SHUKTIKA - ARJUNA
Dr. Pranav Bhagwat
Reader, dept. of Shalakyatantra,
Gomantaka ayurveda college,
Shiroda, Goa.
SHUKTIKA
It is a Shuklagata, Pittaja, Sadhya
Vyadhi.
Shyava: syu: pishitanibhashcha bindavo ye/
Shuktyabha: sitanayane sa shuktisaudnya:// (su ut 4/6)
Dalhana comments :- shuktyabha : iti jalashuktiriva kincit
deerrgha: shuklamandale ye bindava :
• Colour
• Consistency
• Shape
:
:
:
Shyava i.e. blackish white
Mamsa-like
Shell-like: oblong or oval
(Dalhana)
These are multiple spot-like structures .
•
•
•
Gadanigraha (netra-66)
Bhavaprakasha (Madhya 4/16)
Yogaratnakara (netra-66)
= Sushruta’s opinion
According to VagbhataPittam kuryaat site bindoon asita-shyaava-peetakan/
Malaaktaadarshatulyam vaa sarvam shuklam adaaharuk/
Roga: ayam shuktikaasandnya: sashakrudbhedtrudjwara://
( A.S.U. 13/12.)
INDU TIKA:
Pittam kruddham site bhaage asitadivarnaan bindun tilakalakaan
kuryaat/ athavaa sarvam shuklam
malaliptadarpanasadrusham kuryaat/ ubhayatraaapi daaharuk
abhava:/ etat ubhayamapi shakrutbhedadiyogannaamna
shuktika iti rogo bhavati /
Inference
SUSHRUTA
VAGBHATA
• Can be corelated with
Xerosis.
• Can be considered as part
of systemic disease.
• pigmentary lesion of
conjunctiva and sclera
• including malignant
melanoma, primary
acquired melanosis,
naevus,
• Like a dirty mirror- xerosis.
• when we include general
symptoms - viral hepatitis,
liver disorders.
XEROSIS
• Dry lustreless condition of conjunctiva due to deficiency of mucin.
XEROSIS
• Types:- two.
• 1) - as a sequel of local ocular disease
• 2) - associated with general condition.
The first type occurs due to –
• scarring of the conjunctival epithelium and glands
following trachoma, burns, diphtheria, pemphigoid- starts
as a spot and continue to affect whole conjunctiva or
cornea.
• Prolonged exposure to air – due to ectropion or
proptosis.
• Xerosis has nothing to do with lacrimal apparatus. It
depends more on the secretory activity of conjunctiva.
(Goblet cells )
xerosis
• The second general type --a milder form,
-- usually found in children due
to lack of vitamin A in diet and accompanied by night
blindness.
• (vita. A daily requirement is 5000 I. u. /daychief sources – milk, egg, carrots.
Stored in liver.).
Character of xerosis
• A small triangular, white patch, little away from limbus in
the horizontal meridian, usually on temporal side first.
• is covered with foamy substance due to gas produced
by corynebacterium xerosis. (bitot’s spots).
• When patients looks towards affected side wrinkling of
bulbar conjunctiva at the site.
• When the child is marasmic, disease associated with
nyctalopia and keratomalacia.
Treatment
• Prevention:
• 1) vit A 2 lac U every 6 months from the age of 6 months
to 3 years
• 2)diet containing green leafy vegetables etc.
• Curative:
• Vit A IM 1 lac U per day on alternate day for 3 weeks.
• Oral vit. A
• Artificial tears
• Topical antibiotics
• Dark glasses
Pigmentory lesions of conjunctiva
PIGMENTARY LESIONS OF CONJUNCTIVA
DIFFERENTIAL DIAGNOSIS OFMELANOCYTIC LESIONS
Onset
Location
NEVUS
RACIAL
MELANO
SIS
OCULAR PRIMARY MALIGNA
MELANO ACQUIRE
NT
CYTOSIS
D
MELANO
MELANO
MA
SIS (PAM)
First 2
decades.
Can show
changes
during
puberty
Congenital, Congenital,
dark
Can be
individuals associated
with
Naevus of
Ota
40-50 yrs,
in fair
skins, high
chances of
conversion
to Ca.
