, types,
clinical features & management of Pterygium & greater predilication on Nasal side
are dealt in Modern Review.
The drug review,a brief note on the ingredients, properties, method of preparation &
application of the formulations are discussed.
The second section includes material & methods, the study design, source of data,
parameters for assessement of data .
Observations made during the study & the results of the data drawn after the study are
expressed in terms of diagrams & the comparsion between the two Groups have been
made statistically.
Observations made by the study along with Probable mode of action of drugs are
discussed.
A Study on Arma


Lastly the Conclusion drawn out of the clinical study and summary of the entire work
is dealt.
All the 3 Groups were found statistically siginificant. Group A showed overall higher
significance & better response compared to other two Groups.

BEFORE TREATMENT AFTER TREATMENT
(Group A ) (Group A)

A Study on Arma


BIBLIOGRAPHY
1. Taranatha Tarkavachaspathi Bhattacharya. Vachaspatyam, Varanasi:
Chaukhamba Sanskrit Bhavan; 2003. 3442 pp. Vol-4.
2. Raja Radhakanta Deva. Shabdakalpadruma 3
rd
ed. Delhi: Nag Publishers;
1988. 937 pp.Vol 2.
3. Raja Radhakanta Deva. Shabdakalpadruma Delhi: Nag Publishers; 1987.
792 pp.Vol 3.
4. Sushrutha. Sushruta Samhita. Uttara tantra with English translation of text
and Dalhanas commentary along with critical notes edited and translated by
Priyavat Sharma and distributors; 2001. 720 pp. Vol 3.
5. Sir Monier Williams. A Sanskrit English Dictionary, New ed. Delhi: Motilal
Banarsidass Publishers Pvt. Ltd.; 2002. 1333 pp.
6. Sushruta. Sushruta Samhita-- with the Nibandha sangraha Commentary of Sri
Dalhanacharya and the Nyayachandrika Panjika of Sri Gayadasacharya on
Nidanasthana. Edited by Vaidya Jadavji Trikamji Acharya and Narayan Ram
Acharya Kavyatirtha, New ed. Varanasi: Chaukambha surbharati prakashan;
2008. 824 pp.
7. Singhal G.D. and Sharma K.R., Ophthalmic and otorhinolaryngological
considerations in Ancient Indian Surgery. Based on Salakya Tantra portion of
Uttaratantra of sushruta samhita. Allahabad: Published by Dr. G.D. Singhal,
Singhal Publications; 1976. 363 pp.Vol.8.
8. Agnivesha. CarakasamhitaElaborated by Charaka and Dridhabala with the
Ayurveda Dipika commentary by Chakrapanidatta, edited by Vaidya
A Study on Arma


Jadavaji Trikamji Acharya, 5
th
ed. Varanasi: Chaukhamba Surbharati
Prakashan; Reprint 2000. 738 pp.
9. Caraka samhita. Text with English translation and critical expositon based on
Chakrapani dattas Ayurveda Dipika, Edited by Dr. Ram Karan Sharma and
Vaidya Bhagwan dash, Varanasi: Chowkhamba Sanskrit series office; Reprint
2005.619pp Vol.1
10. Vriddha Vagbhata. Astanga Sangraha with Shashilekha commentary by
Indu, Edited by Dr. Shivaprasad Sharma, Varanasi: Chaukhamba Sanskrit
series office; 2006. 965 pp.
11. Vagbhata. Astanga Hrdayam with commentaries (sarvanga sundara) of
Arunadatts and (Ayurnveda rasayana) of Hemadri, edited by Bhisagacharya
Harisastri paradakara vaidya, 9
th
ed. Varanasi: Chaukhamba Orientalia; 2005.
956pp.
12. Vagbhata. Astangahridayam Translated by Prof. K.R. Srikantamurthy,
Varanasi: Chowkhamba Krishnadas Academy; reprint 2005. 586 pp. Vol-III.
13. Bhavamisra. Bhavaprakasha. Text, English translation, notes, appendeces and
Index. Translated by Prof. K.R. Srikantamurthy. 3
rd
Ed. Varanasi:
Chowkhamba Krishnadas Academy; 2005..884 pp. Vol 2
14. Kaviraj Govinda Das. Bhaishajya Ratnavali- edited by Prof. Siddhinandan
Mishra, 1
st
ed. Varanasi: Chowkambha Surbharati Prakashana: 2005. 1196pp.
15. Madhavakara, Madhavanidana, Madhukosha Sanskrit Commentary by Sri
Vijayarakshita and Srikantadatta with Vidyotini Hindi commentary by
A Study on Arma