>50 yrs
(but can be
any age)
Interpalpeb Limbus>bul
Bulbar
ral area
bar>palpeb conjunctiva
ral
conjunctiva
Anywhere
(usually
bulbar
conjuctiva)
Anywhere
NEVUS
RACIAL
MELANOS
IS
OCULAR
MELANO
CYTOSIS
PRIMARY MALIGNA
ACQUIRE
NT
D
MELANO
MELANOS
MA
IS (PAM)
Colour
Brown or
yellow
Brown
gray
Depth
Substanti Epithelium Episclera/ Epitheliu Substanti
a propria
scleral
m/substan a propria
tia propria
Brown
Brown or
pink
Cyst
Present~
50%
None
None
None
Vascular
nodule
Margins
Well
defined
Ill defined
Ill defined
Illdefined
well
defined
Laterally
Unilateral
Bilateral
Usually
unilateral
unliateral
Unilateral
Conclusion
1. Pigmented lesions of the conjunctiva comprise a large and
varied
spectrum of conditions that include benign and malignant
melanocytic lesions.
2. Whilst conjunctival nevi are the most common
Melanocytic lesions, the clinical features of these pigmented
conditions occasionally overlap and cause diagnostic confusion.
3. Clinical inspection and photodocumentation on regular intervals
is utilized to monitor pigmented lesions.
4. A conjunctival biopsy can confirm diagnosis.
Treatment
TREATMENT OF SHUKTIKA
ACCORDING TO AYURVEDA
• Sushruta• Doshhaiadhastaat shuktikaayaam apaaste
sheetairdravyairanjanan kaaryamaashu//
(Su.u.11/14)
Dalhana says
• Adhastaat apaaste doshaihi virechanena iti/
• Anjana of vaidurya, sphatika,
pravala,mukta,shankha,raupya,suvarna along with
sharkara and honey.
Conclusion.
• Sushruta has understood the degenerative condition of
conjunctiva and hence used ratnas,upratnas and
superior dhatus for anjana.
• The advocacy of virechana also points towards
involvement of yakruta (raktavaha srotas ) here the point
should be noted that virechana cannot be given in
Vagbhata’s Shuktika as it already has shakruta bheda.
Vagbhata (A.S.U.14/6)
• says- shuktikaam pittaabhishhyandavat saadhayet //
Treatment of pittabhishandhya includes ( A.S.U.19)
• 1)ghruta pana with sharkara or tiktaka
ghruta/mahatiktaka ghruta/guggula tiktaka ghruta.
• 2) aschotana-kashaya of poundarika,
amalaka,darbha,dashamula,shatavari,manjistha,
talispatra,yasthi,darvi along with sugar and stanya.
• 3)seka-lepa- described here are anti inflammatory which
are not useful in this condition.
• 4) anjanas described here are also rujaghna dahraghna
and hence not useful in this condition
• 5) rasakriya of 50 parts of darvi and 1 part of sariva,
yasthi, kakoli, nisha,draksha, manjistha,lodhra,
usher,chandana, kashmari, sunishannaka. This is useful
in all pittarogas.
• 6)nasya- kalka of sariva+sharkara+kashmari swarasa,
nasya-yashti kalka triturated in ikshu rasa .
• 7)Tarpana and putapaka similar to savrana shuklacream should be taken from kshirapaka of mamsa of
jaangala animals, pigeons, hens etc. along with sheeta,
jevaniya drugs and this cream is subjected to kshirpaka
with kalka of chandana, madhu etc. For putapaka
veshavar of kukkuta along with sheeta, jeevaniya drugs,
honey and ghee should be used.
• 8) Siravedha. –saarvadehika pittadushti.
Conclusion.
• The treatment described by Vagbhata has the action of
raktaprasadana along with pitta shamana. This imparts
arrest of transformation in nature of tissues- metaplasia which is useful in acquired melanosis.
• Fat soluble contents.
• Jeevaneeya action.
Chakradatta (59/195)
Recommends following treatment• koumbha-sarpi(puraana ghrita) paana .- chakshushya
• Virechana.
• Alepa.
• parisheka by madhura sheeta dravyas .
• anjana same as Sushruta with addition of chandana.
• Vrunda madhava, Bhaishajya Ratnavali, Gadanigraha
follow Chakradatta.
Conclusion-
• Sushruta, Chakradatta and others – Xerosis.
• Vagbhata- Xerosis + pigmentations.
ARJUNA.
ARJUNA• This is a shuklagata vyadhi,
• Raktaja, saadhya.
• Sushruta says- ( Su. U. 4/7)
Eko ya: shasharudhiropamastu bindu: shuklastho
bhavati tam arjunam vadanti/
• Gadanigraha (3/netraroga/66) , yogaratnakara(netraroga/67), follow Sushruta.
• Vagbhata says-(A.S.U.13/20)
Neeruk shlakshno arjuno bindu: shashalohit lohita:/
• Vagbhata has added painless lesion as an additional
feature.
SUBCONJUNCTIVAL
ECCHYMOSIS
• Site- bulbarC. Since it is liable to injuries and also
loose connective tissues are there.
• Colour – bright red, then blackish red.
Causes-
• direct trauma to the eye- posterior limit is visible.
• Injury to orbit/head injury- appears within 12-24 hrs after
injury. Since the bleeding is from inside the orbit,
therefore the posterior limit of the hemorrhage is not
visible.
• Marked congestion of neck veins- whooping cough in
children, severe compression of chest/neck
• Blood diseases- leukaemia, haemophilia, purpura.
• HT/ aneurysm of local arterioles.
• Acute inflammation of conjunctiva- -pneumococcal,
herpes simplex, leptospirosis, viral epidemic K-Citis.
•
•
•
•
Acute febrile systemic infections- measles, yellow
fever, subacute bacterial endocarditis,
meningococcal septicaemia.
Endometriosis.
Elderly people
idiopathic
DIFFERENTIAL DIAGNOSIS
Kaposi’s sarcoma (in AIDS cases, bluish red tumour, may
be with similar lesion on eyelid and face)
TREATMENT
• Trivial condition
• Hardly any treatment required.
• Blood absorbs within 2-3 wks. Faster with hot
compresses
• Astringent drops as placebo.
AYURVEDOKTA CHIKITSA
According to Sushruta:
(Su. U. 12/19-27)
Paittam vidhim ashshhena kuryaat arjunashantaye/
•
•
•
•
The vidhi of pittaabhishhyanda should be follwed.
Parisheka with ikshu, honey, sugar, stanya, darvi,
yashti, saindhava
Anjana with same
Ashcyotana- Amla drugs. Also with sugar water,
yashti, mastu, honey, amla, saindhava,
beejapooraka, kola, dadimamla.
• Anjana• 1)sphatika, pravala, shankha, yashti, honey or
2)shankha, honey, sugar, samudraphena or
3)saindhava, honey, kataka or
4) rasanjana with honey or
5) kasis with honey.
• Lekhyanjana- lohadi dhatu, avasadana gana, 5
lavanas, etc.
• Putapaka at last.
According to Vagbhata
(A.S.U.14/8)
Raktaabhishyandavat pratikuryaat/
• Ashchyotana- matulungaras+sugar or mastu
• Anjana- 1)shankhanaabhi+ makshika or
2)samudraphena with sita or 3)sphatika, keshara,
shankhanabhi, yashti, honey or 4)rasanjana with honey
or 5) kasis with honey.
From raktabhishyanda chikitsa
• If required siravyadha
• Nasya- sharkara, stanya,neelotpala.
According to Vrundamaadhava
(Netraroga/226/7/8)
• 1. Pittabhishyandavat.
• 2. Anjanas with
shankha with honey.
kataka with saindhava.
samudraphena with sugar.
• 3. Purana with sita, honey tentu, mastu, yashti,
saindhava.
Chakradatta
Gadanigraha
Yogaratnakara
Bhaishajyaratnavali
Follow anjanas of Vrunda
Yogaratnakara advises aschyotana with sugar, mastu and honey.
Discussion & Conclusion
• Basic treatment principle- early absorption of
extravasated blood to reduce anxiety of patient and
further prevention of recurrence.
• yogas containing CaCO3, sugar, honey, kashaya
dravyas are used.
• Here,. the question can be raised regarding use of amla
rasaa for ashchyotana and not kashaya rasa, though
amla rasa is raktapittaprakopakara.
• The answer is- The amla rasa - ushna so drugs when
instilled in eye get entry into capillaries and veinules and
dilate them causing resorption of blood.(anumaana) The
similar use of amla dravyas are found for lepa in
raktapitta chikitsa and pittaja jwara
chikitsa..(aapptopadesha.)
• Lekhyanjana should be reserved for intractable cases
and generally not required.
• The topic is open for discussion.
• -dr. Pranav Bhagwat.