Sudarshanashastry, 20
th
ed. Varanasi: Chaukhamba Sanskrit Samsthan; 1993.
Part-II 508 pp.
16. Vagbhata. Ashtanga Sangraha uttar tantra English translation by Prof. K. R.
Srikanta Murthy. 2
nd
Ed. Varanasi: Chukhamba Orientalia; 2000. 654 pp. Vol.
3.
17. Yogaratnakara with vidyotini Hindi Commentary by Vaidya Lakshmipati
Sastri, edited by Bhisagratna Brahmasankara Sastri. 5
th
Ed. Varanasi:
Chaukhamba Sanskrit Sansthan; 1993. 1077 pp. purvardha.
18. Sharngadhara. Sharngadhara Samhita with Adhamallas Deepika and
Kashirams Gudartha Dipika Commentary, Edited by Pandith Parashurama
Shastri, 4
th
Ed. Varanasi: Chaukhamba Orientalia; 2000. 398 pp.
19. Yogaratnakara - with vidyotini Hindi Commentary by Vaidya Lakshmipati
Sastri, Edited by Bhisagratna Brahamasankar Sastri. 5
th
ed. Varanasi:
Chaukhamba Sanskrit Sansthan; 1993. 504 pp.
20. Bhela. Bhela Samhita - Text with English translation, Commentary and critical
notes by Krishnamurthy K.H., edited by P.V. Sharma, Varanasi; Choukhamba
Vishwabharathi; Reprint 2005. 660 pp.
21. Kashyapasamhita or Vriddhajivakiya Tantra. Text with English Translation
and Commentary. Edited by Prof. P. V. Tewari, Varanasi: Chaukhamba
Vishwa-bharathi; Reprint 2002. 792 pp.
22. R.C.Choudhury-Shalakya Vijnana Chowkhamba Orientalia,Varanasi 20
th

Edition
A Study on Arma


23. Dr.P.K.Shanthakumari, A text Book of Ophthalmology, 2
nd
ed.
Thiruvananthapuram: 2009 408pp.
24. Priyavrat Sharma. Dravyaguna Vignan Part-2. New ed. Varanasi:
Choukhamba Vishwabharathi Academy; 2002. 873 pp.
25. Sahasrayoga edited by Vaidya Mahendrapal Singh Arya. New Delhi:
Kendriya Ayurveda Evam Siddha Anusandhan Parishad;1990.621 pp.D
26. A. K. Khurana. Indu Khurana. Anatomy and physiology of eye. 2
nd
Ed. New
Delhi: CBS Publishers and Distributors; 2007. 514 pp.
27. A. K. Khurana. Comprehensive Opthalmology 4
th
ed. New Delhi: New Age
International P Ltd. Publishers; New Delhi: 2007. 605 pp.
28. Jack J Kanski, Kanski Clinical Ophthalmology.6
th
ed.china: Elsevier limited;
reprint 2006.931pp.
29. Elsevier. Parsons diseases of eye, 12
th
ed. New Delhi: Elsevier Alsevier India
Pvt Ltd, Reprint 2007. 615pp
30. The Wills eye manual,5
th
edition,editors- Justis P.Ehlers ,Chirag P.Shah
published by Wolters Kluwer (India) Pvt.Ltd.,New Delhi.
31. H.V. Nema & NitinNema Text book of ophthalmology, 2
nd
ed. Jaypee
Brothers Medical Publishers (P) Ltd.1996. 333pp.
32. Dutta L.C, Modern ophthalmology, 3rd edition, 2005.Jaypee brothers
publication Pvt.Ltd.New Delhi.
33. Ophthalmology,Myron Yanoff,Jay S Duker
34. G.N.Seals, Textbook of ophthalmology, 5th edition, 2002, Current books
International publication, Kolkata.
A Study on Arma


35. Essentials of Ophthalmology by Samar k.Basak, 4
th
edition, 2004,
Current books International, Kolkata.
36. Duke Elders S, System of Ophthalmology, st.Louis, 1965; volume-8, Part-
1.Page-573-583.
37. Sandeep Saxena, Clinical Practice in Ophthalmology, 1st edition, 2003.Jaypee
brothers publication Pvt.Ltd.New Delhi.
38. Flavonoids inhibit VEGF/bFGF-induced angiogenesis in vitro by inhibiting
the matrix-degrading proteases. Article first published online: 24 APR 2003
Journal of Cellular Biochemistry ,Volume 89, Issue 3, pages 529538
39. H.B. Sahib, N.A.H. Harchan, S.A.M. Atraqchi and A.A. Abbas, 2010. The
Role of Medicinal Herbs in Angiogenesis Related Diseases. International
Journ of Pharmacology, 6: 616-623
URL: http://scialert.net/abstract/?doi=ijp.2010.616.623
40. Wong W.W. A hypothesis on the pathogenesis of pterygium, Annals of
ophthalmology Mar.1978.Vol-10 pages no -303-308.
41. Cameron ME, Histology of pterygium-An electron microscopic study, British
Journals of ophthalmology, 1983; Vol-67 page no 604-608.
42. www.pubmed.com
43. www.indianjournal of ophthalmology.com
44. www.wikipedia.org/wiki/pterygium
45. http://herbtime.wordpress.com/

A Study on Arma


ANNEXURE
CASE PROFORMA
Department of Postgraduate Studies in Shalakya Tantra G.A.M.C & H,
Dhanwantari Road Bangalore-560 009

Case No : Date :

Name : OPD No. :

Age : IPD No : Bed No

Sex : DOA :

Religion : DOD :

Occupation : Address :

Education : Marital Status :

Socioeconomic status: Provisional Diagnosis:

Pradhana vedana / chief complaint :

Duration

Redness
Watering
Discomfort

Anubandha vedana / Associated complaint :

Photophobia
Blurness of vision
Itching

Adhyatana vyadhi vrittanta / History of present illness :

Duration
Mode of onset gradual / sudden
Course of illness progressive/ receding/ stationary
Aggravating factor sunlight/ dust/ wind/ smoke

A Study on Arma


Poorva vyadhi vrittanta / History of past illness :

Previous eye diseases & operation
Any treatment undergone.

Personal History :

Diet Sleep
Appetite Habit
Bowel
Micturition

Family History : H/O similar complaints

Occupational history:
Nature of work:- Travelling / Labour / agriculture

Astasthana pareeksha :
Nadi Mala
Mootra Jihwa
Shabda Sparsha
Drik Akriti

Vital signs :
Temperature
Pulse
Respiration
B.P.

Local examination:

Examination for the head posture

Examination of forehead

Examination of eyebrows - Level of eyebrow
Cilia

Examination of eyelids - Position
Movements of lids
Lid margin
Abnormalities of skin
A Study on Arma


Palpebral aperture

Examination of lacrimal apparatus Puncta
Lacrimal sac
Regurgitation test
Lacrimal syringing
Examination of eyeball Position
Visual axes of eyeball
Size of eyeball
Movement of eyeball
Examination of conjunctiva Bulbar conjunctiva
Lower palpebral conjunctiva
Upper palpebral conjunctiva
Fornix
Signs - Discoloration
Congestion
Chemosis
Follicles
Papillae
Concretion
Foreign bodies
Membranous growth - Medial canthus
Lateral canthus
Both canthus

RE LE

Length 0 - begining of the growth(0.5cm)
1- In b/w the canthus & limbus(0.75cm)
2- In b/w the canthus & limbus(1cm)
3- Upto limbus(1.5cm)
Thickness 0- negligible growth
1- Had clearly visible episcleral vessels under the
body of pterygium(Atrophic)
2- Had partially visible episcleral vessels under the
body of Pterygium(Intermediate)
3- Had totally obscured episcleral vessels
underlying the body of pterygium(Fleshy)

Examination of sclera Discoloration
Inflammation
Any other abnormality

A Study on Arma


Examination of cornea Size
Shape
Surface
Transparency
Vascularity
Corneal sensation

Examination of anterior chamber Depth

Examination of iris Colour
Pattern
Any other abnormality

Examination of pupil- Number
Location
Size
Shape
Colour Papillary reactions
Examination of lens Position
Transparency
Colour

Examination of Intraocular pressure- Digital method

Fundus examination Disc
Blood vessels
Macular area

Visual acquity : D.V. N.V.

B.E
R.E
L.E

OBSERVATION B/F TREATMENT

Sever Moderate Mild Absent
Redness
Watering

Length
Thickness

Photographs

A Study on Arma


OBSERVATION A/F TREATMENT ON 48
TH
DAY

Sever Moderate Mild Absent
Redness
Watering

Length
Thickness

Photographs

Observation during follow up :

Signature of the Candidate Signature of the Guide

Navya D P 2012

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A COMPARATIVE STUDY ON THE EFFICACY OF PIPPALYADYA

ANJANA AND SHATAVARYADI CHURNA ABHYANTARA IN THE

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